Navigated repetitive transcranial magnetic stimulation improves the outcome of postsurgical paresis in glioma patients-A randomized, double-blinded trial

Background: Navigated repetitive transcranial magnetic stimulation (nrTMS) is effective therapy for stroke patients. Neurorehabilitation could be supported by low-frequency stimulation of the non damaged hemisphere to reduce transcallosal inhibition. Objective: The present study examines the effect of postoperative nrTMS therapy of the unaffected hemisphere in glioma patients suffering from acute surgery-related paresis of the upper extremity (UE) due to subcortical ischemia. Methods: We performed a randomized, sham-controlled, double-blinded trial on patients suffering from acute surgery-related paresis of the UE after glioma resection. Patients were randomly assigned to receive either low frequency nrTMS (1 Hz, 15 min) or sham stimulation directly before physical therapy for 7 consecutive days. We performed primary and secondary outcome measures on day 1, on day 7, and at a 3-month follow-up (FU). The primary endpoint was the change in Fugl-Meyer Assessment (FMA) at FU compared to day 1 after surgery. Results: Compared to the sham stimulation, nrTMS significantly improved outcomes between day 1 and FU based on the FMA (mean [95% CI] +31.9 [22.6, 41.3] vs. +4.2 [-4.1, 12.5]; P =.001) and the National Institutes of Health Stroke Scale (NIHSS) (-5.6 [-7.5,-3.6] vs.-2.4 [-3.6,-1.2]; P = .02). To achieve a minimal clinically important difference of 10 points on the FMA scale, the number needed to treat is 2.19. Conclusion: The present results show that patients suffering from acute surgery-related paresis of the UE due to subcortical ischemia after glioma resection significantly benefit from low-frequency nrTMS stimulation therapy of the unaffected hemisphere. Clinical trial registration: Local institutional registration: 12/15; ClinicalTrials.gov number: NCT03982329 (c) 2021 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Automated summary

This study investigated the effect of postoperative nrTMS therapy on the unaffected hemisphere in glioma patients with acute surgery-related paresis of the upper extremity. Results showed significant improvement in outcomes compared to sham stimulation, with a focus on the Fugl-Meyer Assessment scale and the National Institutes of Health Stroke Scale. The findings suggest that low-frequency nrTMS stimulation therapy is beneficial for these patients in achieving a clinically important difference in upper extremity function.