Houben Milan, Chettouf Sabrina, Van Der Werf Ysbrand D, Stins John
Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7 Amsterdam, The Netherlands.
Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117 Amsterdam, The Netherlands.
Restor Neurol Neurosci. 2021;39(6):447-465. doi: 10.3233/RNN-211228.
Unilateral neglect (UN) is a common and disabling disorder after stroke. UN is a strong and negative predictor of functional rehabilitative outcome. Non-invasive brain stimulation, such as theta-burst transcranial magnetic stimulation (TBS), is a promising rehabilitation technique for treating stroke-induced UN.
To systematically review the available literature, researching whether TBS of the contra-lesional hemisphere is more effective than standard rehabilitation in improving symptoms of UN in patients with right hemisphere stroke.
A systematic review was conducted to retrieve randomized controlled trials (RCTs) that were relevant to the objective of this review. PubMed, Ovid and Cochrane Library electronic databases were comprehensively searched from inception up to February 2021. Of the included studies, methodological quality was assessed using the PEDro scale, whereafter a best evidence synthesis (BES) was conducted to summarize the results.
Nine RCTs investigating the effects of TBS on stroke-induced UN symptoms were included in this review. Seven studies assessing continuous TBS (cTBS) found significantly greater amelioration of UN symptoms in the TBS intervention group when compared to the control group; one study assessing cTBS found no such significant difference. One study assessing intermittent TBS (iTBS) found significant between-group differences in favor of the intervention. The BES yielded strong evidence in favor of cTBS, and limited evidence in favor of iTBS.
The included studies in the present review allow the conclusion that TBS can have favorable effects on UN recovery in stroke patients. Its clinical use is recommended in conjunction with cognitive rehabilitation and occupational or physical rehabilitation as needed. However, many aspects for optimal usage of TBS therapy in clinical settings, such as exact TBS protocols, number of sessions, and treatment duration, are not clear.
单侧空间忽视是卒中后常见且致残的一种病症。单侧空间忽视是功能康复结局的一个强有力的负面预测因素。非侵入性脑刺激，如theta爆发式经颅磁刺激（TBS），是一种有前景的治疗卒中所致单侧空间忽视的康复技术。
系统回顾现有文献，研究对侧半球的TBS在改善右半球卒中患者单侧空间忽视症状方面是否比标准康复更有效。
进行了一项系统回顾，以检索与本综述目的相关的随机对照试验（RCT）。全面检索了PubMed、Ovid和Cochrane图书馆电子数据库，检索时间从建库至2021年2月。对于纳入的研究，使用PEDro量表评估方法学质量，之后进行最佳证据综合（BES）以总结结果。
本综述纳入了9项研究TBS对卒中所致单侧空间忽视症状影响的RCT。7项评估连续TBS（cTBS）的研究发现，与对照组相比，TBS干预组的单侧空间忽视症状改善显著更大；1项评估cTBS的研究未发现此类显著差异。1项评估间歇性TBS（iTBS）的研究发现组间差异显著，干预组更优。最佳证据综合产生了支持cTBS的有力证据和支持iTBS的有限证据。
本综述纳入的研究表明，TBS对卒中患者单侧空间忽视的恢复可能有有益影响。建议根据需要将其与认知康复以及职业或物理康复联合用于临床。然而，TBS疗法在临床环境中的最佳使用的许多方面，如确切的TBS方案、疗程数和治疗持续时间，尚不清楚。
