Repetitive transcranial magnetic stimulation to hemispatial neglect in patients after stroke: an open-label pilot study.

OBJECTIVE To test whether multiple sessions of inhibitory low-frequency repetitive transcranial magnetic stimulation (rTMS) applied to the left parietal area can improve hemispatial neglect after stroke. DESIGN An open-label design. PATIENTS Seven consecutive patients with hemispatial neglect after right hemispheric stroke were compared with 7 retrospectively recruited control patients. METHODS Seven patients received a session of 1 Hz rTMS to the left parietal area immediately prior to occupational therapy for 10 days. Seven control patients received only behavioural therapy. RESULTS Baseline values of the line bisection test and the Albert test were comparable in the two groups. The stimulation group showed a greater improvement in the line bisection test than did the control group. However, no differences were found between the two groups according to the Albert test. CONCLUSION In this pilot study, low-frequency rTMS application to the non-affected left parietal area was found to be safe and to improve line bisection test, which suggests that non-invasive cortical stimulation has a potential role as an adjuvant strategy during cognitive rehabilitation training in patients with hemispatial neglect. A prospective randomized, sham-controlled study is required to determine the beneficial role of non-invasive cortical stimulation on hemispatial neglect.