Neurochemical supplementation in patients with depressed levels of participation after brain tumor surgery: Rationale and preliminary results.

Autor: Briggs RG; Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia., Ahsan SA; Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia., Conner AK; Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia., Nix CE; Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia., Jacobs CC; Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia., Jones RG; Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia., Sheets JR; Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia., Palejwala AH; Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia., Chendeb K; Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia., Sughrue ME; Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia. Electronic address: sughruevs@gmail.com.
Jazyk: angličtina
Zdroj: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2020 Jan; Vol. 71, pp. 93-96. Date of Electronic Publication: 2019 Nov 23.
DOI: 10.1016/j.jocn.2019.10.004
Abstrakt: A unique challenge in some brain tumor patients is the fact that tumors arising in certain areas of the brain involve the neural structures of consciousness or alertness, limiting the patient's ability to participate in rehabilitation following surgery. A critical question is whether neurostimulant therapy can help patients participate in rehabilitation efforts. We performed a retrospective review of all patients undergoing brain tumor surgery by the senior author from 2012 to 2018. We limited this study to patients with tumors occupying critical structures related to consciousness, alertness, and motor initiation. A combination of methylphenidate and levodopa/carbidopa was used to monitor the progress of patients through neurorehabilitation efforts. We identified 101 patients who experienced an inability to participate in rehabilitation (ITPR) in the post-operative period. Of these, 86 patients (85%) were treated with methylphenidate and levodopa/carbidopa. Cases of ITPR were related to dysfunction of the brainstem (12/86 cases, 14%), thalamus (17/86 cases, 20%), hypothalamus (14/86 cases, 16%), basal ganglia (13/86 cases, 15%), and medial frontal lobe (30/86 cases, 35%). Of the 86 individuals treated, 47/86 patients (55%) showed early improvement in their ability to participate with rehabilitation. At three month follow-up, 58/86 patients (67%) had returned to living independently or were at least interactive and cooperative during follow-up examination. This feasibility report suggests that combined therapy with methylphenidate and levodopa/carbidopa may help patients participate in neurorehabilitation efforts in the immediate post-operative period following brain tumor surgery. Randomized, controlled clinical trials are needed to explore this concept more thoroughly.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2019. Published by Elsevier Ltd.)
Databáze: MEDLINE
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