ABSTRACT
Imatinib, a tyrosine kinase inhibitor, is the mainstay of treatment for resected high-risk (adjuvant and metastatic) gastrointestinal stromal tumour (GIST) - a rare form of sarcoma. There has been recent research into the neuroprotective role and modulation of dopaminergic neurones by imatinib through the abl pathway in Parkinson's disease (PD). We describe two patients from a single cancer centre with concurrent diagnoses of PD and metastatic GIST receiving imatinib and standard PD management. The cases highlight a potential reduction in PD progression using Unified Parkinson's Disease Rating Scale. Further research into repurposing of imatinib for PD may provide additional management options for this neurodegenerative illness.
Subject(s)
Antineoplastic Agents/therapeutic use , Gastrointestinal Stromal Tumors/drug therapy , Imatinib Mesylate/therapeutic use , Liver Neoplasms/drug therapy , Parkinson Disease/drug therapy , Stomach Neoplasms/therapy , Aged , Antiparkinson Agents/therapeutic use , Carbidopa/therapeutic use , Drug Combinations , Gastrectomy , Gastrointestinal Stromal Tumors/complications , Gastrointestinal Stromal Tumors/secondary , Humans , Levodopa/therapeutic use , Liver Neoplasms/complications , Liver Neoplasms/secondary , Male , Parkinson Disease/complications , Severity of Illness Index , Stomach Neoplasms/complications , Stomach Neoplasms/pathologyABSTRACT
UNLABELLED: Symptomatic intracerebral haemorrhage following thrombolysis for ischaemic stroke causes significant morbidity and mortality. This study assessed which of four risk scores (SEDAN, HAT, GRASPS and SITS) best predicts symptomatic intracerebral haemorrhage. METHODS: Data from 431 patients treated at Aberdeen Royal Infirmary (2003-2013) were extracted from a thrombolysis database. Score performance was compared using area under the curve. RESULTS: Any intracerebral haemorrhage occurred in 12% of patients (53/413); 11% fulfilling the SITS-MOST symptomatic intracerebral haemorrhage definition (6/53), 34% the ECASS II definition (18/53), and 43% the National Institute of Neurological Disorder and Stroke definition (23/53). Stroke severity, as defined by the National Institutes of Health Stroke Scale, significantly improved after 24 hours in patients without intracerebral haemorrhage, but not in those with. Significant symptomatic intracerebral haemorrhage predictors were age, glucose, stroke severity, hyperdense middle cerebral artery on CT scan, ASPECTS score and anti-platelet therapy. The haemorrhage after thrombolysis score performed best at predicting symptomatic intracerebral haemorrhage (area under the curve 0.67-0.78, p < 0.001). CONCLUSION: The haemorrhage after thrombolysis score uses the least variables and has the best predictive value for symptomatic intracerebral haemorrhage. Using predictive scores for clinical decision making depends on estimation of overall benefits as well as risk.
