Treatment of Unilateral Neglect using Repetitive Transcranial Magnetic Stimulation (rTMS) and Sensory Cueing (SC) in Stroke Patients

【Abstract】 Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and sensory cueing (SC) for improving hemi-spatial attention deficits related to unilateral neglect, upper limb function and independence of stroke patients. Methods An assessor-blinded randomized controlled trial (RCT) was conducted. Eligible stroke patients were treated with rTMS (n =17) or rTMS combined with SC (n =16) in addition to conventional rehabilitation measures. rTMS was applied with low frequency (1 Hz) over the posterior parietal cortex (P5) of the lefthemisphere, 90% resting motor threshold, 900 pulses each session，one session per day, and 5 d per week for 2 weeks. SC was emitted using a wristwatch device attached to the hemiplegic arm for 2 weeks with a cumulative wear time of 3 h per day. The severity of unilateral neglect 〔behavioral inattention test conventional subtests (BITC), Catherine Bergego scale (CBS)〕, activity of daily living 〔modified Barthel index (MBI)〕, and upper limb function 〔Fugl-Meyer assessment (FMA), action research arm test (ARAT)〕 of the patients were measured pre- and post-interventions (immediately after 2 weeks' treatment) by an occupational therapist. Results BIT-C was relieved significantly over time in both groups. But rTMS+SC had greater improvement than rTMS alone (P <0.05). No significant differences was found between the two groups in other outcomes (CBS, FMA, ARAT). Conclusion rTMS combined with SC is better than rTMS alone for treating unilateral neglect in stroke patients.