Efficacy of repetitive transcranial magnetic stimulation combined with visual scanning treatment on cognitive and behavioral symptoms of left hemispatial neglect in right hemispheric stroke patients: study protocol for a randomized controlled trial

Francesco Di Gregorio, Fabio La Porta, Emanuela Casanova, Elisabetta Magni, Roberta Bonora, Maria Grazia Ercolino, Valeria Petrone, Maria Rosaria Leo, Roberto Piperno, Francesco Di Gregorio, Fabio La Porta, Emanuela Casanova, Elisabetta Magni, Roberta Bonora, Maria Grazia Ercolino, Valeria Petrone, Maria Rosaria Leo, Roberto Piperno

Abstract

Background: Left hemispatial neglect (LHN) is a neuropsychological syndrome often associated with right hemispheric stroke. Patients with LHN have difficulties in attending, responding, and consciously representing the right side of space. Various rehabilitation protocols have been proposed to reduce clinical symptoms related to LHN, using cognitive treatments, or on non-invasive brain stimulation. However, evidence of their benefit is still lacking; in particular, only a few studies focused on the efficacy of combining different approaches in the same patient.

Methods: In the present study, we present the SMART ATLAS trial (Stimolazione MAgnetica Ripetitiva Transcranica nell'ATtenzione LAteralizzata dopo Stroke), a multicenter, randomized, controlled trial with pre-test (baseline), post-test, and 12 weeks follow-up assessments based on a novel rehabilitation protocol based on the combination of brain stimulation and standard cognitive treatment. In particular, we will compare the efficacy of inhibitory repetitive-transcranial magnetic stimulation (r-TMS), applied over the left intact parietal cortex of LHN patients, followed by visual scanning treatment, in comparison with a placebo stimulation (SHAM control) followed by the same visual scanning treatment, on visuospatial symptoms and neurophysiological parameters of LHN in a population of stroke patients.

Discussion: Our trial results may provide scientific evidence of a new, relatively low-cost rehabilitation protocol for the treatment of LHN.

Trial registration: ClinicalTrials.gov NCT04080999 . Registered on September 2019.

Keywords: Brain pathology; Brain physiology; Functional laterality; Randomized controlled trial; Stroke rehabilitation methods; Transcranial magnetic stimulation.

Conflict of interest statement

Authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart. r-TMS, repetitive transcranial magnetic stimulation; VS, visual scanning
Fig. 2
Fig. 2
Visual detection task. Each trial starts with a central fixation cross for a jittered time between 640 and 960 milliseconds (ms), then a stimulus is presented randomly either on the left or on the right of the fixation cross for 96 ms. After stimulus presentation, a fixation cross remains for 1000 ms, and then a new trial starts

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Source: PubMed

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