Patient Reported Experience Measures in navigated Transcranial Magnetic Stimulation

Abstract

Introduction
Navigated Transcranial Magnetic Stimulation (nTMS) is a non-invasive adjunct used in surgical planning for lesions in eloquent brain. However, its patient tolerability and effect on their overall healthcare experience is still unknown. To our knowledge, there is no other literature available evaluating patient experience with nTMS.

Methods
A single-institution prospective cohort study carried out between February 2018 and December 2018 at King’s College Hospital. All patients were supplied with a PREMs-TMS questionnaire to evaluate the different domains of the nTMS experience.

Results
Feedback was obtained from 50 patients. 26% of patients underwent motor mapping (MM), whilst 74% underwent both motor and language mapping (MLM). The former group reported a better overall experience (p=0.020). The mean exam duration was 103.3±5.1 min (MM 85.8±6.1 min; MLM 106.9±5.9 min). The whole experience of nTMS received positive feedback (94%), particularly with confidence in the staff (95%). Unsurprisingly, the exam domain received a poorer rating (70% as good) with significant anxiety and pain reported in 26% and 24% of patients respectively. None of the studied variables influenced the way patients rated the overall experience of nTMS (p>0.05).

Conclusions
nTMS is a non-invasive investigative tool, which allows patients to better understand their condition and symptoms related to their lesion. Serial assessment and feedback using a PREM tool, can only improve and enhance this experience. Departmental collaboration may be useful in comparing patient experience with nTMS in different centres.

Full text

Abstracts
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NEURO-ONCOLOGY • Oc t O b e r 2019
Kingdom, 2Centre for Additive Manufacturing, University of Nottingham,
3Children’s Brain Tumour Research Centre, University of Nottingham
‘Bioelectronic therapies’ are dened as treatments that provide therapy
via electrical stimulation. As electrochemical signalling is a key communi-
cation pathway of the human body, learning and modulating these signals
could allow us to regenerate lost functions and restore health where previ-
ously regarded impossible. Bioelectronics do not yet fully exploit this possi-
bility as they lack resolution and plasticity to fully merge with biology. We
aim to negate these problems by pioneering the development of wireless
bioelectronics. One exciting area we hope this can be applied is that of tu-
mour treating elds (TTFs).
TTFs apply electric elds to a tumour region, providing a non-invasive
anti-mitotic treatment modality. This anti-mitotic behaviour arises due to
dipole alignment and di-electrophoresis. However, an understanding of the
exact mode of action has not yet been reached. We aim to improve this
knowledge by analysing how healthy astrocytes vs glioblastoma cells behave
in various electrical systems: comparing ionic currents with electric elds.
Furthermore, we hope to improve targeting of TTFs through the in-situ
growth of conductive structures, via wireless electrochemistry.
Proof of concept has been achieved by wirelessly growing silver micro-
wires in the presence of U251 glioblastoma cells. Wire growth has been op-
timised without the presence of cells, allowing controlled growth direction
via electrode geometry. Wires range from 2–9µm in diameter and have been
shown to be conductive through the completion of a circuit lighting an LED.
Such structures could ultimately be grown in the region of a tumour, there-
fore therapeutically targeting the electric eld to that site.
PATIENT REPORTED EXPERIENCE MEASURES IN NAVIGATED
TRANSCRANIAL MAGNETIC STIMULATION
SabinaPatel1, JoséLavrador1, PrajwalGhimire1, RichardGullan1,
KeyoumarsAshkan1, RanjeevBhangoo1, FrancescoVergani1; 1King’s
College Hospital Foundation Trust, United Kingdom
INTRODUCTION: Navigated Transcranial Magnetic Stimulation
(nTMS) is a non-invasive adjunct used in surgical planning for lesions in
eloquent brain. However, its patient tolerability and effect on their overall
healthcare experience is still unknown. To our knowledge, there is no other
literature available evaluating patient experience with nTMS. METHODS: A
single-institution prospective cohort study carried out between February
2018 and December 2018 at King’s College Hospital. All patients were
supplied with a PREMs-TMS questionnaire to evaluate the different do-
mains of the nTMS experience. RESULTS: Feedback was obtained from 50
patients. 26% of patients underwent motor mapping (MM), whilst 74%
underwent both motor and language mapping (MLM). The former group
reported a better overall experience (p=0.020). The mean exam duration
was 103.3±5.1min (MM 85.8±6.1min; MLM 106.9±5.9min). The whole
experience of nTMS received positive feedback (94%), particularly with
condence in the staff (95%). Unsurprisingly, the exam domain received a
poorer rating (70% as good) with signicant anxiety and pain reported in
26% and 24% of patients respectively. None of the studied variables in-
uenced the way patients rated the overall experience of nTMS (p>0.05).
CONCLUSIONS: nTMS is a non-invasive investigative tool, which allows
patients to better understand their condition and symptoms related to their
lesion. Serial assessment and feedback using a PREM tool, can only improve
and enhance this experience. Departmental collaboration may be useful in
comparing patient experience with nTMS in different centres.
DIFFUSE LOW GRADE GLIOMA - A10-YEAR SINGLE INSTITUTION
CASE SERIES
ShamiAcharya1, PriyaSekhon, JosePedroLavrador, RavindranVisagan,
VijayNarbad, JosephineJung, RichardGullan, FrancescoVergani,
RanjBhangoo, KeymoursAshkan; 1King’s College Hospital, United
Kingdom
OBJECTIVES: To study clinical features and treatment options between
2007–2018 in a population of diffuse low grade glioma (DLGG) patients
(WHO Grade2). METHODS: Single centre retrospective cohort study. Vari-
ables reviewed: demographics, extent of resection (biopsy – Bx, subtotal re-
section – STR, gross total resection – GTR), molecular genetics and outcome.
RESULTS: N=104.M=61 F=43, average age, 41.8 yrs. For their rst surgery,
40.4% underwent a Bx, 32.7% STR, 26.9% GTR. 50.9% of patients had
a second procedure due to clinical progression (13.8% Bx, 38.85% STR,
47.2% GTR). We were more surgically aggressive at the second sitting
(p=0.0021). After 2014, we were more aggressive in terms of achieving a re-
section over a biopsy alone (pre 2013: 26 Bx, 24 resection, post 2013: 15 Bx,
28 resection). 35% had 1p19q co-deletion, 70% had 1DH1 mutation and
44.6% with MGMT methylated. There was no difference in survival and
extent of resection in 1p19 co-deletions (HR 0.35), however there was in the
IDH 1 group (HR 1.25. Post operatively, 37.9% patients had chemotherapy
and 57.3 % radiotherapy. 80.5% (Bx 65,9% alive, resection 95% alive) of
patients are still alive (longest survival 11.6 yrs). Amongst those who died,
the mean overall survival was 4.0 (range 0–7 - 5years): Of these 14% had
undergone a Bx and 6% STR/GTR. The adjusted analysis revealed that EOR
is the only revelant factor for survival in the population when adjusted for
IDH, 1p19q, tumour volume, age, gender and surgery year (p=0.44). CON-
CLUSION: Our data emphasises the importance of achieving maximal re-
section when possible.
PRIMARY LUMBAR PARAGANGLIOMA: ASINGLE-CENTRE UK
EXPERIENCE OVER 21YEARS
FrancescoFiorini1, JoséPedroLavrador1, FrancescoVergani1,
RanjeevBhangoo1, RichardGullan1, KeyoumarsAshkan1; 1King’s College
Hospital, London, United Kingdom
OBJECTIVES: Paragangliomas are rare neuro-endocrine neoplasms
which may occur at multiple anatomical sites, typically the adrenal glands.
In the CNS, they can affect the head and neck, and more rarely the lumbar
region. Primary lumbar paragangliomas are prominently vascularised lesions
which can present variably and pose both diagnostic and surgical challenges.
METHODS: We identied and analysed all cases of lumbar paraganglioma
conrmed both surgically and histologically, treated at our regional neuro-
surgical centre. We collected retrospective clinical, radiological, surgical
and histological data. RESULTS: We treated 25 patients with conrmed
paraganglioma between 1997–2018. This included 19 primary tumours, of
which 13 cases of primary lumbar paraganglioma (8 males (61.5%); mean
age 51.3years, range 33.2–68.9).
Patients presented most frequently with a recent worsening of
long-standing lower back pain and sciatica. 7 patients were admitted as
emergency cases, including 3 with cauda equina syndrome. The average
Ki67 mitotic index was 5.7% (range 1– 10%). CONCLUSION: We present
one of the largest case series of primary lumbar paragangliomas to date to
the best of our knowledge. Dening these clinical, radiological, surgical and
histological features may be of assistance in recognising and managing this
surgical disease.
GLIOBLASTOMA MULTIFORME IN PATIENTS OVER 65– SHOULD
WE OPERATE?
IgorMaleyko1, BenjaminHall1, AndrewBrodbelt2, DavidLawson2,
MichaelJenkinson2, EmmanuelChavredakis2; 1University of Liverpool,
School of Medicine, Liverpool, United Kingdom, 2The Walton Centre NHS
Foundation Trust, Liverpool, United Kingdom
AIM: Current standard of care for glioblastoma is maximum safe resec-
tion followed by radio chemotherapy with Temozolomide. Older patients
are less likely to receive the full treatment. The aim was to determine treat-
ment and outcomes in glioblastoma patients >65years. METHODS: Single
centre retrospective study from 2001–2016. Eligible patients had: (i) diag-
nosis of glioblastoma (ii) undergone biopsy or resection with radiotherapy
± adjuvant chemotherapy. Age at diagnosis, type of surgery, performance
status, complications, adjuvant therapy and median survival (MS) were re-
corded. Patients were assigned to group A(age <65), B (age 65–69years) or
C (age >/= 70years). RESULTS: 637 patients met the eligibility criteria and
403 had complete records for analysis. Age distribution of the cohort was
17.9– 91.6years.
In the group A(n=259), those who had undergone resection had signi-
cantly longer MS compared to biopsy: 17.2 vs 13.2 months (P<0.05 CI:
444.043– 561.957). 70 patients developed complications.
In the group B (n=79), those who had undergone resection had signi-
cantly longer MS compared to biopsy: 12.3 vs 5.1 months (P<0.05 CI:
194.354– 335.646). 17 patients developed complications.
In the group C (n=64), analysis did not show statistically signicant dif-
ference (P=0.066 CI: 220.476– 321.524). Clinically, patients who had re-
section had longer MS (10.5 months vs 3.5 months). Furthermore, there
was no signicant difference in the rate of complications between resection
and biopsy (Fisher’s exact test, P=0.755). CONCLUSION: i) Patients >65
should be treated as per the Stupp protocol ii) In patients >70 surgical resec-
tion should be considered.:
NANOTHERAPEUTICS FOR NEUROSURGICALLY-APPLIED DRUG
DELIVERY
CatherineVasey1, VincenzoTaresco1, StuartSmith1, CameronAlexander1,
RumanRahman1; 1University of Nottingham, Nottingham, United
Kingdom
Despite multimodal treatment, the median survival of Glioblastoma
multiforme (GBM) remains less than 15months, in considerable part due
to diffusely inltrative disease. Better treatment methods are necessary to
eradicate residual tumour burden remaining beyond the resection cavity
boundary. Based on an increasing understanding of GBM intra-tumour het-
erogeneity, the capability to deliver multiple therapeutic moieties from single
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