Non-randomized trial of neuromodulation prehabilitation for brain tumor language networksSmall study tests brain stimulation and language training before brain tumor surgery

medRxiv Published April 19, 2026 Study authors: Brault-Boixader, N.; Roca-Ventura, A.; Delgado-Gallen, S.; Buloz-Osorio, E.; Boccuni, L.; Laredo, C.… DOI ↗ Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain

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Key Takeaway

Consider that neuromodulation prehabilitation may modulate language networks in brain tumor patients, but evidence is limited and not causal.

This is a non-randomized controlled trial from the Prehabilita project (NCT05844605) examining non-invasive neuromodulation-induced prehabilitation (NIP) in 26 patients with operable brain tumors affecting language or motor regions. The study compared language-targeted NIP (11 patients) with NIP targeting non-language networks (14 patients).

The authors report that in the language-targeted group, task-based fMRI revealed reduced overlap between a stimulation target region and fMRI-derived language activation maps. No comparable changes were observed in the control group. The study also found no significant modulation effects in the motor network in either group. Language and cognitive performance were preserved during language network modulation.

Key limitations noted by the authors include the small sample size, non-randomized design, and single-center setting. The study did not report primary outcomes, effect sizes, p-values, or adverse events. Follow-up was assessed before and after prehabilitation.

Practice relevance is restrained; the authors suggest NIP targeting higher-order functions like language may be a safe preoperative strategy to reduce functional constraints on surgery. However, findings are preliminary and require replication in larger, randomized studies.

This study looked at a pre-surgery program called non-invasive neuromodulation-induced prehabilitation (NIP) for patients with operable brain tumors affecting language or motor areas. The program combined brain stimulation with intensive language training. The study included 26 patients, with 11 receiving language-targeted NIP and 14 receiving NIP focused on motor networks.

Researchers found that in the language-targeted group, brain scans showed reduced overlap between the stimulation target and language activation areas. No similar changes were seen in the control group. The study also reported that language and cognitive performance were preserved during this process. No significant changes were seen in motor network activity.

The study did not report any safety concerns, but it was small, non-randomized, and from a single center. This means the findings are early and not yet practice-changing. The main reason to be careful is that the results show an association, not a cause, and cannot be generalized to other patients.

Realistically, this suggests that targeting language networks with NIP might be a safe preoperative strategy to help surgeons plan larger, safer resections. However, more research is needed to confirm these results and see if they lead to better surgical outcomes.

What this means for you:

A small, early study found brain stimulation plus language training changed brain activity without harming skills, but more research is needed.

Study Details

Sample sizen = 26

EvidenceLevel 5

PublishedApr 2026

View Original Abstract ↓

Patients with brain tumors involving language-critical regions face surgical limitations when balancing resection with preservation of function. Non-invasive neuromodulation-induced prehabilitation (NIP) aims to guide preoperative neuroplastic reorganization, potentially facilitating larger resections while preserving function. We investigated whether NIP selectively modulates the targeted language network compared with control networks, and whether such modulation is behaviorally safe. We enrolled 26 patients (mean age = 55.9) from the Prehabilita project (Clinical Trial: NCT05844605) with operable brain tumors affecting language or motor regions. Eleven received language-targeted NIP, combining transcranial magnetic stimulation and/or transcranial direct current stimulation with intensive language training. Fourteen patients with NIP targeting non-language networks, primarily motor networks, served controls. Assessments included task-based functional magnetic resonance imaging (tb-fMRI) and a neuropsychological battery assessing language and cognitive domains before and after prehabilitation. Results indicated a group-specific NIP effect on the language network. In the language-targeted group, tb-fMRI revealed reduced overlap between a region of interest centered on the stimulation target and fMRI-derived language activation maps, whereas no comparable changes were observed in controls. No significant modulation effects were detected in the motor network in either group. These findings indicate that NIP can selectively reorganize the language network, with modulation patterns differing in sensorimotor networks. Importantly, language network modulation occurred while preserving language and cognitive performance. These results support NIP targeting higher-order functions such as language as a safe preoperative strategy that may reduce functional constraints on surgery and enable larger and safer resections in patients with tumors involving language-critical regions.

Non-randomized trial of neuromodulation prehabilitation for brain tumor language networksSmall study tests brain stimulation and language training before brain tumor surgery

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Non-randomized trial of neuromodulation prehabilitation for brain tumor language networksSmall study tests brain stimulation and language training before brain tumor surgery

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