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

• Published in: Scientific reports Vol. 12; no. 1; pp. 3039 - 11
• Main Authors: Poologaindran, Anujan, Profyris, Christos, Young, Isabella M., Dadario, Nicholas B., Ahsan, Syed A., Chendeb, Kassem, Briggs, Robert G., Teo, Charles, Romero-Garcia, Rafael, Suckling, John, Sughrue, Michael E.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 23.02.2022; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4028/546; 692/617/375/1922; Clinical trials; Glioma; Humanities and Social Sciences; Magnetic fields; multidisciplinary; Neural networks; Neuroimaging; Neurological diseases; Neurology; Neuroplasticity; Patients; Recovery of function; Rehabilitation; Science; Science (multidisciplinary); Seizures; Statistical analysis; Transcranial magnetic stimulation
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-06766-8

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.