Engelhardt Melina, Schneider Heike, Reuther Jan, Grittner Ulrike, Vajkoczy Peter, Picht Thomas, Rosenstock Tizian
Department of Neurosurgery, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Einstein Center for Neurosciences, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Front Oncol. 2024 Apr 26;14:1368924. doi: 10.3389/fonc.2024.1368924. eCollection 2024.
Surgical resection of motor eloquent tumors poses the risk of causing postoperative motor deficits which leads to reduced quality of life in these patients. Currently, rehabilitative procedures are limited with physical therapy being the main treatment option. This study investigated the efficacy of repetitive navigated transcranial magnetic stimulation (rTMS) for treatment of motor deficits after supratentorial tumor resection.
This randomized, double-blind, sham-controlled trial (DRKS00010043) recruited patients with a postoperatively worsened upper extremity motor function immediately postoperatively. They were randomly assigned to receive rTMS (1Hz, 110% RMT, 15 minutes, 7 days) or sham stimulation to the motor cortex contralateral to the injury followed by physical therapy. Motor and neurological function as well as quality of life were assessed directly after the intervention, one month and three months postoperatively.
Thirty patients were recruited for this study. There was no significant difference between both groups in the primary outcome, the Fugl Meyer score three months postoperatively [Group difference (95%-CI): 5.05 (-16.0; 26.1); p=0.631]. Patients in the rTMS group presented with better hand motor function one month postoperatively. Additionally, a subgroup of patients with motor eloquent ischemia showed lower NIHSS scores at all timepoints.
Low-frequency rTMS facilitated the recovery process in stimulated hand muscles, but with limited generalization to other functional deficits. Long-term motor deficits were not impacted by rTMS. Given the reduced life expectancy in these patients a shortened recovery duration of deficits can still be of high significance.
手术切除涉及运动功能区的肿瘤有导致术后运动功能障碍的风险，这会降低这些患者的生活质量。目前，康复治疗手段有限，物理治疗是主要的治疗选择。本研究调查了重复导航经颅磁刺激（rTMS）治疗幕上肿瘤切除术后运动功能障碍的疗效。
这项随机、双盲、假刺激对照试验（DRKS00010043）招募了术后上肢运动功能立即恶化的患者。他们被随机分配接受rTMS（1Hz，110%静息运动阈值，15分钟，7天）或对损伤对侧运动皮层进行假刺激，随后进行物理治疗。在干预后、术后1个月和3个月直接评估运动和神经功能以及生活质量。
本研究招募了30名患者。两组在主要结局指标（术后3个月的Fugl Meyer评分）上无显著差异[组间差异（95%可信区间）：5.05（-16.0；26.1）；p = 0.631]。rTMS组患者在术后1个月时手部运动功能更好。此外，一组涉及运动功能区缺血的患者在所有时间点的美国国立卫生研究院卒中量表（NIHSS）评分较低。
低频rTMS促进了受刺激手部肌肉的恢复过程，但对其他功能障碍的改善作用有限。rTMS未影响长期运动功能障碍。鉴于这些患者预期寿命缩短，缩短功能障碍的恢复持续时间仍具有重要意义。
