Brain connections, Stroke, Symptoms Predictions and Brain Repair

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Unravelling the neural basis of spatial delusions after stroke

Publication . Alves, Pedro Nascimento; Fonseca, Ana Catarina; Silva, Daniela; Andrade, Matilde R; Melo, Teresa Pinho e; Thiebaut de Schotten, Michel; Martins, Isabel Pavão

Objective: Knowing explicitly where we are is an interpretation of our spatial representations. Reduplicative paramnesia is a disrupting syndrome in which patients present a firm belief of spatial mislocation. Here, we studied the largest sample of patients with delusional misidentifications of space (i.e. reduplicative paramnesia) after stroke to shed light on their neurobiology. Methods: In a prospective, cumulative, case-control study, we screened 400 patients with acute right-hemispheric stroke. We included 64 cases and 233 controls. First, lesions were delimited and normalized. Then, we computed structural and functional disconnection maps using methods of lesion-track and network-mapping. The maps were compared, controlling for confounders. Second, we built a multivariate logistic model including clinical, behavioural and neuroimaging data. Finally, we performed a nested cross-validation of the model with a support-vector machine analysis. Results: The most frequent misidentification subtype was confabulatory mislocation (56%), followed by place reduplication (19%) and chimeric assimilation (13%). Our results indicate that structural disconnection is the strongest predictor of the syndrome and included two distinct streams, connecting right fronto-thalamic and right occipito-temporal structures. In the multivariate model, the independent predictors of reduplicative paramnesia were the structural disconnection map, lesion sparing of right dorsal fronto-parietal regions, age and anosognosia. Good discrimination accuracy was demonstrated (area under the curve = 0.80[0.75-0.85]). Interpretation: Our results localize the anatomical circuits that may have a role in the abnormal spatial-emotional binding and in the defective updating of spatial representations underlying reduplicative paramnesia. This novel data may contribute to better understand the pathophysiology of delusional syndromes after stroke.

2021Artigo científico

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Entidade financiadora

European Commission

Programa de financiamento

H2020

Número da atribuição

818521