Cognitive brain rehabilitation using transcranial magnetic stimulation in patients with low grade glioma: a proof-of-concept study
Cognitive deficits in patients previously treated for low grade glioma
Only WP3 will be interventional for this study. This will involve 12 sessions of repetitive Transcranial Magnetic Stimulation (rTMS) over 4 weeks. Intermittent Theta Burst dual-target rTMS will be delivered to frontal and parietal targets in the hemisphere contralateral to the treated tumour. The control arm will receive no rTMS. They will only perform the cognitive and MRI assessments to allow comparison. Patients will be allocated to either arm using pairwise randomisation.
WP - Work Package For WP1: 1. Treated for low-grade glioma (grade 2 intrinsic glial tumour) from 2013 onwards at the Walton Centre NHS Foundation Trust 2. Adult patients (>18 years) at time of treatment For WP2: 1. Completed online assessments in WP1 2. Available post-operative volume MRI (T1 or FLAIR) For WP3: 1. Cognitive eligibility: Presence of objective or subjective cognitive deficits defined as >1 SD below the average on any CANTAB test or scoring <55/72 in the Perceived Cognitive Impairments subscale of FACT-Cog 2. Medical stability: no documented change to medical management (chemotherapy, radiotherapy, or surgery) within the last 3 months 3. The invited patients will be selected based on pairwise randomisation from patients who completed assessments in WP1. Pairwise randomisation will be used to balance the two groups on key predictor variables
For WP1: 1. No explicit exclusion criteria For WP2: 1. No explicit exclusion criteria For WP3: 1. Contraindications to strong magnetic fields (applicable to the TMS sessions and the MRI follow-up scans) 2. Active known pregnancy 3. Unable or unwilling to travel to the Sid Watkins building for TMS sessions 4. History of uncontrolled seizures