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1.
Croat Med J ; 62(4): 376-386, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34472741

RESUMO

Malignant brain tumors are among the most aggressive human neoplasms. One of the most common and severe symptoms that patients with these malignancies experience is sleep disruption. Disrupted sleep is known to have significant systemic pro-tumor effects, both in patients with other types of cancer and those with malignant brain lesions. We therefore provide a review of the current knowledge on disrupted sleep in malignant diseases, with an emphasis on malignant brain tumors. More specifically, we review the known ways in which disrupted sleep enables further malignant progression. In the second part of the article, we also provide a theoretical framework of the reverse process. Namely, we argue that due to the several possible pathophysiological mechanisms, patients with malignant brain tumors are especially susceptible to their sleep being disrupted and compromised. Thus, we further argue that addressing the issue of disrupted sleep in patients with malignant brain tumors can, not just improve their quality of life, but also have at least some potential of actively suppressing the devastating disease, especially when other treatment modalities have been exhausted. Future research is therefore desperately needed.


Assuntos
Neoplasias Encefálicas , Qualidade de Vida , Neoplasias Encefálicas/complicações , Humanos , Sono
2.
Int J Mol Sci ; 22(13)2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34210012

RESUMO

Cancer is one of the most common causes of death worldwide. Along with the advances in diagnostic technology achieved through industry-academia partnerships, the survival rate of cancer patients has improved dramatically through treatments that include surgery, radiation therapy, and pharmacotherapy. This has increased the population of cancer "survivors" and made cancer survivorship an important part of life for patients. The senses of taste and smell during swallowing and cachexia play important roles in dysphagia associated with nutritional disorders in cancer patients. Cancerous lesions in the brain can cause dysphagia. Taste and smell disorders that contribute to swallowing can worsen or develop because of pharmacotherapy or radiation therapy; metabolic or central nervous system damage due to cachexia, sarcopenia, or inflammation can also cause dysphagia. As the causes of eating disorders in cancer patients are complex and involve multiple factors, cancer patients require a multifaceted and long-term approach by the medical care team.


Assuntos
Neoplasias Encefálicas/complicações , Transtornos de Deglutição/metabolismo , Sistema Nervoso/metabolismo , Neoplasias Encefálicas/metabolismo , Transtornos de Deglutição/etiologia , Humanos , Olfato , Paladar
3.
Int J Mol Sci ; 22(13)2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34209535

RESUMO

Epilepsy can be both a primary pathology and a secondary effect of many neurological conditions. Many papers show that neuroinflammation is a product of epilepsy, and that in pathological conditions characterized by neuroinflammation, there is a higher probability to develop epilepsy. However, the bidirectional mechanism of the reciprocal interaction between epilepsy and neuroinflammation remains to be fully understood. Here, we attempt to explore and discuss the relationship between epilepsy and inflammation in some paradigmatic neurological and systemic disorders associated with epilepsy. In particular, we have chosen one representative form of epilepsy for each one of its actual known etiologies. A better understanding of the mechanistic link between neuroinflammation and epilepsy would be important to improve subject-based therapies, both for prophylaxis and for the treatment of epilepsy.


Assuntos
Suscetibilidade a Doenças , Epilepsia/etiologia , Inflamação/complicações , Animais , Biomarcadores , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/patologia , Terapia Combinada , Gerenciamento Clínico , Epilepsia/diagnóstico , Epilepsia/metabolismo , Epilepsia/terapia , Predisposição Genética para Doença , Humanos , Inflamação/etiologia , Doenças Neurodegenerativas/complicações , Doenças Neurodegenerativas/etiologia , Doenças Neurodegenerativas/patologia , Avaliação de Sintomas , Resultado do Tratamento
4.
Eur J Endocrinol ; 185(4): 597-606, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34324432

RESUMO

Objective: Childhood brain tumor survivors (CBTS) are at risk to develop hypothalamic-pituitary (HP) dysfunction (HPD). The risk for HPD may vary between different age groups due to maturation of the brain and differences in oncologic treatment protocols. Specific studies on HPD in infant brain tumor survivors (infant-BTS, 0-1 years at diagnosis) or toddler brain tumor survivors (toddler-BTS, ≥1-3 years) have not been performed. Patients and methods: A retrospective nationwide cohort study in CBTS was performed. Prevalence and risk factors for HPD were compared between infant-, toddler-, and older-BTS. Subgroup analysis was performed for all non-irradiated CBTS (n = 460). Results: In total, 718 CBTS were included, with a median follow-up time of 7.9 years. Overall, despite the less frequent use of radiotherapy (RT) in infants, no differences in the prevalence of HPD were found between the three groups. RT (OR: 16.44; 95% CI: 8.93-30.27), suprasellar tumor location (OR: 44.76; 95% CI: 19.00-105.49), and younger age (OR: 1.11; 95% CI: 1.05-1.18) were associated with HP dysfunction. Infant-BTS and toddler-BTS showed more weight gain (P < 0.0001) and smaller height SDS (P = 0.001) during follow-up. In non-irradiated CBTS, infant-BTS and toddler-BTS were significantly more frequently diagnosed with TSH-, ACTH-, and ADH deficiency, compared to older-BTS. Conclusion: Infant and toddler brain tumor survivors seem to be more vulnerable to develop HP dysfunction than older children. These results emphasize the importance of special infant and toddler brain tumor treatment protocols and the need for endocrine surveillance in children treated for a brain tumor at a young age.


Assuntos
Neoplasias Encefálicas/epidemiologia , Sobreviventes de Câncer/estatística & dados numéricos , Doenças Hipotalâmicas/epidemiologia , Adolescente , Adulto , Idade de Início , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/reabilitação , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Doenças Hipotalâmicas/etiologia , Lactente , Masculino , Países Baixos/epidemiologia , Doenças da Hipófise/epidemiologia , Doenças da Hipófise/etiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
5.
J Clin Neurosci ; 89: 249-257, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119276

RESUMO

OBJECTIVE: Previous studies on glioblastomas (GBMs) have not reached a consensus on peritumoral edema (PTE)'s influence on survival. This study evaluated the PTE index's prognostic role in newly diagnosed GBMs using a well-designed method. METHODS: Selected patients were reviewed after a rigorous screening process. Their general information was obtained from electronic medical records. The imaging metrics (MTD, TTM, TTE) representing tumor diameter, laterality, and PTE extent were obtained by manual measurement in Syngo FastView software. The PTE index was a ratio of TTE to MTD. Multiple variables were evaluated using analysis of variance and Cox regression model. RESULTS: Of 143 patients, 62 were included in this study. MGMT promoter methylation and tumor laterality were both independent prognostic factors (p = 0.020, 0.042; HR = 0.272, 2.630). The lateral tumors' index was higher than that of the medial tumors (57.7% vs. 42.6%, p = 0.027). Low-index tumors were located in relatively medial positions compared with high-index tumors (TTM, 4.9 vs. 12.8, p = 0.032). This finding indicated that the PTE index tended to increase with tumor laterality. Moreover, the patients with low-index tumors had a significant survival disadvantage in the univariate analysis but not in the multivariate analysis (p = 0.023, 0.220). However, further analysis found that the combination of tumor laterality and PTE statistically stratified the survival outcome. The patients with lateral high-index tumors survived significantly longer (p = 0.022, HR = 1.927). CONCLUSIONS: In contrast with the previous studies, this study recommends combining PTE and tumor laterality for survival stratification in newly diagnosed GBMs.


Assuntos
Edema Encefálico/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Glioblastoma/diagnóstico por imagem , Adulto , Idoso , Edema Encefálico/etiologia , Edema Encefálico/mortalidade , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/mortalidade , Feminino , Glioblastoma/complicações , Glioblastoma/mortalidade , Humanos , Imageamento por Ressonância Magnética/mortalidade , Imageamento por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências
6.
J Neurol Sci ; 427: 117538, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34146775

RESUMO

BACKGROUND: Venous thromboembolism (VTE) is a very common adverse event for astrocytoma patients, but validation of proposed risk biomarkers has been elusive. We examine whether the status of the isocitrate dehydrogenase (IDH) gene is a risk factor for the development of venous thromboembolism (VTE) in astrocytoma patients. METHODS: We conducted a retrospective chart review of 282 astrocytoma patients enrolled in the PROACTIVE (Prospective Assessment of Correlative Biomarker) study at MD Anderson Cancer Center (MDACC) from 9/1/2000 until 12/31/2013. RESULTS: We identified 282 astrocytoma patients consisting of 49 IDH mutant astrocytomas and 233 IDH wildtype astrocytomas. Glioblastoma was the initial histopathologic diagnosis in 30 (61.2%) of the IDH mutated astrocytomas compared to 227(97.4%) of the IDH wild type astrocytomas. VTE was identified in 52 (18.4%) of patients. VTE was diagnosed in 7 (14.3%) of the IDH mutated astrocytomas compared to 45(19.3%) of the IDH wild type astrocytoma s (p = 0.4094). Median time to VTE from diagnosis was 2.71 months. Median time to VTE from diagnosis was 2.6 months for IDH mutated astrocytomas compared to 3.06 months for the IDH wild type astrocytomas (p = 0.8663). CONCLUSIONS: IDH gene status did not appear as a significant risk factor for the development of venous thromboembolism (VTE) in our cohort of astrocytoma patients. Further research into potential biomarkers for VTE may be warranted.


Assuntos
Astrocitoma , Neoplasias Encefálicas , Isocitrato Desidrogenase , Tromboembolia Venosa , Astrocitoma/complicações , Astrocitoma/genética , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/genética , Humanos , Isocitrato Desidrogenase/genética , Mutação , Estudos Prospectivos , Estudos Retrospectivos , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/genética
7.
J Pak Med Assoc ; 71(6): 1698-1700, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34111103

RESUMO

While the median survival in patients with glioblastoma has not improved significantly over the past decade, aggressive attempts have been made on palliation and improving quality of life in these patients. A confluence of two debilitating pathologies which massively distorts the normal day-to-day functioning of the patients who experience it, seizures in glioblastoma patients portends a poor prognosis. There exists a paucity of reported seizure outcomes after glioblastoma treatment in neurosurgical literature. Herein we present a review examining post-operative seizure control in patients with glioblastoma.


Assuntos
Neoplasias Encefálicas , Glioblastoma , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Glioblastoma/complicações , Glioblastoma/cirurgia , Humanos , Período Pós-Operatório , Prognóstico , Qualidade de Vida , Convulsões/etiologia , Resultado do Tratamento
8.
J Med Life ; 14(2): 170-175, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104239

RESUMO

Gangliogliomas are central nervous system tumors located in the temporal lobe of young patients, frequently associated with epilepsy. In this paper, we propose a grading system based solely on histopathological criteria. We reevaluated all cases of ganglioglioma, atypical ganglioglioma, and anaplastic ganglioglioma diagnosed between 2011 and 2020 in the Pathology Department of the Emergency Clinical Hospital Bagdasar-Arseni, based on the type of glial mitoses, the number of neuronal and glial mitoses, presence of necrosis, microvascular proliferation, eosinophilic granular bodies, hypercellularity, presence and disposition of inflammatory infiltrate and atypical pleomorphism. Based on the proposed grading system, a score of 0-4 corresponded to a benign ganglioglioma, 5-9 to an atypical ganglioglioma, and 10-18 to an anaplastic ganglioglioma. The survival rates were 90% for benign ganglioglioma, 71.43% for atypical ganglioglioma, and 62.54% for anaplastic ganglioglioma. One case of benign ganglioglioma underwent a malignant transformation into anaplastic ganglioglioma, and recurrences were noticed in 28.57% of atypical ganglioglioma cases and 30.7% of all anaplastic gangliogliomas. The presence of rare glial mitoses and hypercellularity was correlated with mortality in cases of atypical ganglioglioma. We believe this histopathological scoring system could be used as a three-tier system to identify atypical ganglioglioma cases that are bound to have an aggressive course of evolution and require close follow-up. The other option would be to convert it to a two-tier grading system that can separate low-grade gangliogliomas from high-grade ones. The latter category can encompass both atypical and anaplastic ganglioglioma due to the high mortality of both entities.


Assuntos
Neoplasias Encefálicas/patologia , Ganglioglioma/patologia , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/metabolismo , Criança , Pré-Escolar , Feminino , Ganglioglioma/complicações , Ganglioglioma/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/patologia , Adulto Jovem
10.
World Neurosurg ; 150: 89-91, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33798775

RESUMO

Epidermoid cysts are rare benign intracranial tumors of congenital origin. They are slow-growing and are seen to insinuate between brain structures. These are commonly located in cerebello-pontine angle and parasellar regions. The symptoms produced are primarily due to mass effect. Hearing loss, facial nerve palsy, and trigeminal neuralgia are reported when cranial nerves are involved; motor palsy of trigeminal nerve is uncommon. Here, we present an interesting case of an extensive multicompartmental epidermoid cyst causing atrophy of trigeminal nerve with radiologic evidence of chronic motor trigeminal nerve palsy characterized by atrophy of masticator space muscles and parotid gland.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Cisto Epidérmico/patologia , Músculos da Mastigação/patologia , Atrofia Muscular/etiologia , Atrofia Muscular/patologia , Glândula Parótida/patologia , Adulto , Neoplasias Encefálicas/complicações , Cisto Epidérmico/complicações , Cisto Epidérmico/diagnóstico por imagem , Feminino , Humanos , Músculos da Mastigação/diagnóstico por imagem , Atrofia Muscular/diagnóstico por imagem , Glândula Parótida/diagnóstico por imagem , Doenças do Nervo Trigêmeo/diagnóstico por imagem , Doenças do Nervo Trigêmeo/etiologia , Doenças do Nervo Trigêmeo/patologia
11.
Radiol Clin North Am ; 59(3): 409-423, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33926686

RESUMO

Neoplastic meningitis (NM) and paraneoplastic syndromes (PNSs) are a rare group of disorders present in patients with cancer. Clinical diagnosis of these conditions is challenging, and imaging and laboratory analysis play a significant role in diagnosing. Diagnosis of NM largely depends on documenting circulating tumor cells in the cerebrospinal fluid (CSF) and/or leptomeningeal and nodular enhancement on contrast-enhanced MR imaging of the brain or axial spine. PNSs encompass a variety of symptoms or syndromes. Paraneoplastic neuronal disorder diagnosis requires a multidimensional approach, high clinical suspicion, CSF and serum examination, and imaging. Neuroimaging is an integral part in the evaluation.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Meningite/diagnóstico por imagem , Síndromes Paraneoplásicas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Encéfalo/diagnóstico por imagem , Neoplasias Encefálicas/complicações , Humanos , Meningite/complicações
12.
BMC Cancer ; 21(1): 386, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33836671

RESUMO

BACKGROUND: Gliomas are often associated with symptoms including seizures. Most patients with high-grade gliomas are treated with radiotherapy or radio-chemotherapy. Since irradiation causes inflammation, it may initially aggravate symptoms. Studies focusing on seizure activity during radiotherapy for gliomas are not available. Such knowledge may improve patient monitoring and anti-epileptic treatment. This study evaluates seizure activity during radiotherapy for high-grade gliomas. METHODS: The primary objective this prospective interventional study is the evaluation of seizure activity during a course of radiotherapy for high-grade gliomas. Progression of seizure activity is defined as increased frequency of seizures by > 50%, increased severity of seizures, or initiation/increase by ≥25% of anti-epileptic medication. Seizure frequency up to 6 weeks following radiotherapy and electroencephalography activity typical for epilepsy will also be evaluated. Patients keep a seizure diary during and up to 6 weeks following radiotherapy. Every day, they will document number (and type) of seizures and anti-epileptic medication. Once a week, the findings of the diary are checked and discussed with a neurologist to initiate or adjust anti-epileptic medication, if necessary. Patients complete a questionnaire regarding their satisfaction with the seizure diary. If the dissatisfaction rate is > 40%, the seizure diary will be considered not suitable for the investigated indication. Thirty-five patients (32 patients plus drop-outs) should be enrolled. With this sample size, a one-sample binomial test with a one-sided significance level of 2.5% has a power of 80% to yield statistical significance, if the rate of patients with progression of seizure activity is 30% (rate under the alternative hypothesis), assuming a 'natural' background progression-rate of 10% without radiotherapy (null hypothesis). DISCUSSION: If an increase in seizure activity during a course of radiotherapy for high-grade glioma occurs, the findings of this study may pave the way for a larger prospective trial and will likely lead to closer patient monitoring and better anti-epileptic treatment. TRIAL REGISTRATION: clinicaltrials.gov ( NCT04552756 ); registered on 16th of September, 2020.


Assuntos
Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/patologia , Irradiação Craniana/efeitos adversos , Glioma/complicações , Glioma/patologia , Convulsões/diagnóstico , Convulsões/etiologia , Anticonvulsivantes/uso terapêutico , Neoplasias Encefálicas/radioterapia , Quimiorradioterapia , Irradiação Craniana/métodos , Gerenciamento Clínico , Suscetibilidade a Doenças , Eletroencefalografia , Feminino , Glioma/radioterapia , Humanos , Masculino , Gradação de Tumores , Estadiamento de Neoplasias , Convulsões/terapia , Avaliação de Sintomas , Resultado do Tratamento
13.
Turk Neurosurg ; 31(3): 389-398, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33759163

RESUMO

AIM: To investigate the underlying conditions in children with torticollis. MATERIAL AND METHODS: Between May 2016 and December 2019, 24 patients (10 girls and 14 boys; mean age, 8 years) presenting with twisted neck, neck pain, weakness of extremities, imbalance, and gait disorder were evaluated retrospectively. RESULTS: Five of the patients had cranial pathologies (cerebellar anaplastic ependymoma and medulloblastoma, brain stem glioma, atypical teratoid rhabdoid tumor, and acute disseminated encephalomyelitis), and five of the patients had spinal pathologies (idiopathic intervertebral disc calcification, vertebral hemangiomatosis, compression fracture, multiple hereditary exostoses, and Langerhans cell histiocytosis at C4). Six of the patients had ocular pathologies (strabismus, Duane syndrome, and Brown syndrome each in two patients). Four patients had otorhinolaryngological infections (Sandifer syndrome, esophageal atresia, reflux, and spasmus nutans, with one patient each). Detailed clinical physical examination and necessary laboratory investigation were performed for all patients. CONCLUSION: Torticollis is a sign that is not always innocent and may herald an underlying severe disease. Misdiagnosis can lead to wrong and unnecessary surgical procedures and treatments, and sometimes, the results can be damaging due to underlying severe conditions if diagnosed late. In addition, we first report a case of vertebral hemangiomatosis and temporomandibular joint ankylosis that presented with torticollis in the English medical literature.


Assuntos
Neoplasias Encefálicas/complicações , Calcinose/complicações , Oftalmopatias/complicações , Cervicalgia/etiologia , Doenças da Coluna Vertebral/complicações , Torcicolo/etiologia , Adolescente , Criança , Pré-Escolar , Ependimoma , Feminino , Humanos , Lactente , Masculino , Exame Físico , Estudos Retrospectivos
14.
World Neurosurg ; 150: e236-e252, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33706019

RESUMO

BACKGROUND: The occurrence of pregnancy in patients with low-grade glioma (LGG) constitutes a unique therapeutic challenge. Owing to the rarity of cases, there is a dearth of information in existing literature. METHODS: We retrospectively identified all patients with a diagnosis of LGG and pregnancy at some point during their illness. Clinical course and obstetrical outcomes were reviewed. A volumetric analysis of tumor growth rate in association with pregnancy was performed. RESULTS: Of 15 women identified, 13 (86.7%) had a prepregnancy LGG diagnosis. Of the 2 patients in whom LGG was diagnosed during pregnancy, one underwent upfront surgery, and the other had watchful waiting with resection after 60 weeks. Nine patients (60.0%) remained asymptomatic during pregnancy, while 5 (33.3%) experienced recurrence of seizures. There was one case of transformation of an astrocytoma to glioblastoma during the third trimester, which was resected emergently. In 10 cases, progression occurred after pregnancy at a median interval of 24.2 months (interquartile range 6.6-37.5 months), with progression within 6 months of delivery in 2 cases. Mean (SD) growth rate during pregnancy was 7.8 (22.2) mm/year compared with 0.62 (1.12) mm/year before pregnancy and 0.29 (1.18) mm/year after pregnancy; the difference did not reach statistical significance (P = 0.306). CONCLUSIONS: Pregnancy was associated with clinical deterioration in one third of patients. No significant change in growth rate was identified. Time to progression and malignant dedifferentiation were unaffected. Patients with LGG wishing to pursue pregnancy should be counseled regarding the risk of complications, and if pregnancy is pursued, close neurological and obstetrical follow-up is recommended.


Assuntos
Neoplasias Encefálicas/patologia , Glioma/patologia , Complicações Neoplásicas na Gravidez/patologia , Adulto , Astrocitoma/patologia , Astrocitoma/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Progressão da Doença , Feminino , Glioblastoma/patologia , Glioblastoma/cirurgia , Glioma/complicações , Glioma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia , Procedimentos Neurocirúrgicos , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Convulsões/etiologia , Conduta Expectante , Adulto Jovem
15.
Intern Med ; 60(16): 2633-2637, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-33642483

RESUMO

We herein report the case of a 20-year-old man with a history of epilepsy who presented with frequent transient loss of consciousness (T-LOC) and polymorphic ventricular tachycardia (VT) with QT interval prolongation. Blood investigations revealed panhypopituitarism. Following a biopsy, he was diagnosed with brain germinoma. During the biopsy, he had an episode of polymorphous VT with QT prolongation. There was no recurrence of T-LOC following chemotherapy and hormone replacement therapy. This case indicates the importance of checking the QT interval in patients with T-LOC, including those with seizures and brain tumors, to ensure appropriate treatment.


Assuntos
Neoplasias Encefálicas , Síndrome do QT Longo , Taquicardia Ventricular , Adulto , Neoplasias Encefálicas/complicações , Eletrocardiografia , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/etiologia , Masculino , Recidiva Local de Neoplasia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Adulto Jovem
17.
Seizure ; 87: 107-113, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33761391

RESUMO

PURPOSE: We investigated, whether epileptic seizures (ES) as presenting symptom in adult patients with GBM are associated with better Overall Survival (OS) compared to ES presenting later during the course of GBM, and efficacy and safety of different antiseizure medications (ASMs). METHODS: Retrospective consecutive cohort study of adults with GBM: 50 from Norway and 50 from Italy. We compared the time to changing ASM treatments. OS was investigated with a Cox regression model adjusted for time dependency. RESULTS: Median follow-up was 17 months from GBM diagnosis. ES were the presenting symptom in 49 patients. All patients received ASM treatment. LEV was the first ASM in the majority of patients and the most effective at one year from the first prescription, (p = 0.004). Occurrence of adverse events (AEs) was similar between LEV and other ASMs (p = 0.47). Poorer OS correlated with older age at GBM diagnosis, country and ASM therapy. A negative impact of ASMs on OS was observed for LEV in a univariate and multivariate analysis, and for VPA (only in multivariate analysis), even when adjusted for O6-methylguanine-DNA-methyltransferase (MGMT) methylation status. Patients with ES as the onset symptom of GBM and patients who had first ES later had similar OS (p = 0.87). CONCLUSION: ES as the GBM debut symptom did not lead to a longer OS. LEV was a more effective ASM compared to other treatments with no differences regarding AEs between LEV and other ASMs. Surprisingly, in our patients LEV and VPA were associated with worse OS than other ASMs. This result should be interpreted with caution due to the retrospective nature of this study along with the many variables which may affect the outcome in this population.


Assuntos
Neoplasias Encefálicas , Glioblastoma , Adulto , Idoso , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/tratamento farmacológico , Glioblastoma/complicações , Glioblastoma/tratamento farmacológico , Humanos , Itália , Noruega , Prognóstico , Estudos Retrospectivos
18.
J Neurol Sci ; 423: 117386, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33706200

RESUMO

Epilepsy is common in patients with brain tumors and frequently presents as the first clinical manifestation of an underlying tumor. Despite a number of available antiepileptic drugs (AED), brain tumor related epilepsy (BTRE) may still be difficult to control. Recently, the AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid)-type glutamate receptor antagonist perampanel (PER) is increasingly acknowledged as an attractive novel add-on AED for seizure control in BTRE. We present a single institutional experience reporting five individual cases with refractory BTRE treated with PER. In two of these five brain tumor patients, worsening of seizure control was caused by SMART-syndrome (stroke-like migraine attacks after radiation therapy). Efficacy of PER was assessed by the responder rate and by evaluating overall changes in seizure frequency before and during PER treatment. In our case series, a reduction in seizure frequency was observed in four out of five patients and the responder rate was 40%. In addition, both cases with symptomatic epilepsy associated with SMART-syndrome were successfully treated with PER. This case series supports the growing evidence that PER may become a promising add-on AED for the treatment of refractory BTRE as well as for seizure control in SMART-syndrome.


Assuntos
Neoplasias Encefálicas , Epilepsia , Anticonvulsivantes/uso terapêutico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/tratamento farmacológico , Epilepsia/tratamento farmacológico , Epilepsia/etiologia , Humanos , Piridonas/uso terapêutico , Resultado do Tratamento
19.
Jpn J Clin Oncol ; 51(6): 886-894, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-33728435

RESUMO

BACKGROUND: The attention on mismatch repair-deficient (dMMR) gastric cancer has increased in this era of anti-PD-1 blockade therapy; however, the prevalence and molecular genetics of patients with dMMR gastric cancer have not been completely investigated. METHODS: Immunohistochemistry of MMR proteins (MLH1, MSH2, MSH6 and PMS2) was performed on formalin-fixed paraffin-embedded sections prepared from resected primary gastric cancers of 513 consecutive patients. Genetic and/or epigenetic alterations of the MMR genes were also investigated. RESULTS: Loss of expression of one or more MMR proteins was observed in 58 patients (11.3%); 54 patients showed loss of MLH1/PMS2, 3 patients showed loss of MLH1/PMS2/MSH6 and 1 patient showed loss of PMS2 alone. Among these 58 patients, 55 showed hypermethylation of the promoter region of MLH1. Genetic testing revealed that the remaining three patients had Lynch syndrome (n = 1) or Lynch-like syndrome (n = 2). A total of 15 patients (25.9% of all patients with dMMR gastric cancer and 2.9% of all patients with gastric cancer), including 11 patients with stage I-III dMMR gastric cancer who had recurrence and 4 patients with stage IV dMMR gastric cancer, are potential candidates for the use of anti-PD-1 blockades. CONCLUSIONS: This is the first study to investigate the frequency and molecular genetic mechanisms of dMMR gastric cancer comprehensively, focusing on the benefit of using PD-1 blockades. Our observations will be beneficial in the clinical practice of metastatic gastric cancer.


Assuntos
Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/genética , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/genética , Testes Genéticos , Síndromes Neoplásicas Hereditárias/epidemiologia , Síndromes Neoplásicas Hereditárias/genética , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/complicações , Neoplasias Colorretais/complicações , Neoplasias Colorretais Hereditárias sem Polipose/epidemiologia , Neoplasias Colorretais Hereditárias sem Polipose/genética , Reparo de Erro de Pareamento de DNA/genética , Feminino , Frequência do Gene , Hospitalização/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Imuno-Histoquímica , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Síndromes Neoplásicas Hereditárias/complicações , Prevalência , Estudos Retrospectivos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Adulto Jovem
20.
Neuropsychologia ; 154: 107769, 2021 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-33524456

RESUMO

Cognitive reserve (CR) theory suggests that individual differences in general intelligence (IQ), occupational attainment or participation in leisure/recreational activities protect against cognitive decline. However the relationship between CR and cognitive functioning in patients with brain tumours has been very rarely investigated in past research. The present study systematically assesses whether CR concept can also be applied to cognitive functions of neurosurgical patients affected by brain tumours. We investigated the role of different CR proxies (education level, premorbid IQ, current IQ, working and leisure activity) in protecting language against brain tumours and surgery effects, considering interactions with demographic (sex/age), anatomical (hemisphere/lobe location of lesion) and clinical/biological variables (tumour type: High/Low Grade Glioma or Meningioma; lesion volume; lesion aggressiveness). One-hundred patients undergoing neuropsychological assessment before and immediately after surgery participated. A "Language Score" summarizing performance on all language tests was derived with Principal Component Analysis. Data were then analyzed with Multiple Regression and Classification and Regression Tree analyses to investigate possible relationships between predictors (CR proxies and clinical variables) and Language Score. We found that premorbid IQ was the best predictor of pre-operatory language integrity, above and beyond all clinical variables considered, also moderating lesion volume effects. Moreover, patients with lower pre-operatory language integrity and low-to-moderately aggressive tumours showed a mitigating effect of current IQ over surgery consequences. Results thus suggest that different CR proxies play a role in moderating cognitive decline following brain tumours and surgery.


Assuntos
Neoplasias Encefálicas , Reserva Cognitiva , Neoplasias Encefálicas/complicações , Humanos , Inteligência , Idioma , Testes Neuropsicológicos
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