Phase 1 rTMS targets motor-network rebalancing via theta-burst neuromodulation (cTBS/iTBS)

This single-center, open-label pilot study evaluates whether image-guided repetitive transcranial magnetic stimulation (rTMS) can accelerate motor recovery after brain tumor surgery by modulating cortical excitability within motor networks. Participants receive inhibitory continuous theta burst stimulation (cTBS) to contralesional supplementary motor area, precentral gyrus, and postcentral gyrus (intended to downshift potentially maladaptive overactivity), plus excitatory intermittent theta burst stimulation (iTBS) to ipsilesional homologous regions (intended to upshift activity in underperforming peri-lesional motor circuitry). The trial enrolls 6 total patients: 3 “acute” patients with new paresis 1–2 weeks post-op who also undergo active rehabilitation/physical therapy, and 3 “chronic” patients with persistent deficits up to 3 years post-op with or without rehab. Outcomes use two standardized motor assessments pre/post intervention to estimate feasibility and signal of benefit over a very short, 3-day dosing course. Commercially, this is a non-drug, device-based neurorehabilitation angle rather than a pharma-led program (investigator-sponsored; no drug owners involved); today’s care for post-craniotomy weakness is mainly time, physical/occupational therapy, and supportive neuro-oncology management, with no established neuromodulation standard.