A novel neuromodulation technique for the rehabilitation of balance and gait: A case study.

Cranial-nerve non-invasive neuromodulation (CN-NINM) through the tongue has been proposed as an adjuvant intervention to improve efficacy of rehabilitation. However, CN-NINM effects have only been explored in multiple sclerosis and stroke populations. In this report we used CN-NINM during a 2-week (2 × 1.5 h sessions daily) physiotherapy program for the rehabilitation of a 57 y/o woman presenting with balance and gait impairments after a surgical resection of a fourth ventricular ependymoma. Clinical and instrumented balance and gait assessments showed improved performance in all tests and without adverse effects This study shows the beneficial effects and feasibility of combined physiotherapy and CN-NINM in this patient.

Dolor lumbar en la adolescencia como presentación de un ependimoma: a propósito de un caso / Low back pain in adolescence as presentation of an ependymoma: a case report

Los ependimomas son neoplasias derivadas de las células gliales, representan el 13% de todos los tumores medulares. La localización varía con la edad, en la adolescencia asientan sobre todo en cauda equina, cono medular y filum terminal. Un 44% son intramedulares. Se presenta el caso de un varón de 13 años con lumbalgia, sin afectación neurológica asociada al inicio, al que se le realizó una resonancia magnética por la aparición de signos de alarma (persistencia en el tiempo, empeoramiento progresivo, mala respuesta a analgésicos y predominio nocturno). Se objetivó una lesión ocupante de espacio en filum terminal cuyo diagnóstico anatomopatológico fue de ependimoma mixopapilar. Fue resecado por completo. La recuperación tras la intervención quirúrgica y un programa de rehabilitación fue ad integrum. El crecimiento es lento, la clínica depende de su localización. El tratamiento de elección es la resección quirúrgica, y si esta no es posible se recurre a la radioterapia focal. El pronóstico tras el tratamiento depende de la situación neurológica previa y el tamaño del tumor. Suele precisar tratamiento rehabilitador asociado (AU)

Ependymomas are tumors derived from glial cells and represent 13% of all spinal tumors. The location varies with age. In adolescence, they occur mainly in the cauda ÿquine, conus and filum terminale. About 44% are intramedullary. We report the case of a 13-year-old boy with low back pain and no associated neurological complications initially. Magnetic resonance imaging was conducted due to the appearance of warning signs (persistence over time, progressive deterioration, poor response to analgesics and nocturnal predominance), and showed a space-occupying injury in the filum terminale. The pathological diagnosis was myxopapillary ependymoma. The tumor was completely resected. Recovery after the surgery and a rehabilitation program was ad integrum. These tumors are slow-growing. Symptoms depend on the location. The treatment of choice consists of complete surgical resection. If resection is not feasible, focal radiotherapy can be used. The prognosis after treatment depends mainly on prior neurological status and tumor size. Rehabilitation treatment is usually necessary (AU)

Intramedullary medullocervical ependymoma--surgical treatment, functional recovery, and long-term outcome.

To evaluate the long-term outcome and functional recovery of intramedullary medullocervical ependymoma (IME), the clinical charts of 38 surgically treated consecutive cases of IME were reviewed. Follow-up was obtained prospectively. The mean age of the patients (19 male and 19 female) was 35.3 years (range: 11-60 years). Complete resection was achieved in 33 (86.8%) patients. Fourteen patients worsened postoperatively; five and seven of these improved to their baseline levels within 1 and 3 months, respectively. By 1 year postoperatively, 17 patients returned to work. After a mean follow-up duration of 81.5 months, 31 patients improved or stabilized, and 3 had recurrence. The means of the modified McCormick grade (mMG) scores before the operation, at discharge, 1 year after the operation, and at the most recent evaluation were 1.76, 2.13, 1.82, and 1.84, respectively. A favorable long-term outcome of the mMG was associated with a good preoperative status (mMG I) (odds ratio [OR] = 9.956, p = 0.008) and well-defined tumor boundary (OR = 7.829, p = 0.035). Improvements in the postoperative walking dysfunction and paresthesia over time were associated with the absence of preoperative walking dysfunction (p = 0.047) and paresthesia (p = 0.028), respectively. The 12-year progression/recurrence-free survival and overall survival rates were 92.0% and 93.7%, respectively. The study suggests that the goal of surgery is to stabilize the preoperative neurological function and that a favorable outcome may be achieved in patients with good preoperative statuses and well-defined tumor boundaries. Surgery should be performed as soon as possible after the diagnoses and before the neurological functions deteriorate.

Language outcomes subsequent to treatment of brainstem tumour in childhood.

While the occurrence and management of brainstem tumours in children would not traditionally indicate potential direct structural impact on classical language centres, recent theories have implicated some involvement of the brainstem in a functional language and cognitive neural loop between the cerebellum and the cerebral hemispheres. Thus, the present paper explored the impact of treatment for brainstem tumour on the general and high-level language abilities of six children treated for brainstem tumour, in addition to phonological awareness skills. Group analysis revealed that children treated for brainstem tumour demonstrated intact language and phonological awareness abilities in comparison to an age- and gender-matched control group. Individual analysis revealed only one of six children treated for brainstem tumour revealed evidence of language disturbances, with an additional child demonstrating an isolated mildly reduced score on one phonological awareness task. Language deficits identified in a child treated with a combination of both radiotherapy and chemotherapy were noted in the high-level language area of lexical generation. Findings highlighted that no overt language disturbances were evident in children treated for brainstem tumour. However, further analysis into higher-level language skills in the present study indicated that both general and high-level language abilities require long-term monitoring in this population.

Intellectual outcome in children with malignant tumors of the posterior fossa: influence of the field of irradiation and quality of surgery.

The purpose of this study was to determine the respective parts played by cerebral hemisphere irradiation, posterior fossa irradiation, and surgery in the poor late functional results often observed in children treated for medulloblastoma. To do this we compared the intellectual outcome in a series of 59 children operated on for medulloblastoma, who had received whole-brain irradiation, to that observed in a series of 37 children operated on for ependymoma of the posterior fossa, who had received radiotherapy only on the posterior fossa. Only patients who had survived for more than 2 years without recurrence were included. At the assessment 1 year after treatment, intellectual outcome was somewhat better in the ependymoma group, but the difference was not statistically significant. At the long-term follow-ups at 5 and 10 years the results remained stable in the children treated for ependymoma, around 60% having an IQ above 90, whereas the intellectual level of the children treated for medulloblastoma was seen to have deteriorated progressively: 20% had an IQ above 90 5 years after treatment and only 10% at the 10-year follow-up. This progressive degradation is most likely due to the irradiation of the cerebral hemispheres, as this prophylactic irradiation constituted the only difference between the two groups. Moreover, irradiation to the posterior fossa did not seem to affect intellectual functions, since in the group of children with ependymomas the proportion of IQs above 90 was high and remained stable over the years. Surgery was certainly responsible for some poor results. The percentage of IQs above 90 observed 1-2 years after treatment was between 70 and 80 when no postoperative complications occurred, and only between 20-40% in the presence of postoperative complications. Postoperative aggravation was in most cases related to a brain-stem lesion. These results encourage the reduction, when possible, of irradiation to the cerebral hemispheres and underline the importance of the quality of surgery.