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Publications

Journal Article Epublish

PubMed: 42776377 DOI: 10.1007/s11060-026-05806-x

nTMS-determined cortical excitability is associated with overall survival in patients with motor-eloquent glioblastoma.

J Neurooncol 179(3)

Authors: José Pedro Lavrador, Ana Mirallave-Pescador, Sabina Patel, Qusai Al-Banna, Feras Fayez, Vindhya Prasad, Asfand Baig Mirza, Filippo Andrea Sinosi, Sankhya Prakashvel, Kapil Rajwani, Nida Kalyal, Yasir A Chowdhury, Francesco Marchi, Ali Elhag, Laura Ferrari, Alba Diaz Baamonde, Jose Sadio Mosquera, Keyoumars Ashkan, Ranjeev Bhangoo, Francesco Vergani

Affiliations

  • Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
  • Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
  • Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
  • National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK.
  • UCL Queen Square Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK.
  • Department of Neurosurgery, Havering and Redbridge University Hospital, Rom Valley Way, Barking, Romford, RM7 0AG, UK.
  • Department of Neurosurgery, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Via Tesserete 46, Lugano, CH-6900, Switzerland.
  • Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Via Volturno 39/E, 43125, Parma, Italy.
  • School of Advanced Studies, Università di Camerino, Area Biblioteche e Alta Formazione, Via Gentile III da Varano, Camerino (MC), 62032, Ital Camerino, Italy.

Abstract

BACKGROUND

Preoperative prognostication in glioblastoma remains challenging despite advances in histomolecular classification. Navigated transcranial magnetic stimulation (nTMS) enables non-invasive assessment of cortical excitability, but its role as a survival biomarker remains unclear.

OBJECTIVE

To determine whether preoperative nTMS-derived cortical excitability metrics independently predict overall survival (OS) in patients with WHO grade 4 IDH-wildtype glioblastoma.

METHODS

This single-centre retrospective cohort study included patients undergoing resection for motor-eloquent WHO grade 4 IDH-wildtype glioblastoma between 2018 and 2024. Preoperative nTMS mapping was used to derive the IntraM1 Excitability Score (IMES) and Cortical Excitability Score (CES). Cox regression adjusted for age, sex, neurological deficit, MGMT methylation, and extent of resection.

RESULTS

Seventy-seven patients were included (mean age 55.4 ± 16.0 years; 41 males; mean OS 20.5 months). Lower IMES and higher CES were associated with worse OS on univariate analysis and remained independently prognostic on multivariate analysis: IMES (HR 0.16, p = 0.003) and CES (HR 2.63, p = 0.034). Bilateral nTMS improved 12-month survival prediction over unilateral mapping.

CONCLUSIONS

Preoperative nTMS-derived cortical excitability metrics independently predict OS after adjustment for established prognostic factors, supporting excitability profiling as a clinically actionable prognostic tool in glioblastoma.

MeSH

Cortical Excitability, Glioblastoma, Nervous System Neoplasms