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Background: Visual field defects (VFD) usually do not show improvement beyond 12 weeks from their onset. It has been shown that repetitive presentation of a stimulus to areas of residual vision in cases of visual field defect can improve vision. The counterpart of these areas in the brain are the partially damaged brain regions at the perilesional areas where plasticity can be enhanced. Objective: We aimed to study the effect of navigated repetitive transcranial magnetic stimulation (rTMS) applied to perilesional areas on the recovery of patients with cortical VFD. Methods: Thirty-two patients with cortical VFD secondary to stroke of more than 3 months duration received 16 sessions of either active or sham high frequency navigated perilesional rTMS. Automated perimetry and visual functioning questionnaire (VFQ-25) were performed at baseline and after completion of the sessions. Results: The active group showed significant improvement after intervention, compared to the sham group, in both mean deviation (MD), visual field index (VFI) and in the VFQ-25 scores. Conclusions: Navigated rTMS is a new treatment option for post-stroke VFD as it can selectively stimulate areas of residual vision around the infarcted tissue, improving the threshold of visual stimulus detection which could be used alone or in combination with existing therapies.

Back Ground: Cerebral small vessel disease (CSVD) is a condition of clinical and neuroimaging presentations that arise mainly from damage to the brain's small perforating vessels causing lacunar type strokes, Intracranial hemorrhage and insidious significant deficits in gait, urinary and cognitive domains which are progressive in nature rTMS showed efficacy regarding improving gait and cognition in subcortical pathologies as Multiple Sclerosis, Parkinson disease and vascular dementia. rTMS exerts efficacy through enhancing neuroplasticity and in part modulating associated neuronal inflammation. Aim of work: Study the effect of High frequency rTMS on Cognitive symptoms among patients with cerebral small vessel disease with no acute stroke presentation. Patients and Methods: 40 patients are included, with MRI documented small vessel disease, symptomatic by either gait or cognitive or urinary symptoms or all. Randomized to 20 active and 20 sham groups, Active group received 6 sessions of high frequency Cz of intensity of 110% Motor Threshold. Sham group received 6 Sham sessions. Baseline line demographic data, vascular risk factors, radiological scales (Fazekas and Global cortical atrophy scale) were done to all patients, Baseline, post-sessions and 1 month follow up assesments were done regarding cognitive scales including FAB ( Frontal assessment Battery) and Adam Brook scale. Results: Comparing active group to sham group. Active rTMS has statistically significant improved FAB scores (P < 0.001) and Adam Brook scale scores (P < 0.001) Conclusion: our results suggested that High frequency Cz applied rTMS sessions showed statistically significant improvement in cognitive performance in patients with small vessel disease.

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