Prehabilitation, Rehabilitation and Comprehensive Approach to the Sequelae of Brain Tumors

The goal of the present pilot single-cohort feasibility trial is to investigate the feasibility and understand potential mechanisms of efficacy for Neuromodulation-Induced Cortical Prehabilitation (NICP) in adults with brain tumours and eligible for neurosurgery. The main questions it aims to answer are: * is the intervention feasible, in terms of adherence, retention, safety and patient's satisfaction; * what are the mechanisms of neuroplasticity primed by NICP Participants will undergo a prehabilitation protocol, consisting of daily sessions (total: 10-20 sessions) structured as follows: * Intervention 1: non-invasive neuromodulation (TMS/tDCS). * Intervention 2: motor and/or cognitive training, during or immediately after non-invasive neuromodulation, for about 60 minutes. The timeline is structured as follows: T1: baseline (before NICP) T2-T3: NICP period T4: after NICP T5: surgery T6: after surgery Clinical, neuroimaging and neurophysiology assessments will be performed before NICP (T1), after NICP (T4), and after neurosurgery (T6). Feasibility outcomes will be determined during NICP protocol (T2-T3). The objective of the proposed intervention is to progressively reduce the functional relevance of eloquent areas, which are healthy brain areas close with the tumour and thus exposed to the risk of being lesioned during surgery. In fact, previous studies have shown that temporary inhibition of eloquent areas (by neuromodulation) coupled with intensive motor/cognitive training promoted the activation of alternative brain resources, with a shift of functional activity from eloquent areas to areas functionally related, but anatomically distant from the tumour. By moving the activation of key motor/cognitive functions away from the tumour, the risk of postoperative functional sequelae will be reduced; which in turn will falicitate a more radical tumour excision by the neurosurgeon.

Sex

All

Minimum age

18 Years

Inclusion Criteria:

* diagnosis of brain tumour requiring neurosurgery
* ability to undertake at least 10 sessions of prehabilitation protocol
* tumour location posing the patient at risk of developing post-operative neurological deficits, for instance at the level of upper limb motor function and speech production
* ability to understand the general purpose of the prehabilitation program and understand simple instructions
* being willing to participate and sign the informed consent
* being able to sit unassisted for one hour.

Exclusion Criteria:

* any contraindication for magnetic resonance imaging or transcranial magnetic stimulation
* unstable medical conditions
* musculoskeletal disorders that may significantly affect functional training
* pain, depression, fatigue that may significantly affect functional training
* history of alcohol/drug abuse

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