Abstract
Left hemispatial neglect (LHSN) is a frequent and disabling condition affecting patients who suffered from traumatic brain injury (TBI). LHSN is a neuropsychological syndrome characterized clinically by difficulties in attending, responding, and consciously representing the right side of space. Despite its frequency, scientific evidence on effective treatments for this condition in TBI patients is still low. According to existing literature, we hypothesize that in TBI, LHSN is caused by an imbalance in inter-hemispheric activity due to hyperactivity of the left hemisphere, as observed in LHSN after right strokes. Thus, by inhibiting this left hyperactivity, repetitive Transcranial Magnetic Stimulation (rTMS) would have a rebalancing effect, reducing LHSN symptoms in TBI patients. We plan to test this hypothesis within a single-blind, randomized SHAM controlled trial in which TBI patients will receive inhibitory i-rTMS followed by cognitive treatment for 15 days. Neurophysiological and clinical measures will be collected before, afterward, and in the follow-up. This study will give the first empirical evidence about the efficacy of a novel approach to treating LHSN in TBI patients.Clinical Trial Registration: https://www.clinicaltrials.gov/ct2/show/NCT04573413?cond=Neglect%2C+Hemispatial&cntry=IT&city=Bologna&draw=2&rank=2, identifier: NCT04573413.
Highlights
It is estimated that every year in Europe, around 235 persons per 100,000 people are affected by Traumatic Brain Injury (TBI) [1]
Previous studies showed the efficacy of 1 Hz inhibitory repetitive Transcranial Magnetic Stimulation (i-rTMS) on visuospatial symptoms in persons with an ischemic lesion of the right hemisphere
The observed effects persisted 15 days after i-rTMS treatment [9,10,11]. These results can be explained considering that spatial attention deficit in Left hemispatial neglect (LHSN) due to a right middle cerebral artery territory stroke relates to abnormal activation of the neural system that mediates attentive spatial operations in the healthy brain [12]
Summary
It is estimated that every year in Europe, around 235 persons per 100,000 people are affected by Traumatic Brain Injury (TBI) [1]. The subsequent inter-hemispheric imbalance leads to a biased attentive allocation toward the ipsilesional space [12] Inhibition of this hyperactivity may have a rebalancing effect, reducing left spatial attention deficit in LHSN. A recent study comparing TBI patients with LHSN against controls showed the presence of hemispheric differences in latencies and amplitudes of the N1 component of VEPs to stimuli presented on both sides [15] These data suggest that the right hemispheric stroke imbalance model could be applied to explain LHSN symptoms in TBI. Bonnì et al demonstrated that a 2-week protocol of i-rTMS (30 Hz Theta burst stimulation on the left PPC) applied to a person affected by LHSN due to TBI reduced the hyper-excitability of the left PPC-primary motor cortex connectivity [20]. We will make use of measures of interhemispheric functional connectivity derived from N1. [2] To detail the effect of combined i-rTMS + VST on cognitive symptoms of LHSN in TBI patients as measured by specific clinical measures. [3] To assess whether the effect of the combined i-rTMS + VST treatment has the potential to promote long-lasting lessening of the behavioral manifestations of LHSN in activities of daily living
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