Summary about Disease
Neglect syndrome, also known as unilateral neglect, hemispatial neglect, or hemineglect, is a neuropsychological condition that occurs after brain damage, typically to the right parietal lobe. It is characterized by a lack of awareness of stimuli or information presented to the side of the body opposite the brain damage (contralateral side), despite intact sensory function. This means that the person may ignore objects, people, and even parts of their own body on the neglected side. Neglect is not simply a visual problem but a complex disorder affecting attention, perception, and spatial awareness.
Symptoms
Symptoms of neglect syndrome can vary in severity and presentation but commonly include:
Ignoring stimuli on one side: Failure to acknowledge objects, sounds, or people in the neglected hemispace.
Personal neglect: Ignoring one side of the body, such as not washing or dressing one side.
Extinction: Detecting a stimulus on either side when presented alone, but only reporting the stimulus on the non-neglected side when stimuli are presented simultaneously on both sides.
Motor neglect: Reduced use of a limb on the non-paralyzed side of the body, even though there is no weakness.
Spatial neglect: Difficulty with spatial tasks such as copying drawings, bisecting lines, or navigating a room.
Anosognosia: Lack of awareness of one's own deficits.
Representational neglect: Neglect affecting mental imagery, such as describing only one side of a familiar place from memory.
Reading and Writing difficulties Only reading or writing on one side of the paper.
Causes
The most common cause of neglect syndrome is damage to the right parietal lobe of the brain, often due to:
Stroke: A stroke affecting the right middle cerebral artery (MCA) is a frequent cause.
Traumatic Brain Injury (TBI): Injury to the right hemisphere.
Brain Tumors: Particularly tumors in the parietal lobe.
Other neurological conditions: Rarely, neglect can be caused by conditions like infections or degenerative diseases affecting the brain.
Medicine Used
There isn't a specific medication to cure neglect syndrome. However, some medications might be used to manage underlying conditions or to potentially improve attention and awareness:
Dopaminergic medications: Some studies have explored the use of medications that increase dopamine levels, such as levodopa or bromocriptine, to improve attention and motor function in neglect. However, the evidence is limited, and the effectiveness is not well-established.
Cholinesterase inhibitors: Used to treat cognitive symptoms, which may indirectly help with attention.
Medications for underlying conditions: Treatment for stroke, brain injury, or other causative factors. The primary treatment approaches for neglect syndrome are rehabilitative therapies rather than pharmacological interventions.
Is Communicable
Neglect syndrome is not communicable. It is a neurological condition resulting from brain damage and cannot be transmitted from person to person.
Precautions
Precautions for individuals with neglect syndrome focus on safety and maximizing awareness:
Environmental modifications: Arrange the environment to encourage awareness of the neglected side (e.g., placing important objects on that side).
Visual cues: Use bright colors or markers to highlight objects or boundaries on the neglected side.
Assistive devices: Use mirrors, prisms, or other devices to improve visual awareness.
Safety measures: Supervise activities to prevent falls or injuries due to inattention to one side of the body or environment.
Educate caregivers: Provide education to family members and caregivers about the nature of neglect and strategies for supporting the individual.
How long does an outbreak last?
Neglect syndrome is not an outbreak; it is a chronic condition resulting from brain damage. The duration of symptoms can vary widely depending on the severity of the brain damage and the effectiveness of rehabilitation. Some individuals may experience significant improvement with therapy over time, while others may have persistent symptoms. The term "outbreak" does not apply in this context.
How is it diagnosed?
Neglect syndrome is diagnosed through a combination of clinical observation and neuropsychological testing. Common diagnostic methods include:
Clinical observation: Observing the patient's behavior and interactions to identify signs of neglect, such as ignoring one side of the body or environment.
Cancellation tasks: Presenting a page with multiple targets (e.g., lines or shapes) and asking the patient to cross them out. Neglect patients often omit targets on the neglected side.
Line bisection tasks: Asking the patient to bisect a horizontal line. Neglect patients typically bisect the line to the right of the true midpoint (for left neglect).
Drawing tasks: Asking the patient to copy a drawing or draw an object from memory. Neglect patients often omit details on the neglected side.
Behavioral Inattention Test (BIT): A standardized test that assesses various aspects of neglect in both near and far space.
Neuroimaging: MRI or CT scans of the brain are used to identify the location and extent of brain damage.
Timeline of Symptoms
The onset of neglect syndrome is typically sudden, coinciding with the event causing brain damage (e.g., stroke or TBI). The timeline of symptoms can be broken down as follows:
Acute phase: Immediately following the brain injury, neglect symptoms are often most severe.
Subacute phase: Over the next weeks to months, some spontaneous recovery may occur. The extent of recovery varies depending on the individual and the severity of the brain damage.
Chronic phase: After several months, symptoms may stabilize. Rehabilitation can continue to improve function and awareness, but some degree of neglect may persist long-term. The timeline and severity of symptoms are highly variable and depend on the location and extent of brain damage, as well as the individual's response to rehabilitation.
Important Considerations
Variability: Neglect syndrome can manifest differently in different individuals.
Comorbidities: Neglect often co-occurs with other neurological deficits, such as hemiparesis (weakness on one side of the body), aphasia (language difficulties), or visual field deficits.
Impact on daily life: Neglect can significantly impact a person's ability to perform activities of daily living, such as dressing, eating, and navigating their environment.
Rehabilitation: Early and intensive rehabilitation is crucial for maximizing recovery and improving functional outcomes. Therapy may include visual scanning training, limb activation therapy, prism adaptation, and other techniques.
Caregiver support: Family members and caregivers play an essential role in supporting individuals with neglect and helping them adapt to their deficits.
Awareness: Anosognosia (lack of awareness) is a common feature of neglect, which can make treatment challenging.
Long-term management: Some individuals may require ongoing support and assistance to manage their symptoms and maintain independence.