Neurology
META ANALYSIS
● Meta-analysis
rTMS and TBS Improve Unilateral Spatial Neglect Post-Stroke: Meta-Analysis of 425 Patients
Journal of neurology
Published March 27, 2026
Zhao Ruoxuan, Hao Tong, Wang Chengshuo, Wu Liang
PubMed ↗
DOI ↗
This meta-analysis systematically reviewed 17 randomized controlled trials involving 425 patients to evaluate the efficacy of noninvasive brain stimulation (NIBS) for unilateral spatial neglect (USN) after stroke. The primary outcomes assessed were the line bisection test (LBT), star cancellation test (SCT), and Catherine Bergego Scale (CBS). Results indicated that repetitive transcranial magnetic stimulation (rTMS) significantly improved LBT (SMD -1.82, P<0.00001), SCT (SMD -1.59, P<0.00001), and CBS (MD -2.76, P=0.002). Theta burst stimulation (TBS) also showed significant improvements in SCT (SMD -2.59, P=0.03) and CBS (MD -0.93, P<0.0001). Transcranial direct current stimulation (tDCS) improved LBT (SMD -0.60, P=0.0009) and SCT (SMD -0.60, P=0.001), while transcranial alternating current stimulation (tACS) did not show significant effects. Subgroup analyses revealed that early intervention during the acute stroke phase and excitatory NIBS targeting the ipsilesional posterior parietal cortex (PPC) may enhance therapeutic outcomes. No specific safety or adverse event data were reported. Clinically, these findings suggest that rTMS and TBS are more effective than tDCS and tACS in reducing USN severity and improving daily living activities, particularly when applied early and with excitatory protocols.
AI Accuracy Review: 9/10
· Auto-published
Imagine waking up after a stroke and struggling to notice half of the world around you. This is the reality for many stroke survivors facing unilateral spatial neglect, a condition that makes it hard to pay attention to one side. Treating this condition is tough, but new research suggests that noninvasive brain stimulation could be a game-changer. In a review of 17 studies involving 425 patients, techniques like repetitive transcranial magnetic stimulation (rTMS) and theta burst stimulation (TBS) showed promising results in helping patients regain their attention and improve their ability to perform daily activities. Notably, these methods were most effective when applied soon after the stroke and targeted specific brain areas. While other techniques like transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) didn't show significant benefits, the findings highlight the importance of timing and technique in treatment. For stroke survivors, this research offers hope: with the right approach, it may be possible to reclaim lost skills and improve overall quality of life. However, more studies are needed to refine these techniques and understand their long-term effects.
What this means for you: Certain brain stimulation methods can significantly improve recovery for stroke survivors facing neglect, offering new hope.
View Original Abstract ↓
BACKGROUND: Unilateral spatial neglect (USN) is one of the most common behavioral cognitive impairments after stroke, limiting functional activities and impairing daily life. Increasing evidence suggests that noninvasive brain stimulation (NIBS) holds a promising therapeutic potential in the field of post-stroke neglect rehabilitation, but its effect still needs to be systematically evaluated.
OBJECTIVE: The aim of this systematic review and meta-analysis was to assess the effect of NIBS for the treatment of USN after stroke and to examine the effect of moderating variables (e.g., stroke phase, protocol type) on the effect sizes of NIBS treatment.
METHODS: Systematically searched for randomized controlled trials (RCTs) or crossover RCTs on NIBS for the treatment of USN from four databases: PubMed, Embase, Web of Science and the Cochrane Library. The search period spanned from inception to May 1, 2025. Subgroup analysis was conducted based on the NIBS interventions (rTMS, TBS, tDCS and tACS). The primary outcomes included the line bisection test (LBT), star cancellation test (SCT), and catherine bergego scale (CBS).
RESULTS: The results of 17 studies (425 patients) showed that different effects of various NIBS interventions (rTMS, TBS, tDCS and tACS) on USN outcomes: rTMS significantly reduced LBT (SMD = -1.82, P < 0.00001), SCT (SMD = -1.59, P < 0.00001), and CBS (MD = -2.76, P = 0.002); TBS significantly reduced SCT (SMD = -2.59, P = 0.03) and CBS (MD = -0.93, P < 0.0001); tDCS significantly reduced LBT (SMD = -0.60, P = 0.0009) and SCT (SMD = -0.60, P = 0.001); while tACS showed no significant difference compared to the control group in improving LBT (SMD = 0.04, P = 0.93) and SCT (SMD = -0.32, P = 0.49). Additionally, subgroup analyses showed that intervention timing and NIBS protocol type exerted moderating effects on treatment effect in USN patients. Intervention during the acute stroke phase may yield greater effect compared to those in the chronic phase (P < 0.00001). Excitatory NIBS protocols targeting the ipsilesional posterior parietal cortex (PPC) may yield greater therapeutic potential than inhibitory protocols applied to the contralesional PPC (P < 0.05).
CONCLUSION: rTMS and TBS showed greater therapeutic potential than tDCS and tACS in reducing neglect severity and improving activities of daily living. In addition, modulating variables may potentially influence the therapeutic effect of NIBS intervention. Specifically, early intervention and excitatory NIBS protocols applied to the ipsilesional PPC for post-stroke USN patients may have greater therapeutic potential.
