Personal Neglect: A Comprehensive Theoretical and Anatomo-Clinical Review

Personal neglect (PN) is the hemi-inattention toward the contralesional bodily space that follows a cerebral lesion, usually to the right hemisphere. Objective: To provide a historical, comprehensive review of the different theoretical accounts, of the available diagnostic measures, of the relationship with different body representation disorders, and of recovery-related issues. Moreover, to review the anatomo-functional correlates of PN, focusing on group studies that used modern voxel-based lesion-symptoms mapping. Method: PubMed database was searched for all the available studies on PN conducted in the last 30 years. Relevant clinical data for each study were reported in a table, which was used as a reference for developing the discussion on the points of interest. Results: Evaluation tools for PN suffer from limitations and should include both face-and body-related testing as well as require both basic exploration and object use in the same personal space. Dedicated rehabilitative procedures are lacking and advocated, given that recovery of PN and extrapersonal neglect can be dissociated and their degree is not correlated. PN is almost constantly associated with a cohort of body representation disorders that do not reveal themselves unless specifically investigated. PN is significantly correlated to alterations at the level of both the anterior parietal cortex and the underlying fronto-parietal fiber bundles. Conclusions: The discussed data point to the need for a diagnostic and rehabilitative update. Following the topological and hodological lesional pattern, PN might emerge from the combination of a body representation disorder and a spatial inattention for half of the space. General Scientific Summary Personal neglect is the lack of attention toward the contralesional side of the body, which is frequently observed after right cerebral lesions. It is often associated with the hemi-inattention for the external visual space as well as different deficits of the body representation. Available diagnostic procedures suffer from limitations, and dedicated rehabilitative procedures are still lacking. By reviewing anatomo-clinical correlates and theoretical perspectives, we suggest that personal neglect might be the combination of a body representation disorder and spatial hemi-inattention.