School of Medicine, 21772 University of California Davis Medical Center, 2315 Stockton Blvd., Sacramento, CA, 95817, USA.
University of Sydney, Camperdown, NSW, 2006, Australia.
J Neurooncol. 2022 Nov;160(2):413-422. doi: 10.1007/s11060-022-04160-y. Epub 2022 Oct 29.
Deficits in neuro-cognitive function are not uncommon for patients who have undergone surgical removal of brain tumors. Our goal is to evaluate the safety and efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) as a non-invasive tool for the treatment of neuro-cognitive dysfunctions following craniotomy.
We present a retrospective review of individualized rTMS in twelve patients from Cingulum Health from December 2019 to July 2021 who presented with neuro-cognitive deficits following craniotomy. Multiple cortical targets were selected based on the patient's neurological disorder, associated networks, and anomalies in the functional connectivity of the brain as determined by machine-learning. TMS treatment was performed for five consecutive days. EuroQol quality of life (EQ-5D), functional extremity scales, and neuropsychiatric questionnaires related to the patient's deficit were assessed prior to, after, and during two-month follow-up of rTMS treatment.
Nine patients had unilateral functional deficits in either upper, lower, or both limbs. One patient reported post-operative depression, another experienced short term memory difficulties, and a third reported hypobulia. All twelve patients reported significantly improved EQ5D after rTMS treatment and during follow-up. More than half of the patients with lower and upper functional deficits had a 9-point improvement during follow-up. In the patient who developed depression, an 88% reduction in depressive symptoms based on the Beck's Depression Inventory (BDI) was observed during follow-up. No adverse events, such as seizures, occurred.
The personalized functional connectivity approach to rTMS treatment may be effective and safe for patients with post-craniotomy neuro-cognitive dysfunction.
接受脑部肿瘤手术切除的患者通常会出现神经认知功能缺陷。我们的目标是评估重复经颅磁刺激（rTMS）作为一种非侵入性治疗开颅术后神经认知功能障碍的工具的安全性和有效性。
我们回顾了 2019 年 12 月至 2021 年 7 月期间 Cingulum Health 接受个体化 rTMS 治疗的 12 名患者的资料，这些患者在开颅术后存在神经认知缺陷。根据患者的神经障碍、相关网络以及机器学习确定的大脑功能连接异常，选择多个皮质靶点。TMS 治疗连续进行 5 天。在 rTMS 治疗前、治疗后和 2 个月随访期间，使用欧洲五维健康量表（EQ-5D）、功能肢体量表以及与患者缺陷相关的神经精神问卷评估患者的生活质量。
9 例患者存在单侧上下肢或双侧肢体功能缺陷。1 例患者报告术后抑郁，1 例患者出现短期记忆困难，1 例患者出现活动减退。所有 12 例患者在 rTMS 治疗后和随访期间的 EQ5D 评分均显著提高。在随访期间，近一半的上下肢功能缺陷患者的评分提高了 9 分。在出现抑郁的患者中，贝克抑郁量表（BDI）显示抑郁症状减少了 88%。在随访期间未发生不良反应，如癫痫发作。
针对开颅术后神经认知功能障碍患者的个性化功能连接 rTMS 治疗可能是安全有效的。
