fMRI-guided TMS treatment of Sequelae from neurosurgery

Guided TMS Therapy for Treatment of Sequelae

Neurosurgery is a highly complex procedure that could leave patients with some disabilities including motor (tremor, dystonia, paresis), sensory (vision, numbness, hearing loss) and cognitive (depression, memory, epilepsy, disorders of consciousness, and arousal) deficit. However, there are very few ways to directly address post neurosurgery and neurological deficits. Currently, after surgery, the patient is sent to physiotherapy with the hope that they will improve over time primarily due to brain’s own recovery capability. In addition to extremely slow rate of recovery in rehabilitation, it is often the case that surgical procedure damages critical areas for motivation, motor initiation, alertness, and consciousness [Poologaindran]. Furthermore, advanced neuroimaging techniques have shown that the type of cortical damage drastically changes neuroplasticity. As such, neurosurgery should ideally develop the capability of guiding cortical reorganization to control functional recovery in the post-operation in matter of weeks, rather than months or years. To achieve this, we have developed “neuromodulation-based rehabilitation” (NBR).  Our NBR uses functional imaging to guide the process of brain network reconstruction, monitoring precise interaction between different brain regions, to achieve therapeutic brain stimulation that increases network plasticity, which in turn accelerates functional recovery.

Currently, there are post-op therapies such as physical, occupational, and cognitive rehabilitation that have been shown to be long and tedious with suboptimal results.  Post-op neuromodulatory treatments are presently lacking and are areas of intense need.

It is also important to know that neurosurgery uses optically tracked stereotactic navigation systems in combination with co-registered MRI images to guide surgery.  They also use the same technology in combination with TMS to detect functioning sites before surgery, to avoid resection of functional tissue.  Presently, neurosurgery uses fMRI-guided-TMS for finding salvageable sites by stimulating them, using reconstruction of 3D MRI images of the patient’s brain.  Such navigated transcranial magnetic stimulation (TMS) has been so powerful that they are now widely used in guiding surgery for patients with brain tumors and other neurosurgical procedures. Surgeries that use neuronavigation-guided TMS before surgery, as a preoperative planning tool, have reported a much better outcomes and higher survival rates in brain tumor patients [Kreig, Raffa].

Neurotherapeutix has used fMRI-guided-TMS for neurorehabilitation in patients after neurosurgery with great success. This complex capability has shown to accelerate regaining function on affected brain regions post-surgery [Einstein]. We have seen improvements in paresis, language, attention, memory, and somatosensory processing. We have also seen improvements in motor recovery and depression.

In summary, at Neurotherapeutix, we offer fMRI-guided TMS for post-op patients, which is a unique and noninvasive technique with ability to rectify pathologic remnants of neurosurgery and to increase the rate of recovery after neurosurgery.

References

1. Poologaindran, A., Lowe, S. R. &Sughrue, M. E. The cortical organization of language: Distilling human connectome insights for supratentorial neurosurgery. J. Neurosurg. 134(6), 1959–1966 (2020).

2. Krieg SM, Sollmann N, Obermueller T, et al. Changing the clinical course of glioma patients by preoperative motor mapping with navigated transcranial magnetic brain stimulation. BMC Cancer. 2015;15(1):231.

3. Raffa G, Bährend I, Schneider H, et al. A novel technique for region and linguistic specific nTMS-based DTI fiber tracking of language pathways in brain tumor patients [J]. Front Neurosci. 2016;10:552.

4. Einstein, E.H., Dadario, N.B., Khilji, H. et al. Transcranial magnetic stimulation for post-operative neurorehabilitation in neuro-oncology: a review of the literature and future directions. J Neurooncol 157, 435–443 (2022). https://doi-org.ezproxy.cul.columbia.edu/10.1007/s11060-022-03987-9

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Neurotherapeutix is the leading clinic for functional imaging guided transcranial magnetic stimulation (TMS), a safe, innovative, and non-invasive methodology for treating a wide range of acute and chronic mental disorders and brain injuries. Our advanced fMRI technology allows us to map the brain for the… Learn More »

Published: March 24, 2023NYC

Last Reviewed: January 10, 2024

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