Article
Repetitive navigated transcranial magnetic stimulation (rnTMS) to facilitate recovery of motor deficits after supratentorial tumour resection – interim analysis
Beschleunigte Rehabilitation motorischer Defizite nach supratentorialer Tumorresektion mittels repetitive navigierte transkranielle Magnetstimulation (rnTMS) – Interim Analyse
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Authors
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Melina Engelhardt
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland; Charité Universitätsmedizin, Einstein Center für Neurowissenschaften, Berlin, Deutschland
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Heike Schneider
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Jan Reuther
- Charité Universitätsmedizin, Arbeitsbereich Physikalische Medizin und Rehabilitation, Berlin, Deutschland
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Peter Vajkoczy
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Thomas Picht
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland; Charité Universitätsmedizin, 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, Klinik für Neurochirurgie, Berlin, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Surgical resection of motor eloquent tumors poses the risk of causing postoperative motor deficits which leads to significantly reduced quality of life in these patients. Thus, development of treatment strategies to facilitate postoperative rehabilitation of motor deficits is crucial. The present study aims to investigate the effect of repetitive navigated transcranial magnetic stimulation (rnTMS) on motor function after supratentorial tumor resection by normalizing the interhemispheric excitability. Specifically, we hypothesize that rnTMS therapy will facilitate rehabilitation, leading to improvements in investigated outcomes early on.
Methods: 19 patients (age 51 ± 13 years, range 30-67 years, 10 females) with supratentorial tumors and new postoperative motor deficits in upper limbs 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: The results presented here constitute an interim analysis of the clinical trial. 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: 40.0 vs. 19.5, p = 0.083; month 1: 56.5 vs. 9.0, p = 0.050). Similarly, patients in the active arm presented with a better motor status of distal (day 7: 3.5 vs. 0.0, p = 0.053; month 1: 5.0 vs. 0.0, p = 0.036) and proximal muscles of the upper extremities (day 7: 3.5 vs. 1.0, p = 0.054; month 1: 4.5 vs. 3.0, p = 0.039) as well as higher finger tapping scores (day 7: 41.5 vs. 0.0, p = 0.028; month 1: 47.0 vs. 0.0, p = 0.026) compared to sham. There were no significant differences between both groups in any of the other measures or timepoints.
Conclusion: RnTMS therapy is a promising treatment tool for postoperative upper limb motor deficits, specifically improving early rehabilitation. In consequence, a faster recovery period potentially shortens the time to adjuvant tumor therapy, reduces the emotional burden on the patient and lowers socioeconomic costs.
