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BACKGROUND: Patients with multiple sclerosis (MS) often experience high levels of anxiety, specifically about the (unpredictable) future related to MS. Worries about physical and cognitive declines can cause frightening mental representations of future 'worst-case scenarios'. Evidence of the applicability of eye movement desensitization reprocessing (EMDR) using flash-forward on anxiety is growing. OBJECTIVE: This pilot study examines the flash-forward EMDR procedure as a treatment option in MS patients suffering from anxiety specifically related to future MS problems. METHODS: Eight MSpatients suffering from anxiety were treated with one to three sessions of EMDR with a flash-forward target. Treatment effects were evaluated with the use of questionnaires on anxiety, depression, worry, cognitive avoidance, and quality of life at three time points: pre-treatment, direct post-treatment, and three-month follow-up. RESULTS: Significant improvement was shown post-treatment compared to pre-treatment on anxiety, depression, and worry. In a case series analysis, all but one participant showed a clinically important difference in anxiety. CONCLUSION: Before implementation on a larger scale can be recommended, the value of EMDR with flash forward targets for anxiety in MS need to be further examined. However, the positive results on this pilot can be seen as promising and motivation for future studies.
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OBJECTIVE: The authors evaluated the cognitive performance of patients with low-grade glioma (LGG) before and after surgery, and specifically investigated 1) the effects of hemispheric tumor location and 2) the type of surgery (either with or without intraoperative stimulation mapping [ISM]). METHODS: Patients underwent neuropsychological assessment 1 day before (T0) and 3 months after (T3) surgery. ISM targeted motor and/or language functions, but no other cognitive functions. Using 2-way mixed ANOVAs, differences between groups (i.e., for patients with right- vs left-sided lesions and normative controls [NCs], and also for patients operated on with vs without ISM and NCs), effects over time (T0-T3), and interaction effects in cognitive functioning were explored. Individual changes over time were assessed with reliable change indices for each neuropsychological test. RESULTS: In total, 77 patients with LGG were included (38 and 39 patients with right- and left-sided lesions, respectively; and 42 patients with and 35 patients without ISM). The majority of patients who were operated on with ISM had left-sided lesions. Patients with right- and left-sided lesions scored significantly lower on 6 and 3 out of 8 tests, respectively, compared to NCs. No significant differences between hemispheric groups were found at T0 or at T3. Patients with left-sided lesions showed significant deterioration of performance on verbal memory and sustained attention over time. Patients who underwent operation with versus without ISM scored significantly lower on 6 and 3 out of 8 tests, respectively, compared to NCs. Patients in the ISM group scored significantly lower on the Stroop test, shifting attention test, and verbal fluency test than patients without ISM. Also, the ISM group showed a significant decline in mean cognitive flexibility and sustained attention performance over time. CONCLUSIONS: Cognitive impairments were found in patients irrespective of hemispheric tumor location, whereby patients who were operated on with ISM performed slightly worse after surgery than patients without ISM. The authors conclude that there is room for improvement of cognitive functioning in surgically treated patients with LGG. The use of specific tests for higher cognitive functions during surgery may potentially improve functional outcome, but that is to be determined in future studies and balanced against oncological outcome. Implementation of neuropsychological assessments into the clinical management of patients with LGG should be encouraged, to inform and alert patients and clinicians on the status of cognitive functioning.