NeuroImage. Clinical · 2026
Functional gradient analysis reveals potential therapeutic mechanisms of nrTMS for postoperative motor deficits in glioma patients: A randomized controlled trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Li Yuzhe, Wang Jiangwei, Zhang Zhong, Fan Xing, Wang Yinyan, Ma Wenbin, Jiang Tao, Fang Shengyu
Аннотация
OBJECTIVE: This study aimed to investigate the therapeutic effects and neural mechanisms of high-frequency neuro-navigated repetitive transcranial magnetic stimulation (nrTMS) targeting the hand knob in glioma patients with postoperative motor deficits, using functional gradient analysis to characterize cortical reorganization.
METHODS: Thirty patients with postoperative motor deficits were randomized to receive nrTMS or sham stimulation targeting the ipsilateral hand knob. Motor function was assessed using Fugl-Meyer Assessment (FMA) and muscle strength. Resting-state fMRI was acquired to compute principal functional gradients. Control/tumor, nrTMS/sham, and Pre-TMS/Post-TMS gradient changes were analyzed. Correlation and regression analyses related to motor recovery were performed.
RESULTS: The nrTMS group showed significantly greater improvement in muscle strength (Post-treatment: nrTMS: 3.533 ± 0.720, Sham: 2.067 ± 0.572, p = 0.019, d = 1.082; 3-month follow-up: nrTMS: 4.600 ± 0.408, Sham: 3.733 ± 0.609, p = 0.035, d = 1.012). Gradient analysis revealed increased sensorimotor network (SMN) gradient scores following nrTMS (Pre-TMS: -0.707 ± 0.108; Post-TMS: -0.636 ± 0.077; p = 0.016), and HH_SomMot_22 within upper limb motor cortex is most strongly correlated with motor recovery.
CONCLUSIONS: High-frequency nrTMS targeting the hand knob accelerated the motor recovery. Gradient analysis findings provide novel insights into therapeutic mechanisms of nrTMS and underscore the value of the hand knob as a stimulation target.
METHODS: Thirty patients with postoperative motor deficits were randomized to receive nrTMS or sham stimulation targeting the ipsilateral hand knob. Motor function was assessed using Fugl-Meyer Assessment (FMA) and muscle strength. Resting-state fMRI was acquired to compute principal functional gradients. Control/tumor, nrTMS/sham, and Pre-TMS/Post-TMS gradient changes were analyzed. Correlation and regression analyses related to motor recovery were performed.
RESULTS: The nrTMS group showed significantly greater improvement in muscle strength (Post-treatment: nrTMS: 3.533 ± 0.720, Sham: 2.067 ± 0.572, p = 0.019, d = 1.082; 3-month follow-up: nrTMS: 4.600 ± 0.408, Sham: 3.733 ± 0.609, p = 0.035, d = 1.012). Gradient analysis revealed increased sensorimotor network (SMN) gradient scores following nrTMS (Pre-TMS: -0.707 ± 0.108; Post-TMS: -0.636 ± 0.077; p = 0.016), and HH_SomMot_22 within upper limb motor cortex is most strongly correlated with motor recovery.
CONCLUSIONS: High-frequency nrTMS targeting the hand knob accelerated the motor recovery. Gradient analysis findings provide novel insights into therapeutic mechanisms of nrTMS and underscore the value of the hand knob as a stimulation target.