Therapie postoperativer motorischer Defizite mittels repetitiver navigierter transkranieller Magnetstimulation – eine Multicenter-Analyse

Recently, reduction of transcallosal inhibition by contralateral navigated repetitive transcranial magnetic stimulation (nrTMS) improved neurorehabilitation of glioma patients with new postoperative paresis. This multicentric study examines the effect of postoperative nrTMS in brain tumor patients to treat surgery-related upper extremity paresis in the first days after surgery.

This is a secondary analysis of two randomized and two one-arm studies in brain tumor patients with new/progressive postoperative paresis in four centers in US, UK and Germany. Patients underwent either low frequency contralesional nrTMS or sham stimulation followed by physiotherapy. Outcome was assessed on postoperative day 1, 7, and after 3 months using British Medical Research Council (BMRC) score, Fugl-Meyer assessment (FMA), Karnofsky Performance Scale (KPS) and National Institutes of Health Stroke Scale (NIHSS).

A total of 135 patients (mean age of 53.8 years, 60 women) were included, of whom 21 patients were treated in sham groups. Linear mixed models showed an advantage for the treatment group for the BMRC (7 days: OR 4.22; 95%CI: 1.08-16.52; 3 months: OR 10.85, 95%CI: 1.32-89.26) and KPS (7 days: MD 11, 95%CI: 3.19; 3 months: MD 11, 95%CI: 2.19), less pronounced for the FMA (7 days: MD 0.42, 95%CI: -0.23-1.06; 3 months: MD 0.26, 95%CI: -0.43-0.95). A stronger treatment effect was evident with proven ischemia on the postoperative MRI. To observe an improvement by at least one grade at 3 months, the NNT for the entire cohort is 4 (BMRC) and 3 patients (KPS), respectively.

Our multicenter data confirm the positive treatment effect of nrTMS on postoperative paresis with a considerably low NNT - especially if caused by ischemia.