In unilateral inattention or hemineglect, damage to the neural network responsible for directed sensory attention results in decreased exploration and a distorted internal representation of the left hemispace. This inattention has been found to be predictive of poor functional outcome after stroke. The large sale neural network has been characterized and its components have been defined. Many of these components involve dopaminergic pathways. Restoring the balance of dopamine through the use of a dopamine agonist should improve directed attention. Past research has focused on the use of bromocriptine, a dopamine agonist with effects at both the D1 and D2 receptors. There is now a new generation of dopamine agonists which are selective for only the D2 receptor, which is felt to be the receptor of interest in the attentional networks. It is hypothesized that ropinirole, a selective D2 agonist, will show beneficial effects in patients with chronic inattention after right hemisphere stroke with fewer side effects.
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