Abstract
OBJECTIVE: Unilateral neglect (UN) is a common complication after stroke, with limited effective treatment strategies. This study evaluates the therapeutic effects of intermittent theta-burst stimulation (iTBS) on the intact dorsolateral prefrontal cortex (DLPFC) in UN patients and explores the neurophysiological mechanisms. METHODS: Twenty UN patients were randomly assigned to an iTBS or sham stimulation group, receiving 10 consecutive days of treatment. Clinical assessments and TMS-EEG recordings were performed before and after treatment. RESULTS: Patients receiving iTBS showed significant improvements in the Line Cancellation Test (p = 0.012). In addition, iTBS led to notable changes in cortical excitability and neural signal propagation. Specifically, the iTBS group exhibited a significant increase in the N100 component (p < 0.001). Time-frequency analysis also revealed a reduction in theta-band power in the affected frontal cortex post-treatment. At the network level, functional connectivity in the iTBS group was significantly enhanced, particularly within interhemispheric frontal and frontoparietal networks during the later stages of the treatment. CONCLUSION: iTBS effectively alleviates UN symptoms by modulating cortical excitability and enhancing functional connectivity, suggesting it as a promising therapeutic intervention for UN.