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1.
BMC Neurol ; 22(1): 250, 2022 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-35804291

RESUMO

INTRODUCTION: In seizure-naive brain tumor patients, the efficacy of perioperative prophylactic antiepileptic drug treatment remains controversial. In case of administration, the common preferred drug is levetiracetam (LEV) because of its favorable pharmacological profile. Research to date has not sufficiently determined how LEV affects cognition in the short term, as is the case in the perioperative period. The objective of this prospective study was to examine the neurocognitive functioning of seizure-naive brain tumor patients after receiving LEV perioperatively. METHODS: Fortythree patients with supratentorial brain tumor scheduled for surgery received LEV three days before until six days after surgery as seizure prophylaxis. Cognitive functioning (NeuroCogFX), LEV plasma-levels, hematotoxicity, side-effects, as well as health-related quality of life (HRQoL, Qolie31), were recorded preoperatively before (Baseline) and after onset of LEV (Pre-Op), 4-6 days postoperatively (Post-Op) and 21 days postoperatively (Follow-Up). RESULTS: No significant changes in cognitive functioning and HRQoL were seen after onset of preoperative LEV. There was a significant improvement of NeuroCogFX total-score at Follow-Up (p = 0.004) compared to Baseline. The overall-score Qolie31 showed simultaneous improvement patterns as cognitive functioning (p < 0.001). The most frequent side effect related to study drug was somnolence (in 28.6% of patients). CONCLUSIONS: A significant improvement of cognitive functioning, as well as an improvement in HRQoL, were detected postoperatively. This is presumably due to the debulking effect of the surgery. Nevertheless, LEV has no detrimental effect on cognitive functioning in the perioperative phase in seizure-naive brain tumor patients. TRIAL REGISTRATION: This study was registered prospectively (Date: 25/11/2015; EudraCT: 2015-003,916-19).


Assuntos
Neoplasias Encefálicas , Piracetam , Neoplasias Supratentoriais , Anticonvulsivantes/uso terapêutico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/cirurgia , Humanos , Levetiracetam/uso terapêutico , Piracetam/uso terapêutico , Estudos Prospectivos , Qualidade de Vida , Convulsões/tratamento farmacológico , Convulsões/etiologia , Convulsões/prevenção & controle
2.
Am J Hosp Palliat Care ; 33(10): 985-988, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26472939

RESUMO

BACKGROUND: High-grade gliomas are the most frequent primary brain tumors. Despite improvement in diagnostics and treatment, survival is still poor and quality-of-life issues are of major importance. Little is known regarding the clinical signs and symptoms of dying patients with glioblastoma. OBJECTIVE: The aim of this study was to investigate signs and symptoms as well as therapeutic strategies in patients with glioblastoma in the end-of-life phase in order to improve end-of-life care. METHODS: In this prospective single-center study, clinical data were obtained using a standardized protocol. We descriptively analyzed signs, symptoms, and therapeutic strategies on a daily basis. RESULTS: A total of 57 patients, who died due to glioblastoma in a hospital setting, were included. The most frequent signs and symptoms in the last 10 days before death were decrease in level of consciousness (95%), fever (88%), dysphagia (65%), seizures (65%), and headache (33%). Concerning medication, 95% received opioids. There was a high need for nonsteroidal anti-inflammatory drugs (77%) and anticonvulsants (75%). Steroids were given to 56%. CONCLUSION: Due to a decrease in level of consciousness and cognitive impairment, assessment of clinical signs and symptoms such as headache at the end of life is difficult. Based on the signs and symptoms in the last days before death in patients with glioblastoma, supportive drug treatment remains challenging. Our study emphasizes the importance of standardized guidelines for end-of-life care in patients with glioblastoma.


Assuntos
Neoplasias Encefálicas/fisiopatologia , Glioblastoma/fisiopatologia , Convulsões/tratamento farmacológico , Assistência Terminal/métodos , Corticosteroides/administração & dosagem , Idoso , Analgésicos Opioides/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Anticonvulsivantes/administração & dosagem , Neoplasias Encefálicas/complicações , Transtornos de Deglutição/etiologia , Feminino , Febre/tratamento farmacológico , Febre/etiologia , Hidratação , Glioblastoma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Estudos Prospectivos , Qualidade de Vida , Convulsões/etiologia , Inconsciência/etiologia , Sinais Vitais
3.
J Brachial Plex Peripher Nerve Inj ; 10(1): e53-e56, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27917240

RESUMO

INTRODUCTION: The Pancoast syndrome (PS) has been termed after Henry Pancoast. Its neurologic core symptoms include pain, radicular sensory and motor syndromes, and Horner syndrome. A PS is often the presenting sign of lung cancer and bears a grim prognosis. METHODS: This case report describes an atypical onset of a lung tumor causing a PS. Electrophysiological examination was not conclusive. The diagnosis was confirmed by MRI, CT scan, and biopsy. The intervention consisted of preoperative chemo- and radiotherapy and was followed by an extensive surgical approach with histologically confirmed perineural invasion of the brachial plexus. RESULTS: The postoperative period was dominated by neuropathic pain. Despite considerable loss of distal sensorimotor function of the right hand, the patient uses the extremity and has returned to professional life. DISCUSSION: This observation triggered by the advances in general oncology and surgery also demonstrates the management of a lesion of the peripheral nervous system caused by cancer.

4.
Handb Clin Neurol ; 126: 317-33, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25410231

RESUMO

Neuropathy is a highly prevalent complication of diabetes that is only likely to increase as the diabetic epidemic continues. Unfortunately, the only disease-modifying treatment is to address the underlying diabetes with enhanced glucose control. In patients with type 1 diabetes, improved glycemic control dramatically reduces the incidence of neuropathy. In contrast, in patients with type 2 diabetes, better glucose control has only a marginal effect on the prevention of neuropathy. However, recognition and treatment of neuropathic pain is also important. An ever expanding number of randomized, controlled clinical trials support multiple medications for the reduction of pain. This includes medications such as calcium channel agonists, tricyclic antidepressants, and selective serotonin/norepinephrine reuptake inhibitors. However, the precise order and combination of these medications remains unclear. Furthermore, several new promising medications are being developed. Overall, the cornerstones of the treatment of diabetic neuropathy are improved glycemic control and initiation of a neuropathic pain medication with high levels of evidence to support its use when pain is present.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Neuropatias Diabéticas/terapia , Neuralgia/terapia , Analgésicos Opioides/administração & dosagem , Animais , Capsaicina/administração & dosagem , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/epidemiologia , Humanos , Neuralgia/diagnóstico , Neuralgia/epidemiologia
5.
Neurol Clin Pract ; 3(2): 90-98, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23914318

RESUMO

Peripheral neuropathy is a common disorder, often prompting an extensive initial laboratory evaluation. The initial evaluation is particularly challenging to primary care physicians and neurologists because of the broad differential diagnosis. Although screening thyroid and rheumatologic tests are frequently ordered, the diagnostic yield of these tests is unclear. Data from our institution were collected on patient demographics, clinical characteristics including warning signs suggestive of a diagnosis other than distal symmetric polyneuropathy, history of thyroid or rheumatologic disease, and laboratory tests ordered. Thyroid and rheumatologic screening tests are commonly ordered in the evaluation of peripheral neuropathy. Our findings suggest a low aggregate value of these tests based on low yield and infrequent changes in the suspected etiology or management of these patients.

6.
Handb Clin Neurol ; 115: 591-606, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23931804

RESUMO

More than half of all patients with diabetes develop neuropathic disorders affecting the distal sensory and/or motor nerves, or autonomic or cranial nerve functions. Glycemic control can decrease the incidence of neuropathy but is not adequate alone to prevent or treat the disease. This chapter introduces diabetic neuropathy with a morphological description of the disease then describes our current understanding of metabolic and molecular mechanisms that contribute to neurovascular dysfunctions. Key mechanisms include glucose and lipid imbalances and insulin resistance that are interconnected via oxidative stress, inflammation, and altered gene expression. These complex interactions should be considered for the development of new treatment strategies against the onset or progression of neuropathy. Advances in understanding the combined metabolic stressors and the novel study of epigenetics suggest new therapeutic targets to combat this morbid and intractable disease affecting millions of patients with type 1 or type 2 diabetes.


Assuntos
Biologia , Neuropatias Diabéticas , Neuropatias Diabéticas/metabolismo , Neuropatias Diabéticas/patologia , Neuropatias Diabéticas/fisiopatologia , Humanos , Insulina/metabolismo , Condução Nervosa/fisiologia , Estresse Oxidativo , Nervos Periféricos/patologia
8.
J Neurooncol ; 112(3): 403-11, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23412776

RESUMO

Glioblastoma multiforme (GBM) still harbors a fatal prognosis. The involvement of the neurocognition and psyche poses unique challenges for care provision by relatives. We lack data about the caregivers' perspective on the end-of-life (EOL) phase of GBM patients to improve counseling and support. In this study we investigated the experiences of 52 caregivers of deceased GBM patients treated in Austria. We used a questionnaire developed by the University Medical Centre of Amsterdam for exploration of the EOL-phase in glioma patients. The caregivers (17 men, 34 women) completed the questionnaire in median three years after the patients' death. 29 % of caregivers reported that they felt incompletely prepared for their tasks, however, those with higher education levels felt significantly better informed. 29 % suffered from financial difficulties, which was associated with burnout (60 %) and reduced quality of life (QOL). The patients' most common symptoms reported by caregivers were fatigue (87 %), reduced consciousness (81 %) and aphasia (77 %). 22 % of patients were bedbound during their last three months increasing to 80 % in the last week of life. The reported QOL of caregivers was very low and did not differ between caregivers of patients, who died at home (40 %) and caregivers of patients, who died in hospital (46 %). The caregiver reported that their QOL was only slightly better than the QOL they attributed to the patients. Furthermore, the high frequency of financial difficulties, burnout symptoms and feelings of insufficient information emphasize the urgent need for support and training dedicated to caregivers.


Assuntos
Neoplasias Encefálicas , Cuidadores/psicologia , Glioblastoma , Qualidade de Vida , Assistência Terminal/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/psicologia , Cuidadores/estatística & dados numéricos , Feminino , Glioblastoma/mortalidade , Glioblastoma/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Assistência Terminal/estatística & dados numéricos
9.
J Neurooncol ; 110(2): 221-6, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22886532

RESUMO

Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults. Compared with other malignancies, remote metastases in GBM are rare. However, multicentric spreading within the central nervous system is common and also metastases to the spinal cord have been reported. Some of these drop metastases may also lead to malignant spinal cord compression (MSCC). We retrospectively identified nine patients from 2001 to 2010 and performed data analysis according to a standardized clinical protocol. We also provide a review of the literature on this rare condition. MSCC from cerebral GBM is rare and is found in approximately 1 % of GBM patients. Median age of 54 years in this case series is comparable with that of GBM patients without MSCC. Treatment regimens for cerebral GBM and overall survival was similar to those for patients without MSCC. Spinal metastasis seems to occur in the advanced state of the disease, and the outcome subsequently is extremely poor. All patients presented with multicentric radiological features of GBM on cerebral MRI when MSCC was diagnosed. Subependymal enhancement is another common radiological finding in GBM patients with spinal drop metastases. Steroids and focal radiotherapy were used to treat all patients, with little clinical benefit. This study is the largest case series of MSCC from cerebral GBM. Multicentric cerebral distribution and subependymal enhancement of GBM are observed on cerebral MRI at the time of MSCC. On the basis of our results, no specific treatment recommendations for MSCC in GBM patients can be given. However, accurate diagnosis of MSCC in GBM patients with spinal signs and symptoms can lead to adequate management of symptoms and improvement of quality of life in terms of best palliative care.


Assuntos
Neoplasias Encefálicas/patologia , Glioblastoma/patologia , Compressão da Medula Espinal/patologia , Neoplasias da Medula Espinal/patologia , Adulto , Idoso , Neoplasias Encefálicas/complicações , Feminino , Glioblastoma/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Literatura de Revisão como Assunto , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/etiologia
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