Theta-burst stimulation of the left hemisphere accelerates recovery of hemispatial neglect
Theta-burst stimulation of the left hemisphere accelerates recovery of hemispatial neglect
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DOI：
10.1212/wnl.0b013e31823ed08f
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发表时间：
2012-01-01
期刊：
影响因子：
9.9
通讯作者：
Caltagirone, C.
中科院分区：
文献类型：
--
作者：
Koch, G.;Bonni, S.;Caltagirone, C.
目的：由于右半球（RH）中风而导致半侧空间忽视的患者，源自完整左半球（LH）后顶叶皮质（PPC）的皮质-皮质回路可能会变得过度兴奋。方法：在目前的随机、双盲、假对照研究中，我们研究了连续θ爆发刺激的安全性和有效性 (cTBS) 在 2 周内进行 10 次疗程，应用于亚急性缺血性中风患者 LH 的完整 PPC。通过标准化行为注意力不集中测试（BIT）评估忽视的严重程度。我们还通过双焦经颅磁刺激 (TMS) 测量了 cTBS 如何改变完整 LH 中顶额叶功能连接的兴奋性。 结果：我们发现 2 周的 cTBS（而非假 cTBS）可有效改善通过 BIT 评分衡量的忽视症状。经过 2 周的 cTBS 治疗后，BIT 分数提高了 16.3%，随访 1 个月后提高了 22.6%。我们还发现，在使用真实而非假的 cTBS 治疗后，LH 顶额叶回路的过度兴奋性有所降低。结论：这些研究结果表明，在 LH PPC 上进行为期 2 周的 cTBS 疗程可能是加速亚急性中风患者视觉空间忽视恢复的潜在有效策略，可能抵消 LH 顶额叶的过度兴奋性。 证据分类：本研究提供了 III 级证据，表明左后顶叶皮层 theta 爆发刺激可改善治疗后长达 2 周的半侧空间忽视。神经病学（R）2012；78：24-30
Objective: Cortico-cortical circuits originating from the posterior parietal cortex (PPC) of the intact left hemisphere (LH) may become hyperexcitable in patients with hemispatial neglect due to a right hemispheric (RH) stroke.Methods: In the current randomized, double-blind, sham-controlled study, we investigated safety and efficacy of continuous theta-burst stimulation (cTBS) in 10 sessions over 2 weeks applied over the intact PPC of the LH in subacute ischemic stroke patients. Severity of neglect was assessed through the standardized Behavioral Inattention Test (BIT). We also measured, by means of bifocal transcranial magnetic stimulation (TMS), how cTBS modified the excitability of the parieto-frontal functional connections in the intact LH.Results: We found that 2 weeks of cTBS, but not sham cTBS, were effective in improving neglect symptoms as measured by BIT score. BIT scores improved by 16.3% after 2 weeks of cTBS and 22.6% at 1 month follow-up. We also found that hyperexcitability of LH parieto-frontal circuits was reduced following treatment with real but not sham cTBS.Conclusion: These findings suggest that a 2-week course of cTBS over the LH PPC may be a potential effective strategy in accelerating recovery from visuospatial neglect in subacute stroke patients, possibly counteracting the hyperexcitability of LH parieto-frontal circuits.Classification of evidence: This study provides Class III evidence that left posterior parietal cortex theta-burst stimulation improves hemispatial neglect for up to 2 weeks after treatment. Neurology (R) 2012;78:24-30