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@ARTICLE{Moser:277799,
      author       = {Moser, Ismael and Engelhardt, Melina and Grittner, Ulrike
                      and Ferreira, Felipe Monte Santo Regino and Denker, Maren
                      and Reinsch, Jennifer and Fischer, Lisa and Link, Tilman and
                      Heppner, Frank L and Capper, David and Vajkoczy, Peter and
                      Picht, Thomas and Rosenstock, Tizian},
      title        = {{A}nalysis of {N}euronal {E}xcitability {P}rofiles for
                      {M}otor-{E}loquent {B}rain {T}umor {E}ntities {U}sing n{TMS}
                      in 800 {P}atients.},
      journal      = {Cancers},
      volume       = {17},
      number       = {6},
      issn         = {2072-6694},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DZNE-2025-00477},
      pages        = {935},
      year         = {2025},
      abstract     = {Non-invasive motor mapping with navigated transcranial
                      magnetic stimulation (nTMS) is an established diagnostic
                      tool to identify spatial relationships between functional
                      and tumor areas and to characterize motor excitability.
                      Recently, nTMS has been used to analyze the impact of
                      different brain tumor entities on motor excitability.
                      However, entity-specific excitability patterns are not
                      sufficiently validated yet.We retrospectively analyzed nTMS
                      motor mapping data of 800 motor-eloquent brain tumor
                      patients in this observational study. The motor excitability
                      profile consisted of four nTMS parameters (resting motor
                      threshold (RMT), cortical motor area, amplitude and latency)
                      measured on both hemispheres. The relationship between motor
                      excitability parameters and tumor entity, glioma subtype and
                      motor status were assessed using multiple regressions
                      analyses. Regression models included patient- and
                      tumor-specific factors.Gliomas had more frequent pathologic
                      RMT ratios (OR 1.76, $95\%CI:$ 1.06-2.89, p = 0.030)
                      compared to benign entities. In the subgroup of gliomas,
                      pathologic RMT ratios were more associated with the
                      isocitrate dehydrogenase (IDH)-wildtype status (OR 0.43,
                      $95\%CI:$ 0.23-0.79, p = 0.006) and less so with higher WHO
                      grades (OR 1.61, $95\%CI:$ 0.96-2.71, p = 0.074). This was
                      true for both IDH-mutant astrocytomas (OR 0.43, $95\%CI:$
                      0.20-0.91, p = 0.027) and IDH-mutant oligodendrogliomas (OR
                      0.43, $95\%CI:$ 0.20-0.93, p = 0.031). Motor area
                      enlargement on the tumor hemisphere was more frequently
                      observed in lower WHO-graded gliomas (OR 0.87, $95\%CI:$
                      0.78-0.97, p = 0.019). Interestingly, a larger cortical
                      motor area was additionally found for oligodendrogliomas on
                      the healthy hemisphere (OR 1.18, $95\%CI:$ 1.01-1.39, p =
                      0.041). Motor deficits were related with higher RMT (OR
                      1.12, $95\%CI:$ 1.05-1.21, p = 0.001), reduced amplitude (OR
                      0.78, $95\%CI:$ 0.64-0.96, p = 0.019) and prolonged latency
                      (OR 1.12, $95\%CI:$ 1.02-1.24, p = 0.025) in the tumor
                      hemisphere.Neuroplastic phenomena such as adjustment of the
                      motor excitability level and an enlargement of the
                      nTMS-positive motor area were more frequently observed in
                      benign tumors and in IDH-mutated gliomas. Consequently,
                      patients experienced motor deficits less often, suggesting a
                      differentiated susceptibility to resection-related paresis.
                      Future studies will analyze which stimulation paradigms are
                      most effective in stimulating and optimizing neuroplasticity
                      processes to improve the functional outcomes (and thus the
                      quality of life) for patients.},
      keywords     = {brain tumor (Other) / corticospinal tract (Other) / glioma
                      (Other) / motor cortex (Other) / motor evoked potential
                      (Other) / motor excitability (Other) / navigated
                      transcranial magnetic stimulation (Other) / neuroplasticity
                      (Other) / resting motor threshold (Other)},
      cin          = {AG Heppner},
      ddc          = {610},
      cid          = {I:(DE-2719)1810007},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40149270},
      doi          = {10.3390/cancers17060935},
      url          = {https://pub.dzne.de/record/277799},
}