title: rTMS stimulation to induce plastic changes at the language motor area in a patient with a left recidivant brain tumor affecting Broca's area.
abstract: BACKGROUND
  Extent of resection is one of the most powerful predictors of outcome in surgery of gliomas. Tumors located within areas governing eloquence may impede a total tumor resection. Functional plasticity may be induced by therapeutic means, such as cortical stimulation with repetitive transcranial magnetic stimulation (rTMS). Thus, rTMS is a potential tool to induce an improvement of functions of eloquence menaced by brain tumors.
  
  
  METHODS
  We report a case of a 59-year-old woman operated for a left sided precentral oligodendroglioma with awake intraoperative stimulation, whose tumor could not be completely removed because it affected areas governing language. Nine months later the tumor progressed and the motor language functions worsened. We submitted the patient to rTMS directed to Broca's area, next to the anterior pole of the tumor, with the aim of improving motor language function before a new tumor resection attempt. We performed 12 daily sessions of theta-burst rTMS followed by intensive language rehabilitation for 10 minutes, and 5 different aspects of language were measured before, immediately after and 10 minutes after each session.
  
  
  RESULTS
  Repetition and nomination worsened immediately after each rTMS session, and improved after 10 min of rehabilitation. However, basal values improved globally along the experiment. Also, the impact of rTMS on motor language was increasingly less along the procedure.
  
  
  CONCLUSIONS
  rTMS induces changes in Broca's area and this effect can be potentially used to improve language function in tumors located at or close to eloquent cortical areas.
authors.affiliation: Servicio de Neurocirugía and Instituto de Neurociencias, Hospital Clínico San Carlos, 28040 Madrid, Spain. Juan.A.Barcia@uv.es
authors.forename: Juan A
authors.initials: JA
authors.lastname: Barcia
authors.forename: Ana
authors.initials: A
authors.lastname: Sanz
authors.forename: Mercedes
authors.initials: M
authors.lastname: González-Hidalgo
authors.forename: Carmen
authors.initials: C
authors.lastname: de Las Heras
authors.forename: Pedro
authors.initials: P
authors.lastname: Alonso-Lera
authors.forename: Pedro
authors.initials: P
authors.lastname: Díaz
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual-Leone
authors.forename: Antonio
authors.initials: A
authors.lastname: Oliviero
authors.forename: Tomás
authors.initials: T
authors.lastname: Ortiz
mesh_terms: D001931:Brain Mapping; D001932:Brain Neoplasms / Q000503:physiopathology / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007802:Language; D008875:Middle Aged; D009837:Oligodendroglioma / Q000503:physiopathology / Q000601:surgery*; D050781:Transcranial Magnetic Stimulation