We’ve come a long way in our understanding of stroke-related conditions. But for all our breakthroughs, some conditions remain notoriously difficult to treat. One such disorder is visuospatial neglect (VSN). Affecting up to 80% of right-brain stroke sufferers, VSN commonly presents as an impaired awareness of the stroke-affected side of the body. This condition can manifest as reduced attention to specific areas of the visual field, limited response to stimuli, and issues with physical orientation or posture. The most common approach to therapy in these cases is medication with a behavioral training-based program. This approach has been shown to offer some clinical benefit. However, evidence of real-world improvements (such as reduced disability or improved independence) is lacking.
According to a team of researchers from Beijing, help may be at hand in the form of continuous theta-burst stimulation (cTBS). cTBS uses a non-invasive system to deliver magnetic stimulation across the skull. It provides magnetic pulses in high-frequency ‘bursts’. Previous studies showed that this approach increases brain activity, and therefore, the researchers believed it could treat VSN.
Can cTBS improve visuospatial neglect?
The team tested this approach in a group of 12 patients. Their ages ranged from 37 to 78 years. All had experienced a stroke more than two weeks before the study. Six of the patients in this study received cTBS 4 sessions per day for 10 days. Each session lasted 40 seconds and delivered 600 ‘bursts’ of magnetic stimulation. The other six patients did not receive this kind of treatment.
Compared to the untreated patients, those treated with cTBS showed improvements in their ability to search across their entire visual field. The researchers believe this is linked to positive changes brought about by the treatment. Researchers measured the improvements with the star cancellation test. In this test, patients have to mark the small stars on a screen. They also used the line bisection test. Patients using this test need to mark the middle of different horizontal lines. No side effects were reported, and no patients complained of pain or discomfort during the sessions.
So if you suffer from VSN, talk with your doctor about cTBS. If your rehabilitation clinic offers TMS, they might be able to provide cTBS. Ask to find out your options. It could change how you see the world around you.
The star cancellation test: patients have to mark the small stars. Patients reduced the number of not marked stars from 51% to 21% after treatment. Control patients stayed at 50%.
The two lead authors of this study were Wei Lu and Lei Cao, Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, P.R. China.