Transcranial direct current stimulation to the parietal cortex in hemispatial neglect: A feasibility study

Objectives: Prior research suggests that dampening neural activity of the intact, presumably overactive hemisphere, combined with increasing neural activity in the damaged hemisphere, might restore cortical interhemispheric balance and reduce neglect. In the present study we repeatedly applied a relatively new technique, transcranial direct current stimulation (tDCS), to the posterior parietal cortex to modulate spontaneous neural activity levels in a polarity dependent fashion to find evidence for improvements in severe hemispatial neglect in chronic patients. Methods: Eighty-nine patients were initially identified from our databases as having neglect, after thoroughly screening databases, consulting medical practitioners and baseline testing, only five met our inclusion criteria and agreed to participate. Sixty-five patients were excluded as they did not meet safety criteria for tDCS (epilepsy, metal implants), suffered from other medical conditions (i.e., heart disease, epilepsy, current psychiatric disorder) or displayed only mild neglect at baseline testing. Five patients with severe chronic hemispatial neglect were enrolled in a double-blind, placebo-controlled treatment program. TDCS or placebo was applied for 20 minutes over the left (cathodal) and right (anodal) posterior parietal cortex at an intensity of 2 mA on five consecutive days. Treatment conditions were separated by a four week wash-out period. Baseline corrected change in performance on the conventional subtests of the Behavioral Inattention Test (BIT) was our primary endpoint. Results: No treatment-related effects were observed for the BIT change scores and performance on individual subtests. Moreover, patients' performance somewhat improved only during the stimulation period (day one vs day five, irrespective of whether it was placebo or tDCS), but not thirty days later, indicating a practice effect. Discussion: The present study does not provide evidence that tDCS to the posterior parietal cortex improves chronic hemispatial neglect. As a result of in- and exclusion health and safety criteria the majority of patients were excluded, which indicates that performing large randomized controlled trials is not feasible in chronic neglect patients