NEUROPHARMACOLOGIC TREATMENT OF HEMINEGLECT - A CASE-REPORT COMPARINGBROMOCRIPTINE AND METHYLPHENIDATE

Individuals who have hemineglect fail to attend to stimuli presented o n the side of the body contralateral to a brain lesion. Although in an imal studies the severity of neglect correlates with the degree of dop amine depletion, in hemineglect patients dopamine-enhancing medication s have produced inconsistent results, We present a case of hemineglect following a right cerebrovascular accident in a 68-year-old man treat ed consecutively with methylphenidate and bromocriptine. Tests sensiti ve to neglect were administered during treatment with methylphenidate, then after all medications had been discontinued, then then when the patient was taking low and moderate doses of bromocriptine, and again after all medications had been discontinued for 4 and 26 days. Methylp henidate was superior to no drug treatment, Bromocriptine produced mor e improvement in neglect than methylphenidate. Although the patient sh owed an exacerbation of his neglect after withdrawal from methylphenid ate, performance gains persisted after withdrawal from bromocriptine. Treatment effects appear related to medication choice, timing of drug treatment, and the adaptability of dopaminergic receptor systems. (C) 1998 by the American Congress of Rehabilitation Medicine and the Ameri can Academy of Physical Medicine and Rehabilitation.