Bicentre, randomized, parallel-arm, sham-controlled trial of transcranial direct-current stimulation (tDCS) in the treatment of palliative care patients with refractory cancer pain.

BACKGROUND: Pain is a common symptom in palliative care cancer patients and is often insufficiently relieved. In recent years, transcranial direct-current stimulation (tDCS) of the motor cortex has been shown to be effective to treat chronic pain, essentially neuropathic pain. We propose to test the efficacy of tDCS in patients experiencing cancer pain in the palliative care setting. METHOD/DESIGN: This article describes the protocol of a bicentre, randomized, parallel-arm, sham-controlled clinical trial evaluating tDCS in the treatment of palliative care patients with refractory cancer pain. Seventy patients between the ages of 18 and 80 years experiencing refractory pain with a pain score of 4/10 on a numerical rating scale (NRS) ranging from 0 to 10 will be enrolled in this trial. The main exclusion criteria are patients unable to fill in the various rating scales and life expectancy less than 3 weeks. Treatment consists of 5 consecutive tDCS sessions targeting the motor cortex (one daily session for 5 days) on the contralateral side to the pain. After randomization (1:1 ratio), 35 patients will receive active stimulation and 35 patients will receive sham stimulation. The primary endpoint is the NRS score and the primary objective is a significant improvement of this score between the baseline score recorded between D-3 and D-1 and the score recorded 4 days after stopping treatment (D8). The secondary objectives are to evaluate whether this improvement is maintained 16 days after stopping treatment (D21) and whether the following scores are improved on D14 and D21: Brief Pain Inventory, Edmonton Symptom Assessment System, Hospital Anxiety and Depression scale, State-Trait Anxiety Inventory and Medication Quantification Scale. DISCUSSION: Positive results of this trial would indicate that tDCS can improve pain and quality of life of cancer patients in the palliative care setting. Reduction of analgesic consumption and improvement of activities of daily living should allow many patients to return home with a decreased workload for caregivers.

Effects of Combining Music Therapy, Light Therapy, and Chromotherapy in the Treatment of Chronic Pain Patients: A Pilot Study.

Background: It is currently considered that around 30% of chronic pain patients are totally refractory to medical treatment. Among patients who remain responsive to medical treatment, it is estimated that between 20% and 50% are likely to discontinue treatment due to severe side effects. Given these therapeutic difficulties, a significant number of patients turn to complementary therapies. Objective: The LineQuartz® is a medical device that combines 3 complementary therapies, namely, music therapy, light therapy, and chromotherapy. We propose to evaluate its effectiveness in chronic pain patients. Methods: Between October 2021 and October 2022, 44 patients aged between 23 and 85 years (mean: 55.4 years) were included in a prospective study. All patients had background pain intensity greater than 4/10 on the Numerical Pain Scale (NS). Treatment consisted of 4 half-hour sessions, divided into one session per week for 3 weeks (21 days). Patients were assessed by the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression scale (HAD) the day before starting treatment (Day 0) and the day after the end of treatment (Day 22). Results: Apart from the BPI item, "relationship with others," all items improved significantly (p < 0.050). Background pain intensity (NS) and frequency of painful attacks improved very significantly (p < 0.001). The HAD anxiety subscore was also significantly improved (p < 0.001). Discussion. This open pilot study supports the idea that LineQuartz® has a place among complementary therapies dedicated to the treatment of chronic pain. However, these results need to be confirmed by a controlled study.

Treatment of cognitive and mood disorders secondary to traumatic brain injury by the association of bilateral occipital nerve stimulation and a combined protocol of multisite repetitive transcranial magnetic stimulation and cognitive training: A case report.

Purpose: Cognitive impairment secondary to traumatic brain injury (TBI) is difficult to treat and usually results in severe disability. Method: A 48-year-old man presented with chronic refractory headaches and persistent disabling cognitive impairment after TBI. He was first treated with occipital nerve stimulation (ONS) implanted bilaterally to relieve headaches (8 years after the head trauma). Two years later, he was treated with a 6-week protocol combining repetitive transcranial magnetic stimulation (rTMS) delivered to multiple cortical sites (prefrontal cortex, language areas, and areas involved in visuo-spatial functions) and computerized cognitive training (CogT) (targeting memory, language, and visuo-spatial functions) to improve cognitive performance. Results: Executive and cognitive functions (attention, ability to perform calculations, and verbal fluency) improved in association with pain relief after ONS (33-42% improvement) and then improved even more after the rTMS-CogT protocol with an additional improvement of 36-40% on apathy, depression, and anxiety, leading to a significant reduction in caregiver burden. The functional improvement persisted and even increased at 6 months after the end of the rTMS-CogT procedure (10 years after the onset of TBI and 2 years after ONS implantation). Conclusion: This is the first observation describing sustained improvement in post-TBI refractory headache, depression, and cognitive impairment by the association of bilaterally implanted ONS and a combined procedure of multisite rTMS and CogT to target various brain functions.

Efficacy of Transcranial Direct Current Stimulation Combined with Cognitive Training in the Treatment of Apathy in Patients with Alzheimer's Disease: Study Protocol for a Randomized Trial.

BACKGROUND: Apathy, commonly defined as the loss of motivation, is a symptom frequently encountered in Alzheimer's Disease (AD). The treatment of apathy remains challenging in the absence of any truly effective medications. Transcranial Magnetic Stimulation (rTMS) or Transcranial Direct Current Stimulation (tDCS) can improve cognitive disorders, but do not appear to improve apathy. Isolated cognitive training also appears to have no effect on apathy. We propose to test the efficacy of a new procedure for the treatment of apathy in AD patients consisting of a combination of tDCS and cognitive training, based on the latest guidelines for the design of therapeutic trials in this field. METHODS/DESIGN: This article primarily describes the design of a monocentre, randomized, doubleblind trial to be conducted in France to evaluate the effect of the combination of tDCS and cognitive training on apathy compared to a group treated exclusively by cognitive training (sham tDCS). Twenty- four patients under the age of 90 years with mild-to-moderate Alzheimer's disease (Mini Mental State Examination score between 15 and 26/30) (MMSE)) presenting clinically significant apathy evaluated by the Apathy Inventory (AI) and the NeuroPsychiatric Inventory (NPI) apathy subscore will be enrolled. Severe depression will be excluded by using the NPI depression subscore. Treatment will comprise 10 sessions (D0-D11) including tDCS (bilateral prefrontal, temporal and parietal targets) and Cognitive Training (Cog) (6 simple tasks involving working memory, language and visuospatial function). After randomization (ratio 2:1), 16 patients will receive the complete treatment comprising tDCS and Cog (group 1) and 8 patients will be treated exclusively by Cog (sham tDCS) (group 2). The primary endpoint will be a significant improvement of the AI score by comparing baseline measures (D-15) to those recorded one month after stopping treatment (D44). Secondary endpoints will be an improvement of this score immediately after treatment (D14), 2 weeks (D29) and 2 months (D74) after stopping treatment and improvement of the MMSE score, NPI apathy subscore, ADAS Cog (Alzheimer Disease Assessment cognitive Scale subsection), ADCS-ADL (Alzheimer Disease Cooperative Study-Activities of Daily Living), FAB (Frontal Assessment Battery) and the latency of P300 evoked potentials at the same timepoints. CONCLUSION: The purpose of our study is to check the assumption of tDCS and cognitive training efficacy in the treatment of apathy encountered in AD patients and we will discuss its effect over time.

Repetitive transcranial magnetic stimulation combined with cognitive training for the treatment of Alzheimer's disease.

OBJECTIVE: To assess the efficacy of a combination of cognitive training (COG) and repetitive transcranial magnetic stimulation (rTMS), on cognitive performance, locomotor activity, apathy, caregiver burden and dependence of patients with Alzheimer's disease (AD). METHODS: A combination of COG and rTMS was performed in 10 patients with AD (NeuroAD procedure) for a period of 5weeks (one session per day, 5days a week), without maintenance sessions. Patients were evaluated at the end of the treatment (D45) and 6months later (M6) by the Mini Mental State Examination (MMSE), the Alzheimer disease assessment scale - cognitive subscale (ADAS-Cog), various neuropsychological tests and clinical scores specific for locomotor activity, apathy, caregiver burden, and dependence, recorded before the study (baseline). RESULTS: The primary endpoint was the improvement of the ADAS-Cog score at D45, which was reached. Six months after the end of the treatment, the ADAS-Cog score returned to baseline value, except for the best responders who remained significantly improved. The other main result was the improvement of apathy and dependence scores at both D45 and M6 for the entire series of patients. No serious adverse events occurred and all patients completed the study. CONCLUSIONS: The results of this open-label study confirm the feasibility of the rTMS-COG procedure in AD patients, and suggest that these patients can benefit from the procedure, in terms of cognitive performances, apathy and dependence, even in the long term. These promising results remain to be confirmed in controlled studies based on a larger population size, which could also help identify the prognostic factors associated with good outcome, in order to optimize patient selection.

Tumores de la nasofaringe: análisis de casos años 1960-1991 / Nasopharynx tumors: analysis of cases years 1960-1991

Analisis retrospectivo de 20 casos tratados en el Hospital Central de las FFAA. Las adenomegalias fueron universales en el 100 por ciento (20-20). El 80 por ciento (16-20) fueron malignos, y entre estos el 62,50 por ciento epidermoides. Como estadio III se clasificó el 50 por ciento de los casos (8-16). Recibieron radioterapia todos los pacientes, con una tasa de respuesta parcial del 43.75 por ciento (7-16). Recibieron además de la radioterapia, drogas antineoplásicas 6 pacientes con una tasa de respuesta parcial del 50 por ciento (3-6). La sobrevida actuarial a los 5 años fue del 40 por ciento . Se concluye en la necesidad de diagnóstico precoz, buena técnica del tratamiento radiante y manejo interdisciplinario

Cáncer de vagina y vulva: revisión de nuestra experiencia con radioterapia / Vaginal and vulvar neoplasm: revision of our experience with radiotherapy

El cáncer de localización en vagina y vulva no es frecuente, ocupa el 5to. y 4to. lugar de incidencia respectivamente entre todos los cánceres ginecológicos. En este trabajo retrospectivo revisamos 20 casos tratados entre 1970-1995. Se analizan por edad, síntomas, histología, estadio, modalidad terapéutica, técnica de Rt, complicaciones, sobrevida actuarial a los 5 años. El 55 por ciento (11/20) eran de vulva y 45 por ciento (9/20) de vagina. La mayoría de los pacientes estaban entre los 60 y 79 años de edad. Para ambas localizaciones predoninó el estadío III 63.6 por ciento 87/11) vulva y 55.5 por ciento (5/9) vagina. La histología más frecuente fue epidermoide: vulva 81.8 por ciento (9/11) y 88.8 por ciento (8/9) vagina. El dolor, prurito y sangramiento fueron universales. Recibienron Rt 85 por ciento (17/20) con una RC de 37.5 por ciento (3/8) y RP 50 por ciento (4/8) en vagina. RC 44.4 por ciento (4/9) RP 33.3 por ciento (3/9) para vulva. En 13/20 pacientes usamos QT como sensibilizante a la Rt. Las complicaciones fueron de leves a moderadas. La sobrevida actuarial 5 años fue: vagina: Estadío I (85 por ciento) Estadio II (55 por ciento) Estadio III (40 por ciento) Estadio IV (-11 por ciento). En vulva: insitu (100 por ciento) I (86 por ciento) III (35 por ciento) IV (0 por ciento). Se concluye que con el uso de Rt externa y braquiterapia obtenemos un buen control locoregional que se incrementa usando esquemas de Qt. El tratamiento combinado permite la utilización de procedimientos quirúrgicos preservadores, disminuyendo la mortalidad y mejorando la calidad de vida de nuestros pacientes. La sobrevida se incrementará con el diagnóstico precoz

Tumores malignos en niños: revisión clínico patológica 1970-1990 / Malign tumors in children: patology clinical revision 1970-1990

Revisión clínico patológico de 226 pacientes tratados en el HCFFAA entre 1970-1990. El 56,63 por ciento (128/226) pudieron ser analizados para seguimiento y sobrevida. En orden de frecuencia leucemias y linfomas ocuparon el primer lugar 55/128 (42.96 por ciento). Seguimos por SNC 19.53 por ciento (25/128). Sarcomas de partes blandas 4.68 por ciento (6/128). Retinoblastoma y tumores germinales 3.90 por ciento (5/128) respectivamente. Se revisan histología, modalidades terapéuticas y sobrevida actuarial a los 3 años. Se obtienen conclusiones de nuestros resultados.