EEG in metastatic brain tumour before, during and after radiation treatment

EEG IN M E T A S T A T I C B R A I N T U M O U R BEFORE, D U R I N G A N D AFTER RADIATION TREATMENT

WILLEM STORM VAN LEEUWEN, M D , (assisted by Mess MARIKE G. DIJK) Neuro.phys~ologtcal Department o[ the Neu*ologtcal Clinic, Academ,sch Z~ekenhu~s, Le~den, The Netherlands Ix S a boy of 7 years, was suspected to have a metastatic bxam tumour m Au0ust 19't9 The prevtous history of the patient was as follows In Au0ust 1946 a hard tumour was dmgnosed m the right s~de of the abdomen From September onwards the right kidney reomn was lrradmted, until d total dose of 4750 r (m atr) m five weeks had been g~ven After th~s treatment the tumour almost disappeared On November, 1946, the abdomen was opened A small tumour growth which had penetrated into the rtght caval veto was found, and considered to be inoperable The X-ray treatment was continued until March 28 1947, when the total skin dose was 4950 r During th~s period the clinical cond~tmn of the patient had ~mproved considerably, and he was allowed home In 1947 small swelhngs m the groin were observed and ~rradmted Some two years later. m August 1949, the pattent returned to hospital again, m a poor chmcal condRmn Rontgenograms showed a large metastas~s m the left lung, whtle the chn~cal stgns and symptoms, such as headaches, vomiting and a shght papdloedema, suggested the presence of a bram metastas~s There were no other neurological s~gns or symptoms, but the pabent was almost mdtfferent to his surroundings The ]un 0 turnout decreased rapidly in s~ze after arradmtmn up to a total tumour dose of 1575 r m 4 weeks On August 27 19~9. the first E E G was taken, using a 't-channel Offner Model A crystograph The t~me-constant was not less than 0 5 sec The electrodes were chlonded sdver dtscs stuck to the scalp wRh collodmn The posmon of the electrodes ts mdtcated m the figures The records showed many low frequency waves of ~ - - 3 per sec. with a h~gh amphtude m all leads, and especially m the right temporal, temporo-panetal and temporc~occtp~tal leads, where the waves had voltages up to 150 ttV (hg I) In the corresponding leads from the left stde of the head the amphtudes were rather lower There were numerous phase reversals m leads having a common electrode m the right temporo-par~etal region Apart from these waves, there were also waves of h~gher frequencies to be seen, ]e 5-6 per sec especml]y m the frontal and fronto-partetal leads There was no asymmetry of these waves It was concluded that the patient had an actwe organic process m the right

temporo-panetal re01on, probably located superbctally, and possibly penetratm0 towards deeper structures Combmed with the h~story and chntcal picture it seemed probable that this process was a metastatic turnout The pauent therefore received ~rradlatton treatment of the head ~'~ one frontal and two parietal fields from August 31 to October 5 The total brain tumour dose during th~s permd ~ a s

Fig

1

27th Aug 1949, just before X-ray treatment showing many slow wave~ especially m the right temporoparietal and temporo-occ~p]tal leads Focus m the temporo-panetal regmn estimated at 474 r After thts date the pattent received treatment over a wider held, untal a total tumour dose of -4- 2000 r had been gwen Durra0 this t~me the patients chmcal condttton improved greatly, he was no longer apathettc, and no more abnormally sweet-tempered, but had become interested m hts surroundings During this same period the E E G changed gradually. One week after the X-ray treatment had started (September 7, 1949) the right temporo-partetal leads showed no great change, but large slow waves appeared m the correspondm 9 leads from the left stde (ftg 2) It was thou0ht probable that these waves mtght be produced by a reacttve ocdema caused by the X-ray treatment Ten day~ later (September 17, 1949) these waves had almost disappeared

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332

WILLIAM

STORM

"Ih~ .,lov, u.axes on the right ',]de seemed to be rather fev, er m number and smaller m a m p h t u d e Ih 9 :3t than before and the focus of these w a v e s moreo'.er w a s m u c h less e m d e n t A b o u t a m o n t h later (October lq 1949) these slov, w a v e s h a d de-

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LEEUWEN

seen and the amphtud~ ot ,all w a v e s had decreased m a r k e a l y ehg 5) T h e patient is still u n d t r o b s e r v o n o n

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F]q "t I i t h Oct 1949 n m e d a y s after end of X-ra'/ treatment T h e 6-8 per sec w a v e s are lower on the right ~lde than on the left ~lde

F~g 2 2th Sept I eye9 seven d a y s after start of X-ra~ treatment N o great c h a n g e m leads from right side but more and larger slow w a v e s in leads from left sxde

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creased m a r k e d l y and w a v e s of 6-8 per sec with an a m p h t u d e of 20-50 l~V n o w became a p p a r e n t t fxg q) In the right t e m p o r o - p a n e t a l a n d ocop~tal leads these w a v e s were s o m e w h a t smaller than those m the c o r r e s p o n d i n g leads from the left hemisphere

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fftg 5 ~8th Dec 19J~9 Fhe records are almost w~thm the normal r a n g e for the a~e of the patient, t h o u g h rather low voltaqes are seen in right temporo-ocop~tal leads

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SUMMARY

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Fig 3 l?rh Sept 1949 s e v e n t e e n d a y s after start of X - r a y t r e a t m e n t F e w e r and lower slow w a v e s on both sides F e ' a e r phase reversals T h e last E E G w a s taken about two m o n t h s later ~December 28 1949) O n l y a few slow w a v e s were

In a boy with m e t a s t a n c brain t u m o u r electroe n c e p h a t o o r a m s were recorded before durra0, and after X - r a y treatment of the t u m o u r Both the chmcal c o n d m o n and the E E G aspect improved v e r y much during this treatment

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T h e ]rra&at~on data were kindly submitted by D r Spe~,er of the Rontqenolog]c D e p a r t m e n t

t~etercnce STORM VAN LEISUWkN, W E E G m metastatic brain t u m o u r before during and after radiation treatment E E G Chn Neurophysao! 1080 2 331-3212