Pre-requisites for conscious awareness: clues from electrophysiological and behavioral studies of unilateral neglect patients

Encoding sensory events entails processing of several physical attributes. Is the processing of any of these attributes a pre-requisite of conscious awareness? This selective review examines a recent set of behavioral and event-related potentials, studies conducted in patients with visual and auditory unilateral neglect or extinction, with the aim of establishing what aspects of initial processing are impaired in these patients. These studies suggest that extinguished visual stimuli excite the sensory cortices, but perhaps to a lesser degree than acknowledged stimuli do. However, encoding spatial attributes of auditory and visual stimuli appear to be preferentially impaired. In light of results from patients with other neuro-behavioral deficits, it is argued that egocentric spatial information is an essential pre-requisite for knowing that an external event occurred. In contrast, information handled by mostly domain-specific circuits, such as in the ventral temporal lobe, supports awareness of the identity of a stimulus, but not of its mere presence. Without spatial information, the stimulus identity will remain implicit.