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

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.

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

Introduction: Neurosurgery for brain tumors needs to find a complex balance between the effective removal of targeted tissue and the preservation of surrounding brain areas. Neuromodulation-induced cortical prehabilitation (NICP) is a promising strategy that combines temporary inhibition of critical areas (virtual lesion) with intensive behavioral training to foster the activation of alternative brain resources. By progressively reducing the functional relevance of targeted areas, the goal is to facilitate resection with reduced risks of neurological sequelae. However, it is still unclear which modality (invasive vs. non-invasive neuromodulation) and volume of therapy (behavioral training) may be optimal in terms of feasibility and efficacy. Methods and analysis: Patients undertake between 10 and 20 daily sessions consisting of neuromodulation coupled with intensive task training, individualized based on the target site and neurological functions at risk of being compromised. The primary outcome of the proposed pilot, single-cohort trial is to investigate the feasibility and potential effectiveness of a non-invasive NICP protocol on neuroplasticity and post-surgical outcomes. Secondary outcomes investigating longitudinal changes (neuroimaging, neurophysiology, and clinical) are measured pre-NICP, post-NICP, and post-surgery. Ethics and dissemination: Ethics approval was obtained from the Research Ethical Committee of Fundació Unió Catalana d'Hospitals (approval number: CEI 21/65, version 1, 13/07/2021). The results of the study will be submitted to a peer-reviewed journal and presented at scientific congresses. Clinical trial registration: ClinicalTrials.gov, identifier NCT05844605.

Efecto del traumatismo craneoencefálico en la toma de decisiones sociales / The effect of traumatic brain injury on social decision making

Introducción: Los pacientes con traumatismo craneoencefálico (TCE) pueden presentar dificultades para tomar decisiones de tipo social. Tales dificultades condicionan un deterioro en sus relaciones personales. Objetivos: Valorar la toma de decisiones de tipo social en una muestra de pacientes con TCE moderado y grave y contrastar empíricamente si, como defiende el modelo de procesamiento socioemocional de Ochsner, la capacidad para reconocer y responder a estímulos socioafectivos se relaciona con la capacidad para regular respuestas sensibles al contexto basándose en las pruebas de valoración propuestas. Sujetos y métodos: Muestra de 21 pacientes con TCE moderado y grave (grupo experimental), emparejados por sexo, edad y años de escolaridad con 24 sujetos sanos (grupo control). La toma de decisiones de tipo social se valoró mediante el Social Decision Making Test (SDMT), y la capacidad para reconocer y responder a estímulos socioafectivos, mediante el Pictures of Facial Affect (PoFA). Resultados: Se obtuvieron diferencias estadísticamente significativas entre el grupo experimental y el grupo control en el SDMT. Respecto al PoFA, el rendimiento del grupo control también fue sensiblemente mejor que el del grupo experimental. Sin embargo, no se observó relación entre el rendimiento en el SDMT y el PoFA para ninguno de los grupos. Conclusiones: El SDMT parece ser una prueba sensible para detectar alteraciones en la toma de decisiones sociales en pacientes con TCE moderado o grave. No se ha observado relación entre los resultados del SDMT y el PoFA

Introduction: Patients with traumatic brain injury (TBI) can present difficulties in making decisions of a social nature. Such difficulties condition complicate their personal relationships. Aims: To assess social decision-making in a sample of patients with moderate and severe TBI, and to empirically contrast if, as Ochsner’s social-emotional processing model proposes, the ability to recognize and respond to socio-affective stimuli is related to the ability to regulate sensitive responses to the context based on the proposed assessment tests. Subjects and methods: Twenty-one patients with a moderate and severe TBI (experimental group) matched by gender, age and years of education with 24 healthy subjects (control group). Social decision making was measured through the Social Decision Making Test (SDMT), and the ability to recognize and respond to socio-affective stimuli through the Pictures of Facial Affect (PoFA) test. Results. Statistically significant differences in the SDMT were obtained between the experimental group and the control group. Regarding PoFA, the performance of the control group was also significantly better than that of the experimental group. However, no relationship was observed between the performance in the SDMT and the PoFA for any of the groups. Conclusions: The SDMT seems to be a sensitive test to detect alterations in social decision making in patients with moderate or severe TBI. No relationship was observed between the results in the SDMT and the PoFA