title: θ-burst stimulation of the left hemisphere accelerates recovery of hemispatial neglect.
abstract: OBJECTIVE
  Cortico-cortical circuits originating from the posterior parietal cortex (PPC) of the intact left hemisphere (LH) may become hyperexcitable in patients with hemispatial neglect due to a right hemispheric (RH) stroke.
  
  
  METHODS
  In the current randomized, double-blind, sham-controlled study, we investigated safety and efficacy of continuous theta-burst stimulation (cTBS) in 10 sessions over 2 weeks applied over the intact PPC of the LH in subacute ischemic stroke patients. Severity of neglect was assessed through the standardized Behavioral Inattention Test (BIT). We also measured, by means of bifocal transcranial magnetic stimulation (TMS), how cTBS modified the excitability of the parieto-frontal functional connections in the intact LH.
  
  
  RESULTS
  We found that 2 weeks of cTBS, but not sham cTBS, were effective in improving neglect symptoms as measured by BIT score. BIT scores improved by 16.3% after 2 weeks of cTBS and 22.6% at 1 month follow-up. We also found that hyperexcitability of LH parieto-frontal circuits was reduced following treatment with real but not sham cTBS.
  
  
  CONCLUSIONS
  These findings suggest that a 2-week course of cTBS over the LH PPC may be a potential effective strategy in accelerating recovery from visuospatial neglect in subacute stroke patients, possibly counteracting the hyperexcitability of LH parieto-frontal circuits.
  
  
  METHODS
  This study provides Class III evidence that left posterior parietal cortex theta-burst stimulation improves hemispatial neglect for up to 2 weeks after treatment.
authors.affiliation: Laboratory of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Italy. g.koch@hsantalucia.it
authors.forename: G
authors.initials: G
authors.lastname: Koch
authors.forename: S
authors.initials: S
authors.lastname: Bonnì
authors.forename: V
authors.initials: V
authors.lastname: Giacobbe
authors.forename: G
authors.initials: G
authors.lastname: Bucchi
authors.forename: B
authors.initials: B
authors.lastname: Basile
authors.forename: F
authors.initials: F
authors.lastname: Lupo
authors.forename: V
authors.initials: V
authors.lastname: Versace
authors.forename: M
authors.initials: M
authors.lastname: Bozzali
authors.forename: C
authors.initials: C
authors.lastname: Caltagirone
mesh_terms: D002545:Brain Ischemia / Q000150:complications; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006801:Humans; D009415:Nerve Net / Q000503:physiopathology; D010468:Perceptual Disorders / Q000503:physiopathology / Q000628:therapy*; D010919:Placebos; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications; D013826:Theta Rhythm; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
chemical_list: D010919:Placebos