scholarly journals Levetiracetam Prophylaxis Therapy for Brain Tumor-Related Epilepsy (BTRE) Is Associated With a Higher Psychiatric Burden

2022 ◽  
Vol 12 ◽  
Author(s):  
Fedele Dono ◽  
Stefano Consoli ◽  
Giacomo Evangelista ◽  
Annalisa Ricci ◽  
Mirella Russo ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Group Treatment ◽  
Neuropsychiatric Symptoms ◽  
Prophylaxis Group ◽  
Distress Score ◽  
Multiplicative Effect ◽  
Prophylaxis Therapy ◽  
Neuropsychiatric Side Effects

Purpose: Brain tumor-related epilepsy (BTRE) is a condition characterized by the development of seizures in the context of an undergoing oncological background. Levetiracetam (LEV) is a third-generation anti-seizure medication (ASM) widely used in BTRE prophylaxis. The study evaluated LEV neuropsychiatric side effects (SEs) in BTRE prophylaxis.Method: Twenty-eight patients with brain tumors were retrospectively selected and divided into two groups. In one group, we evaluated patients with a BTRE diagnosis using LEV (BTRE-group). The other group included patients with brain tumors who never had epilepsy and used a prophylactic ASM regimen with LEV (PROPHYLAXIS-group). Neuropsychiatric SEs of LEV were monitored using the Neuropsychiatric Inventory Questionnaire (NPI-Q) at the baseline visit and the 6- and 12-month follow-up.Results: Eighteen patients of the BTRE-group and 10 patients of the PROPHYLAXIS-group were included. Compared to the BTRE-group, the PROPHYLAXIS-group showed a higher severity of neuropsychiatric symptoms. According to Linear Mixed Models (LMM), a multiplicative effect was observed for the interaction between group treatment and time. For the caregiver distress score (CDS), only a time-effect was observed.Conclusion: Prophylactic ASM with LEV is associated with an increased frequency of neuropsychiatric SE. Accurate epileptological evaluations in patients with brain tumors are mandatory to select who would benefit most from ASM.

Access to radiation oncology centers with brain tumor treatment expertise for patients with resectable brain tumors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18509-e18509
Author(s):  
Mehee Choi ◽  
Brian P. Martin ◽  
Lisa Misell ◽  
Joseph M. Zabramski ◽  
David G. Brachman
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Access To Care ◽  
Radiation Treatment ◽  
Fold Increase ◽  
Tumor Treatment ◽  
Brain Radiotherapy ◽  
The Us ◽  
Brain Radiation

e18509 Background: Many patients with brain tumors face challenges with access to care. For rural patients, prolonged travel times may limit access to appropriate radiotherapy. Radiation centers (RCs) offering specialized brain radiotherapy, e.g., stereotactic radiosurgery (SRS), are geographically limited. Utilization of brain brachytherapy at the time of resection offers an option for such patients, but technical challenges have limited the adoption. To address the limitations of traditional brachytherapy, a device with Cs-131 seeds embedded in a bioresorbable collagen tile (GammaTile, GT Medical Technologies, Tempe, AZ USA) was developed. GammaTile (GT) is FDA-cleared for permanent implantation at the time of resection for all recurrent intracranial tumors and for newly diagnosed malignant intracranial neoplasms. To investigate if wider availability of this treatment could possibly lower the geographic barrier to access to care, we mapped the US population against existing RCs with brain tumor expertise and neurosurgery centers (NSCs) performing craniotomies. Methods: We analyzed 2018 CMS claims data using CPT codes for single- and multi-fraction SRS to identify RCs with brain tumor treatment expertise and mapped these against the population. Using similar methodology, using CPT codes for craniotomies, we identified NSCs, as any facility performing craniotomies is potentially eligible to implant GT. Results: 135 RCs used CPT codes for SRS. 193-, 119-, 82-, and 52-million Americans lived >30-, >60-, >90-, and >120-minutes from one of these centers, respectively. 530 NSCs preform craniotomies, including ≥1 in every state, a 4-fold increase over the number of RCs offering SRS. Conclusions: For many patients, substantial travel distances limit their access to RCs with brain tumor treatment expertise. In contrast, the 530 craniotomy-performing NSCs have far greater geographic dispersion. The option of undergoing brain radiation with GT implantation at the time of brain tumor craniotomy brings treatment closer to millions, ensures compliance, and reduces additional travel for follow-up radiation treatment.[Table: see text]

scholarly journals Neurological evaluation of children and adolescents with brain tumor, based on ambulatory-oriented follow-up

2001 ◽  
Vol 59 (4) ◽  
pp. 849-853 ◽  
Author(s):  
Alexandre Serafim ◽  
Luiz Celso Pereira Vilanova ◽  
Najla Saba Silva
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Children And Adolescents ◽  
Tumor Recurrence ◽  
Clinical Perspective ◽  
Tumor Patients ◽  
Female Patients ◽  
Neurological Evaluation ◽  
Infratentorial Tumors

Taken as proved that brain tumors are the second most frequent childhood neoplasm - only outnumbered by leukemias - we have undertaken a clinical perspective study with seventy brain tumor patients ranging from one to fifteen years of age, throughout a four-year period (1993-1997), based on ambulatory-oriented follow-up. Forty-one male and twenty-nine female patients were analyzed, in that a slightly higher number of infratentorial tumors was observed (thirty-eight cases), compared to those supratentorially located (thirty-two cases). The most repeatedly observed during the study was the medulloblastoma (twenty-one patients), followed by the astrocytoma (fifteen patients) and the germinoma (eleven patients). It should be pointed out that during the ambulatory follow-up 75,5% of patients developed neurological sequels. A tumor recurrence was noticed in 34,3% of them, while 21,4% eventually died.

scholarly journals RONC-18. ANALYSIS OF BRAIN TUMOR INDUCED BY IRRADIATION IN CHILDHOOD - A SINGLE INSTITUTIONAL ANALYSIS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii458-iii459
Author(s):  
Takashi Sano ◽  
Kaoru Tamura ◽  
Masae Kuroha ◽  
Kazutaka Sumita ◽  
Yukika Arai ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Irradiation Dose ◽  
Clinical Characteristics ◽  
Cranial Irradiation ◽  
Surgical Removal ◽  
Long Term Follow Up ◽  
Long Time ◽  
Radiation Induced

Abstract BACKGROUND Radiation-induced brain tumors are rare tumors that appear during long-term follow-up after radiation therapy. Children are at greater risk for radiation -induced brain tumors than adults. The clinical characteristics of radiation-induced brain tumor treated at our hospital were retrospectively examined. PATIENTS AND METHODS Clinical characteristics of seven radiation-induced brain tumors that developed in 6 patients irradiated in their childhood at our hospital were analyzed. The background disease, age at irradiation, irradiation dose, period from irradiation to onset, pathological diagnosis, and treatment for radiation-induced brain tumor were examined. RESULTS Background diseases for irradiation were leukemia in 3 patients, germinoma in 2, medulloblastoma in 1, and the average cranial irradiation dose was 23.2 Gy. The patients tended to be young at irradiation (2–17 yeays; median:4 years old). The time between irradiation and the onset of radiation-induced brain tumors ranged from 9.5 to 39.1 years (median:28 years). Radiation-induced brain tumors comprised 6 meningioma（grade I:5, grade II:1）and 1 high-grade gliomas. All patients underwent surgical removal of the radiation-induced brain tumors and 2 received additional irradiation. During a median of 5.3 years of follow-up after the diagnosis of radiation-induced brain tumors, 2 underwent second surgery, while the remaining 4 have no recurrence. DISCUSSION: In most cases, radiation-induced brain tumors occur for a long time after irradiation in childhood. Monitoring of radiation-induced brain tumors as well as primary tumor recurrence was considered important.

scholarly journals EPCT-06. PRECISION ONCOLOGY IN THE PEDIATRIC TARGETED THERAPY 2.0 PROGRAM

2021 ◽  
Vol 23 (Supplement_1) ◽  
pp. i47-i48
Author(s):  
Jonas Ecker ◽  
Florian Selt ◽  
Andrey Korshunov ◽  
David Capper ◽  
Nicola Dikow ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Brain Tumor ◽  
Brain Tumors ◽  
Sanger Sequencing ◽  
Methylation Array ◽  
Dna Methylation Array ◽  
The Impact ◽  
Gene Panel Sequencing ◽  
Panel Sequencing

Abstract Introduction Precise diagnoses and robust detection of actionable alterations is required for individualized treatments. By using extended molecular diagnostics, the Pediatric Targeted Therapy (PTT) 2.0 program aims at the improvement of diagnostic accuracy and detection of actionable alterations for pediatric high-risk patients. The impact of these analyses on clinical management is reported. Methods Pediatric patients with relapsed or progressive tumors after standard of care treatment were included, independent of histological diagnosis. Formalin fixed paraffin embedded material and a blood sample for germline correction were requested. DNA methylation array, targeted gene panel sequencing (130 genes), RNA and Sanger sequencing in selected cases, and immunohistochemistry (IHC) of selected markers (pERK, pAKT, pS6, PD-L1) were performed. A questionnaire-based follow-up was used to determine the clinical impact of the analysis. Results We enrolled n=263 patients from February 2017 to February 2019. Complete molecular analysis was possible for n=260 cases (99%). The most common entities were brain tumors (n=172/260, 65%). In brain tumors, DNA methylation array alone allowed robust diagnostic classification (score of >=0.9) in n=104/172 cases (60%). Actionable targets as detected by copy number calculation, gene panel sequencing, RNA sequencing and IHC were found in n=94/172 (55%) brain tumor cases. The most common actionable targets in brain tumors were MAPK (pERK, BRAF fusions, BRAF V600E), mTOR (pS6), PI3K (pAKT), CDK4/6 (CDKN2A/B loss), and immune checkpoints (PD-L1). Pathogenic germline alterations with clinical relevance were identified in n=12/172 brain tumor cases (6.9%) and were confirmed by Sanger sequencing, 5/12 (41%) of which were previously unknown. Clinical follow-up of subsequent treatment and outcome are ongoing. Conclusion The combination of next-generation diagnostics such as methylation arrays and targeted sequencing in addition to selected IHC markers added robust information with regard to diagnosis and actionable alterations. The impact on clinical decision-making and on outcome is currently being evaluated.

P09.05 Treatment strategy of MRI postcontrast non-enhanced gliomas

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii27-ii27
Author(s):  
O Kalita ◽  
L Hrabalek ◽  
V Jan ◽  
M Slachta ◽  
Y Klementová ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Tumor Volume ◽  
Residual Tumor ◽  
Idh1 Mutation ◽  
Low Grade ◽  
Contrast Enhanced ◽  
Grade Ii ◽  
Grade Iii

Abstract BACKGROUND MRI postcontrast nonenhanced brain tumors are found benign biologic entities with the better prognosis. The aim of this paper is to evaluate predictive features on MRI considered definite diagnosis occurrence, tumor progression, upgrading and postcontrast enhancement evolution on follow-up serial MRI. MATERIAL AND METHODS We retrospectively collected patients with the initially MRI postcontrast nonenhanced brain tumors, treated in our hospital from January 2009 to June 1, 2006. All tumors were converted into WHO 2016 IDH status classifications in accordance with current recommendations. Information about surgeries, patient clinical condition, MRI, and results of histological, immunohistochemical, molecular genetic, and cytogenetic investigations were gathered. Semiautomatic segmentations were performed using FSLeyes software (part of FSL package) on preoperative and followed-up 3D T1-w MPRAGE, T2-w or FLAIR scans. We focused on residual tumor volume, and time distribution of T2/FLAIR changes and T1-w postcontrast enhancement evolution. RESULTS Seventy-eight patients were enrolled in this study. There were 47 gliomas grade II 22 grade III and 9 grade IV. Glioma II comprised 35 diffuse astrocytomas (23 patients had IDH1 mutation). Nine gliomas grade III and 6 gliomas grade IV had IDH1 mutation. Overall survival in glioma group grade II, grade III, grade IV was 187.9 months, 71.1 months and 25.2 months, respectively. Oncotherapy underwent 14 gliomas grade II after first surgery, 13 patients had radiotherapy a 1 patient had neoadjuvant chemotherapy. Seventeen gliomas grade III were indicated to oncotherapy, 5 patients had radiotherapy and 12 had chemoradiotherapy. All patients with glioma grade IV experienced oncotherapy. Time to progression of non-contrast enhanced brain tumor was 5.8 years. Time to up-grading of non-contrast enhanced brain tumor was 16.8 months. Detailed time relations of glioma subgroup will be displayed in tables. CONCLUSION Regarding MRI postcontrast non-enhanced tumors, predominantly low grade gliomas (LGG), aggressive oncotherapy are reluctant to use but they are prone to repeat surgeries. Decision making issues are age, clinical patient status, histologic and genetic tumor characteristics, residual tumor volume, published guidelines for brain tumor treatment, and patient′s willing. Generally, hyposignal on the T1 postcontrast scans strictly relate to the better prognosis, even in HGG. Longer survival expectancy increases quality of life awareness. Prior to MRI postcontrast enhanced evolution and up-grading, T2/FLAIR changes have been demonstrated. T2/FLAIR scans considered also main role in LGG follow-up strategy. Individual tailored therapy is principal strategy. Supported by Ministry of Health of the Czech Republic, grant nr. NV19-04-00281 and grant nr. NU21-03-00195

scholarly journals SWK-02. WEAVING COMFORT AND SUPPORT FOR CHILDREN WITH BRAIN TUMORS AND THEIR FAMILIES IN AN OUTPATIENT CLINIC

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii464-iii465
Author(s):  
Ria Hawks ◽  
Jane Bloom ◽  
Maurine Packard ◽  
Sonia Lugo ◽  
Nadine Ulysses ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Outpatient Clinic ◽  
Low Vision ◽  
Medical Center ◽  
Primary Brain Tumor ◽  
Childhood Brain Tumor ◽  
Tumor Patients ◽  
Neurologic Disability

Abstract Parents of children diagnosed with brain tumors report high levels of stress at diagnosis and feelings of “being lost” on transition to outpatient follow-up care (Jackson AC, et al, 2007). Ssori is a Japanese form of free-style weaving that encourages people facing life-limiting challenges to discover inner strengths. We report our experience with Saori weaving with brain tumor patients and their families in a pediatric oncology outpatient clinic at a major university medical center. During 2019, we offered weaving sessions twice a week. We had a total of 151 encounters with hematology/oncology patients (age 5–18 years), siblings, or parents. Among these patients there were 20 with primary brain tumor diagnoses. Weaving was offered in the art therapy area of the clinic. After creating a fabric, the weavers had the opportunity to have their work sewn into functional objects, such as pillows, bags, purses, or healing pouches filled with beans that can be heated or cooled for comfort. Brain tumor patients readily engaged in weaving, despite various degrees of neurologic disability including hemiparesis or low vision. In the words of an 8 y/o weaver. “This is so cool. Daddy, can we always come when the weavers are here, so I can weave?” And from a mother: “This is great. She’s focused and busy!” Case studies, including a presentation of Legacy work, will be reported. In conclusion, Saori weaving can be an impactful intervention for childhood brain tumor patients and their families in an outpatient clinic setting.

scholarly journals NEUROPSYCHIATRIC SYMPTOMS IN BEHAVIORAL VARIANT FRONTOTEMPORAL DEMENTIA AND ALZHEIMER’S DISEASE: A 12-MONTH FOLLOW-UP STUDY

2021 ◽  
Author(s):  
Thais Lima- Silva ◽  
Tiago Ordonez ◽  
Allan Bregola ◽  
Valéria Bahia ◽  
Mario Cecchini ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Frontotemporal Dementia ◽  
Neuropsychiatric Symptoms ◽  
Predictor Variable ◽  
Therapeutic Approaches ◽  
Behavioral Variant Frontotemporal Dementia ◽  
Distress Score ◽  
State Examination

Background: Neuropsychiatric symptoms in patients with frontotemporal dementia (FTD) are highly prevalent and may complicate clinical managements. Objective: We tested whether the Neuropsychiatry Inventory (NPI) could detect change in neuropsychiatric symptoms and caregiver´s distress in patients diagnosed with behavioral variant frontotemporal dementia (bvFTD) and Alzheimer’s disease (AD) from baseline to a 12-month follow-up. Methods: The sample consisted of 31 patients diagnosed with bvFTD and 28 patients with AD and their caregivers. A sociodemographic questionnaire, the Mini-Mental State Examination (MMSE), Addenbrooke´s Cognitive Examination Revised (ACE-R), the INECO Frontal Screening (IFS), the Frontal Assessment Battery (FAB), the Executive Interview (EXIT-25) and the Neuropsychiatric Inventory (NPI) were used. Results: Neuropsychiatric symptoms total (NPI Total) and the caregiver Distress score were statistically higher among bvFTD patients at both assessment points. MMSE, ACE-R scores significantly declined and NPI Total and Distress scores significantly increased in both groups. Age was the only independent predictor variable for the NPI Total score in the bvFTD group in the follow up. In the AD group, ACE-R and EXIT-25, conjunctively, were associated with the NPI total score at follow up. Conclusion: Knowing how symptoms evolve over the course of the disease could help the clinician and the caregiver in decisions regarding future management and therapeutic approaches.

Improving care coordination for brain tumor patients through value-based care redesign of a virtual integrated practice unit.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 110-110
Author(s):  
Phioanh Leia Nghiemphu ◽  
Darlene Dezelan ◽  
Jackie H Tran ◽  
Timothy Francis Cloughesy ◽  
Linda M. Liau ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Brain Tumor ◽  
Brain Tumors ◽  
Care Coordination ◽  
Care Pathway ◽  
Patient Navigator ◽  
Patient Satisfaction Scores ◽  
Percentile Rank ◽  
Value Based Care

110 Background: Brain tumor care at our institution involves providers from multiple departments in separate clinics and can cause patient frustration and poor patient experience. We previously reported on engaging care teams from Neurosurgery, Neuro-Oncology, Radiation Oncology, Neuroradiology and Neuropathology using lean methodology to re-design the care pathway for patients with brain tumors. A Patient Navigator Program was also established to help with patient’s care coordination. For this study, we evaluate whether this value-based care redesign has improved patient coordination and satisfaction. Methods: The care pathway and navigator process were implemented at the end of Dec 2015. We identified 202 patients who had brain tumor resections and were followed by our Navigator Program from July 2015 – Sept 2016. We evaluated the time from surgery to appointments and whether these appointments were all made within 1 week. We also reviewed our patient satisfaction scores using Press Ganey percentile ranks and HCAHPS metrics in the areas of patient education and coordination. We compared these data from July-Dec 2015 (pre-redesign) to data from Jan-Sep 2016 (post-redesign). Results: Of the patients followed by the Navigator Program, 137 patients required follow-up with providers from at least 2 different departments for treatment planning. Pre-redesign, the program followed 49 patients and made their appointments 14 median days from surgery (range 3-37), with 59% within 1 week. The 88 patients followed after-redesign had appointments in 16 median days (range 1-33) with 70% scheduled within 1 week. Pre-redesign, our Press Ganey Percentile rank ranged from 1st-32nd. After-redesign, the ranks increased to 16th-99th percentile, with most domains over the 80th percentile. Patients also reported higher satisfaction on HCAHPS post-redesign compared to pre-redesign. Conclusions: Development of a clear process for care coordination within the patient navigator program helped improve our patient satisfaction and streamline timely follow-up care. For our future coordination, we will implement a centralized access to care for our patients with brain tumors.

Social determinants of health affecting treatment of pediatric brain tumors

2019 ◽  
Vol 24 (2) ◽  
pp. 159-165
Author(s):  
Jillian M. Berkman ◽  
Jonathan Dallas ◽  
Jaims Lim ◽  
Ritwik Bhatia ◽  
Amber Gaulden ◽  
...  
Keyword(s):  
African American ◽  
Health Disparities ◽  
Brain Tumors ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Cns Tumor ◽  
Initial Symptoms ◽  
Caucasian Patients

OBJECTIVELittle is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival.METHODSThe authors conducted a retrospective study of pediatric patients (< 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson’s chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p < 0.05.RESULTSThe analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p < 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified.CONCLUSIONSNo significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.

Recent advancements in Fuzzy C-means based techniques for brain MRI Segmentation

2021 ◽  
Vol 16 ◽  
Author(s):  
Ghazanfar Latif ◽  
Jaafar Alghazo ◽  
Fadi N. Sibai ◽  
D.N.F. Awang Iskandar ◽  
Adil H. Khan
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Brain Mri ◽  
Tumor Segmentation ◽  
Brain Anatomy ◽  
Mri Segmentation ◽  
Brain Tumor Segmentation ◽  
Brain Images ◽  
Low Contrast ◽  
Fuzzy C Means

Background: Variations of image segmentation techniques, particularly those used for Brain MRI segmentation, vary in complexity from basic standard Fuzzy C-means (FCM) to more complex and enhanced FCM techniques. Objective: In this paper, a comprehensive review is presented on all thirteen variations of FCM segmentation techniques. In the review process, the concentration is on the use of FCM segmentation techniques for brain tumors. Brain tumor segmentation is a vital step in the process of automatically diagnosing brain tumors. Unlike segmentation of other types of images, brain tumor segmentation is a very challenging task due to the variations in brain anatomy. The low contrast of brain images further complicates this process. Early diagnosis of brain tumors is indeed beneficial to patients, doctors, and medical providers. Results: FCM segmentation works on images obtained from magnetic resonance imaging (MRI) scanners, requiring minor modifications to hospital operations to early diagnose tumors as most, if not all, hospitals rely on MRI machines for brain imaging. In this paper, we critically review and summarize FCM based techniques for brain MRI segmentation.

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