nTMS-determined cortical excitability is associated with overall survival in patients with motor-eloquent glioblastoma.

Authors

José Pedro Lavrador, Ana Mirallave-Pescador, Sabina Patel, Qusai Al-Banna, Feras Fayez, Vindhya Prasad, Asfand Baig Mirza, Filippo Andrea Sinosi, Sankhya Prakashvel, Kapil Rajwani, Nida Kalyal, Yasir A Chowdhury, Francesco Marchi, Ali Elhag, Laura Ferrari, Alba Diaz Baamonde, Jose Sadio Mosquera, Keyoumars Ashkan, Ranjeev Bhangoo, Francesco Vergani

Published in

Journal of neuro-oncology. Volume 179. Issue 3. Sep 23, 2026. Epub Sep 23, 2026.

Abstract

Preoperative prognostication in glioblastoma remains challenging despite advances in histomolecular classification. Navigated transcranial magnetic stimulation (nTMS) enables non-invasive assessment of cortical excitability, but its role as a survival biomarker remains unclear.
To determine whether preoperative nTMS-derived cortical excitability metrics independently predict overall survival (OS) in patients with WHO grade 4 IDH-wildtype glioblastoma.
This single-centre retrospective cohort study included patients undergoing resection for motor-eloquent WHO grade 4 IDH-wildtype glioblastoma between 2018 and 2024. Preoperative nTMS mapping was used to derive the IntraM1 Excitability Score (IMES) and Cortical Excitability Score (CES). Cox regression adjusted for age, sex, neurological deficit, MGMT methylation, and extent of resection.
Seventy-seven patients were included (mean age 55.4 ± 16.0 years; 41 males; mean OS 20.5 months). Lower IMES and higher CES were associated with worse OS on univariate analysis and remained independently prognostic on multivariate analysis: IMES (HR 0.16, p = 0.003) and CES (HR 2.63, p = 0.034). Bilateral nTMS improved 12-month survival prediction over unilateral mapping.
Preoperative nTMS-derived cortical excitability metrics independently predict OS after adjustment for established prognostic factors, supporting excitability profiling as a clinically actionable prognostic tool in glioblastoma.

PMID:
42776377
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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