Artikel
Repetitive navigated Transcranial Magnetic Stimulation (rnTMS) to facilitate recovery of motor deficits after supratentorial tumour resection
Beschleunigte Rehabilitation motorischer Defizite nach supratentorialer Tumorresektion mittels repetitiver navigierter transkranieller Magnetstimulation (rnTMS)
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Autoren
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Melina Engelhardt
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland; Charité – Universitätsmedizin Berlin, Einstein Center für Neurowissenschaften, Berlin, Deutschland
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Heike Schneider
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Jan Reuther
- Charité – Universitätsmedizin Berlin, Arbeitsbereich Physikalische Medizin und Rehabilitation, Berlin, Deutschland
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Peter Vajkoczy
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Thomas Picht
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland; Charité – Universitätsmedizin Berlin, Einstein Center für Neurowissenschaften, Berlin, Deutschland; Humboldt Universität Berlin, Cluster of Excellence: „Matters of Activity. Image Space Material“, Berlin, Deutschland
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Tizian Rosenstock
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Recently, the positive effect of rnTMS in ischemic postoperative motor deficits was demonstrated. The aim of the present study was to investigate the effect of rnTMS on motor deficits caused by direct surgical impairment of the motor system. Specifically, we hypothesized that rnTMS therapy normalizes the interhemispheric excitability, leading to a facilitated rehabilitation and improvements in investigated outcomes early on.
Methods: 30 patients (age 51 ± 12 years, range 30-72 years, 14 females) with supratentorial tumors and new postoperative motor deficits were recruited immediately postoperatively for this randomized, double-blinded, controlled clinical trial. Patients received rnTMS treatment (1Hz, 110% RMT, 15 minutes, daily for seven days) or sham stimulation to the motor cortex contralateral to the injury followed by 30 minutes of physiotherapy. Motor function was assessed using the Fugl-Meyer score at the beginning and end of rnTMS therapy as well as one month and three months after the end of rnTMS. Secondary endpoints included additional assessments of motor and neurological function as well as quality of life.
Results: Compared to the sham group, median Fugl-Meyer scores were higher in the active rnTMS group at the end of therapy and the one-month follow-up (day 7: 33 vs. 4, p = 0.046; month 1: 56.5 vs. 6, p = 0.010). Similarly, patients in the active arm presented with a better motor status of distal (day 7: 2.5 vs. 0, p = 0.024; month 1: 5 vs. 0, p = 0.008) and proximal muscles of the affected extremities (day 7: 3.5 vs. 0.5, p = 0.020; month 1: 5 vs. 1, p = 0.010) as well as higher finger tapping scores (day 7: 43 vs. 0, p = 0.003; month 1: 47 vs. 0, p = 0.007) and Karnofsky Performance Status (month 1: 80 vs. 50, p = 0.028) compared to sham. There were no significant differences between both groups in quality of life or three months postoperatively in any of the previously stated outcomes.
Conclusion: RnTMS therapy is a promising treatment tool for both ischemic- and structure-related postoperative motor deficits, specifically improving early rehabilitation. In consequence, a faster recovery potentially shortens the time to adjuvant tumor therapy, reduces the emotional burden on the patient and lowers socioeconomic costs.
