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Neural Plasticity
Volume 2018, Article ID 1638763, 25 pages
Review Article

Noninvasive Brain Stimulations for Unilateral Spatial Neglect after Stroke: A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Controlled Trials

1Neurology Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
2Science and Technology Institute, Universidade Estadual Paulista (UNESP), São José dos Campos, SP, Brazil
3Department of Pharmacy, Tanta Chest Hospital, Tanta, Egypt
4Research Institute, Hospital do Coração (HCor), São Paulo, SP, Brazil
5Neurostimulation Laboratory, University of São Paulo (USP), São Paulo, SP, Brazil
6Department of Applied Physical Therapy, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil

Correspondence should be addressed to Gustavo José Luvizutto; rb.psenu.bmf@ottuzivulg

Received 7 September 2017; Accepted 15 April 2018; Published 28 June 2018

Academic Editor: Michele Fornaro

Copyright © 2018 Flávio Taira Kashiwagi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Unilateral spatial neglect (USN) is the most frequent perceptual disorder after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve perception and functional capacity. Objective. To assess the impact of NIBS on USN after stroke. Methods. An extensive search was conducted up to July 2016. Studies were selected if they were controlled and noncontrolled trials examining transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and theta burst stimulation (TBS) in USN after stroke, with outcomes measured by standardized USN and functional tests. Results. Twelve RCTs (273 participants) and 4 non-RCTs (94 participants) proved eligible. We observed a benefit in overall USN measured by the line bisection test with NIBS in comparison to sham (SMD −2.35, 95% CI −3.72, −0.98; ); the rTMS yielded results that were consistent with the overall meta-analysis (SMD −2.82, 95% CI −3.66, −1.98; ). The rTMS compared with sham also suggested a benefit in overall USN measured by Motor-Free Visual Perception Test at both 1 Hz (SMD 1.46, 95% CI 0.73, 2.20; ) and 10 Hz (SMD 1.19, 95% CI 0.48, 1.89; ). There was also a benefit in overall USN measured by Albert’s test and the line crossing test with 1 Hz rTMS compared to sham (SMD 2.04, 95% CI 1.14, 2.95; ). Conclusions. The results suggest a benefit of NIBS on overall USN, and we conclude that rTMS is more efficacious compared to sham for USN after stroke.