Neuromodulation-induced prehabilitation to leverage neuroplasticity before brain tumor surgery: a single-cohort feasibility trial protocol

Boccuni, Leonardo; Abellaneda-Pérez, Kilian; Martín-Fernández, Jesús; Leno-Colorado, David; Roca-Ventura, Alba; Prats Bisbe, Alba; Buloz-Osorio, Edgar Antonio; Bartrés-Faz, David; Bargalló, Nuria; Cabello-Toscano, María; Pariente, José Carlos; Muñoz-Moreno, Emma; Trompetto, Carlo; Marinelli, Lucio; Villalba-Martinez, Gloria; Duffau, Hugues; Pascual-Leone, Álvaro; Tormos Muñoz, Josep María

doi:10.3389/fneur.2023.1243857

Cited by 3 publications

(1 citation statement)

References 73 publications

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“…NICP refers to invasive (direct cortical stimulation) and noninvasive (e.g., transcranial magnetic or electric stimulation) neuromodulation coupled with intensive language or motor training [78]. Neuromodulation inhibits functional areas affected by the tumor, which are mapped with neurophysiological and neuroimaging [79,80]. By promoting neuroplasticity in distant areas, intensive training reduces the functional relevance of the tumor affected brain region, allowing more radical resections to improve survival.…”

Section: Cognitivementioning

confidence: 99%

Prehabilitation in Adults Undergoing Cancer Surgery: A Comprehensive Review on Rationale, Methodology, and Measures of Effectiveness

Guerra-Londono,

Cata,

Nowak

et al. 2024

Current Oncology

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Cancer surgery places a significant burden on a patients’ functional status and quality of life. In addition, cancer surgery is fraught with postoperative complications, themselves influenced by a patient’s functional status. Prehabilitation is a unimodal or multimodal strategy that aims to increase a patient’s functional capacity to reduce postoperative complications and improve postoperative recovery and quality of life. In most cases, it involves exercise, nutrition, and anxiety-reducing interventions. The impact of prehabilitation has been explored in several types of cancer surgery, most commonly colorectal and thoracic. Overall, the existing evidence suggests prehabilitation improves physiological outcomes (e.g., lean body mass, maximal oxygen consumption) as well as clinical outcomes (e.g., postoperative complications, quality of life). Notably, the benefit of prehabilitation is additional to that of enhanced recovery after surgery (ERAS) programs. While safe, prehabilitation programs require multidisciplinary coordination preoperatively. Despite the existence of numerous systematic reviews and meta-analyses, the certainty of evidence demonstrating the efficacy and safety of prehabilitation is low to moderate, principally due to significant methodological heterogeneity and small sample sizes. There is a need for more large-scale multicenter randomized controlled trials to draw strong clinical recommendations.

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Section: Cognitivementioning

confidence: 99%

Prehabilitation in Adults Undergoing Cancer Surgery: A Comprehensive Review on Rationale, Methodology, and Measures of Effectiveness

Guerra-Londono,

Cata,

Nowak

et al. 2024

Current Oncology

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Non-invasive prehabilitation to foster widespread fMRI cortical reorganization before brain tumor surgery: lessons from a case series

Boccuni,

Roca-Ventura,

Buloz-Osorio

et al. 2024

J Neurooncol

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Purpose The objective of this prospective, single-centre case series was to investigate feasibility, clinical outcomes, and neural correlates of non-invasive Neuromodulation-Induced Cortical Prehabilitation (NICP) before brain tumor surgery. Previous studies have shown that gross total resection is paramount to increase life expectancy but is counterbalanced by the need of preserving critical functional areas. NICP aims at expanding functional margins for extensive tumor resection without functional sequelae. Invasive NICP (intracranial neuromodulation) was effective but characterized by elevated costs and high rate of adverse events. Non-invasive NICP (transcranial neuromodulation) may represent a more feasible alternative. Nonetheless, up to this point, non-invasive NICP has been examined in only two case reports, yielding inconclusive findings. Methods Treatment sessions consisted of non-invasive neuromodulation, to transiently deactivate critical areas adjacent to the lesion, coupled with intensive functional training, to activate alternative nodes within the same functional network. Patients were evaluated pre-NICP, post-NICP, and at follow-up post-surgery. Results Ten patients performed the intervention. Feasibility criteria were met (retention, adherence, safety, and patient’s satisfaction). Clinical outcomes showed overall stability and improvements in motor and executive function from pre- to post-NICP, and at follow-up. Relevant plasticity changes (increase in the distance between tumor and critical area) were observed when the neuromodulation target was guided by functional neuroimaging data. Conclusion This is the first case series demonstrating feasibility of non-invasive NICP. Neural correlates indicate that neuroimaging-guided target selection may represent a valid strategy to leverage neuroplastic changes before neurosurgery. Further investigations are needed to confirm such preliminary findings.

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Exploring the neural basis of non-invasive prehabilitation in brain tumour patients: An fMRI-based case report of language network plasticity

Boccuni,

Roca-Ventura,

Buloz-Osorio

et al. 2024

Front. Oncol.

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Primary brain neoplasms are associated with elevated mortality and morbidity rates. Brain tumour surgery aims to achieve maximal tumour resection while minimizing damage to healthy brain tissue. Research on Neuromodulation Induced Cortical Prehabilitation (NICP) has highlighted the potential, before neurosurgery, of establishing new brain connections and transfer functional activity from one area of the brain to another. Nonetheless, the neural mechanisms underlying these processes, particularly in the context of space-occupying lesions, remain unclear. A patient with a left frontotemporoinsular tumour underwent a prehabilitation protocol providing 20 sessions of inhibitory non-invasive neuromodulation (rTMS and multichannel tDCS) over a language network coupled with intensive task training. Prehabilitation resulted in an increment of the distance between the tumour and the language network. Furthermore, enhanced functional connectivity within the language circuit was observed. The present innovative case-study exposed that inhibition of the functional network area surrounding the space-occupying lesion promotes a plastic change in the network’s spatial organization, presumably through the establishment of novel functional pathways away from the lesion’s site. While these outcomes are promising, prudence dictates the need for larger studies to confirm and generalize these findings.

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Neuromodulation-induced prehabilitation to leverage neuroplasticity before brain tumor surgery: a single-cohort feasibility trial protocol

Cited by 3 publications

References 73 publications

Prehabilitation in Adults Undergoing Cancer Surgery: A Comprehensive Review on Rationale, Methodology, and Measures of Effectiveness

Prehabilitation in Adults Undergoing Cancer Surgery: A Comprehensive Review on Rationale, Methodology, and Measures of Effectiveness

Non-invasive prehabilitation to foster widespread fMRI cortical reorganization before brain tumor surgery: lessons from a case series

Exploring the neural basis of non-invasive prehabilitation in brain tumour patients: An fMRI-based case report of language network plasticity

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