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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.
Conclusion: 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.
Classification of evidence: This study provides Class III evidence that left posterior parietal cortex theta-burst stimulation improves hemispatial neglect for up to 2 weeks after treatment.
Glossary
- GLOSSARY
- AG=
- angular gyrus;
- AMT=
- active motor threshold;
- ANOVA=
- analysis of variance;
- BIT=
- Behavioral Inattention Test;
- BIT-B=
- behavioral scale of the Behavioral Inattention Test;
- BIT-C=
- conventional scale of the Behavioral Inattention Test;
- CS=
- conditioning stimulus;
- cTBS=
- continuous theta-burst stimulation;
- FDI=
- first dorsal interosseous;
- IPL=
- inferior parietal lobule;
- IPS=
- intraparietal sulcus;
- ISI=
- interstimulus interval;
- LH=
- left hemisphere;
- M1=
- primary motor cortex;
- MEP=
- motor evoked potential;
- MNI=
- Montreal Neurological Institute;
- PPC=
- posterior parietal cortex;
- RH=
- right hemispheric;
- RMT=
- resting motor threshold;
- TMS=
- transcranial magnetic stimulation;
- TS=
- test stimulus
Footnotes
-
Study funding: Supported by grants from the Italian Ministry of Health (RF 08.18) to G.K.
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Editorial, page13
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Supplemental data at www.neurology.org
- Received March 28, 2011.
- Accepted June 27, 2011.
- Copyright © 2012 by AAN Enterprises, Inc.
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