The time course for visual extinction after a ‘virtual’ lesion of right posterior parietal cortex

Our understanding of the attentional networks in the human brain largely relies on neuropsychological studies in patients with lesions to the posterior parietal cortex (PPC), particularly in the right hemisphere, that may cause severe disruptions of attentional functions. However, lesion studies only capture a point in time when the dysfunctions caused by the damage have triggered a chain of adaptive responses in the brain. To disentangle deficits and ensuing cortical plasticity, here we examined the time course for one's ability to detect objects in the visual periphery after an inhibitory continuous theta-burst stimulation (cTBS) protocol to the left or right PPC. Our results showed that cTBS of right PPC caused participants to be less sensitive to objects appearing on the left side as well as to objects appearing on both sides at the same time, consistent with an overall shift of attention to the right side of space. In addition, we found that participants missed more objects during bilateral presentations similar to patients with visual extinction. Critically, extinction evolved over time; that is, visual extinction for ipsilateral objects improved after 10 min whereas contralateral extinction peaked around 15-25 min after cTBS. Our findings suggest that lesions to the PPC impair competition between the two visual hemifields, resulting in contralateral extinction as a secondary response, arguably due to ensuing disruptions in interhemispheric balance.