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.

Long-term effects of continuous theta-burst stimulation in visuospatial neglect

“…Our observation of a reduction in visuospatial neglect after cTBS over the unaffected PPC is in line with other noninvasive brain stimulation studies, which used singlepulse TMS and paired TMS as a 'virtual lesion' technique, 23,24 low-frequency ( 1 Hz) repetitive TMS, 17,24,25 cathodal transcranial direct current stimulation 26 or continuous TBS. 10,12 Koch et al 10 applied left PPC TBS in two sessions per day with an interval of 15 min every day for 2 weeks (10 days), which reduced hemispatial neglect for up to 2 weeks after treatment: behavioural inattention test scores improved by 16.3% at There were no significant differences between the treatment groups (post hoc tests: least significant difference or Student-Newman-Keuls). BG, basal ganglia; MCA, middle cerebral artery; R, right.…”

“…10, Another study showed a 37% improvement in the everyday behaviour of patients with visuospatial neglect for !3 weeks, after two consecutive days of continuous theta-burst stimulation. 12 Here, we used a modified version of a cTBS protocol that is known to be effective in inducing long-term depression and longlasting changes in the excitability of the stimulated cortex.…”

Rapid Relief of Treatment Resistant Depression by Facilitated Ketamine Infusion: A Preliminary Report

“…Hence, the primary goal of the present study is to identify a therapy that will provide a greater likelihood of lasting successful results than has been achieved with ketamine or TMS along, while hopefully reducing the undesirable adverse effects of the conventional pharmacopoeia (Cazzoli et al, 2012;Gersner et al, 2011;Wang et al, 2011). …”

Novel insights in rehabilitation of neglect

“…Scores on the BIT improved by 16.3% immediately after TBS application and by 22.6% at 1 month follow-up. In a double-blind, shamcontrolled experiment, Cazzoli et al (2012) applied four TBS trains to the left posterior parietal cortex of 16 neglect patients over two consecutive days. This resulted in a 37% improvement in the spontaneous everyday neglect behavior of the patients as measured by the Catherine Bergego Scale.…”

“…In the present review we will describe the studies characterizing four of these approaches that have emerged since approximately a decade: prism adaptation (PA), virtual reality (VR) training, noninvasive brain stimulation (NIBS), and pharmacological therapies. Table S1 in Supplementary Material gives an overview of these studies (McIntosh et al, 2002, Angeli et al, 2004, Dijkerman et al, 2004, Jacquin-Courtois et al, 2008, Nijboer et al, 2011, Bauer et al, 2012, Luauté et al, 2012.…”