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Objective: To investigate whether the efficacy of continuous theta-burst stimulation (cTBS) for improving visuospatial neglect can be enhanced by providing more days of stimulation and more stimulation trains per day. Methods: In a prospective study, right-handed patients with right hemisphere stroke and visuospatial neglect were randomized to cTBS or sham cTBS treatment for 2 weeks and were followed up for 4 weeks. The cTBS group received active cTBS over the posterior parietal cortex of the unaffected hemisphere, combined with conventional rehabilitation therapy. Changes in scores for two paper-pencil tests for visuospatial neglect (star cancellation and line bisection) were evaluated. Results: In each group, 10 patients completed follow up. Compared with the sham group, star cancellation test scores in the cTBS group were improved by 37.03% at the end of treatment and by 47.21% after 4 weeks' follow up, and the line bisection score improved by 21.37% at the end of treatment and by 35.99% after 4 weeks' follow up. Conclusions: These results suggest that the efficacy of cTBS in visuospatial neglect can be enhanced and prolonged by increasing the days of stimulation and the number of stimulation trains per day over the left posterior parietal cortex.

This study indicates that low-frequency repetitive transcranial magnetic stimulation of the unimpaired hemisphere might improve visual spatial neglect after stroke and points to the need for further studies. The results support the theory of inter-hemispheric competition in the attentional network.

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