Postoperative Nodal Efficiency of the Lesional-Hemispheric Hand Motor Area Increasing Potentially Facilitated Motor Recovery for SMA Syndrome

Background

Supplementary motor area (SMA) syndrome commonly occurs after glioma resection and requires weeks to months of recovery.

Methods

Thirty-four glioma patients with SMA syndrome were reviewed and assigned to recovered and non-recovered groups based on whether their motor function recovered on postoperative day 7. To validate the association between variations in nodal properties and recovery time, neuro-navigated repetitive transcranial magnetic stimulation (nrTMS) was applied to stimulate potential nodes. Nine other patients (five nrTMS therapy and four sham-nrTMS treatments) with SMA syndrome with unrecovered motor functions on postoperation day 7 were prospectively enrolled.

Results

The potential nodes of the sensorimotor network related to recovery time were investigated using preoperative and postoperative resting-state functional magnetic resonance imaging, graph theoretical analysis, and dynamic functional connectome analysis. Nodal efficiency of the lesional-hemispheric upper limb region of BA 4 (A4ul_L) increased in the recovered group (preoperative, 0.472 ± 0.027; postoperative, 0.535 ± 0.020; p = 0.0006). The patients in the nrTMS therapy group quickly recovered (12.0 ± 1.6 days) compared to the sham-nrTMS group (29.5 ± 3.8 days, p = 0.0024). Variations in A4ul_L nodal efficiency was negatively correlated with recovery time (r = −0.841; p = 0.0046).

Conclusion

A4ul_L demonstrates enhanced postoperative nodal efficiency and shows therapeutic potential in SMA syndrome recovery, suggesting its viability as a therapeutic target.