Background
Combined radiochemotherapy followed by maintenance chemotherapy with cisplatin, lomustine and vincristine within the NOA-07 study resulted in considerable short-term toxicity in adult ...medulloblastoma patients. Here we investigated the long-term impact of this treatment, focusing on neurocognitive functioning and health-related quality of life (HRQoL).
Methods
Neurocognitive functioning and HRQoL scores over time were determined, and differences between the post-treatment and follow-up assessments were calculated up to 18 months for neurocognition and 60 months for HRQoL.
Results
28/30 patients were analyzed. The three preselected HRQoL scales (role, social and cognitive functioning) showed improved scores, to a clinically relevant extent (≥ 10 points), compared to post-treatment levels up to 30 months, but decreased afterwards. Z-scores for verbal working memory were worse during follow-up compared to post-treatment scores and remained impaired during 18 months follow-up (i.e. z-score below − 1 standard deviation). Attention was impaired post-treatment, and remained impaired to a clinically relevant extent during follow-up. Coordination/processing speed and lexical verbal fluency improved compared to post-treatment scores, and remained within the normal range thereafter. Other tests of verbal fluency were stable over time, with z-scores within the normal range.
Conclusions
This long-term follow-up study showed that the NOA-07 treatment regimen was not associated with a deterioration in HRQoL in the post-treatment period. Verbal working memory deteriorated, while other neurocognitive domains did not seem to be impacted negatively by the treatment.
To identify radiological and laboratory hallmarks in patients with primary Sjögren's syndrome (pSS) presenting with spinal cord involvement.
Clinical and laboratory routine parameters were analyzed ...in a retrospective multicenter case series of four patients who developed myelitis associated with pSS. Serological and cerebrospinal fluid (CSF) measurements of pSS associated anti-SSA(Ro)-antibodies were initiated, and CSF neurofilament light chain (NFL) levels were assessed. NFL values were compared with results from 15 sex- and age-matched healthy controls. Radiological assessment was performed using multi-sequence spinal cord magnetic resonance imaging.
Three of the four patients initially developed neurological signs suggestive of myelitis and were subsequently diagnosed with pSS. All patients presented a longitudinal spinal T2-hyperintense lesion in the cervical spinal cord, whereas only two patients showed pleocytosis and oligoclonal bands in the CSF. Median (range) CSF-NFL levels were significantly elevated in patients compared to controls (6672 pg/mL (621-50000) vs. 585 pg/mL (357-729),
= 0.009). One patient showed sustained, highly increased NFL levels (50000 pg/mL) in the initial assessment when radiological signs of axonal injury were still absent. Anti-SSA(Ro)-antibodies were found in the serum of three patients, while two patients additionally presented intrathecal anti-SSA(Ro)-antibody production. Elevated CSF-NFL levels and intrathecal synthesis of anti-SSA(Ro)-antibodies were associated with a relapsing and treatment-resistant disease course.
Inflammatory spinal cord lesions associated with pSS are a rare but serious disease leading to severe disability. NFL and anti-SSA(Ro)-antibodies in CSF might serve as prognostic biomarkers and should be routinely assessed in patients with pSS.
Radiation induced optic neuropathy (RION) is a rare but severe consequence of radiation therapy that is associated with adjuvant chemotherapy, specifically therapy with vincristine or nitrosoureas. ...However, there is very little evidence regarding the occurrence of RION after concomitant radiochemotherapy with temozolomide.
The case of a 63 year old woman with glioblastoma multiforme and concomitant radiochemotherapy with temozolomide is described. Due to a slight depressive episode the patient also took hypericum perforatum. Five months after cessation of fractionated radiation and adjuvant chemotherapy with temozolomide (cumulative dose of 11040 mg) the patient developed bilateral amaurosis due to RION. Tumor regrowth was excluded by magnetic resonance imaging. After the application of gadolinium a pathognomonic contrast enhancement of both prechiasmatic optic nerves could be observed.
In this patient, the occurrence of RION may have been the result of radiosensitization by temozolomide, which could have been strengthened by hypericin. Consequently, physicians should avoid a concomitant application of hypericum perforatum and radiochemotherapy.
Anästhesie und Multiple Sklerose - Was gilt es zu beachten? Drust, Andreas; Bartels, Claudius; Hachenberg, Thomas
Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS,
07/2016, Letnik:
51, Številka:
7/08
Journal Article
Recenzirano
Odprti dostop
Zusammenfassung
Patienten mit seltenen neurologischen Erkrankungen sind stets eine Herausforderung im klinisch-operativen Alltag. Insbesondere anästhesiologische Interventionen können dabei mit ...vielfältigen Problemen behaftet sein. Der Artikel befasst sich mit dem aktuellen Wissensstand zur Multiplen Sklerose in der Anästhesie. Dabei beziehen sich die Autoren auf die sichere Vorbereitung und Durchführung verschiedener Anästhesieformen sowie die Vermeidung und ggfs. die Therapie möglicher Komplikationen.
Patients with rare neurological diseases are always a challenge in routine clinical activity. In particular, anesthetic interventions can be fraught with many problems. This article deals with the ...current state of knowledge on multiple sclerosis in anesthesia. Here, the authors refer to the safe preparation for and implementation of various forms of anesthesia as well as the prevention and if necessary, treatment of possible complications.
Primary objectives: Description and analysis of neuropsychological deficits following brain trauma with diffuse lesion probably corresponding to diffuse axonal injury (DAI).Research design: A series ...of 111 patients suffering from traumatic brain injury could be investigated neuropsychologically within the first 4 weeks after injury and re-assessed after 5-8 months. They included 11 subjects with CT-evidence of diffuse axonal injury, but no CT-signs of focal contusions. Eleven patients with focal frontal contusions but no CT signs of DAI were matched to and compared with the DAI subjects. Seventeen TBI patients with normal CT scans served as controls.Results: When assessed within the first 4 weeks after TBI, both DAI and frontal contusion patients exhibited behavioural abnormalities and deficits in Wechsler Similarities. The DAI patients were also impaired in Digit Span backward and Stroop interference. When re-assessed, the DAI patients showed considerable deficits in the California Verbal Learning Test and in the Wisconsin Card Sorting Test.Conclusions: DAI leads to neuropsychological impairment dominated by executive and memory dysfunction.
Gemella morbillorum is an anaerobic gram-positive diplococcus and in most cases a harmless commensal, which occasionally causes infections in the central nervous system. We report on an ...immunocompetent young man with focal neurological symptoms and cephalgia caused by a cerebral abscess. Although successful treatment was done with neurosurgical intervention and antibiotic therapy, he suffered from a venous infarction 5 weeks after first diagnosis, which mimicked cerebritis as an early stage of relapsing abscess. Imaging and investigation of cerebrospinal fluid was necessary for sufficient differential diagnosis and antibiotic therapy could be stopped after altogether 8 weeks of treatment. In summary, G morbillorum causes not only biphasic infections, but also can be accompanied by infarction in the central nervous system despite sufficient antibiotic therapy.
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