Botulinum toxin injection and intense rehabilitation program: a single institution experience of a multidisciplinary care approach for spasticity

Oral-Poster Presentation 2: no. FP2-03Conference Theme: Brain Attack: A New EraSpasticity is the velocity-dependent increase in muscle tone due to upper motor neuron lesions. It is becoming an important health issue as the incidence of stroke is increasing in our aging population. Spasticity gives rise to major impairment in motor functions and activities of daily living as well as pain and difficulty with nursing care. Botulinum toxin (BTX) can be injected to the affected muscles to relieve spasticity by blocking transmission across neuromuscular junctions. The temporary paralysis so induced provides a window of opportunity for prompt, intense rehabilitation. In this article, we present our 2.5-year experience with BTX injection and a patient-specific rehabilitation program provided by a multidisciplinary team, which consists of neurosurgeons, nurses, physiotherapists, occupational therapists and prosthetic orthotists. We found that this multidisciplinary management could lead to improvement in patients’ goal attainment, caregiver burden and biomechanical assessment. The approach is feasible within our healthcare setting and our promising findings indicate its wider adoption in this locality

Whole brain radiotherapy for more than 3 brain metastases: a single centre experience

Poster Presentation 1: no. P103Conference Theme: Controversies in Neurosurger

Whole-brain radiotherapy with simultaneous integrated boost using volumetric modulated arc therapy (VMAT) for patients of recursive partitioning analysis (RPA) class I and II suffering from 1-3 brain metastases

Objective: We evaluated the feasibility and treatment outcomes of recursive partitioning analysis (RPA) Class I and II patients with 1-3 brain metastases treated with whole-brain radiotherapy with simultaneous integrated boost using volumetric modulated arc therapy (VMAT). Materials and methods: 11 patients (9 with lung cancer, 1 with breast cancer and 1 with renal cell carcinoma), of which 3 and 8 belonging to RPA Class I and II respectively), were treated with VMAT for their brain metastases (mean volume 2.45cm3, range 0.07 – 14.48cm3). After immobilization by thermoplastic casts, they underwent planning computed tomography (CT) scan of the whole brain with 2.5mm slice thickness. The whole brain (WB), all brain metastases (BM) and organs at risks were contoured manually. A 4-mm margin was created for the whole brain and each of the brain metastases to generate the planning target volumes (PTV-WB and PTV-BM respectively). A VMAT plan with 2 modulated arcs was generated for all patients. 30Gy and 40Gy all in 10 fractions over 2 weeks were delivered simultaneously to PTV-WB and PTV-BM by a linear accelerator with a dose rate of 600 MU/minute. Serial CT scans of the brain were performed every 2-3 months after VMAT until progression or death. Overall local response rate, local brain control rate, distant brain control rate, brain progression-free survival (BPFS), progression-free survival (PFS), overall survival (OS) and toxicities were assessed. Results: After a median follow up of 7.6 months, 6 (54.5%) patients died and all succumbed to progressive disease of their underlying malignancies. Overall local response rate, local brain control rate and distant brain control rate were 81.9%, 100% and 81.9% respectively. Median BPFS, PFS and OS were 12.6 months, 10.0 months and 14.3 months respectively whereas 1-year BPFS, 1-year PFS and 1-year OS were 75.0%, 30.0% and 58.3% respectively. 2 (18.2%) and 3 (27.3%) patients developed acute grade 1 and grade 2 treatment-related toxicities during VMAT with subsequent complete resolution. Mean monitor units was 713.4 MU (range 392-891 MU) and mean beam-on time was 1.2 minutes (range 0.7-1.5 minutes). Conclusion: VMAT for 1-3 brain metastases in RPA class I and II patients seemed promising with a favorable treatment outcome as well as well-tolerated and self-limiting toxicities

The Use of Tranexamic Acid for Traumatic Brain Injury with Contusions or Traumatic Subarachnoid Haemorrhage in the Elderly

Objective: To investigate the impact of Tranexamic Acid (TXA) as an initial non-operative treatment on the mortality rate of traumatic brain injury with contusions or traumatic subarachnoid haemorrhage in the elderly. Method: This was a seven-year retrospective study of consecutive patients admitted for traumatic brain injury with contusions or traumatic subarachnoid haemorrhage at Queen Mary Hospital from 2010-2016. Primary outcome was the overall mortality rate. Secondary outcomes included rate of deterioration requiring operation and the survival rate without operations. Result: In total 651 consecutive patients were identified. 81 patients had TXA (TXA group) while 570 did not have TXA (control group) during admission. The average age was 73.92 years old (95%CI 68.77-77.84 years old) for the TXA group versus 65.36 years old (95%CI 63.24-67.48 years old) for the control group (p=0.0062). The overall mortality rate with TXA was 7.40% versus 8.77% in the control group (OR 0.832 95%CI 0.345-2.007, p=0.682). The rate of deterioration requiring operation in the TXA group was 6.17% versus 16.3% in the control group (OR 0.337 95%CI 0.133-0.857, p=0.022). The survival rate with no operations in the TXA group was 88.89% versus 77.89% in the control group (OR 2.270 95%CI 1.104-4.667, p=0.026). Conclusion: In this study, patients in the TXA group was significantly older than that in the control group. The overall mortality rates were comparable in the two groups. The TXA group had a lower rate of operation. With the use of Tranexamic Acid, there were significantly more survivors without operations