{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:47:09Z","timestamp":1786124829713,"version":"build-2736575974"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2020,9,5]],"date-time":"2020-09-05T00:00:00Z","timestamp":1599264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Diffuse gliomas have an increased biological aggressiveness\u00a0across the World Health Organization (WHO) grading system. The implications of glioma grading on the primary motor cortex (M1)-corticospinal tract (CST) excitability is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To assess the excitability of the motor pathway with navigated transcranial magnetic stimulation (nTMS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Retrospective cohort study of patients admitted for surgery with diffuse gliomas within motor eloquent areas.\u00a0Demographic, clinical, and\u00a0nTMS-related variables were collected. The Cortical Excitability Score (CES 0 to 2 according to the number of abnormal\u00a0interhemispheric resting motor threshold (RMT) ratios) was calculated for patients where bilateral upper and lower limb mapping was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      A total of 45 patients were included: 9 patients had a low-grade glioma and 36 patients had a high-grade glioma.\u00a0The unadjusted analysis revealed an increase in the latency of the motor evoked potential of the lower limb with an increase of the WHO grade (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.038). The adjusted analysis confirmed this finding (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.013) and showed a relation between the increase in the WHO and a decreased RMT (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.037) of the motor evoked responses in the lower limb. When CES was calculated, an increase in the score was related with an increase in the WHO grade (unadjusted analysis\u2014\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.0001; adjusted analysis\u2014\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.001) and in isocitrate dehydrogenase (IDH) wild-type tumors (unadjusted analysis\u2014\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.020).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>An increase in the WHO grading system and IDH wild-type tumors are associated with an abnormal excitability of the motor eloquent areas in patients with diffuse gliomas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyaa354","type":"journal-article","created":{"date-parts":[[2020,8,3]],"date-time":"2020-08-03T23:25:49Z","timestamp":1596497149000},"page":"183-192","source":"Crossref","is-referenced-by-count":35,"title":["Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading"],"prefix":"10.1227","volume":"88","author":[{"given":"Jos\u00e9 Pedro","family":"Lavrador","sequence":"first","affiliation":[{"name":"Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ifigeneia","family":"Gioti","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Szymon","family":"Hoppe","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Jung","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Patel","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Gullan","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keyoumars","family":"Ashkan","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjeev","family":"Bhangoo","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Vergani","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,1]]},"reference":[{"issue":"1","key":"bib1-20231011","doi-asserted-by":"crossref","first-page":"4608","DOI":"10.1038\/s41598-018-22681-3","article-title":"The mode and dynamics of glioblastoma cell invasion into a decellularized tissue-derived extracellular matrix-based three-dimensional tumor model","volume":"8","author":"Koh","year":"2018","journal-title":"Sci Rep"},{"issue":"6","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1007\/s00401-016-1545-1","article-title":"The 2016 world health organization classification of tumors of the central nervous system: a summary","volume":"131","author":"Louis","year":"2016","journal-title":"Acta Neuropathol"},{"issue":"3","key":"bib3-20231011","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.ccell.2017.02.009","article-title":"The microenvironmental landscape of brain tumors","volume":"31","author":"Quail","year":"2017","journal-title":"Cancer Cell"},{"issue":"1","key":"bib4-20231011","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1093\/neuonc\/nov147","article-title":"Differentiation of high-grade and low-grade diffuse gliomas by intravoxel incoherent motion MR imaging","volume":"18","author":"Togao","year":"2016","journal-title":"Neuro Oncol"},{"issue":"2","key":"bib5-20231011","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1515\/raon-2017-0010","article-title":"Diffusion kurtosis imaging of gliomas grades II and III - 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