35, P = 0.24) or rTMS-induced
recovery (r = 0.15, P > 0.05). Overall, this observation Fulvestrant price suggests that lesion size was not the main determinant of the observed discrepancies between Responders and Non-responders. In the current study, we aimed at maximizing our chances of driving significant recovery by accruing 70 sessions of excitatory rTMS on a well-determined perilesional area shown to adopt lost visuospatial function after parietal injuries in felines (Lomber et al., 2006). Our rTMS regime generated significant improvements in visuospatial orienting deficits in approximately half of our subjects, while the other half experienced maladaptive effects for the detection of static or motion stimuli displayed mainly in the ipsilesional visual hemispace. Furthermore, our data indicate that, while ameliorations outlasted the discontinuation of
compound screening assay the rTMS regime, maladaptive ipsilesional visuospatial phenomena tended to regress as soon as the rTMS regime ceased. Our data provide new insights into the advantages and disadvantages of stimulating patients afflicted by different severities of hemispatial neglect, and sheds light on the potential and limitations of noninvasive neurostimulation approaches applied on perilesional cortex to rehabilitate visuospatial attentional orienting. In agreement with the initial hypothesis of this paper, the accrual of a high number of rTMS sessions proved to be a key factor in the achievement of significant levels of recovery (Valero-Cabré et al., 2008), as enhancements in performance emerged only after ~30–40 sessions of stimulation. If, similarly to most clinical studies, we had limited our rTMS regime to 2 weeks or less of treatment we would not have observed functional recovery. Therefore, our findings strongly emphasize the role of the accumulation of a high number of perilesional rTMS sessions
to induce significant and long-lasting clinical ameliorations, particularly in chronic brain-damage patients. It is critical to point out that during the rTMS phase no negative behavioral effects of the stimulation were noted. Animals displayed normal motor and sensory behavior during the execution of the tasks and exhibited normal behavior outside of the Carnitine palmitoyltransferase II testing arena, indicating the safety of such an extensive rTMS regime. Conventionally, functional recovery aims to restore the imbalance of interhemispheric inhibition by treating an overexcited contralesional hemisphere (Oliveri et al., 2001; Brighina et al., 2003; Shindo et al., 2006). The latter approach might have the advantage of acting on a structurally intact cortex, and the effect of magnetically induced electric current fields can be better predicted (Wagner et al., 2007). Moreover, seizures would be less likely, particularly due to the use of suppressive instead of excitatory stimulatory patterns (Rossi et al., 2009).
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