Trigeminal neuralgia

Trigeminal neuralgia is a rare, episodic facial pain that is unilateral, electric shock-like, and provoked by light touch. At first, it is often mistaken as a tooth problem owing to its presentation in the two lower branches of the trigeminal nerve. Patients may undergo unnecessary—and sometimes irreversible—dental treatment before the condition isrecognised. Initially, a small dose of an antiepileptic drug (such as carbamazepine) rather than any analgesic drug can provide excellent pain relief. However, up to 10% of patients will not respond to antiepileptic drugs,1 and in rare instances trigeminal neuralgia can be secondary to a brain tumour, multiple sclerosis, or vascular anomalies, which will be identified only on neuroimaging.2 If quality of life becomes impaired and symptoms are uncontrolled with drug treatment, patientsshould be referred to a neurosurgeon for consideration of surgical management. Studies in Europe have shown that trigeminal neuralgia results in considerable interference with activities of daily living that is comparable to other neuropathic pain conditions,3 and could lead to suicide.4 This review aims to highlight the key features of trigeminal neuralgia and familiarise readers with both the medical and surgical management of this condition, which remains based on limited evidence and expert opinion

Trigeminal neuralgia

Trigeminal neuralgia is a rare, episodic facial pain that is unilateral, electric shock-like, and provoked by light touch. At first, it is often mistaken as a tooth problem owing to its presentation in the two lower branches of the trigeminal nerve. Patients may undergo unnecessary—and sometimes irreversible—dental treatment before the condition isrecognised. Initially, a small dose of an antiepileptic drug (such as carbamazepine) rather than any analgesic drug can provide excellent pain relief. However, up to 10% of patients will not respond to antiepileptic drugs,1 and in rare instances trigeminal neuralgia can be secondary to a brain tumour, multiple sclerosis, or vascular anomalies, which will be identified only on neuroimaging.2 If quality of life becomes impaired and symptoms are uncontrolled with drug treatment, patientsshould be referred to a neurosurgeon for consideration of surgical management. Studies in Europe have shown that trigeminal neuralgia results in considerable interference with activities of daily living that is comparable to other neuropathic pain conditions,3 and could lead to suicide.4 This review aims to highlight the key features of trigeminal neuralgia and familiarise readers with both the medical and surgical management of this condition, which remains based on limited evidence and expert opinion

FACT-MNG: tumor site specific web-based outcome instrument for meningioma patients

To formulate Functional Assessment of Cancer Therapy-Meningioma (FACT-MNG), a web-based tumor site-specific outcome instrument for assessing intracranial meningioma patients following surgical resection or stereotactic radiosurgery. We surveyed the relevant literature available on intracranial meningioma surgery and subsequent outcomes (38 papers), making note of which, if any, QOL/outcome instruments were utilized. None of the surgveyed papers included QOL assessment specific to tumor site. We subsequently developed questions that were relevant to the signs and symptoms that characterize each of 11 intracranial meningioma sites, and incorporated them into a modified combination of the Functional Assessment of Cancer Therapy-Brain (FACT-BR) and SF36 outcome instruments, thereby creating a new tumor site-specific outcome instrument, FACT-MNG. With outcomes analysis of surgical and radiosurgical treatments becoming more important, measures of the adequacy and success of treatment are needed. FACT-MNG represents a first effort to formalize such an instrument for meningioma patients. Questions specific to tumor site will allow surgeons to better assess specific quality of life issues not addressed in the past by more general questionnaires

Neuronal markers are expressed in human gliomas and NSE knockdown sensitizes glioblastoma cells to radiotherapy and temozolomide

<p>Abstract</p> <p>Background</p> <p>Expression of neuronal elements has been identified in various glial tumors, and glioblastomas (GBMs) with neuronal differentiation patterns have reportedly been associated with longer survival. However, the neuronal class III β-tubulin has been linked to increasing malignancy in astrocytomas. Thus, the significance of neuronal markers in gliomas is not established.</p> <p>Methods</p> <p>The expressions of class III β-tubulin, neurofilament protein (NFP), microtubule-associated protein 2 (MAP2) and neuron-specific enolase (NSE) were investigated in five GBM cell lines and two GBM biopsies with immunocytochemistry and Western blot. Moreover, the expression levels were quantified by real-time qPCR under different culture conditions. Following NSE siRNA treatment we used Electric cell-substrate impedance sensing (ECIS) to monitor cell growth and migration and MTS assays to study viability after irradiation and temozolomide treatment. Finally, we quantitated NSE expression in a series of human glioma biopsies with immunohistochemistry using a morphometry software, and collected survival data for the corresponding patients. The biopsies were then grouped according to expression in two halves which were compared by survival analysis.</p> <p>Results</p> <p>Immunocytochemistry and Western blotting showed that all markers except NFP were expressed both in GBM cell lines and biopsies. Notably, qPCR demonstrated that NSE was upregulated in cellular stress conditions, such as serum-starvation and hypoxia, while we found no uniform pattern for the other markers. NSE knockdown reduced the migration of glioma cells, sensitized them to hypoxia, radio- and chemotherapy. Furthermore, we found that GBM patients in the group with the highest NSE expression lived significantly shorter than patients in the low-expression group.</p> <p>Conclusions</p> <p>Neuronal markers are aberrantly expressed in human GBMs, and NSE is consistently upregulated in different cellular stress conditions. Knockdown of NSE reduces the migration of GBM cells and sensitizes them to hypoxia, radiotherapy and chemotherapy. In addition, GBM patients with high NSE expression had significantly shorter survival than patients with low NSE expression. Collectively, these data suggest a role for NSE in the adaption to cellular stress, such as during treatment.</p

Inhibition of proliferation and induction of differentiation of glioma cells with Datura stramonium agglutinin

We found that a lectin, Datura stramonium agglutinin, induced irreversible differentiation in C6 glioma cells. The differentiated cells had long processes, a low rate of proliferation and a high content of glial fibrillary acidic protein. When the medium was replaced with Datura stramonium agglutinin-free medium after 1 h, cell proliferation continued to be inhibited. Experiments with several other lectins indicated that both recognition of linear N-acetyllactosamine repeats and recognition of multiantennary units of cell-surface glycans were required for the inhibition of C6 proliferation. Proliferation of four human glial tumour cells was also inhibited by Datura stramonium agglutinin. Further, these differentiated human glial tumour cells had long processes and a high content of glial fibrillary acidic protein similar to differentiated C6 glioma cells. Taken together, these observations suggest that Datura stramonium agglutinin may be useful as a new therapy for treating glioma without side effects

Factors influencing overall survival rates for patients with pineocytoma

Given its rarity, appropriate treatment for pineocytoma remains variable. As the literature primarily contains case reports or studies involving a small series of patients, prognostic factors following treatment of pineocytoma remain unclear. We therefore compiled a systematic review of the literature concerning post-treatment outcomes for pineocytoma to better determine factors associated with overall survival among patients with pineocytoma. We performed a comprehensive search of the published English language literature to identify studies containing outcome data for patients undergoing treatment for pineocytoma. Kaplan–Meier analysis was utilized to determine overall survival rates. Our systematic review identified 168 total patients reported in 64 articles. Among these patients, 21% underwent biopsy, 38% underwent subtotal resection, 42% underwent gross total resection, and 29% underwent radiation therapy, either as mono- or adjuvant therapy. The 1 and 5 year overall survival rates for patients receiving gross total resection versus subtotal resection plus radiotherapy were 91 versus 88%, and 84 versus 17%, respectively. When compared to subtotal resection alone, subtotal resection plus radiation therapy did not offer a significant improvement in overall survival. Gross total resection is the most appropriate treatment for pineocytoma. The potential benefit of conventional radiotherapy for the treatment of these lesions is unproven, and little evidence supports its use at present