Convulsion in a Pregnant Woman

2017 ◽  
Author(s):  
Eudocia Q. Lee
Keyword(s):  
Brain Tumors ◽  
Multidisciplinary Approach ◽  
Medical Oncology ◽  
Low Grade ◽  
Chemotherapeutic Drugs ◽  
Maternal Fetal Medicine ◽  
Ethical Implications ◽  
Patient Gender ◽  
In Pregnancy

The management and treatment of brain tumors is the same regardless of patient gender, except when considering fertility and pregnancy. Fortunately, brain tumors are rare during pregnancy. Because the lives of the mother and the fetus may be at risk, the care of pregnant women with brain tumors has ethical implications and requires a multidisciplinary approach involving obstetrics, maternal-fetal medicine, neurosurgery, anesthesiology, neurology, medical oncology, and radiation oncology. Chemotherapy and radiation are generally considered incompatible with normal fetal development. Only a few chemotherapeutic drugs have been tested in pregnancy, and therefore most are considered contraindicated during pregnancy. Radiation can have long-term implications for the fetus, including increased risks of cancer and mental retardation. This chapter will review the management of low-grade gliomas in pregnancy.

scholarly journals Long-term surgical outcomes of temporal lobe epilepsy associated with low-grade brain tumors

Cancer ◽  
2009 ◽  
Vol 115 (24) ◽  
pp. 5771-5779 ◽  
Author(s):  
Ji Hoon Phi ◽  
Seung-Ki Kim ◽  
Byung-Kyu Cho ◽  
Seo Young Lee ◽  
Su Yeon Park ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Surgical Outcomes ◽  
Low Grade

Secondary brain tumors in children treated for acute lymphoblastic leukemia at St Jude Children's Research Hospital.

1998 ◽  
Vol 16 (12) ◽  
pp. 3761-3767 ◽  
Author(s):  
A W Walter ◽  
M L Hancock ◽  
C H Pui ◽  
M M Hudson ◽  
J S Ochs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Brain Tumors ◽  
Lymphoblastic Leukemia ◽  
Low Grade ◽  
High Grade ◽  
Research Hospital ◽  
Dose Dependent

PURPOSE To evaluate the incidence of and potential risk factors for second malignant neoplasms of the brain following treatment for childhood acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS The study population consisted of 1,612 consecutively enrolled protocol patients treated on sequential institutional protocols for newly diagnosed ALL at St Jude Children's Research Hospital (SJCRH) between 1967 and 1988. The median follow-up duration is 15.9 years (range, 5.5 to 29.9 y). RESULTS The cumulative incidence of brain tumors at 20 years is 1.39% (95% confidence interval [CI], 0.63% to 2.15%). Twenty-two brain tumors (10 high-grade gliomas, one low-grade glioma, and 11 meningiomas) were diagnosed among 21 patients after a median latency of 12.6 years (high-grade gliomas, 9.1 years; meningiomas, 19 years). Tumor type was linked to outcome, with patients who developed high-grade tumors doing poorly and those who developed low-grade tumors doing well. Risk factors for developing any secondary brain tumor included the presence of CNS leukemia at diagnosis, treatment on Total X therapy, and the use of cranial irradiation, which was dose-dependent. Age less than 6 years was associated with an increased risk of developing a high-grade glioma. CONCLUSION This single-institution study, with a high rate of long-term data capture, demonstrated that brain tumors are a rare, late complication of therapy for ALL. We report many more low-grade tumors than others probably because of exhaustive long-term follow-up evaluation. The importance of limiting cranial radiation is underscored by the dose-dependent tumorigenic effect of radiation therapy seen in this study.

Long-Term Neurological and Neurosurgical Outcomes After Surgery Only in Children with Low-Grade Brain Tumors

2008 ◽  
Vol 1 (4) ◽  
pp. A354-A355 ◽  
Author(s):  
Liliana Goumnerova ◽  
Dan Drzymalski ◽  
Mark Kieran ◽  
Scott Pomeroy ◽  
R. Michael Scott ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Tumor Recurrence ◽  
Treatment Options ◽  
Low Grade ◽  
Neurological Sequelae ◽  
Institutional Review ◽  
Initial Surgery ◽  
Extent Of Surgery

Introduction Brain tumors are the most common solid tumors of childhood. As treatment options such as surgery, chemotherapy, and radiotherapy improve, and affected children's survival increases, the focus has shifted toward understanding long-term outcomes. We hypothesized that tumor recurrence and long-term neurological outcomes can be correlated with age at diagnosis, site and size of tumor, histology, extent of surgery, and presence or absence of hydrocephalus. Thus, the aims of this study were to determine predictive factors for tumor recurrence and long-term morbidity in children who undergo surgery only for low-grade brain tumors. The study was approved by the institutional review board. Methods Medical records were reviewed for each child and information collected regarding sex, age at surgery, histology site, size of tumor, presence of hydrocephalus, extent of surgery, and date of tumor recurrence. Preoperative, postoperative, and last follow-up neurological exams were reviewed and patients were evaluated for ataxia, hemiparesis, impaired vision, cranial nerve deficits, presence of seizures or headaches, dysmetria, nystagmus, and depression. Results Forty-nine children (29 male, 20 female) ranging from 2.2 to 16.9 years of age at first operation were included; 31% had recurrence/progression. This was significantly correlated with tumors that were subtotally resected (p = 0.002) located in the supratentorial region (p = 0.017) and not astrocytoma or craniopharyngioma (p = 0.041). At last follow-up, 42% of children had no neurological sequelae, 53% had mild neurological sequelae, and 5% had moderate neurological sequelae. No children had experienced depression before or immediately after their initial surgery. However, 6 patients (16% of 38 patients) had depression at long-term follow-up. Conclusion These data indicate that we may be able to predict recurrence/progression of low-grade brain tumors based on extent of surgery location and histology. We also see that more than half of these children will experience a variety of surgical and neurological burdens throughout their lives.

scholarly journals Hippocampal radiotherapy dose constraints for predicting long-term neurocognitive outcomes: mature data from a prospective trial in young patients with brain tumors

2020 ◽  
Vol 22 (11) ◽  
pp. 1677-1685 ◽  
Author(s):  
Jayant S Goda ◽  
Debnarayan Dutta ◽  
Uday Krishna ◽  
Savita Goswami ◽  
Vikas Kothavade ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Intelligence Quotient ◽  
Young Patients ◽  
Low Grade ◽  
Histologic Subtype ◽  
Left Hippocampus ◽  
Dose Constraint ◽  
Dose Constraints ◽  
Radiotherapy Dose

Abstract Background Hippocampus is considered to be the seat for neurocognitive functions. Avoidance of hippocampus during radiotherapy to brain may serve to preserve various domains of neurocognition. We aimed to derive radiotherapy dose constraints to hippocampi for preserving neurocognition in young patients with brain tumors by measuring various neurocognitive parameters. Methods Forty-eight patients with residual/progressive benign or low-grade brain tumors treated with stereotactic conformal radiotherapy (SCRT) to a dose of 54 Gy in 30 fractions underwent prospective neuropsychological assessments at baseline before SCRT and at 6 months and 2, 3, 4, and 5 years. Hippocampi were drawn as per the Radiation Therapy Oncology Group atlas. Longitudinal change in intelligence quotient scores was correlated with hippocampal doses. Results Mean volume of bilateral hippocampi was 4.35 cc (range: 2.12–8.41 cc). Craniopharyngioma was the commonest histologic subtype. A drop of >10% in mean full-scale intelligence quotient (FSIQ) scores at 3 and 5 years post SCRT was observed in patients in whom left hippocampus received a mean dose of 30.7 Gy (P = 0.04) and 31 Gy (P = 0.04), respectively. Mean performance quotient (PQ) scores dropped > 10% at 5 years when the left hippocampus received a dose of > 32 Gy (P = 0.03). There was no significant correlation of radiotherapy doses with verbal quotient, or with doses received by the right hippocampus. Multivariate analysis revealed young age (<13 y) and left hippocampus dose predicted for clinically relevant decline in certain neurocognitive domains. Conclusions A mean dose of ≤30 Gy to the left hippocampus as a dose constraint for preserving intelligence quotient is suggested. Key Points 1. Children and young adults with benign and low-grade gliomas survive long after therapy. 2. Higher dose to the hippocampi may result in long-term neurocognitive impairment. 3. Mean dose of <30 Gy to left hippocampus could be used as a pragmatic dose constraint to prevent long-term neurocognitive decline.

scholarly journals A Case Presentation on Seizure Disorder (Epilepsy during Pregnancy)

2018 ◽  
Vol 08 (01) ◽  
pp. 52-55
Author(s):  
A. Jeyasudha ◽  
B. Sree Renjini ◽  
Sanjana S. ◽  
Keyword(s):  
Differential Diagnosis ◽  
Pregnant Women ◽  
Multidisciplinary Approach ◽  
Perinatal Outcomes ◽  
Medical Providers ◽  
Case Presentation ◽  
Stepwise Approach ◽  
Timely Fashion ◽  
In Pregnancy

AbstractSeizures during pregnancy complicate <1% of all gestations; however, they are associated with increased adverse maternal and perinatal outcomes (acute and long term). The differential diagnosis of seizures in pregnancy is extensive. Determining the underlying etiology is crucial in the management of these patients. Medical providers caring for pregnant women should be educated about possible etiologies of seizures during pregnancy and the importance of prompt management of these women in a timely fashion. Evaluation and management should be performed in a stepwise fashion and may require a multidisciplinary approach with other specialties such as neurology. Objective: The objective of this article is to increase awareness and to provide a stepwise approach toward the diagnosis and management of pregnancies complicated by seizures.

scholarly journals Life-long persistence of infectious Zika virus: inflammation and behavioral sequela

2020 ◽  
Author(s):  
Derek D.C. Ireland ◽  
Mohanraj Manangeeswaran ◽  
Aaron Lewkowicz ◽  
Kaliroi Engel ◽  
Sarah M. Clark ◽  
...  
Keyword(s):  
Zika Virus ◽  
Post Infection ◽  
Late Pregnancy ◽  
Congenital Defects ◽  
Low Grade ◽  
Mrna Levels ◽  
Neurodevelopmental Disease ◽  
Behavioral Monitoring ◽  
In Pregnancy

AbstractThe recent spread of Zika virus (ZIKV) and its association with congenital defects and neurological disorders has created an urgent need to understand the pathogenesis of ZIKV and identify therapeutic strategies that will prevent or eliminate them. The neurodevelopmental defects associated with ZikV infections early in pregnancy are well documented, however the potential defects associated with infections in late pregnancy and perinatal period are less well characterized. Further, the long-term sequelae of these infections are not fully understood. Immunocompetent C57BL/6 mice infected at one day old (P1), which neurodevelopmentally model late pregnancy in humans, develop a transient neurological syndrome including unsteady gait, kinetic tremors, severe ataxia and seizures 10-15 days post-infection (dpi) but symptoms subside after a week, and most animals survive. Despite apparent recovery, MRI of convalescent mice shows reduced cerebellar volume that correlates with altered coordination and motor function as well as hyperactivity and impulsivity. Persistent mRNA levels of pro-inflammatory genes including Cd80, Il-1α, and Ifn-γ together with Cd3, Cd8 and perforin (PrfA), suggested the persistence of a low-grade inflammatory process. Further, the brain parenchyma of convalescent mice harbor multiple small foci with viral antigen, active apoptotic processes in neurons, and cellular infiltrates, surrounded by activated astrocytes and microglia as late as 1-year post-infection. Detection of negative-sense strand viral RNA and replication of virus derived from these convalescent mice by blinded passage in Vero cells confirmed that low levels of live ZikV persist in CNS of convalescent mice life-long. Our studies establish that Zika can establish reservoirs in CNS and suggest that anti-viral treatment that clears virus from the CNS as well as long-term neurological and behavioral monitoring may be needed for patients known to be exposed to ZikV at an early age.Author’s summaryThe congenital brain malformations associated with ZikV infections early in pregnancy are well documented, however whether apparently asymptomatic perinatal exposure could lead to long term sequelae is not fully understood. Using a non-lethal neonatal mouse model, we examine host-pathogen interactions, anatomical changes and behavioral patterns by following survivors of the acute infection for over 1 year. We discover that infectious Zika virus has the potential to remain in the CNS for life, lodged within small foci surrounded by gliosis and infiltrating immune cells that may act to limit the viral spread, but also interfere with healing and contribute to life-long neuropathic and behavioral sequelae. These results suggest that anti-viral treatment and long-term neurological and behavioral monitoring may be indicated for patients known to have been exposed to Zika virus, regardless of neurodevelopmental disease severity.

Response to vincristine of recurrent brain tumors in children

1976 ◽  
Vol 45 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Jeffrey G. Rosenstock ◽  
Audrey E. Evans ◽  
Luis Schut
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Clinical Evidence ◽  
Pediatric Brain Tumors ◽  
Low Grade ◽  
Content Type ◽  
Recurrent Brain Tumor ◽  
Pediatric Brain ◽  
Fine Print

✓ Seventeen children with clinical evidence of a recurrent brain tumor were treated with vincristine 1.5 mg/sq m weekly for 12 weeks with doses on alternate weeks thereafter. Eight of the 16 patients who received four or more doses of vincristine showed significant objective responses; these included patients with high- and low-grade astrocytomas and patients with medulloblastoma. Six of the eight who responded remained asymptomatic for more than 2 years. The toxicity encountered was minimal except for seizures possibly related to vincristine in three children, who were able to resume treatment. Vincristine therapy results in long-term regression in a wide variety of pediatric brain tumors and causes little or no toxicity.

Sign in / Sign up

Export Citation Format

Share Document