29 Repetitive Transcranial Magnetic Stimulation (rTMS) for Motor Rehabilitation in Neuro-Oncology: the impact of the Orpington Prognostic Score (OPS)

Abstract Introduction rTMS is well-evidenced in the stroke population. Its therapeutic use is increasing in post-operative neuro-oncology patients. Functional outcomes using the OPS, a prognostic indicator for onwards rehabilitation needs, are yet to be explored. This is an exploratory study assessing the feasibility of the OPS to monitor functional outcomes and guide rehabilitation streams in post-operative neuro-oncology patients receiving the rTMS motor rehabilitation protocol for new motor deficit. Method Over 3 months on a neurosciences ward, patients were assessed using the OPS and Fugl Meyer (FM) outcome measures while receiving rTMS post tumour resection with new motor deficit. FM scores were compared to studies reporting the minimal clinically important difference (MCID) for both upper extremity (FM-UE) and lower extremity (FM-LE). OPS scores were analysed alongside predictive values from previous studies - a low score (<3.2) suggesting suitability for discharge home, a higher score (> 3.2) recommending inpatient rehabilitation. Results From October to December 2025 2 patients (mean age 75 years, both females, both meningiomas) were included. Patient 1: the OPS improved from 5.2 (Day 0) to 3.2 (Day 14). FM-UE scores increased by 41, and FM-LE by 7. Patient 2: the OPS improved from 4.8 (Day 0) to 2 (Day 14). FM-UE scores increased by 59, and FM-LE by 30. In the stroke population, the MCID of the FM-UE is 12.4, and 6 for the FM-LE. Patient 1 was admitted for inpatient rehabilitation, and Patient 2 was discharged home with community therapy. Conclusions rTMS can increase the rate of functional recovery in the neuro-oncology population post tumour resection. The OPS was easy and timely to administer and is a good prognostic indicator of rehabilitation need to determine discharge destination.