Pharmacological interventions for unilateral spatial neglect after stroke

Luvizutto, Gustavo José; Bazan, Rodrigo; Braga, Gabriel Pereira; Resende, Luiz Antônio de Lima; Bazan, Silméia Garcia Zanati; Dib, Regina El

doi:10.1002/14651858.cd010882.pub2

Cited by 13 publications

(13 citation statements)

References 80 publications

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“…The research question we investigated in our review has been addressed before from different perspectives using our population of interest but with a different intervention (i.e., pharmacological intervention) [ 7 ] or investigating either the intervention or the control arms explored in this review but with a different population (e.g., idiopathic Parkinson's disease (IPD) [ 48 ], panic disorder in adults [ 66 ], or amyotrophic lateral sclerosis or motor neuron disease) [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

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Noninvasive Brain Stimulations for Unilateral Spatial Neglect after Stroke: A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Controlled Trials

Kashiwagi

Dib

Gomaa³

et al. 2018

Neural Plasticity

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Background Unilateral spatial neglect (USN) is the most frequent perceptual disorder after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve perception and functional capacity. Objective To assess the impact of NIBS on USN after stroke. Methods An extensive search was conducted up to July 2016. Studies were selected if they were controlled and noncontrolled trials examining transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and theta burst stimulation (TBS) in USN after stroke, with outcomes measured by standardized USN and functional tests. Results Twelve RCTs (273 participants) and 4 non-RCTs (94 participants) proved eligible. We observed a benefit in overall USN measured by the line bisection test with NIBS in comparison to sham (SMD −2.35, 95% CI −3.72, −0.98; p = 0.0001); the rTMS yielded results that were consistent with the overall meta-analysis (SMD −2.82, 95% CI −3.66, −1.98; p = 0.09). The rTMS compared with sham also suggested a benefit in overall USN measured by Motor-Free Visual Perception Test at both 1 Hz (SMD 1.46, 95% CI 0.73, 2.20; p < 0.0001) and 10 Hz (SMD 1.19, 95% CI 0.48, 1.89; p = 0.54). There was also a benefit in overall USN measured by Albert's test and the line crossing test with 1 Hz rTMS compared to sham (SMD 2.04, 95% CI 1.14, 2.95; p < 0.0001). Conclusions The results suggest a benefit of NIBS on overall USN, and we conclude that rTMS is more efficacious compared to sham for USN after stroke.

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Section: Discussionmentioning

confidence: 99%

“…Pharmacological interventions such as dopamine and noradrenergic agonists or procholinergic treatment have been used in people affected by USN after stroke, but the evidence derived from a Cochrane systematic review that included only two available RCTs was very low and inconclusive [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Brain Stimulations for Unilateral Spatial Neglect after Stroke: A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Controlled Trials

Kashiwagi

Dib

Gomaa³

et al. 2018

Neural Plasticity

Self Cite

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“…There already exists an extensive literature on psychopharmaceuticals in the treatment of attention deficits, and a full review is beyond the scope of this article. Pharmaceuticals that primarily target the noradrenergic system (e.g., guanfacine) or catecholamine system in general (e.g., methylphenidate, amphetamine, modafinil) have consistently been shown to improve wakefulness and sustained attention in a variety of populations, including children and adults with ADHD, patients suffering from hemispatial neglect, and healthy adults . Research suggest that the effects of therapeutic doses of these pharmaceuticals are relatively specific to the prefrontal cortex, strengthening its functioning and interactions with other brain regions .…”

Section: Modulating Sustained Attention Abilitymentioning

confidence: 99%

Recent theoretical, neural, and clinical advances in sustained attention research

Fortenbaugh

DeGutis

Esterman

2017

Annals of the New York Academy of Sciences

217

161

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Models of attention often distinguish between attention subtypes, with classic models separating orienting, switching, and sustaining functions. Compared to other forms of attention, the neurophysiological basis of sustaining attention has received far less attention yet it is known that momentary failures of sustained attention can have far ranging negative impacts in healthy individuals and lasting sustained attention deficits are pervasive in clinical populations. In recent years, however, there has been increased interest in characterizing moment-to-moment fluctuations in sustained attention in addition to the overall vigilance decrement and understanding how these neurocognitive systems change over the lifespan and across various clinical populations. The use of novel neuroimaging paradigms and statistical approaches has allowed for better characterization of the neural networks supporting sustained attention, and highlighted dynamic interactions within and across multiple distributed networks that predict behavioral performance. These advances have also provided potential biomarkers to identify individuals with sustained attention deficits. These findings have led to new theoretical models of why sustaining focused attention is a challenge for individuals and form the basis for the next generation of sustained attention research, which seeks to accurately diagnose and develop theoretically-driven treatments for sustained attention deficits that affect a variety of clinical populations.

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“…The aims of the current review were (1) to give an overview of human studies investigating pharmacotherapy to ameliorate VSN symptoms and (2) to evaluate the quality of those studies. These aims parallel those made in a Cochrane review 39 on the pharmacological treatment of VSN, published shortly before we completed the current review. However, several differences positively distinguish the current review from the Cochrane review.…”

Section: Objectives and Distinctivenessmentioning

confidence: 76%

Pharmacological Treatment of Visuospatial Neglect: A Systematic Review

Kemp

Dorresteijn

Brink

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Pharmacological interventions for unilateral spatial neglect after stroke

Abstract: The quality of the evidence from available RCTs was very low. The effectiveness and safety of pharmacological interventions for USN after stroke are therefore uncertain. Additional large RCTs are needed to evaluate these treatments.

Cited by 13 publications

References 80 publications

Noninvasive Brain Stimulations for Unilateral Spatial Neglect after Stroke: A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Controlled Trials

Noninvasive Brain Stimulations for Unilateral Spatial Neglect after Stroke: A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Controlled Trials

Recent theoretical, neural, and clinical advances in sustained attention research

Pharmacological Treatment of Visuospatial Neglect: A Systematic Review

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