From the Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany.
Stroke. 2014 Aug;45(8):2465-8. doi: 10.1161/STROKEAHA.114.006059. Epub 2014 Jun 12.
Right hemisphere stroke patients frequently experience spatial neglect, a severe lack of awareness for contralesional hemispace. Although neglect counts among the strongest predictors for poor functional outcome after stroke, there is no established therapy, particularly not for the acute stage.
In a randomized controlled trial, we compared the combined treatment of hemifield eye patching and repetitive optokinetic stimulation in acute stroke patients with neglect to the spontaneous course. Outcome measures were a neuropsychological test battery for neglect as well as scales of functional independence and clinical impairment. Outcomes were assessed at baseline (day 1), post treatment (day 8), and at 1-month follow-up (day 30).
Final analysis included 21 acute right hemisphere stroke patients with neglect (23 enrolled, 2 lost to follow-up) allocated either to the treatment (1 week hemifield eye patching and daily sessions of optokinetic stimulation, n=11) or the control group (no neglect-specific treatment, n=10). At baseline, both groups did not differ in neuropsychological test performance, clinical impairment, or functional disability. At the post treatment session, both groups had improved in all these measures, and results were stable or further improved at follow-up. However, there was no significant difference in this change between the treatment and the control group.
An early intervention of combined hemifield eye patching and optokinetic stimulation in acute stroke patients with spatial neglect has no additive effect to the spontaneous remitting course of the disorder.
http://www.clinicaltrials.gov. Unique identifier: NCT01617343.
右脑卒患者常出现空间忽略，即对病变对侧半空间严重缺乏意识。尽管忽略是卒中后功能预后不良的最强预测因素之一，但目前尚无既定的治疗方法，尤其是在急性阶段。
在一项随机对照试验中，我们将急性卒中伴忽略患者的半视野眼贴与重复视动刺激联合治疗与自然病程进行了比较。主要观察指标为忽略的神经心理学测试组合以及功能独立性和临床损伤量表。结果在基线（第 1 天）、治疗后（第 8 天）和 1 个月随访（第 30 天）时进行评估。
最终分析包括 21 例急性右脑卒伴忽略患者（23 例入组，2 例失访），分为治疗组（1 周半视野眼贴和每日视动刺激治疗，n=11）或对照组（无忽略特异性治疗，n=10）。基线时，两组在神经心理学测试表现、临床损伤或功能残疾方面无差异。在治疗后评估时，两组在所有这些指标上均有改善，且结果在随访时保持稳定或进一步改善。然而，治疗组与对照组之间在这种变化上没有显著差异。
急性卒中伴空间忽略患者的早期联合半视野眼贴和视动刺激治疗对该疾病的自然缓解过程没有额外的效果。
