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

Sci Rep. 2022 Feb 23;12(1):3039. doi: 10.1038/s41598-022-06766-8.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aphasia / etiology
  • Aphasia / therapy
  • Brain / diagnostic imaging
  • Brain / surgery
  • Brain Mapping
  • Connectome / methods
  • Craniotomy / rehabilitation*
  • Female
  • Glioma / complications
  • Glioma / surgery
  • Hemiplegia / etiology
  • Hemiplegia / therapy
  • Humans
  • Machine Learning
  • Male
  • Middle Aged
  • Neurological Rehabilitation / methods*
  • Recovery of Function
  • Transcranial Magnetic Stimulation / adverse effects
  • Transcranial Magnetic Stimulation / methods