Theta burst stimulation in neglect after stroke: functional outcome and response variability origins.
Spatial neglect is a strong and negative predictor of general functional outcome after stroke, and its therapy remains a challenge. Whereas inhibitory non-invasive brain stimulation over the contralesional, intact hemisphere has generally been shown to ameliorate neglect on a group level, a conspicu...
| Publicado en: | Brain: A Journal of Neurology Vol. 142; no. 4; pp. 992 - 1009 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | research randomized controlled trial Journal Article |
| Publicado: |
Oxford University Press / USA
Apr2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=137253723&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 137253723 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00068950 2RY jtl: Brain: A Journal of Neurology issn: 00068950 maglogo: N pubinfo: dt: Apr2019 vid: 142 iid: 4 pid: 622 pub: Oxford University Press / USA artinfo: ui: 137253723 137253723 NLM30783648 137253723 10.1093/brain/awz029 NLM30783648 137253723 ppf: 992 ppct: 17 formats: tig: atl: Theta burst stimulation in neglect after stroke: functional outcome and response variability origins. aug: au: Nyffeler, Thomas Vanbellingen, Tim Kaufmann, Brigitte C Pflugshaupt, Tobias Bauer, Daniel Frey, Julia Chechlacz, Magdalena Bohlhalter, Stephan Müri, René M Nef, Tobias Cazzoli, Dario affil: Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland Neurocenter, Luzerner Kantonsspital, Switzerland sug: subj: Electroencephalography Stroke Physiopathology Transcranial Magnetic Stimulation Methods Perceptual Disorders Physiopathology Neuropsychological Tests Human Stroke Metabolism Male Aged Stroke Complications Severity of Illness Indices Spatial Perception Female Middle Age Activities of Daily Living Parietal Lobe Physiology Validation Studies Comparative Studies Evaluation Research Multicenter Studies Scales Aged: 65+ years Middle Aged: 45-64 years Male Female ab: Spatial neglect is a strong and negative predictor of general functional outcome after stroke, and its therapy remains a challenge. Whereas inhibitory non-invasive brain stimulation over the contralesional, intact hemisphere has generally been shown to ameliorate neglect on a group level, a conspicuous variability of the effects at the individual level is typically observed. We aimed to assess the characteristics and determinants of the effects of inhibitory non-invasive brain stimulation in neglect, identifying which patients would respond to this therapeutic approach and which not. To this end, we prospectively included 60 patients with a subacute right-hemispheric stroke. In 30 patients with spatial neglect, continuous theta burst stimulation (cTBS) was applied over the left posterior parietal cortex in a randomized clinical trial, either in eight or 16 trains, or as sham stimulation. Thirty patients without neglect served as a control group. Neglect severity was measured with a neuropsychological test battery and the Catherine Bergego Scale, at admission to and at discharge from inpatient neurorehabilitation, as well as at 3 months follow-up. General functional outcome was assessed by means of the Functional Independence Measure and the Lucerne ICF-based Multidisciplinary Observation Scale. The impact of clinical and demographic factors was evaluated, and the influence of lesion location and extension was assessed by means of voxel-based lesion-symptom mapping. On a group level, both cTBS protocols (i.e. eight and 16 trains) significantly reduced neglect severity in both the Catherine Bergego Scale and the neuropsychological tests, at discharge and 3 months later. Furthermore, cTBS significantly improved general functional outcome. On an individual level, hierarchical cluster and voxel-based lesion-symptom mapping analyses revealed that the variability in the responses to cTBS is determined by the integrity of interhemispheric connections within the corpus callosum, in particular parieto-parietal connections. In cTBS responders, in whom neglect and general functional outcome were significantly improved, the corpus callosum was intact, whereas this was not the case in cTBS non-responders. Moreover, analyses based on the proportional recovery rule and the Maugeri predictive stroke recovery model showed that the recovery of neglect and of the activities of daily living was accelerated only in cTBS responders. Furthermore, the level of activities of daily living recovery of these neglect patients was brought close to the one of right-hemispheric control patients without neglect. Hence, in neglect patients with intact interhemispheric connectivity, cTBS over the contralesional posterior parietal cortex significantly improves and accelerates neglect recovery and, associated with it, general functional outcome. pubtype: Academic Journal doctype: research randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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