Article

Hemispatial neglect - defined as the failure to attend, explore, and act upon the
contralesional side of space - is a frequent and disabling neurological syndrome.
Interhemispheric rivalry is considered as a major pathophysiological mechanism
underlying hemispatial neglect. According to this account, the contralesional,
intact hemisphere undergoes a pathological hyperactivity due to a deficient
transcallosal inhibition from the damaged hemisphere.
This model offers a
framework for possible therapeutic interventions with repetitive transcranial
magnetic stimulation (rTMS), i.e. a reduction of the pathological hyperactivity
with a rTMS protocol that has lasting inhibitory effects. In the present work, we
will first review evidence for the interhemispheric rivalry account coming from
animals and humans. We will then describe studies showing the possibility to
perturb and to restore interhemispheric balance in healthy subjects as a proof of
concept for therapeutic rTMS application. Finally, we will consider studies
applying rTMS as a therapeutic approach in hemispatial neglect. We conclude that
rTMS is a promising approach to reduce the interhemispheric imbalance in neglect
patients and to ameliorate symptoms. Newly developed protocols such as Theta
Burst Stimulation (TBS) - with short stimulation times and long offline effects -
seem to be particularly convenient. However, future studies should assess
stimulation effects not only in clinical testing, but also on disability,
considering combination with traditional therapies as well.

Langue : ANGLAIS

Tiré à part : OUI