The effects of repetitive transcranial magnetic stimulation on unilateral neglect of acute stroke patients: A randomised controlled trial

Hyun Gyu Cha, Myoung Kwon Kim, Hyun Gyu Cha, Myoung Kwon Kim

Abstract

Background: Rehabilitation of the unilateral neglect of acute stroke patients represents a major challenge.

Objectives: This study aimed to evaluate the effects of repetitive transcranial magnetic stimulation on the functional recovery of stroke patients with unilateral neglect.

Methods: Twenty patients with stroke were randomly assigned to two groups: a repetitive transcranial magnetic stimulation group (experimental) and a control group. The stroke patients in the experimental group underwent repetitive transcranial magnetic stimulation therapy and comprehensive rehabilitation therapy. The stroke patients in the control group underwent sham magnetic stimulation therapy and comprehensive rehabilitation therapy. The patients in both groups received therapy 5 days per week for 4 weeks. The Motor Free Visual Perception Test (MVPT), Line Bisection Test (LBT), Albert Test (AT), and Star Cancellation Test (SCT) were assessed before and after the 4-week therapy period.

Results: The experimental group showed a significant increase in the MVPT, LBT, AT, and SCT values compared with the preintervention values (p < 0.05). Furthermore, the control group showed a significant increase in the MVPT, LBT, and AT results compared with the preintervention results (p < 0.05). A significant difference in the post-training gains for the MVPT (8.9 ± 2.5 vs. 4.8 ± 3.0), LBT (-19.3 ± 7.5 vs. -6.5 ± 9.5), AT (13.1 ± 8.0 vs. 4.0 ± 1.9), and SCT (-13.6 ± 6.9 vs. -4.5 ± 6.9) were observed between the experimental group and the control group (p < 0.05). In addition, the effect size for gains in the experimental and control groups was very large in MVPT and AT (effect size = 3.25 and 2.90), respectively, and the effect size for gains in the experimental and control groups was small in LBT and SCT (effect size = 0.22 and 0.23, respectively).

Conclusion: The current study findings indicated that repetitive transcranial magnetic stimulation may be beneficial in decreasing the unilateral neglect of stroke patients.

Keywords: repetitive transcranial magnetic stimulation; stroke; unilateral neglect.

Conflict of interest statement

Conflicts of interest: The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Study flowchart. CRT = comprehensive rehabilitation therapy; rTMS = repetitive transcranial magnetic stimulation; ST = sham therapy.

References

    1. Kerkhoff G. Spatial hemineglect in humans. Prog Neurobiol 2001;63: 1–27.
    1. Marotta JJ, Mckeeff TJ, Behrmann M. Hemispatial neglect: Its effects on visual perception and visually guided grasping. Neuropsychologia 2003;41: 1262–1271.
    1. Goldon C, Leslie L, Christopher L. Visual neglect can be object-based or scene-based depending on task representation. Cortex 2004;40: 237–246.
    1. Wee JY, Hopman WM. Comparing consequences of right and left unilateral neglect in a stroke rehabilitation population. Am J Phys Med Rehabil 2008;87: 910–920.
    1. Mizuno K, Tsuji T, Takebayashi T, Fujiwara T, Hase K, Liu M. Prism adaptation therapy enhances rehabilitation of stroke patients with unilateral spatial neglect: a randomized, controlled trial. Neurorehabil Neural Repair 2011;25: 711–720.
    1. Gillen R, Tennen H, McKee T. Unilateral spatial neglect: Relation to rehabilitation outcomes in patients with right hemisphere stroke. Arch Phys Med Rehabil 2005;86: 763–767.
    1. Maggie B, Riddoch M, Peter C. Treatment of visual neglect in elderly patients with stroke: a single-subject series using either a scanning and cueing strategy ora left-limb activation strategy. Phys Ther 2002;8: 782–797.
    1. Pierce SR, Buxbaum LJ. Treatments of unilateral neglect: a review. Arch Phys Med Rehabil 2002;83: 256–268.
    1. Gorsler A, Baumer T, Weiller C, Munchau A, Liepert J. Interhemispheric effects of high and low frequency rTMS in healthy humans. Clin Neurophysiol 2003;114: 1800–1807.
    1. Speer AM, Kimbrell TA, Wassermann EM, D Repella J, Willis MW, Herscovitch P, et al. . Opposite effects of high and low frequency rTMS on regional brain activity in depressed patients. Biol Psychiatry 2003;48: 1133–1141.
    1. Paus T, Jech R, Thompson CJ, Comeau R, Peters T, Evans AC. Transcranial magnetic stimulation during positron emission tomography: A new method for studying connectivity of the human cerebral cortex. J Neurosci 1997;17: 3178–3184.
    1. Shindo K, Sugiyama K, Huabao L, Nishijima K, Kondo T, Izumi S. Long-term effect of low-frequency repetitive transcranial magnetic stimulation over the unaffected posterior parietal cortex in patients with unilateral spatial neglect. J Rehabil Med 2006;38: 65–67.
    1. Le Q, Qu Y, Tao Y, Zhu S. Effects of repetitive transcranial magnetic stimulation on hand function recovery and excitability of the motor cortex after stroke: A meta-analaysis. Am J Phys Med Rehabil 2014;93: 422–430.
    1. Kim YH, Min SJ, Ko MH, Park JW, Jang SH, Lee PK. Facilitating visuospatial attention for the contralateral hemifield by repetitive TMS on the posterior parietal cortex. Neurosci Lett 2005;382: 280–282.
    1. Mitchell AJ, Shukla D, Ajumal HA, Stubbs B, Tahir TA. The mini-mental state examination as a diagnostic and screening test for delirium: Systematic review and meta-analysis. Gen Hosp Psychiatry 2014;36: 627–633.
    1. Han AR, Kim DY, Choi TW, Moon HI, Ryu BJ, Yang SN, et al. . Characteristics of visual-perceptual function measured by the motor-free visual perception test-3 in korean adults. Ann Rehabil Med 2014;38: 548–553.
    1. Kleinman JT, Newhart M, Davis C, Heidler-Gary J, Gottesman RF, Hillis AE. Right hemispatial neglect: frequency and characterization following acute left hemisphere stroke. Brain Cogn 2007;64: 50–59.
    1. Brem AK, Unterburger E, Speight I, Jäncke L. Treatment of visuospatial neglect with biparietal tDCS and cognitive training: A single-case study. Front Syst Neurosci 2014;29: 180.
    1. Na DL, Adair JC, Choi SK, Seo DW, Kang Y, Heilman KM. Ipsilateral versus contralesional neglect depends on attentional demands. Cortex 2000;36: 455–467.
    1. Mansur CG, Fregni F, Boggio PS, Riberto M, Gallucci-Neto J, Santos CM, et al. . A sham stimulation-controlled trial of rTMS of the unaffected hemisphere in stroke patients. Neurology 2005;64: 1802–1804.
    1. Brighina F, Bisiach E, Oliveri M, Piazza A, La Bua V, Daniele O, et al. . 1 Hz repetitive transcranial magnetic stimulation of the unaffected hemisphere ameliorates contralesional visuospatial neglect in humans. Neurosci Lett 2003;336: 131–133.

Source: PubMed

3
S'abonner