Artículo
Interventional neurorehabilitation for promoting functional recovery post-craniotomy: a proof-of-concept
Autor/es | Poologaindran, Anujan
Profyris, Christos Young, Isabella M. Dadario, Nicholas B. Ahsan, Syed A. Chendeb, Kassem Briggs, Robert G. Teo, Charles Romero García, Rafael Suckling, John Sughrue, Michael E. |
Departamento | Universidad de Sevilla. Departamento de Fisiología Médica y Biofísica |
Fecha de publicación | 2022 |
Fecha de depósito | 2022-10-19 |
Publicado en |
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Resumen | 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 ... 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. |
Cita | Poologaindran, A., Profyris, C., Young, I.M., Dadario, N.B., Ahsan, S.A., Chendeb, K.,...,Sughrue, M.E. (2022). Interventional neurorehabilitation for promoting functional recovery post-craniotomy: a proof-of-concept. Scientific Reports, 12 (1), 3039. https://doi.org/10.1038/s41598-022-06766-8. |
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