Article

Hemi-spatial neglect syndrome is common and sometimes long-lasting. It is
characterized by a deficit in the use and awareness of one side of space, most
often consecutive to a right hemisphere injury, mainly in the parietal region.
Acknowledging the different types and all clinical characteristics is essential
for an appropriate evaluation and adapted rehabilitation care management,
especially as it constitutes a predictive factor of a poor functional prognosis.
Some new approaches have been developed in the last fifteen years in the field of
hemi-spatial neglect rehabilitation, where non-invasive brain stimulation (TMS
and tDCS) holds an important place. Today's approaches of unilateral spatial
neglect modulation via non-invasive brain stimulation are essentially based on
the concept of inter-hemispheric inhibition, suggesting an over-activation of the
contralesional hemisphere due to a decrease of the inhibiting influences of the
injured hemisphere. Several approaches may then be used: stimulation of the
injured right hemisphere, inhibition of the hyperactive left hemisphere, or a
combination of both. Results are promising, but the following complementary
aspects must be refined before a more systematic application: optimal stimulation
protocol, individual management according to the injured region, intensity,
duration and frequency of care management, delay post-stroke before the beginning
of treatment, combination of different approaches, as well as prognostic and
efficacy criteria. An encouraging perspective for the future is the combination
of several types of approaches, which would be largely facilitated by the
improvement of fundamental knowledge on neglect mechanisms, which could in the
future refine the choice for the most appropriate treatment(s) for a given
patient.
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Langue : ANGLAIS