Improving postsurgical paresis in brain tumor patients by transcranial magnetic stimulation.

IF 3.1 2区医学 Q2 CLINICAL NEUROLOGY Journal of Neuro-Oncology Pub Date : 2025-04-01 Epub Date: 2025-01-23 DOI:10.1007/s11060-024-04931-9

Tizian Rosenstock, Thomas Picht, Melina Engelhardt, Ulrike Grittner, Maximilian Mönch, Peter Vajkoczy, José Pedro Lavrador, Ana Mirallave-Pescador, Francesco Vergani, Maximilian Schwendner, Axel Schroeder, Leonie Kram, Haosu Zhang, Sujit Prabhu, Sarah Prinsloo, Bernhard Meyer, Sebastian Ille, Sandro M Krieg

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Abstract

Background and objectives: Recently, reduction of transcallosal inhibition by contralateral navigated repetitive transcranial magnetic stimulation (nrTMS) improved neurorehabilitation of glioma patients with new postoperative paresis. This multicentric study examines the effect of postoperative nrTMS in brain tumor patients to treat surgery-related upper extremity paresis.

Methods: This is a secondary analysis of two randomized and three one-arm studies in brain tumor patients with new/progressive postoperative paresis. Patients underwent either low frequency contralesional nrTMS or sham stimulation followed by physiotherapy. Outcome was assessed on postoperative day 1, 7, and after 3 months using British Medical Research Council score (BMRC), Fugl-Meyer assessment (FMA), Karnofsky Performance Scale (KPS) and National Institutes of Health Stroke Scale (NIHSS).

Results: A total of 135 patients (mean age of 53.8 years, 60 women) were included, of whom 51 patients were treated in RCTs (30 treatment group, 21 sham group) and 84 in prospective, single-arm studies. Linear mixed models showed an advantage for the treatment group for the BMRC (7 days: OR 3.28; 95%CI: 1.08-9.99; 3 months: OR 2.03, 95%CI: 0.65-6.39) and KPS (7 days: mean difference (MD) 11, 95%CI: 2-19; 3 months: MD 11, 95%CI: 2-20), less pronounced for the FMA (7 days: MD 0.28, 95%CI: -0.34-0.9; 3 months: MD 0.14, 95%CI: -0.52-0.81). A stronger treatment effect was evident with proven ischemia on the postoperative MRI. To observe an improvement by at least one grade at 3 months, the number needed to treat (NNT) for the entire cohort is 4 (BMRC) and 3 patients (KPS), respectively.

Conclusion: Our multicenter data confirm the positive treatment effect of nrTMS to reduce transcallosal inhibition with a considerably low NNT - especially if caused by ischemia.

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经颅磁刺激改善脑肿瘤患者术后瘫瘫。

背景和目的：最近，通过对侧导航重复经颅磁刺激（nrTMS）减少经胼胝体抑制可以改善胶质瘤术后新发瘫患者的神经康复。这项多中心研究探讨了脑肿瘤患者术后nrTMS治疗手术相关性上肢瘫的效果。方法：这是对两项随机研究和三项单臂研究的二次分析，研究对象为脑肿瘤术后新发/进展性麻痹患者。患者接受低频对侧nrTMS或假刺激后进行物理治疗。采用英国医学研究委员会评分（BMRC）、Fugl-Meyer评估（FMA）、Karnofsky绩效量表（KPS）和美国国立卫生研究院卒中量表（NIHSS）在术后第1天、第7天和第3个月评估结果。结果：共纳入135例患者（平均年龄53.8岁，60名女性），其中51例患者接受随机对照试验（治疗组30例，假手术组21例），84例接受前瞻性单臂研究。线性混合模型显示，治疗组在BMRC方面具有优势(7天：OR 3.28；95%置信区间:1.08—-9.99;3个月：OR 2.03, 95%CI: 0.65-6.39)和KPS(7天：平均差异（MD） 11, 95%CI: 2-19；3个月：MD 11, 95%CI: 2-20)， FMA不明显(7天：MD 0.28, 95%CI: -0.34-0.9；3个月：MD 0.14, 95%CI: -0.52-0.81)。术后MRI证实缺血后治疗效果明显。为了在3个月时观察到至少一个等级的改善，整个队列中需要治疗的患者（NNT）分别为4例（BMRC）和3例（KPS）。结论：我们的多中心数据证实了nrTMS对减少经胼胝体抑制的积极治疗作用，特别是在NNT相当低的情况下-特别是在缺血引起的情况下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuro-Oncology 医学-临床神经学

CiteScore

6.60

自引率

7.70%

发文量

277

审稿时长

3.3 months

期刊介绍： The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.