Effectiveness of repetitive transcranial magnetic stimulation on post-stroke unilateral spatial neglect: a systematic review and meta-analysis

Post-stroke cognitive impairment refers to the cognitive impairment caused by stroke. Unilateral spatial neglect is the main symptom and results in remarkably lower independence in activities of daily living and participation. Recent studies suggested that repetitive transcranial magnetic stimulation (rTMS) may have a positive effect on post-stroke cognitive impairment, but no relevant systematic review has been conducted on post-stroke cognitive impairment, especially unilateral spatial neglect. Therefore, relevant studies on rTMS in the treatment of post-stroke were collected and analyzed by systematic review and meta-analysis to determine whether rTMS can improve the cognitive function of patients, especially post-stroke unilateral spatial neglect, to provide reliable evidence for rTMS intervention. PubMed, Cochrane Central Register of Controlled Trials, Embase, PsycINFO databases, Web of Science and CINAHL were searched up to February 3, 2021. Three authors screened the reviews and independently assessed their methodological quality using the Jadad scale. The number of studies finally pooled was 28, and the sample size was 819. In the overall cognition function, the efficacy of the intervention group was superior to that of the control group. This meta-analysis result indicated that rTMS influences unilateral spatial neglect. rTMS was effective in improving patients’ activities of daily living. Subgroup analysis showed the preferred items in selecting frequency pulses and session. Furthermore, rTMS could not improve unilateral spatial neglect with an onset time of less than 1 month and over 1 month. This meta-analysis shows that rTMS intervention may be a promising way to treat post-stroke cognitive impairment.