Effect of High- and Low-Frequency Repetitive Transcranial Magnetic Stimulation on Visuospatial Neglect in Patients With Acute Stroke: A Double-Blind, Sham-Controlled Trial

Objective: To compare the therapeutic effect of low- and high-frequency repetitive transcranial magnetic stimulation (rTMS) of the posterior parietal cortex (PPC) in patients with acute stroke with visuospatial neglect. Design: This study was a prospective, double-blind, sham-controlled trial. Data are presented from 27 patients (15 men, 12 women; mean age, 67.0y) randomly assigned to receive 10 sessions of low-frequency (1Hz) rTMS over the nonlesioned PPC, high-frequency (10Hz) rTMS over the lesioned PPC, or sham stimulation. Setting: National university hospital. Participants: Patients (N=27) diagnosed with visuospatial neglect after stroke. Intervention: Ten sessions of rTMS over a 2-week period. Main Outcome Measures: The severity of visuospatial neglect was assessed pre- and posttreatment using the Motor-Free Visual Perception Test, line bisection test, star cancellation test, and Catherine Bergego Scale. Results: When comparing the differences in the Motor-Free Visual Perception Test, line bisection test, star cancellation test, Catherine Bergego Scale, and Korean-Modified Barthel Index (K-MBI) scores before and after treatment according to group, we found that changes in the line bisection test and K-MBI scores were significantly different between 3 groups. In the post hoc analysis, the improvement in the line bisection test score in the high-frequency rTMS group was statistically significant compared with that in the sham stimulation group (high vs sham P=.03, low vs sham P=.09, high vs low P=.58), and the improvements in the K-MBI scores of the 2 rTMS groups were statistically significant compared with those in the sham stimulation group (high vs sham P<.01, low vs sham P=.02, high vs low P=.75). Conclusions: These results indicate that high-frequency rTMS is effective in the treatment of visuospatial neglect in patients with acute stroke. Archives of Physical Medicine and Rehabilitation 2013;94:803-7 (C) 2013 by the American Congress of Rehabilitation Medicine