RESUMO
Children's ability to transfer the gains of a motor experience, such as learning to write a letter, to novel conditions, such as cursive writing of the same letter, are affected by the way in which the learning experience is parsed. Parsing may have limitations because a short session may hamper the engagement of procedural memory consolidation processes. Here, we compared the effects of two practice schedules with the total amount of practice identical training provided in a single-session practice versus multi-session practice, wherein each session on its own was insufficient for generating long-term gains. A total of 40 7- and 8-year-old children practiced the production of a novel letter form by connecting dots, namely, the Invented Letter Task (ILT). Multiple ILT-related transfer tasks were assessed at 24 h post-training and again at 4-5 weeks post-training. Although by the end of training the single-session practice group outperformed the multi-session practice group in speed and accuracy, at 24 h post-training both groups showed comparable gains. However, after multi-session practice, children were as fast or faster and more accurate in the transfer tasks. By 4-5 weeks post-training, the multi-session practice group showed larger gains in the trained condition, a speed advantage in the transfer tasks, and a significant improvement on the transfer tasks. The results suggest that parsing training over several brief sessions may lead to long-term gains in children's grapho-motor skills. Moreover, multi-session practice protocols may contribute to the potential for transfer and to more effective learning from experiences such as transfer tasks.
Assuntos
Escrita Manual , Destreza Motora , Criança , HumanosRESUMO
Optic nerve glioma is a rather rare tumor. It predominantly arises in pediatric patients, including those with type I neurofibromatosis. This neoplasm is accompanied by decreased visual function and exophthalmos. Treatment strategy is individualized depending on age, volume and spread of tumor, as well as severity of clinical manifestations. Possible treatment options are surgical resection, chemotherapy, radiotherapy and their combination. Radiotherapy can be recommended for patients with intact visual functions, no severe proptosis and trophic lesions. Classic fractionation mode is used as a standard. Currently, the possibility of hypofractionated irradiation is being considered. OBJECTIVE: To evaluate safety and efficacy of hypofractionated radiotherapy in patients with optic nerve glioma. MATERIAL AND METHODS: Sixteen patients with optic nerve gliomas underwent hypofractionated stereotactic irradiation (CyberKnife) between May 2014 and October 2019. Single focal dose was 5.5 Gy. There were 5 fractions up to total focal dose of 27.5 Gy. The sample enrolled 14 children with a median age of 4 years (range 23 months - 13 years) and 2 adults aged 47 and 66 years, respectively. Median of tumor volume was 2.77 cm3 (range 1.69-10.01 cm3). RESULTS: Tumor growth control was achieved in all patients, partial remission was observed in 5 (32%) patients. None patient had deterioration of visual function. Improvement of visual acuity was noted in 3 (19%) cases. Visual field enlargement occurred in 4 (67%) out of 6 patients who were preoperatively examined. After irradiation, proptosis decreased by ≥ 1 mm in 9 (60%) out of 15 patients.
Assuntos
Exoftalmia , Neoplasias , Glioma do Nervo Óptico , Radiocirurgia , Adulto , Criança , Pré-Escolar , Exoftalmia/etiologia , Humanos , Lactente , Glioma do Nervo Óptico/radioterapia , Glioma do Nervo Óptico/cirurgia , Hipofracionamento da Dose de Radiação , Radiocirurgia/efeitos adversos , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the results of combined management of large vestibular schwannomas (VS) with initial subtotal resection (STR) followed by adjuvant stereotactic radiosurgery (SRS), with a particular emphasis on the timing and regimen of irradiation. METHODS: Seventeen patients underwent STR of a VS followed by SRS, whereas five others were observed after STR. Early SRS (<6 months after surgery) and late SRS (>6 months after surgery) were done in 8 and 9 patients, respectively. Single- and multisession SRS treatments were administered in 10 and 7 patients, respectively. The mean follow-up durations after surgery and SRS were 40 and 28 months, respectively. RESULTS: The rates of radiological and oncological tumor control after SRS were 82% and 100%, respectively. The tumor volume at the last follow-up and its relative changes after SRS did not differ significantly on the basis of the irradiation timing (early versus late) or on the basis of the irradiation regimen (single-session versus multisession). In no patient who was observed after STR of a VS was tumor regrowth noted during a mean follow-up period of 49 months. At 12 months after surgery, motor function of the ipsilateral facial nerve corresponded to House-Brackmann grades I, II, III, and IV in 16 patients (73%), 3 patients (14%), 1 patient (5%), and 2 patients (9%), respectively. Facial nerve function at the last follow-up did not differ significantly on the basis of the irradiation timing (early versus late) or on the basis of the irradiation regimen (single-session versus multisession). CONCLUSION: The combination of initial STR followed by adjuvant SRS is an effective treatment strategy for patients with a large VS. Although the optimal timing and regimen of postoperative irradiation of the residual lesion should be defined further, our preliminary data suggest that either early or late SRS after surgery may provide good tumor control and optimal functional results.
Assuntos
Neuroma Acústico , Radiocirurgia , Nervo Facial , Seguimentos , Humanos , Neuroma Acústico/radioterapia , Neuroma Acústico/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Carga TumoralRESUMO
OBJECTIVE: Experience with management of craniopharyngiomas (CPH) was evaluated retrospectively. METHODS: Between 1981 and 2012, 100 patients underwent removal of a CPH (the main surgical group), and an original tumor grading system was applied to these cases. The mean length of follow-up was 121 months. Additionally, 17 patients underwent removal of a CPH between 2012 and 2017 (the supplementary surgical group), and in 6 of them, CyberKnife radiosurgery was performed on a residual tumor (in 5 cases) or at the time of recurrence (in 1 case). RESULTS: In the main surgical group, the gross total resection (GTR) rate was 81%. The early and late disease-specific postoperative mortality rates were 0% and 2%, respectively. Tumor recurrence was never noted after GTR. There was a statistically significant increase in the Karnofsky Performance Scale (KPS) score after surgery. The tumor surgical grade was inversely associated with both the pre- and postoperative KPS scores, and was lower in cases operated on via the transnasal transsphenoidal approach, but was unrelated to the GTR rate. In the supplementary surgical group, the GTR rate was 65%. CyberKnife radiosurgery consistently resulted in tumor shrinkage. CONCLUSION: GTR is the preferred management option for CPH. The original surgical grading system developed at Tokyo Women's Medical University may be helpful for clinical decision-making. CyberKnife radiosurgery for residual and recurrent CPH is associated with high tumor response rates.
Assuntos
Craniofaringioma , Neoplasias Hipofisárias , Radiocirurgia , Craniofaringioma/cirurgia , Feminino , Humanos , Recidiva Local de Neoplasia/cirurgia , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: Most recent literature has confirmed the efficacy of single-session radiosurgery (sRS) in the treatment of intracranial meningioma. Unfortunately, sRS is not always applicable due to large tumor volume and the proximity of the tumor to critical structures. When sRS is not recommended, multi-session radiosurgery (mRS) can be the solution. The best treatment schedule for mRS, however, is not well established. The aim of the present retrospective study is to validate the effectiveness of one approach, 25 Gy delivered in 5 fractions in 5 consecutive days, to treat skull base meningiomas. METHODS: This is a retrospective multicenter study. Patients with an anterior or a medium skull base meningioma that could not be treated by sRS due to large volume or proximity to the anterior optic pathways (AOPs) underwent 5-fraction mRS. Only patients with at least 36 months follow-up were included in the analysis. Local control and visual outcomes were investigated. RESULTS: One-hundred-sixty-seven patients were included in the analysis. One-hundred-one patients underwent RS as a primary indication and 66 were treated after a previous surgery. The median follow-up period was 51 months (range 36-129 months). Progression-free survival at 3, 5 and 8 years were, respectively, 98%, 94% and 90%. Excluding the progressive disease patients, the visual worsening rate was 3.7%. The 42% of the patients with a pre-treatment visual deficit experienced improvement in vision. CONCLUSION: 25 Gy delivered in 5 fractions is an effective modality for meningiomas that are near the AOP or are too large to be treated by sRS. The treatment schedule controlled the tumors while sparing visual function.
Assuntos
Neoplasias Meníngeas/mortalidade , Meningioma/mortalidade , Radiocirurgia/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/patologia , Meningioma/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Carga Tumoral , Adulto JovemRESUMO
PURPOSE: To evaluate the efficacy of Gamma Knife radiosurgery (GKS) in patients with large brain metastases by comparing single-session radiosurgery (S-GKS) and multisession radiosurgery (M-GKS), we retrospectively analyzed the clinical outcomes of patients who underwent GKS for brain metastases from non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Between January 2010 and December 2016, 66 patients with 74 lesions ≥10 cm3 from large brain metastases from only NSCLC were included. Fifty-five patients with 60 lesions were treated with S-GKS; 11 patients with 14 lesions were treated with M-GKS. Median doses were 16 Gy (range, 11-18 Gy) for the S-GKS group and 8 Gy (range, 7-10 Gy) in three fractions for the M-GKS group. RESULTS: With a mean follow-up period of 13.1 months (range, 1.3-76.4 months), the median survival duration was 21.1 months for all patients. Median tumor volume was 14.3 cm3 (range, 10.0-58.3 cm3). The local control rate was 77.0% and the progression-free survival rate was 73.6% at the last follow-up. There were no significant between-group differences in terms of local control rate (p = 0.10). Compared with S-GKS, M-GKS did not differ significantly in radiation-induced complications (38.1 vs. 45.4%, p =0.83). While 8 patients who underwent S-GKS experienced major complications of grade ≥3, no toxicity was observed in patients treated with M-GKS. CONCLUSIONS: M-GKS may be an effective alternative for large brain metastases from NSCLC. Specifically, severe radiation-induced toxicity (≥grade 3) did not occur in M-GKS for large-volume metastases. Although the long-term effects and results from larger samples remain unclear, M-GKS may be a suitable palliative treatment for preserving neurological function.
Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Carga Tumoral/fisiologiaRESUMO
The article describes the clinical observation of a 41-year-old woman suffering from non-Hodgkin's B-cell primary lymphoma of the central nervous system involving both eyes. The article features the data on 85-month follow-up, as well as description of the clinical and instrumental features of the disease. The study provides analysis of the long-term results of combined treatment of recurrent primary intraocular lymphoma including repeated courses of radiation therapy.
Assuntos
Linfoma Intraocular , Linfoma de Células B , Adulto , Feminino , Humanos , Linfoma Intraocular/diagnóstico , Linfoma de Células B/diagnóstico , Resultado do TratamentoRESUMO
This study aimed to explore the safety and efficacy of multisession gamma knife surgery (GKS) for large brain metastases with a volume of 10 cm3 or larger. Fifty-six patients who had 65 brain metastases with a volume of at least 10 cm3 were treated with multisession GKS. Three-session GKS at a prescription dose of 10 Gy to the tumor margin per session with a 2-week interval between doses was performed in 3 patients. Other patients were treated with 2-session GKS at a prescription dose of 10-13 Gy to the tumor margin per session with an interval of 1-4 weeks. The median tumor volume was 21 cm3. The median survival was 7 months. The 6-, 12-, and 18-month survival rates were 62, 42, and 31%, respectively. The progression-free survival rates at 6, 12, and 18 months were 93, 80, and 74%, respectively. At the time of the first and last GKS sessions, the median tumor volumes were 21 and 15 cm3, respectively, which decreased to 5 cm3 with a median follow-up period of 6 months. Seventy-four percent of evaluated patients who had pre-GKS clinical symptoms obtained symptomatic improvement in a mean interval of 2 months. Multisession GKS was a safe and effective alternative to surgical resection for patients who had brain metastases with a tumor volume of 10 cm3 or larger. Although long-term results remain unclear, multisession GKS may be a suitable palliative treatment to preserve neurological function.
Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/patologia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
To minimize cargo theft during transport, mobile radio frequency identification (RFID) grouping proof methods are generally employed to ensure the integrity of entire cargo loads. However, conventional grouping proofs cannot simultaneously generate grouping proofs for a specific group of RFID tags. The most serious problem of these methods is that nonexistent tags are included in the grouping proofs because of the considerable amount of time it takes to scan a high number of tags. Thus, applying grouping proof methods in the current logistics industry is difficult. To solve this problem, this paper proposes a method for generating multilayered offline grouping proofs. The proposed method provides tag anonymity; moreover, resolving disputes between recipients and transporters over the integrity of cargo deliveries can be expedited by generating grouping proofs and automatically authenticating the consistency between the receipt proof and pick proof. The proposed method can also protect against replay attacks, multi-session attacks, and concurrency attacks. Finally, experimental results verify that, compared with other methods for generating grouping proofs, the proposed method can efficiently generate offline grouping proofs involving several parties in a supply chain using mobile RFID.
RESUMO
Accurate and efficient non-rigid registration is important to investigate neural mechanisms in multi-session two-photon (2p) imaging across a few days. The 2p imaging recordings from different sessions usually possess certain complex misalignment or huge data variance due to relocation errors during experimental operations or brain recovery. Most of the reported neural image registration tools were able to solve the registration problem in the same session with small deformation. However, the registration of neural images across multi-sessions remains a challenge. In this study, we report the development of a non-rigid registration method for 2p imaging in mice based on image triangulation and piecewise affine transformation (TPAT) technologies. The TPAT method supported both automatic and semi-automatic operation types, and both showed great performance in the benchmark test of non-rigid neural image registration. The proposed method constitutes a step forward in promoting and accelerating discoveries from multi-session 2p imaging research.
Assuntos
Algoritmos , Encéfalo , Animais , Encéfalo/diagnóstico por imagem , Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Camundongos , FótonsRESUMO
Background: Motor imagery practice (MIP) and anodal transcranial direct current stimulation (a-tDCS) are innovative methods with independent positive influence on motor sequence learning (MSL) in older adults. Objective: The present study investigated the effect of MIP combined with a-tDCS over the primary motor cortex (M1) on the learning of a finger tapping sequence of the non-dominant hand in healthy older adults. Methods: Thirty participants participated in this double-blind sham-controlled study. They performed three MIP sessions, one session per day over three consecutive days and a retention test 1 week after the last training session. During training / MIP, participants had to mentally rehearse an 8-element finger tapping sequence with their left hand, concomitantly to either real (a-tDCS group) or sham stimulation (sham-tDCS group). Before and after MIP, as well as during the retention test, participants had to physically perform the same sequence as fast and accurately as possible. Results: Our main results showed that both groups (i) improved their performance during the first two training sessions, reflecting acquisition/on-line performance gains, (ii) stabilized their performance from one training day to another, reflecting off-line consolidation; as well as after 7 days without practice, reflecting retention, (iii) for all stages of MSL, there was no significant difference between the sham-tDCS and a-tDCS groups. Conclusion: This study highlights the usefulness of MIP in motor sequence learning for older adults. However, 1.5 mA a-tDCS did not enhance the beneficial effects of MIP, which adds to the inconsistency of results found in tDCS studies. Future work is needed to further explore the best conditions of use of tDCS to improve motor sequence learning with MIP.
RESUMO
BACKGROUND: This study examined whether a multisession gait-slip training could enhance reactive balance control and fall-resisting skills of people with chronic stroke (PwCS). METHODS: A total of 11 PwCS underwent a four-week treadmill-based gait-slip training (four sessions). Pre- and post-training assessment was performed on six intensities of gait-slips (levels 1-6). Training consisted of 10 blocks of each progressively increasing intensity (four trials per block) until participants fell at >2 trials per block (fall threshold). In the next session, training began at a sub-fall threshold and progressed further. Fall outcome and threshold, number of compensatory steps, multiple stepping threshold, progression to higher intensities, pre- and post-slip center of mass (CoM), state stability, clinical measures, and treadmill walking speed were analyzed. RESULTS: Post-training, PwCS demonstrated a reduction in falls and compensatory steps on levels 5 and 6 (p < 0.05) compared to pre-training. While an increase in pre-slip stability was limited to level 6 (p < 0.05), improvement in post-slip stability at lift-off was noted on levels 2, 3, and 5 (p < 0.05) along with improved post-slip minimum stability on levels 5 and 6 (p < 0.05). Post-training demonstrated improved fall (p < 0.05) and multiple stepping thresholds (p = 0.05). While most participants could progress to level 4 between the first and last training sessions, more participants progressed to level 6 (p < 0.05). Participants' treadmill walking speed increased (p < 0.05); however, clinical measures remained unchanged (p > 0.05). CONCLUSIONS: Multisession, progressively increasing intensity of treadmill-based gait-slip training appears to induce significant adaptive improvement in falls, compensatory stepping, and postural stability among PwCS.
RESUMO
The role of robotic radiosurgery (RRS) in the treatment of optic nerve sheath meningiomas (ONSM) remains controversial and it is only performed in specialized institutions due to tight dose constraints. We evaluated the effectiveness and safety of RRS in the management of ONSM. Twenty-five patients with 27 ONSM lesions who underwent RRS using the Cyberknife (CK) system were retrospectively analyzed (median age, 47.9 years; 84.0% women). Multisession RRS was used with 4-5 fractions with a cumulative dose of 20.0-25.0 Gy in 84.0% of patients and a single fraction at a dose of 14.0-15.0 Gy in 16% of patients. Prior to RRS, seven (28%) patients experienced blindness on the lesion side. In those patients with preserved vision prior to radiosurgery, the visual acuity remained the same in 90.0% and improved in 10.0% of the patients. Overall local tumor control was 96.0% (mean follow-up period; 37.4 ± 27.2 months). Neither patient age, previous surgery, or the period from the initial diagnosis to RRS showed a dependency on visual acuity before or after radiosurgery. RRS is a safe and effective treatment for the management of ONSM. Hypofractionation of radiosurgery in patients with preserved vision before CK treatment results in stable or improved vision.
RESUMO
BACKGROUND: Stereotactic radiosurgery (SRS) for benign intracranial meningiomas is an established treatment. OBJECTIVE: To summarize the literature and provide evidence-based practice guidelines on behalf of the International Stereotactic Radiosurgery Society (ISRS). METHODS: Articles in English specific to SRS for benign intracranial meningioma, published from January 1964 to April 2018, were systematically reviewed. Three electronic databases, PubMed, EMBASE, and the Cochrane Central Register, were searched. RESULTS: Out of the 2844 studies identified, 305 had a full text evaluation and 27 studies met the criteria to be included in this analysis. All but one were retrospective studies. The 10-yr local control (LC) rate ranged from 71% to 100%. The 10-yr progression-free-survival rate ranged from 55% to 97%. The prescription dose ranged typically between 12 and 15 Gy, delivered in a single fraction. Toxicity rate was generally low. CONCLUSION: The current literature supporting SRS for benign intracranial meningioma lacks level I and II evidence. However, when summarizing the large number of level III studies, it is clear that SRS can be recommended as an effective evidence-based treatment option (recommendation level II) for grade 1 meningioma.
Assuntos
Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Radiocirurgia/métodos , Feminino , Humanos , Masculino , Resultado do TratamentoRESUMO
This study investigated effects of multisession transcranial direct-current stimulation on learning and maintenance of novel memory content and scrutinised effects of baseline cognitive status and the role of multi-session tDCS on overnight memory consolidation. In a prospective, randomized, double-blind, parallel-group, sham-tDCS controlled design, 101 healthy young and older adults completed a five-day verbal associative learning paradigm while receiving multisession tDCS to the task-relevant left prefrontal cortex. In older adults, active multisession tDCS enhanced recall performance after each daily training session. Effects were maintained the next morning and during follow-up assessments (one week; three months). In young adults, multisession tDCS significantly increased long-term recall. Unlike previous findings in the motor domain, beneficial effects of multisession tDCS on cognitive learning and memory were notexclusively due to enhanced memory consolidation. Positive stimulation effects were primarily found in participants with lower baseline learning ability, suggesting that multisession tDCS may counteract memory impairment in health and disease.
Assuntos
Envelhecimento/fisiologia , Consolidação da Memória/fisiologia , Desempenho Psicomotor/fisiologia , Estimulação Transcraniana por Corrente Contínua/métodos , Aprendizagem Verbal/fisiologia , Adolescente , Idoso , Envelhecimento/psicologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Rememoração Mental/fisiologia , Pessoa de Meia-Idade , Córtex Pré-Frontal/fisiologia , Estudos Prospectivos , Estimulação Transcraniana por Corrente Contínua/psicologia , Adulto JovemRESUMO
There is a lack of multi-session P300 datasets for Brain-Computer Interfaces (BCI). Publicly available datasets are usually limited by small number of participants with few BCI sessions. In this sense, the lack of large, comprehensive datasets with various individuals and multiple sessions has limited advances in the development of more effective data processing and analysis methods for BCI systems. This is particularly evident to explore the feasibility of deep learning methods that require large datasets. Here we present the BCIAUT-P300 dataset, containing 15 autism spectrum disorder individuals undergoing 7 sessions of P300-based BCI joint-attention training, for a total of 105 sessions. The dataset was used for the 2019 IFMBE Scientific Challenge organized during MEDICON 2019 where, in two phases, teams from all over the world tried to achieve the best possible object-detection accuracy based on the P300 signals. This paper presents the characteristics of the dataset and the approaches followed by the 9 finalist teams during the competition. The winner obtained an average accuracy of 92.3% with a convolutional neural network based on EEGNet. The dataset is now publicly released and stands as a benchmark for future P300-based BCI algorithms based on multiple session data.
RESUMO
BACKGROUND: Acquired Brain Injury (ABI) admissions have an incidence of 385 per 100,000 of the population in the UK, and as brain injury often involves the frontal networks, cognitive domains affected are likely to be executive control, working memory, and problem-solving deficits, resulting in difficulty with everyday activities. The above observations make working memory, and related constructs such as attention and executive functioning attractive targets for neurorehabilitation. We propose a combined home-based rehabilitation protocol involving the concurrent administration of a working memory training program (adaptive N-back task) with non-invasive transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex to promote long-lasting modification of brain areas underlying working memory function. METHOD: Patients with a working memory deficit will be recruited and assigned to two age-matched groups receiving working memory training for 2 weeks: an active group, receiving tDCS (2 mA for 20 min), and a control group, receiving sham stimulation. After the end of the first 2 weeks, both groups will continue the working memory training for three more weeks. Outcome measures will be recorded at timepoints throughout the intervention, including baseline, after the 2 weeks of stimulation, at the end of the working memory training regimen and 1 month after the completion of the training. DISCUSSION: The aim of the study is to assess if non-invasive tDCS stimulation has an impact on performance and benefits of a working memory training regimen. Specifically, we will examine the impact of brain stimulation on training gains, if changes in gains would last, and whether changes in training performance transfer to other cognitive domains. Furthermore, we will explore whether training improvements impact on everyday life activities and how the home-based training regimen is received by participants, with the view to develop an effective home healthcare tool that could enhance working memory and daily functioning. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov: NCT04010149 on July 8, 2019.
Assuntos
Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/terapia , Cognição/fisiologia , Memória de Curto Prazo/fisiologia , Estimulação Transcraniana por Corrente Contínua , Adulto , Idoso , Encéfalo/fisiologia , Encéfalo/fisiopatologia , Lesões Encefálicas/reabilitação , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Single session radiosurgery represents a widely accepted treatment for intracranial meningiomas. However, this approach could involve a high risk of treatment-related complications when applied to large volume lesions. In these cases and for those not suitable for surgical resection, radiosurgery in multisession setting could represents a viable option. The literature results are reassuring in terms of correlated adverse events as well as in terms of tumor control. However, no prospective long-term results are available. In this scenario, we design a prospective monocentric phase II study, in order to verify the safety of a multisession radiosurgery schedule delivering 25 Gy in 5 daily fractions. METHODS: Patients diagnosed with large and/or near to critical structures, intracranial meningiomas have been treated by means of multisession radiosurgery in both exclusive and postoperative settings. The primary study aim is safety that has been being prospectively scored based on international scales, including NCI Common Toxicity criteria, version 4.03, Barrow Neurological Institute pain intensity score, Barrow Neurological Institute facial numbness score and House-Brackmann Facial Nerve Grading System for qualitative analysis. Secondary aim is treatment efficacy in terms of local control that has been being assessed on volumetric analysis. DISCUSSION: This is the first prospective phase II trial on multisession radiosurgery for large and/or near to critical structures intracranial meningiomas. If positive results will be found, this study could represent the starting point for a phase III trial exploring the role of multisession radiosurgery in the exclusive and postoperative radiation therapy treatment of intracranial meningiomas. TRIAL REGISTRATION: Trial registration: clinicaltrials.gov platform (Multisession Radiosurgery in Large Meningiomas -MuRaLM- identifier NCT02974127). Registered: November 28, 2016. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02974127?term=radiosurgery&cond=Intracranial+Meningioma&draw=2&rank=1.
Assuntos
Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Radiocirurgia/métodos , Fracionamento da Dose de Radiação , Humanos , Neoplasias Meníngeas/patologia , Meningioma/patologia , Estudos Prospectivos , Radiocirurgia/efeitos adversos , Segurança , Resultado do TratamentoRESUMO
The acquisition and retention of motor skills is necessary for everyday functioning in the elderly and may be critical in the context of motor rehabilitation. Recent studies indicate that motor training closely followed by sleep may result in better engagement of procedural ("how to") memory consolidation processes in the elderly. Nevertheless, elderly individuals are mostly morning oriented and a common practice is to time rehabilitation programs to morning hours. Here, we tested whether the time-of-day wherein training is afforded (morning, 8-10:30 a.m., or evening, 6-9 p.m.) affects the long-term outcome of a multi-session motor practice program (10 sessions across 3-4 weeks) in healthy elderly participants. Twenty-nine (15 women) older adults (60-75 years) practiced an explicitly instructed five-element key-press sequence by repeatedly generating the sequence "as fast and accurately as possible." The groups did not differ in terms of sleep habits and quality (1-week long actigraphy); all were morning-oriented individuals. All participants gained robustly from the intervention, shortening sequence tapping duration and retaining the gains (> 90%) at 1-month post-intervention, irrespective of the time-of-day of training. However, retesting at 7-months post-intervention showed that the attrition of the training induced gains was more pronounced in the morning trained group compared to the evening group (76 and 56.5% loss in sequence tapping time; 7/14 and 3/14 participants showed a > 5% decline in accuracy relative to end of training, respectively). Altogether, the results show that morning-oriented older adults effectively acquired skill in the performance of a sequence of finger movements, in both morning and evening practice sessions. However, evening training leads to a significant advantage, over morning training, in the long-term retention of the skill. Evening training should be considered an appropriate time window for motor skill learning in older adults, even in individuals with morning chronotype. The results are in line with the notion that motor training preceding a sleep interval may be better consolidated into long-term memory in the elderly, and thus result in lower forgetting rates.
RESUMO
PURPOSE: Repeat stereotactic radiosurgery (SRS) is an attractive alternative to whole brain radiation therapy (WBRT) for treatment of recurrent brain metastases (BM). The purpose of this study is to determine the cumulative doses to the brain and critical normal structures in patients who underwent repeat courses of Gamma Knife (GK) SRS. MATERIALS AND METHODS: We retrospectively identified ten patients who received at least three GK-SRS sessions for multiply recurrent BM at our institution from 2013 to 2016. We used Velocity™ 3.1.0 software to co-register the magnetic resonance imaging images and the dose data of all treatment sessions for each patient. The cumulative doses to brain, lenses, eyes, brainstem, optic nerves, chiasm, and hippocampi were calculated. Dose-volume histograms, as well as the mean, median and maximum doses of these structures, were analyzed. RESULTS: The median number of SRS was five sessions (range = 3-7 sessions) per patient over a median treatment span of 510 days (112-1,197 days), whereas the median number of metastatic tumors treated per patient was 25.0 (10-63). The median of the total tumor volume was 9.5 cc (2.3-75.9 cc). The median of the mean cumulative dose to the whole brain was 4.1 Gy (1.7-16.4 Gy). The medians of the maximum doses to the critical structures were as follows: brainstem, 6.1 Gy (2.2-28.9 Gy), chiasm, 3.9 Gy (1.8-10.8 Gy), right optic nerve, 2.9 Gy (1.2-9.0 Gy), and left optic nerve, 2.6 Gy (1.0-6.5 Gy). The medians of the mean and maximum cumulative doses to the hippocampi were 3.4 Gy (1.0-14.4 Gy) and 13.8 Gy (1.5-39.3 Gy), respectively. The median survival for the entire cohort was 26.7 months, and no patients developed radiation necrosis. CONCLUSION: Our study demonstrated that multisession GKSRS could be delivered with low cumulative doses to critical normal structures. Further studies are required to fully establish its role as an alternative treatment strategy to WBRT for the treatment of multiply recurrent BM.