Theta burst stimulation reduces disability during the activities of daily living in spatial neglect

被引：116

作者：

Cazzoli, Dario ^{[1
,2
,3
]}

Mueri, Rene M. ^{[1
,2
]}

Schumacher, Rahel ^{[1
,2
]}

von Arx, Sebastian ^{[1
,2
]}

Chaves, Silvia ^{[1
,2
]}

Gutbrod, Klemens ^{[1
,2
]}

Bohlhalter, Stephan ^{[1
,2
,4
]}

Bauer, Daniel ^{[4
]}

Vanbellingen, Tim ^{[1
,2
]}

Bertschi, Manuel ^{[1
,2
]}

Kipfer, Stefan ^{[1
,2
]}

Rosenthal, Clive R. ^{[3
]}

Kennard, Christopher ^{[3
]}

Bassetti, Claudio L. ^{[1
,2
]}

Nyffeler, Thomas ^{[1
,2
,4
]}

机构：

[1] Univ Hosp Bern, Inselspital, Percept & Eye Movement Lab, Dept Neurol, CH-3010 Bern, Switzerland

[2] Univ Hosp Bern, Inselspital, Percept & Eye Movement Lab, Dept Clin Res, CH-3010 Bern, Switzerland

[3] Univ Oxford, Nuffield Dept Clin Neurosci, Oxford OX3 9DU, England

[4] Luzerner Kantonsspital, Ctr Neurol & Neurorehabil, Dept Internal Med, CH-6000 Luzern 16, Switzerland

来源：

BRAIN | 2012年 / 135卷

基金：

瑞士国家科学基金会;

关键词：

hemispatial neglect; neurorehabilitation; activities of daily living; repetitive transcranial magnetic stimulation; interhemispheric rivalry; TRANSCRANIAL MAGNETIC STIMULATION; NONINVASIVE BRAIN-STIMULATION; POSTERIOR PARIETAL CORTEX; LEFT UNILATERAL NEGLECT; RIGHT-HEMISPHERE STROKE; HEMISPATIAL NEGLECT; VISUAL NEGLECT; VISUOSPATIAL NEGLECT; BODY ORIENTATION; REHABILITATION;

D O I：

10.1093/brain/aws182

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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.

引用

页码：3426 / 3439

页数：14

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