Noninvasive Brain Stimulation Improves Hemispatial Neglect After Stroke: A Systematic Review and Meta-Analysis

Salazar, Ana Paula; Vaz, Patricia Graef; Marchese, Ritchele Redivo; Stein, Cinara; Pinto, Camila; Pagnussat, Aline de Souza

doi:10.1016/j.apmr.2017.07.009

Cited by 65 publications

(64 citation statements)

References 45 publications

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“…Twelve systematic reviews with 9,117 adult participants with post-stroke impairments following ischaemic and/or haemorrhagic strokes in acute and chronic post-stroke phase were included. Six systematic reviews (n = 6,317 participants) (18,21,23,24,27,32) evaluated the effectiveness of rTMS on motor and functional outcomes; 3 reviews evaluated (n = 1,916) (9, 24, 26) post-stroke depression outcomes, and 2 reviews each evaluated aphasia (n = 157) (24,33), cognitive impairment (n = 301) (24,34) and dysphagia (n = 255) (25,35).…”

Section: Description Of Included Systematic Reviewsmentioning

confidence: 99%

“…There was marked variability amongst the studies with regard to the rTMS protocols used. Nine of the 12 included systematic reviews (21,(24)(25)(26)(27)(32)(33)(34)(35) performed meta-analyses, and the other 3 provided only qualitative description of findings due to heterogeneous data (9,18,23). Hao et al 24 rTMS protocols in the included studies.…”

Section: Description Of Included Systematic Reviewsmentioning

confidence: 99%

“…Cognition. Two reviews (n = 12 RCTs, 301 participants) evaluated the effects of rTMS on cognitive outcomes in person with stroke (24,34). The overall findings indicate a "moderate-" quality evidence for beneficial effect of rTMS on cognitive function (such as hemispatial neglect, mental state, etc.).…”

Section: Motor Functionmentioning

confidence: 99%

See 2 more Smart Citations

Repetitive transcranial magnetic stimulation for management of post-stroke impairments: An overview of systematic reviews

Kim¹,

Rosselin²,

Amatya³

et al. 2020

J Rehabil Med

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Stroke causes significant disability and morbidity. Currently, a range of rehabilitation interventions to manipulate or induce brain plasticity, including repetitive transcranial magnetic stimulation (rTMS) are used for stroke care. There is a growing body of research in this area, with several systematic reviews evaluating efficacy and safety of rTMS for various clinical outcomes. This review systematically evaluates evidence from published systematic reviews of clinical trials to determine the effectiveness of rTMS in people with stroke to guide treating clinicians. The included reviews used varied rTMS protocols and outcome measures. The findings suggest limited high-quality evidence for improved motor and non-motor functions following stroke; hence, routine clinical use of rTMS is yet to be established. Objective: To evaluate evidence from published systematic reviews of clinical trials to determine the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in stroke population. Methods: The Cochrane Library, MEDLINE, CINAHL, EMBASE, and PubMed were searched for systematic reviews up to 15 January 2019. Three authors independently screened the reviews and assessed the methodological quality, using Assessment of Multiple Systematic Reviews (AMSTAR) appraisal tool. Quality of evidence for outcomes evaluated within the reviews was appraised with Grade of Recommendation, Assessment, Development and Evaluation (GRADE) tool. Results: Twelve reviews (n = 9,117 participants) evaluated the effectiveness of rTMS on motor and non-motor (aphasia, depression, dysphagia and cognition) functions. The rTMS protocols applied and outcomes measured were diverse amongst the selected reviews. The findings suggest beneficial effect of rTMS with: "moderate quality" evidence for dysphagia and hemineglect, "low to moderate quality" evidence for motor function (upper limb function, daily activities), and "low quality" evidence for aphasia and post-stroke depression. Conclusion: Despite widespread use of rTMS, highquality evidence for its routine use for the treatment of stroke survivors is lacking. Further studies are required to establish differential roles of various protocols and long-term effects of rTMS in the stroke population.

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Section: Description Of Included Systematic Reviewsmentioning

confidence: 99%

Section: Description Of Included Systematic Reviewsmentioning

confidence: 99%

See 1 more Smart Citation

Repetitive transcranial magnetic stimulation for management of post-stroke impairments: An overview of systematic reviews

Kim¹,

Rosselin²,

Amatya³

et al. 2020

J Rehabil Med

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“…At baseline demographic and clinical data were recorded including impairment caused by stroke using the National Institute of Stroke Scale (NIHSS) (15). Global cognitive functioning were assessed by the Montreal Cognitive Assessment (MoCA) (17). Neglect symptoms were assessed at baseline and followup (Star-, Letter-, and Line Cancellation, Line Bisection, Figure Copying and Text Reading ).…”

Section: Assessmentsmentioning

confidence: 99%

“…Nevertheless, whether results, even obtained in healthy older adults (16) apply to brain-damaged neglect patients, who are mainly suffer from perceptual and attentional de cits, remain unknown. So far, different current densities (0.29 -0.8 A/m²) have been administered in neglect patients (17,18). Methodological heterogeneity and/or no information about controlling effective blinding challenge conclusive remarks.…”

Section: Introductionmentioning

confidence: 99%

Blinding in electric current stimulation in subacute neglect patients with current densities of 0.8 A/m²: A cross-over pilot study

Gorsler¹,

Grittner

Külzow

et al. 2020

Preprint

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Objective Neglect after stroke is a disabling disorder and its rehabilitation is a major challenge. Transcranial direct current stimulation (tDCS) seems to be a promising adjuvant technique to improve standard care neglect therapy. Since electric fields are influenced by age-related factors higher current densities are probably needed for effective treatment in aged stroke patients. The validation of treatment efficacy requires sham-controlled experiments but increased current densities might comprise blinding. Therefore, we conducted a pilot study to test sham adequacy when using current density of 0.8 A/m2. Whether especially neglect patients who mainly suffer from perceptual and attentional deficits are able to differentiate beyond chance active from sham tDCS was investigated in a cross-over design (active/sham stimulation, randomized order) in 12 early subacute patients with left-sided hemineglect. Stimulation was performed simultaneous to standard care neglect therapy with 0.8 A/m². Progress of neglect symptomatology was also monitored during inpatient rehabilitation.Results Higher odds of correct guessing an active tDCS condition compared to wrongly judge an active tDCS condition as sham stimulation (Odds ratio 10.00, 95%CI: 0.65 - 154.40, p = 0.099) were observed. Therefore, blinding success remains debatable in neglect studies with current densities of 0.8 A/m² and still warrants further investigation.

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Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury

Longley

Hazelton

Heal

et al. 2021

Cochrane Database of Systematic Reviews

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Noninvasive Brain Stimulation Improves Hemispatial Neglect After Stroke: A Systematic Review and Meta-Analysis

Cited by 65 publications

References 45 publications

Repetitive transcranial magnetic stimulation for management of post-stroke impairments: An overview of systematic reviews

Repetitive transcranial magnetic stimulation for management of post-stroke impairments: An overview of systematic reviews

Blinding in electric current stimulation in subacute neglect patients with current densities of 0.8 A/m²: A cross-over pilot study

Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury

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