Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading.

Autor:	Lavrador JP; Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom., Gioti I; Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom., Hoppe S; Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom., Jung J; Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom., Patel S; Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom., Gullan R; Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom., Ashkan K; Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom., Bhangoo R; Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom., Vergani F; Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2020 Dec 15; Vol. 88 (1), pp. 183-192.
DOI:	10.1093/neuros/nyaa354
Abstrakt:	Background: Diffuse gliomas have an increased biological aggressiveness across the World Health Organization (WHO) grading system. The implications of glioma grading on the primary motor cortex (M1)-corticospinal tract (CST) excitability is unknown. Objective: To assess the excitability of the motor pathway with navigated transcranial magnetic stimulation (nTMS). Methods: Retrospective cohort study of patients admitted for surgery with diffuse gliomas within motor eloquent areas. Demographic, clinical, and nTMS-related variables were collected. The Cortical Excitability Score (CES 0 to 2 according to the number of abnormal interhemispheric resting motor threshold (RMT) ratios) was calculated for patients where bilateral upper and lower limb mapping was performed. Results: A total of 45 patients were included: 9 patients had a low-grade glioma and 36 patients had a high-grade glioma. The unadjusted analysis revealed an increase in the latency of the motor evoked potential of the lower limb with an increase of the WHO grade (P = .038). The adjusted analysis confirmed this finding (P = .013) and showed a relation between the increase in the WHO and a decreased RMT (P = .037) of the motor evoked responses in the lower limb. When CES was calculated, an increase in the score was related with an increase in the WHO grade (unadjusted analysis-P = .0001; adjusted analysis-P = .001) and in isocitrate dehydrogenase (IDH) wild-type tumors (unadjusted analysis-P = .020). Conclusion: An increase in the WHO grading system and IDH wild-type tumors are associated with an abnormal excitability of the motor eloquent areas in patients with diffuse gliomas. (Copyright © 2020 by the Congress of Neurological Surgeons.)
Databáze:	MEDLINE
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