Interventional neurorehabilitation for promoting functional recovery post-craniotomy: a proof-of-concept.
Young, Isabella M
Dadario, Nicholas B
Ahsan, Syed A
Briggs, Robert G
Sughrue, Michael E
Springer Science and Business Media LLC
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Poologaindran, A., Profyris, C., Young, I. M., Dadario, N. B., Ahsan, S. A., Chendeb, K., Briggs, R. G., et al. (2022). Interventional neurorehabilitation for promoting functional recovery post-craniotomy: a proof-of-concept.. Sci Rep, 12 (1) https://doi.org/10.1038/s41598-022-06766-8
Funder: Alan Turing Institute; doi: http://dx.doi.org/10.13039/100012338
Funder: Guarantors of Brain; doi: http://dx.doi.org/10.13039/501100000627
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.
Article, /692/4028/546, /692/617/375/1922, article
External DOI: https://doi.org/10.1038/s41598-022-06766-8
This record's URL: https://www.repository.cam.ac.uk/handle/1810/334379