Behandlung postoperativer Sprachstörungen nach Hirntumorresektionen mittels rTMS – eine Pilotstudie

Postoperative aphasia is a serious complication after brain tumor resection which can occur despite monitoring during awake craniotomies. In addition to a considerable impairment of the quality of life, the oncological prognosis in these patients is also limited. The neuromodulatory application of rTMS is already established in the treatment of stroke-related aphasia. The aim of this study is to investigate the feasibility of rTMS-based neuromodulation to patients with postoperative aphasia after brain tumor resection.

This pilot study aims to include all patients who have experienced new or progressive aphasia after brain tumor resection. The rTMS therapy started in the first 3 days after surgery, with ipsilesional peritumoral inhibitory / low-frequency stimulation (1 Hz; 110% of the individual RMT; duration: 10 min) and contralesional excitatory / high-frequency stimulation in the corresponding area (10 Hz; 110% of the individual RMT; duration: 8 min). During the stimulation, patients continuously work on specific language tasks to activate the language areas intrinsically. This is followed by 30-45 minutes of speech and language therapy (SLT). Beside treatment related side effects, the language outcome – as primary outcome - is assessed using the Aachener Aphasie Test (AAT) before, immediately after therapy, and at 1 and 3 months post-therapy. The second outcomes are examined using the National Institutes of Health Stroke Scale (NIHSS) and. Quality of Life questionnaires.

So far, two patients were included. In both cases, therapy was completed without the occurrence of serious side effects. Only one patient experienced a mild, temporary headache during a session, which subsided with the routine postoperative pain medication. Short-term language outcome analysis (immediately after rTMS therapy) revealed clear improvements of the first patient compared to the post-operative deficits (mean AATpre therapy: 196/460; mean AATpost therapy: 291/440).

The initial preliminary results indicate that rTMS neuromodulation may be used to treat postoperative aphasia without relevant side effects. Neuromodulatory treatment of postoperative neurological deficits is of great importance not only to improve the patients' quality of life but also their oncological prognosis.