Noninvasive Brain Stimulation Improves Hemispatial Neglect After Stroke: A Systematic Review and Meta-Analysis

Abstract

Objective: To 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 sources: MEDLINE (PubMed), EMBASE, Cochrane CENTRAL, Scopus, SciELO, and Physiotherapy Evidence Database were searched from database inception to December 2016.

Data selection: Randomized 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 extraction: Methodological characteristics of the studies, number of participants, comparison groups, interventions, and outcomes were extracted.

Data synthesis: Ten trials comprising 226 participants had data that were suitable for the meta-analysis. Meta-analysis showed that NIBS combined with other therapies significantly improves hemispatial neglect (standardized mean difference [SMD]=-1.91; 95% confidence interval [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.

Conclusions: This meta-analysis reveals moderate-quality evidence for the effectiveness of NIBS protocols combined with other therapies on hemispatial neglect and performance in ADL after stroke.

Keywords: Neurological rehabilitation; Physical therapy modalities; Rehabilitation; Transcranial direct current stimulation; Transcranial magnetic stimulation.