Motor cortex reorganization in glioma patients assessed by repeated nTMS - a longitudinal study.
World Neurosurg. 2018 Jan 19;:
Authors: Barz A, Noack A, Baumgarten P, Seifert V, Forster MT
Abstract
OBJECTIVE: Evidence for cerebral reorganization after resection of low-grade glioma has mainly been obtained by serial intraoperative cerebral mapping. Non-invasively collected data on cortical plasticity in tumor patients over a surgery-free period are still scarce. The present study therefore aimed at evaluating motor cortex reorganization by navigated transcranial magnetic stimulation (nTMS) in patients after perirolandic glioma surgery.
METHODS: nTMS was performed pre- and postoperatively in 20 patients, separated by 26.1 ± 24.8 months. Further nTMS mapping was conducted in 14 patients, resulting in a total follow-up period of 46.3 ± 25.4 months. Centers of gravity (CoGs) were calculated for every muscle representation area, and Euclidian distances (EDs) between CoGs over time were defined. Results were compared with data from 12 healthy subjects, who underwent motor cortex mapping by nTMS in two sessions.
RESULTS: Pre- and postoperatively pooled CoGs from the area of the dominant abductor pollicis brevis muscle and of the non-dominant leg area differed significantly compared to healthy subjects (p<0.05). Most remarkably, during the ensuing follow-up period, a reorganization of all representation areas was observed in 3 patients, and a significant shift of hand representation areas was identified in further 3 patients. Complete functional recovery of postoperative motor deficits was exclusively associated with cortical reorganization.
CONCLUSION: Despite the low potential of remodeling within the somatosensory region, long-term reorganization of cortical motor function can be observed. nTMS is best suited for a non-invasive evaluation of this reorganization.
PMID: 29360588 [PubMed - as supplied by publisher]
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