Efficacy of Noninvasive Brain Stimulation on Unilateral Neglect After Stroke: A Systematic Review and Meta-analysis

Objective Unilateral neglect (UN) is a common debilitating consequence of stroke. This review focused on the effect of noninvasive brain stimulation (NIBS) techniques in the recovery of UN in poststroke patients. Methods Relevant databases were comprehensively searched, including Cochrane Central Register of Controlled Trials, Medline, Embase, the Web of Knowledge, and relevant websites. All randomized controlled trials were identified which used NIBS for poststroke UN. The methodological quality and risk of bias were systematically evaluated. Results Twelve studies were included, and 11 randomized controlled trials were made further meta-analysis. Participants who were randomized to active transcranial direct current stimulation (effect size [ES], -0.51; 95% confidence interval [CI], -1.02 to -0.01; P = 0.04) and repetitive transcranial magnetic stimulation (ES, -1.76; 95% CI, -2.40 to -1.12; P < 0.00001) decreased UN severity after intervention compared with the control group. Nonsignificant pooled effect size presented for continuous theta burst stimulation results (ES, -0.77; 95% CI, -1.90 to 0.37; P = 0.18). No participants experienced serious adverse events. Conclusions This review found evidence for the efficacy of repetitive transcranial magnetic stimulation in the remediation of poststroke UN, but the efficacy of transcranial direct current stimulation and continuous theta burst stimulation was uncertain. Large-sample randomized controlled clinical trials are needed to understand effects of NIBS on poststroke UN.