rTMS in visual hemineglect after stroke

Abstract

This chapter presents an overview of the literature of clinical application of TMS in the treatment of visual hemineglect. Eleven studies were found. In general, inhibitory protocols (low-frequency repetitive TMS, rTMS, or continuous theta burst stimulation, cTBS) were used to stimulate the contralesional intact hemisphere. The quality of evidence of the different studies is heterogeneous ranging from single case reports to randomized, blinded, and sham-controlled studies. Repetitive TMS is safe; no serious side effects were reported. There is a clear advantage for the use of inhibitory rTMS protocols such as cTBS. At the moment, a week recommendation based on the GRADE system is given for cTBS protocols with repeated daily applications as described in the study of Cazzoli et al. (Brain 135:3426-3439, 2012). This protocol has also a low burden for the patient due to the short duration of the stimulation and the duration of the whole therapy limited to 2 days. The effects on visual hemineglect are long lasting, more than 3 weeks. The improving effects are not only found on a neuropsychological test level but also on daily activities of the patient.