EVALUATING GLIOMA PATIENT PERCEPTIONS TOWARDS REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION FOR REHABILITATION

Abstract

Abstract AIMS Repetitive Transcranial Magnetic Stimulation (rTMS) is established for depression, chronic pain, and motor rehabilitation after stroke. It is an emerging tool for other purposes including cognitive rehabilitation. Recent evidence supports its use for motor rehabilitation after brain surgery. We sought to evaluate patient perceptions towards rTMS. METHOD Two studies were undertaken. Group 1 – patients who received seven days of rTMS for motor rehabilitation for post-operative weakness (MRC 0-1 in any limb) following resection of a glioma or other resective pathology were prospectively surveyed on the last day of their rTMS treatment, as well as their next of kin (NOK). Group 2 – patients who had previously been treated for a glioma but did not receive rTMS were retrospectively surveyed through two brain tumour charities, as well as their NOK. RESULTS Group1: 21 responses. 11 patients, 10 NOK. Commonest pathology was glioblastoma(n=3). Group2: 24 responses. 16 patients, 8 NOK. Commonest pathology was grade 2 glioma(n=7). Most Group1 respondents reported a positive experience with rTMS(n=15). Group1 patients experienced substantial subjective improvements in motor functioning(n=6), some improvements(n=3), or no change(n=2). None reported worsening. Experiencing adverse symptoms (e.g. headache) was associated with reduced likelihood of motor improvements(p=0.01). Most improvements were in gross rather than finer motor domains. Patients in Group2 were accepting of longer and more frequent rTMS sessions than Group1(p=0.03 and p=0.01 respectively). The commonest concerns raised pertained to seizures, side effects, and geographic availability. The commonest hope raised pertained to cognitive or motor improvements. CONCLUSION rTMS is well-tolerated and patients and their NOK support its use. Respondents would find longer and more sessions acceptable. Understandably, there is less tolerance for rTMS in the early post-operative period. However, enthusiasm for rTMS is substantial in the later stable post-operative phases. Our findings support the further development of rTMS as a tool for improving patient rehabilitation.