title: Theta burst stimulation reduces disability during the activities of daily living in spatial neglect.
abstract: Left-sided spatial neglect is a common neurological syndrome following right-hemispheric stroke. The presence of spatial neglect is a powerful predictor of poor rehabilitation outcome. In one influential account of spatial neglect, interhemispheric inhibition is impaired and leads to a pathological hyperactivity in the contralesional hemisphere, resulting in a biased attentional allocation towards the right hemifield. Inhibitory transcranial magnetic stimulation can reduce the hyperactivity of the contralesional, intact hemisphere and thereby improve spatial neglect symptoms. However, it is not known whether this improvement is also relevant to the activities of daily living during spontaneous behaviour. The primary aim of the present study was to investigate whether the repeated application of continuous theta burst stimulation trains could ameliorate spatial neglect on a quantitative measure of the activities of daily living during spontaneous behaviour. We applied the Catherine Bergego Scale, a standardized observation questionnaire that can validly and reliably detect the presence and severity of spatial neglect during the activities of daily living. Eight trains of continuous theta burst stimulation were applied over two consecutive days on the contralesional, left posterior parietal cortex in patients suffering from subacute left spatial neglect, in a randomized, double-blind, sham-controlled design, which also included a control group of neglect patients without stimulation. The results showed a 37% improvement in the spontaneous everyday behaviour of the neglect patients after the repeated application of continuous theta burst stimulation. Remarkably, the improvement persisted for at least 3 weeks after stimulation. The amelioration of spatial neglect symptoms in the activities of daily living was also generally accompanied by significantly better performance in the neuropsychological tests. No significant amelioration in symptoms was observed after sham stimulation or in the control group without stimulation. These results provide Class I evidence that continuous theta burst stimulation is a viable add-on therapy in neglect rehabilitation that facilitates recovery of normal everyday behaviour.
authors: Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK.
authors: Dario
authors: D
authors: Cazzoli
authors: René M
authors: RM
authors: Müri
authors: Rahel
authors: R
authors: Schumacher
authors: Sebastian
authors: S
authors: von Arx
authors: Silvia
authors: S
authors: Chaves
authors: Klemens
authors: K
authors: Gutbrod
authors: Stephan
authors: S
authors: Bohlhalter
authors: Daniel
authors: D
authors: Bauer
authors: Tim
authors: T
authors: Vanbellingen
authors: Manuel
authors: M
authors: Bertschi
authors: Stefan
authors: S
authors: Kipfer
authors: Clive R
authors: CR
authors: Rosenthal
authors: Christopher
authors: C
authors: Kennard
authors: Claudio L
authors: CL
authors: Bassetti
authors: Thomas
authors: T
authors: Nyffeler
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D001931:Brain Mapping / Q000379:methods / Q000523:psychology*; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010296:Parietal Lobe / Q000473:pathology / Q000502:physiology; D010468:Perceptual Disorders / Q000150:complications / Q000473:pathology / Q000523:psychology* / Q000534:rehabilitation*; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000523:psychology; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation / Q000379:methods / Q000523:psychology*