Distinct motor profiles in neuromodulation-induced prehabilitation before brain tumor surgery: a resting-state fMRI study of motor performance

Introduction Brain tumor surgery near motor areas requires balancing maximal resection with functional preservation. Neuromodulation-induced prehabilitation (NIP) may support preoperative functional reorganization, but individual motor and neural responses remain poorly characterized. Methods Sixteen patients ( n = 16) underwent a 1–3-week NIP protocol comprising at least 10 sessions, with twice-daily sessions when necessary, combining low-frequency transcranial magnetic stimulation and/or multichannel transcranial direct current stimulation with intensive motor training. Participants were stratified using Fuzzy C-Means clustering based on pre-post changes (ΔPOST–PRE) in performance components, specifically dexterity (Simple/Choice Reaction Time, 9-Hole Peg Test) and strength (Handgrip). Pre-post changes in resting-state functional connectivity and motor performance relationships were analyzed within the identified profiles. Results Clustering revealed two distinct functional profiles: Strength and Dexterity groups (strength-dominant vs. dexterity-dominant, respectively). While overall performance remained stable, profile-specific performance and neural reorganizations emerged. The Dexterity group showed improved Simple Reaction Time and a significant decrease in Frontal Pole (FP)–Middle Frontal Gyrus (MFG) connectivity. Conversely, the Strength group exhibited a significant increase in Precentral Gyrus–Supplementary Motor Area and FP-MFG connectivity. Remarkably, in the Strength group, an increase in FP–MFG connectivity was correlated with improved manual dexterity. Discussion This exploratory study addresses an emerging area of preoperative neurorehabilitation. Behavioral profiling identified distinct motor-change patterns and connectivity trajectories during NIP, suggesting different neurobiological pathways of prehabilitation. Although preliminary, these findings provide a framework for understanding individual variability in preoperative functional reorganization and support functional profiling as a promising approach to guide individualized neuromodulation and motor training before tumor surgery.