Noninvasive brain stimulation improves hemispatial neglect after stroke: a systematic review and meta-analysis

Publication date: Available online 9 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ana Paula S. Salazar, Patrícia G. Vaz, Ritchele R. Marchese, Cinara Stein, Camila Pinto, Aline S. Pagnussat
ObjectiveTo evaluate the effectiveness of noninvasive brain stimulation (NIBS) – repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) - on hemispatial neglect and performance in activities of daily living (ADL) after stroke.Data sourcesMEDLINE (Pubmed), Embase, Cochrane CENTRAL, SCOPUS, Scielo and Physiotherapy Evidence Database (PEDro) were searched from database inception to December 2016.Data SelectionRandomized controlled trials or crossover trials focused on determining the effects of tDCS or rTMS combined or not combined with other therapies for hemispatial neglect after stroke.Data ExtractionMethodological characteristics of the studies, number of participants, comparison groups, interventions and outcomes were extracted.Data SynthesisTen trials comprising 226 participants had data that were suitable for the meta-analysis. Meta-analysis showed that NIBS combined with another therapy significantly improves hemispatial neglect [SMD -1.91 (95% CI, -2.57 to -1.25; I² 71%)]. A sensitivity analysis showed that rTMS [SMD -2.16 (95% CI, -3.00 to -1.33; I² 76%)] and tDCS [SMD -1.07 (95% CI, -1.76 to -0.37; I² 0%)] had positive effects on hemispatial neglect. Furthermore, both excitatory [SMD -2.34 (95% CI, -3.56 to -1.12; I² 65%)] and inhibitory [SMD -1.69 (95% CI, -2.49 to -0.88; I² 75%)] stimulations were effective.ConclusionsThis meta-analysis revels a moderate-quality of evidence for the effectiveness of NIBS protocols combined with other therapies on hemispatial neglect and performance in ADL after stroke.



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