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Interventional neurorehabilitation for promoting functional recovery post-craniotomy: a proof-of-concept

Authors :
Universidad de Sevilla. Departamento de Fisiología Médica y Biofísica
Poologaindran, Anujan
Profyris, Christos
Young, Isabella M.
Dadario, Nicholas B.
Ahsan, Syed A.
Chendeb, Kassem
Briggs, Robert G.
Teo, Charles
Romero García, Rafael
Suckling, John
Sughrue, Michael E.
Universidad de Sevilla. Departamento de Fisiología Médica y Biofísica
Poologaindran, Anujan
Profyris, Christos
Young, Isabella M.
Dadario, Nicholas B.
Ahsan, Syed A.
Chendeb, Kassem
Briggs, Robert G.
Teo, Charles
Romero García, Rafael
Suckling, John
Sughrue, Michael E.
Publication Year :
2022

Abstract

The human brain is a highly plastic ‘complex’ network—it is highly resilient to damage and capable of self-reorganisation after a large perturbation. Clinically, neurological deficits secondary to iatrogenic injury have very few active treatments. New imaging and stimulation technologies, though, offer promising therapeutic avenues to accelerate post-operative recovery trajectories. In this study, we sought to establish the safety profile for ‘interventional neurorehabilitation’: connectome-based therapeutic brain stimulation to drive cortical reorganisation and promote functional recovery post-craniotomy. In n = 34 glioma patients who experienced post-operative motor or language deficits, we used connectomics to construct single-subject cortical networks. Based on their clinical and connectivity deficit, patients underwent network-specific transcranial magnetic stimulation (TMS) sessions daily over five consecutive days. Patients were then assessed for TMS-related side effects and improvements. 31/34 (91%) patients were successfully recruited and enrolled for TMS treatment within two weeks of glioma surgery. No seizures or serious complications occurred during TMS rehabilitation and 1-week post-stimulation. Transient headaches were reported in 4/31 patients but improved after a single session. No neurological worsening was observed while a clinically and statistically significant benefit was noted in 28/31 patients post-TMS. We present two clinical vignettes and a video demonstration of interventional neurorehabilitation. For the first time, we demonstrate the safety profile and ability to recruit, enroll, and complete TMS acutely post-craniotomy in a high seizure risk population. Given the lack of randomisation and controls in this study, prospective randomised sham-controlled stimulation trials are now warranted to establish the efficacy of interventional neurorehabilitation following craniotomy.

Details

Database :
OAIster
Notes :
English
Publication Type :
Electronic Resource
Accession number :
edsoai.on1410791298
Document Type :
Electronic Resource