Hemi-spatial neglect rehabilitation using non-invasive brain stimulation: or how to modulate the disconnection syndrome


Jacquin-Courtois S. Institution Jacquin-Courtois, S. Impact, centre des neurosciences de Lyon, Inserm UMR-S 1028; CNRS UMR 5292, 16, avenue Lepine, 69676 Bron, France; Universite Lyon 1, 69000, Lyon, France; Hospices civils de Lyon, service de reeducation neurologique, plate-forme mouvement et handicap, hopit al Henry-Gabrielle, 20, route de Vourles, 69230 Saint Genis Laval, France. Electronic address: sophie.courtois@chu-lyon.fr .


Hemi-spatial neglect rehabilitation using non-invasive brain stimulation: or how to modulate the disconnection syndrome?. [Review]

Source: Annals of Physical & Rehabilitation Medicine. 58(4):251-8, 2015 Sep .


Hemi-spatial neglect syndrome is common and sometimes long-lasting. It is characterized by a deficit in the use and awareness of one side of space, most often consecutive to a right hemisphere injury, mainly in the parietal region. Acknowledging the different types and all clinical characteristics is essential for an appropriate evaluation and adapted rehabilitation care management, especially as it constitutes a predictive factor of a poor functional prognosis. Some new approaches have been developed in the last fifteen years in the field of hemi-spatial neglect rehabilitation, where non-invasive brain stimulation (TMS and tDCS) ho lds an important place. Today’s approaches of unilateral spatial neglect modulation via non-invasive brain stimulation are essentially based on t he concept of inter-hemispheric inhibition, suggesting an over-activ ation of the contralesional hemisphere due to a decrease of the inhibiting influences of the injured hemisphere. Several approaches may then be used: stimulation of the injured right hemisphere, inhibition of the hyperac tive left hemisphere, or a combination of both. Results are promising, but th e following complementary aspects must be refined before a more systematic application: optimal stimulation protocol, individual managem ent according to the injured region, intensity, duration and frequency of care management, delay post-stroke before the beginning of treatment, combination of different approaches, as well as prognostic and efficacy criteria. An encouraging perspective for the future is the combination of several types of approaches, which would be largely facilitated by the improvement of fundamental knowledge on neglect mechanisms, which could in the future refine the choice for the most appropriate treatment(s) for a given patient.

Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Publication Type Journal Article. Review.