Analysis of Toxicity in Patients with Collagen Vascular Diseases or Multiple Sclerosis Treated with Gamma Knife Radiosurgery for Intracranial Tumors

ObjectiveReadmission is used as a quality indicator and is the primary target outcome for disease-modifying therapy (DMT) for multiple sclerosis (MS). However, data on readmissions for patients with MS are limited.MethodsUsing the US Nationwide Readmissions Database, we performed a retrospective cohort study of adults hospitalized for MS in 2014. Primary study outcomes were within 30- and 90-day readmissions. Descriptive analyses compared patient, clinical, and hospital variables readmission status. Multivariable logistic regression models estimated the associations between these variables and readmission.ResultsOf 16,629 individuals meeting the study criteria, most were women (73.7%), aged 35–54 years (48.0%), and Medicare program participants (36.8%). In total, 49.7% of inpatients with MS had 1–2 comorbid medical conditions and 23.7% had 3 or more. Having 3 or more comorbidity conditions associated with increased adjusted odds of the 30-day readmission (adjusted odds ratio [AOR] 1.92, 1.34–2.74). Anemia (AOR 1.62, 1.22–2.14), rheumatoid arthritis/collagen vascular diseases (AOR 2.20, 1.45–3.33), congestive heart failure (AOR 2.43, 1.39–4.24), chronic pulmonary disease (AOR 1.35, 1.02–1.78), diabetes with complications (AOR 2.27, 1.45–3.56), hypertension (AOR 1.25, 1.03–1.53), obesity (AOR 1.35, 1.05–1.73), and renal failure (AOR 1.68, 1.06–2.67) were associated with the 30-day readmission. Medicare insurance and nonroutine discharge were also associated with readmission, whereas patient characteristics (sex, age, and socioeconomic status) were not. The most frequent (26.7%) reason for readmission was multiple sclerosis. Ninety-day analyses produced similar findings.ConclusionsComorbid diseases were associated with the readmission for persons with multiple sclerosis. Evaluations of the real-world effectiveness for DMTs in reducing hospitalizations in patients with MS may need to consider comorbid disease burden and management.

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Commentary: Gamma Knife Radiosurgery for Multiple Sclerosis-Associated Trigeminal Neuralgia

Neurosurgery ◽

10.1093/neuros/nyz277 ◽

2019 ◽

Vol 85 (5) ◽

pp. E941-E942

Author(s):

Andrew Song ◽

Wenyin Shi ◽

Simon S Lo ◽

Richard Ellenbogen ◽

Andrew L Ko

Keyword(s):

Multiple Sclerosis ◽

Trigeminal Neuralgia ◽

Gamma Knife ◽

Gamma Knife Radiosurgery

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Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis

Journal of Neurosurgery ◽

10.3171/jns.2002.97.supplement_5.0529 ◽

2002 ◽

Vol 97 ◽

pp. 529-532 ◽

Cited By ~ 70

Author(s):

C. Leland Rogers ◽

Andrew G. Shetter ◽

Francisco A. Ponce ◽

Jeffrey A. Fiedler ◽

Kris A. Smith ◽

...

Keyword(s):

Multiple Sclerosis ◽

Pain Relief ◽

Trigeminal Neuralgia ◽

Gamma Knife ◽

Maximum Dose ◽

Gamma Knife Radiosurgery ◽

Content Type ◽

Experienced Pain ◽

The Mean ◽

Fine Print

Object. The authors assessed the efficacy and complications from gamma knife radiosurgery (GKS) for multiple sclerosis (MS)-associated trigeminal neuralgia (TN). Methods. There were 15 patients with MS-associated TN (MS—TN). Treatment involved three sequential protocols, 70 to 90-Gy maximum dose, using a single 4-mm isocenter targeting the ipsilateral trigeminal nerve at its junction with the pons with the 50% isodose. Pain was appraised by each patient by using Barrow Neurological Institute (BNI) Scores I through IV: I, no pain; II, occasional pain not requiring medication; IIIa, no pain but continued medication; IIIb, some pain, controlled with medication; IV, some pain, not controlled with medication; and V, severe pain/no pain relief. With a mean follow up of 17 months (range 6–38 months), 12 (80%) of 15 patients experienced pain relief. Three patients (20%) reported no relief (BNI Score V). For responders, the mean latency from treatment to the onset of pain relief was 13 days (range 1–61 days). Maximal relief was achieved after a mean latency of 56 days (range 1–157 days). Five patients underwent a second GKS after a mean interval of 534 days (range 231–946 days). The mean maximum dose at this second treatment was 48 Gy. The target was unchanged from the first treatment. All five patients who underwent repeated GKS improved. Complications were limited to delayed facial hypesthesias. Two (13%) of 15 patients experienced onset of numbness after the first GKS, as well as two of five patients following a second GKS. The patients found this mild and not bothersome. Each patient who developed hypesthesias also experienced complete pain relief. Conclusions. Gamma knife radiosurgery is an effective treatment for MS—TN. Radiosurgery carries an acceptable small risk of mild facial hypesthesias, and hypesthesia appears predictive of a favorable outcome.

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