Navigated perilesional transcranial magnetic stimulation can improve post-stroke visual field defect: A double-blind sham-controlled study

Article type: Research Article

Authors: El Nahas, Nevine^a | Elbokl, Ahmed M.^a | Abd Eldayem, Eman Hamid^a | Roushdy, Tamer M.^a | Amin, Randa M.^a | Helmy, Shahinaz M.^a | Akl, Ahmed Zaki^a | Ashour, Aya Ahmed^a | Samy, Shady^a | Amgad, Alaa^a | Emara, Tamer H.^a | Nowara, Mohamed^b | Kenawy, Fatma Fathalla^{a; *}

Affiliations: [a] Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt | [b] Al-Mashreq Eye Center, Cairo, Egypt

Correspondence: [*] Corresponding author: Fatma Fathalla Kenawy, Faculty of medicine, Ain shams University, Abbassia square, Cairo, Egypt PO box: 11538. Tel.: 00201128593444; E-mail: fatma.fathalla@med.asu.edu.eg.

Abstract: Background:Visual field defects (VFD) usually do not show improvement beyond 12 weeks from their onset. It has been shown that repetitive presentation of a stimulus to areas of residual vision in cases of visual field defect can improve vision. The counterpart of these areas in the brain are the partially damaged brain regions at the perilesional areas where plasticity can be enhanced. Objective:We aimed to study the effect of navigated repetitive transcranial magnetic stimulation (rTMS) applied to perilesional areas on the recovery of patients with cortical VFD. Methods:Thirty-two patients with cortical VFD secondary to stroke of more than 3 months duration received 16 sessions of either active or sham high frequency navigated perilesional rTMS. Automated perimetry and visual functioning questionnaire (VFQ-25) were performed at baseline and after completion of the sessions. Results:The active group showed significant improvement after intervention, compared to the sham group, in both mean deviation (MD), visual field index (VFI) and in the VFQ-25 scores. Conclusions:Navigated rTMS is a new treatment option for post-stroke VFD as it can selectively stimulate areas of residual vision around the infarcted tissue, improving the threshold of visual stimulus detection which could be used alone or in combination with existing therapies.

Keywords: rTMS, stroke, visual field defect, restoration, perimetry, navigated

DOI: 10.3233/RNN-211181

Journal: Restorative Neurology and Neuroscience, vol. 39, no. 3, pp. 199-207, 2021