6. Future Directions and Limitations
neurologic diseases, cancer
CANCER, NEUROLOGIC COMPLICATION, DISEASES, CORTEX
This research is in its infancy and will require much more study to answer critical questions. For example, how long will the benefits of the treatments last? What is the variability amongst individuals for testing and treatment? Will patients with long-term CRCI benefit from chronic treatments akin to those performed for other neurologic diseases? Will TMS be effective in patients with various types of cancer and treatment regimens (chemotherapy, immunotherapy, hormonal therapy, etc.) that contribute to CRCI? It will be interesting to investigate whether patients with a more acute onset of CRCI report a greater subjective response in correlation with objective response. Our participant did report significant improvement in the quality of her sleep, which raises the possibility that TMS’s beneficial effect on sleep may at least partially mediate its potential efficacy. Future research with wearable sensor technology or sleep laboratory studies may therefore be useful. Moreover, the limitations of the study are multifaceted, including but not confined to the following: firstly, its design’s absence of sham control and its non-blinded nature, which thus opens the door to the potential influence of the placebo effect on short-term cognitive enhancement and specific brain regions, such as the DLPFC and the anterior cingulate cortex [The impact of this research may extend to other diseases that could benefit from improving the functional pathways involving memory and processing. Given the magnitude and devastation of the COVID-19 pandemic, it is interesting to suggest that our findings may be relevant to the treatment of the lasting neurologic complications from COVID-19. The similarities between long COVID and CRCI may extend beyond the similar “brain fog” described by patients and reach the level of similar structural and functional abnormalities. A study from the UK Biobank analyzed brain scans from patients pre- and post-infection. Compared to non-hospitalized COVID-19 patients, hospitalized COVID-19 patients had a greater loss of gray matter in the amygdala and hippocampal regions, which are involved in the processing of emotional stimuli and memory, respectively, but these results did not achieve statistical significance, possibly since the hospitalized group had only 15 patients [