Gorgoraptis N et al. – This proof–of–concept study suggests a beneficial role of dopaminergic modulation on visual search and selective attention in patients with hemispatial neglect following stroke.

• A double-blind, randomized, placebo-controlled ABA design was used, in which each patient was assessed for 20 testing sessions, in three phases: pretreatment (Phase A1), on transdermal rotigotine for 7–11 days (Phase B) and post-treatment (Phase A2), with the exact duration of each phase randomized within limits.
• Outcome measures included performance on cancellation (visual search), line bisection, visual working memory, selective attention and sustained attention tasks, as well as measures of motor control.
• Sixteen right-hemisphere stroke patients were recruited, all of whom completed the trial.
• Performance on the Mesulam shape cancellation task improved significantly while on rotigotine, with the number of targets found on the left side increasing by 12.8% (P=0.012) on treatment and spatial bias reducing by 8.1% (P=0.016).

• This improvement in visual search was associated with an enhancement in selective attention but not on the measures of working memory or sustained attention.
• The positive effect of rotigotine on visual search was not associated with the degree of preservation of prefrontal cortex and occurred even in patients with significant prefrontal involvement.
• Rotigotine was not associated with any significant improvement in motor performance.