The therapeutic effect of transcranial direct current stimulation combined with cognitive training on patients with unilateral neglect after stroke

Abstract

BACKGROUND:

Unilateral neglect (UN) is a frequent cognitive disability following a stroke. Additional research is needed to determine the most effective cognitive rehabilitation techniques.

OBJECTIVE:

Based on the unilateral neglect neural network, we aim to explore the effect of a new model of transcranial direct current stimulation (tDCS) combined with cognitive training on stroke patients with unilateral neglect.

METHODS:

Thirty stroke patients with UN after stroke were randomly divided into three groups. All patients received cognitive training for UN and transcranial direct current stimulation with an anode placed on the corresponding part of the right hemisphere for 2 weeks. Treatment group A received multi-site tDCS from the inferior parietal lobule, middle temporal gyrus to prefrontal lobe. Group B received single-site tDCS of the inferior parietal lobule. The improvement of UN symptoms was evaluated by the scores of the Deviation index and Behavioral Inattention Test conventional tests.

RESULTS:

All groups showed improvements in all tests, and the scores of the treatment groups were statistically significant compared with the control group.

CONCLUSION:

Both single-site tDCS and multi-site tDCS have therapeutic effects on UN after stroke, and the difference in the therapeutic effects of the two modes still needs to be further explored.

Keywords

Transcranial direct currentstimulation cognitive training stroke unilateral neglect

Get full access to this article

View all access options for this article.

References

Bornheim,

, Maquet,

, Croisier,

J. L.

, Crielaard,

J. M.

, & Kaux,

J. F.

(2018). Motor cortex Transcranial Direct Current Stimulation (tDCS) improves acute stroke visuo-spatial neglect: A series of four case reports. Brain stimulation, 11(2), 459–461.

Cappon,

, Jahanshahi,

, & Bisiacchi,

(2016). Value and Efficacy of Transcranial Direct Current Stimulation in the Cognitive Rehabilitation: A Critical Review Since 2000. Front Neurosci, 10, 157.

Corbetta,

, & Shulman,

G. L.

(2011a). Spatial neglect and attention networks. Annu Rev Neurosci, 34, 569–599.

Corbetta,

, & Shulman,

G. L.

(2011b)Spatial neglect and attention networks. Annu Rev Neurosci, 34, 569–599.

ELLISON,

, SCHINDLER,

, PATTISON,

L. L.

, & MILNER,

A. D.

(2004). An exploration of the role of the superior temporal gyrus in visual search and spatial perception using TMS. Brain (London, England : 1878), 127(Pt 10), 2307–2315.

Gammeri,

, Iacono,

, Ricci,

, & Salatino,

(2020). Unilateral Spatial Neglect After Stroke: Current Insights. Neuropsychiatr Dis Treat, 16, 131–152.

Halligan,

P. W.

, Cockburn,

, & Wilson,

B. A.

(1991). The behavioural assessment of visual neglect. Neuropsychological Rehabilitation, 1(1), 5–32.

Halligan,

P. W.

, Fink,

G. R.

, Marshall,

J. C.

, & Vallar,

(2003). Spatial cognition: evidence from visual neglect. Trends in Cognitive Sciences, 7(3), 125–133.

Heilman,

K. M.

, & Van Den Abell,

(1980). Right hemisphere dominance for attention: the mechanism underlying hemispheric asymmetries of inattention (neglect). Neurology, 30(3), 327–330.

10.

Hillis,

A. E.

, Newhart,

, Heidler,

, Barker,

P. B.

, Herskovits,

E. H.

, & Degaonkar,

(2005). Anatomy of Spatial Attention: Insights from Perfusion Imaging and Hemispatial Neglect in Acute Stroke. The Journal of Neuroscience, 25(12), 3161–3167.

11.

Kinsbourne,

(1977). Hemi-neglect and hemisphere rivalry. Advances in Neurology, 18, 41.

12.

Làdavas,

, Giulietti,

, Avenanti,

, Bertini,

, Lorenzini,

, Quinquinio,

, et al. (2015). a-tDCS on theipsilesional parietal cortex boosts the effects of prism adaptationtreatment in neglect. Restorative Neurology and Neuroscience, 33(5), 647–662.

13.

Lunven,

, & Bartolomeo,

(2016). Attention and spatial cognition: Neural and anatomical substrates of visual neglect. Annals of Physical and Rehabilitation Medicine, 60(3), 124–129.

14.

Mangun,

G. R.

, Buonocore,

M. H.

, & Hopfinger,

J. B.

(2000). The neural mechanisms of top-down attentional control. Nature Neuroscience, 3(3), 284–291.

15.

Meister,

I. G.

, Wienemann,

, Buelte,

, Grünewald,

, Sparing,

, Dambeck,

, et al. (2006). Hemiextinction induced by transcranial magnetic stimulation over the right temporo-parietal junction. Neuroscience, 142(1), 119–123.

16.

Mort,

D. J.

, Malhotra,

, Mannan,

S. K.

, Rorden,

, Pambakian,

, Kennard,

, et al. (2003). The anatomy of visual neglect. American Journal of Ophthalmology, 136(6), 1200–1201.

17.

Nitsche,

M. A.

, & Paulus,

(2001). Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology, 57(10), 1899–1901.

18.

Nitsche,

M. A.

, & Paulus,

(2001). Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology, 57(10), 1899–1901.

19.

Rossini,

P. M.

, Burke,

, Chen,

, Cohen,

L. G.

, Daskalakis,

, Di Iorio,

, et al. (2015). Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves:Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol, 126(6), 1071–1107.

20.

Shulman,

G. L.

, & Corbetta,

(2002). Control of goal-directed and stimulus-driven attention in the brain. Nature reviews. Neuroscience, 3(3), 201–215.

21.

Sparing,

, Thimm,

, Hesse,

M. D.

, Kust,

, Karbe,

, & Fink,

G. R.

(2009). Bidirectional alterations of interhemispheric parietal balance by non-invasive cortical stimulation. Brain, 132(Pt 11), 3011–3020.

22.

Stonsaovapak,

, Hemrungroj,

, Terachinda,

, & Piravej,

(2020). Effect of Anodal Transcranial Direct Current Stimulation at the Right Dorsolateral Prefrontal Cortex on the Cognitive Function in Patients With Mild Cognitive Impairment: A Randomized Double-Blind Controlled Trial. Arch Phys Med Rehabil, 101(8), 1279–1287.

23.

Sunwoo,

, Kim,

, Chang,

W. H.

, Noh,

, Kim,

, & Ko,

(2013). Effects of dual transcranial direct current stimulation on post-stroke unilateral visuospatial neglect. Neuroscience Letters, 554, 94–98.

24.

Tobler-Ammann,

B. C.

, Weise,

, Knols,

R. H.

, Watson,

M. J.

, Sieben,

J. M.

, de Bie,

R. A.

, et al.(2020). Patients’ experiences of unilateral spatial neglect between stroke onset and discharge from inpatient rehabilitation: a thematic analysis of qualitative interviews. Disability and Rehabilitation, 42(11), 1578–1587.

25.

Wiesen,

, Sperber,

, Yourganov,

, Rorden,

, & Karnath,

(2019). Using machine learning-based lesion behavior mapping to identify anatomical networks of cognitive dysfunction: Spatial neglect and attention. NeuroImage (Orlando, Fla.), 201, 116000.