RESUMO
Delayed radiation myelopathy (DRM) is a rare yet severe complication of radiotherapy. This condition has a progressive pattern that is often irreversible. Several therapeutic strategies have been introduced to alleviate disease complications, including corticosteroids, hyperbaric oxygen, anticoagulants, and antivascular endothelial growth factor (VEGF) agents. However, despite their beneficial effect, they have not been the definitive treatments for DRM. Here we present the case of a 55-year-old woman with a history of multiple myeloma who developed neurological complications 11 months after radiation therapy. As her radiologic findings demonstrated transverse myelitis, based on the DRM diagnostic criteria, the diagnosis of delayed radiation myelitis was reached. Therefore, methylprednisolone pulse therapy was initiated, resulting in the complete resolution of her neurological symptoms. However, on her follow-up examination, although she did not have new neurological complications, magnetic resonance imaging (MRI) demonstrated a residual enhancement in the thoracic spinal cord area. Hence, due to the possibility of myelitis progression and spinal cord atrophy, intravenous immune globulin (IVIG) was administered, resulting in the resolution of lesion enhancement. Considering this outcome and the immunomodulatory properties of IVIG, it could be regarded as a potential therapeutic option in the case of DRM activity.
RESUMO
BACKGROUND: Emotional competencies (i.e., understanding emotions in self and others) are crucial for psychological well-being and successful social interaction. However, despite the deficits in psychological well-being and social interaction among individuals with multiple sclerosis (MS), emotional competencies have not been broadly investigated in MS. The present study: (1) compared emotional competencies between persons with MS and (a) previously published norms for the general population and (b) persons with major depressive disorder; and (2) investigated the association between emotional competencies and symptoms of insomnia, depression, fatigue, and paresthesia in persons with MS. METHODS: The sample of 1135 persons with MS (mean age: 34.6 years; 81.1% female; median EDSS: 2; range: 0 - 5) self-rated emotional competencies and symptoms of insomnia, symptoms of depression, fatigue, and paresthesia. Data on emotional competencies of historical samples (general population: N = 622; mean age: 22.0 years; 61% females; outpatients with major depressive disorders (MDD); N = 50; mean age: 42.46 years; 68% females) were used for comparison. RESULTS: Persons with MS reported lower levels of emotional competencies than both the general population (t (1, 1756) = 55.18, p < 0.001, d = 1.66; large effect size) and outpatients with MDD (t (1, 1183) = 3.48, p <0.001, d = 0.50; medium effect size). Among persons with MS, lower levels of emotional competencies were associated with higher MS-related symptoms of insomnia(r = - 0.24; p < 0.001), depression (r = - 0.42; p < 0.001), fatigue (r = - 0.31; p < 0.001), and paresthesia (r = - 0.18; p < 0.001). CONCLUSIONS: Persons with MS reported significantly lower scores for emotional competencies when compared with the general population and outpatients with MDD. Further, lower scores for emotional competencies were associated with typical MS-related symptoms of insomnia, depression, fatigue and paresthesia. These findings suggest that emotional competencies may be an important target for intervention in persons with MS.
RESUMO
BACKGROUND: Compared to the general population, individuals with multiple sclerosis (MS) report higher levels of insomnia, depression, fatigue, and paresthesia, and lower levels of emotional competencies (understanding emotions in self and others). Available treatments are limited, and novel approaches to reducing symptoms and enhancing emotional competencies in MS are needed. Two potentially beneficial treatments are Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Stress Reduction (MBSR). The aim of the present study was to investigate the impact of ACT and MBSR on symptoms and emotional competencies in patients with MS. METHODS: A total of 76 individuals with MS (81.6% females; mean age: 38.88 years; EDSS median: 2; range: 0-5) were randomly assigned to an 8-week ACT treatment, an 8-week MBSR treatment, or a wait-list control condition. At baseline and study-end (week 8), participants completed a series of questionnaires covering symptoms and emotional competencies. At mid-term (week 4), participants rated their insomnia and depression. RESULTS: Over time, symptoms of MS decreased (medium effect size for insomnia, fatigue, and paresthesia, and large effect size for depression) and emotional competencies improved (large effect size), but more so in the MBSR and ACT conditions, compared with the control condition. At study-end, the outcome improvement did not differ between the ACT and MBSR conditions. CONCLUSIONS: Both ACT and MBSR led to reduced symptoms and enhanced emotional competencies. Psychotherapeutic interventions such as these should be considered as a means of decreasing symptoms and increasing emotional competencies among individuals with MS.
