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Consecutive Versus Return Motor Perseveration During Line Cancellation Task in Hemispatial Neglect

Kim, Eun-Joo MD*; Lee, Byung Hwa MA; Park, Key Chung MD; Suh, Mee Kyung MS; Ku, Bon D. MD§; Heilman, Kenneth M. MD; Na, Duk L. MD

Cognitive and Behavioral Neurology: June 2009 - Volume 22 - Issue 2 - p 122-126
doi: 10.1097/WNN.0b013e3181a7227f
Original Studies

Background Patients with neglect often repeatedly cancel the same targets, a form of motor perseveration (MP). There seems to be 2 types of MP, making uninterrupted multiple strokes for each target, consecutive MP (CMP) or return MP (RMP) where patients return to previously canceled targets and remark them.

Objective The purpose of this study is to learn whether these 2 forms of MP are dissociable.

Methods We studied 3 patients, 1 with primarily CMP, another with primarily RMP and a third with mixed CMP and RMP by having them perform the cancellation task with and without background movement.

Results In the patient with primarily RMPs (patient 1), leftward background movement decreased the severity of the neglect and the perseveration. Rightward background movement increased both. In contrast to patient 1, who showed the correspondence between the severity of neglect and perseveration, the patient with both CMP and RMP (patient 2) and the patient with primarily CMPs (patient 3) did not show such correspondence.

Conclusions The different responses of CMP and RMP to the treatment of neglect suggest that different mechanisms account for these 2 forms of MP. Although RMP might be related to neglect induced aberrant approach behaviors, CMP seems to be related to a disengagement disorder.

*Department of Neurology, Pusan National University School of Medicine and Medical Research Institute, Busan

Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine

Department of Neurology, College of Medicine, Kyung Hee University, Seoul

§Department of Neurology, Kwandong University College of Medicine, Myongji Hospital, Gyeonggi, Korea

Department of Neurology, University of Florida and Veterans Affairs Medical Center, Gainesville, FL

This study was supported by a grant of the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (A050079).

Reprints: Duk L. Na, MD, Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea (e-mail:

Received for publication June 17, 2008; accepted February 15, 2009

© 2009 Lippincott Williams & Wilkins, Inc.