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Safety of bevacizumab with or without anticoagulant treatment in neuro-oncological patients: A systematic review
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Abstracts / Journal of the Neurological Sciences 333 (2013) e579–e628
Diagnostics include using the Kato-Katz technique or a biopsy of the infected tissue. We report a case of a 32 year old female, with an isolated cerebral infection due to Schistosoma sp, who presented with newonset seizure, negative diagnostic tests, and necessitated brain tissue biopsy. Patient was subsequently treated with praziquantel 600 mg/tab twice a day. doi:10.1016/j.jns.2013.07.2099
Abstract - WCN 2013 No: 552 Topic: 36 - Other Topic Pseudobulbar affect (PBA) in multiple sclerosis (MS), Parkinson's disease (PD), stroke and amyotrophic lateral sclerosis (ALS) G.E. Rodriguez, N.S. Garretto, T. Arakaki, O. Garcea, N. Bohorquez, L. Gonzalez, C. Quarracino. Hospital de Agudos José María Ramos Mejía, Buenos Aires, Argentina Background: PBA is an affective disinhibition group of signs and symptoms characterized by uncontrollable episodes of laughing or crying. Its prevalence in ALS is 34%, in MS 8%, in PD 16% and in stroke 15%. There is currently no conclusive information about the involvement of the pyramidal or extrapyramidal tract in its pathogenesis. Objective: to diagnose PBA in ALS, MS, PD and non acute stroke. Materials and Methods: 10 patients with PD, non acute stroke (more than three months since the diagnosis), MS remission recurrence type and ALS that concurred spontaneously to a specialist follow-up between April and June 2012 were evaluated with the CNS-LS and PLACS PBA scales. Results: There were 23 men and 17 women. The mean age was 54 (±13.31) years for ALS, 37 (±12.14) for MS, 71 (±16.59) for stroke and 61 (±9.92) for PD. Sixteen patients were diagnosed of PBA with de CNS-LS (31.2% PD, 25% ALS, 25% Stroke and 18.8% MS). 9 were diagnosed with PLACS (33.3% Stroke, 33.3% ALS, 22.2% PD y 11.1% MS). Of them all, 75% had pyramidal tract dysfunction, 22.5% extrapyramidal and 5% none of the above. Between those diagnosed by CNS-LS, 75% had pyramidal signs and 25% extrapyramidal. With PLACS the percentages were 88.9 and 11.1 respectively. Conclusion: PD was the disease with most PBA diagnoses with CNS-LS. With PLACS were ALS and Stroke. MS had the lowest PBA diagnoses with both scales. PBA patients had the same frequency of pyramidal and extrapyramidal dysfunction as the general population interviewed. doi:10.1016/j.jns.2013.07.2100
Abstract - WCN 2013 No: 567 Topic: 36 - Other Topic Safety of bevacizumab with or without anticoagulant treatment in neuro-oncological patients: A systematic review G. Simonettia, E. Trevisanb, P. Gaviania, E. Lampertia, A. Salmaggia, A. Silvania. aDepartment of Neurooncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; bDepartment of Neuroscience, University and San Giovanni Battista Hospital, Turin, Italy Background: Neoangiogenesis has recently become a major target for the development of new antineoplastic drugs. The most serious adverse events linked to angiogenesis inhibitors are venous/arterial thromboembolism and hemorrhage. Thus, there is a need to define with more certainty the impact of these new drugs in terms of adverse effects in neurological patients. Objective: the aim of the study is to assess the risk of venousthromboembolism (VTE) and bleeding in neurooncological patients
treated with bevacizumab with or without concomitant anticoagulant therapy. Material and methods: a review of published literature was performed in Medline, from which we identified 476 records. We assessed for eligibility 27 full-text articles including retrospective analyses, retrospective reviews, and open label trials. The investigated drugs included bevacizumab alone, bevacizumab plus chemotherapy with/without concomitant radiation therapy; only two articles dealt with bevacizumab in association with anticoagulant treatment. Results: a total of 2208 neurooncological patients were identified and included in the analysis. Data confirmed that patients receiving bevacizumab had a major risk of developing VTE that increased when bevacizumab is associated with radio-chemotherapy (4.27% vs. 7.46%). Regarding bleeding, data showed that patients treated with anticoagulant had a significantly increased risk of severe intracranial bleeding compared to patients not receiving anticoagulant therapy (0.6% vs 8.2%). Conclusion: the use of bevacizumab combined with chemoradiotherapy is associated with a higher risk for VTE compared to patients receiving antiangiogenic therapy alone. The associated use of anticoagulants and bevacizumab far increases the risk of developing intra-extracranial bleeding higher than grade 3, compared to patients receiving bevacizumab alone. doi:10.1016/j.jns.2013.07.2101
Abstract - WCN 2013 No: 586 Topic: 36 - Other Topic Alexander von Humboldt and his medical research L. Harmsa, L.A. Dögnitzb. aDepartment of Neurology, Charité Universitätsmedizin Charité, Germany; bDepartment of Neurology, Jewish Hospital, Berlin, Germany Background: Medical research in the second half of the 18th c was characterised by a remarkable dynamism in theory construction and a turn towards hard science. For a long time Humboldt's (AvH) contribution to this was overshadowed by his other achievements. Objective: Inspired by Galvani's publication of Animal Electricity in 1791, AvH conducted numerous neurophysiologic experiments between 1792 and 1797. He published his results in “Experiments on stimulated muscular and nervous tissue” in 1797. How significant were his findings? Material and methods: In nearly 4000 stimulation tests by means of electrical power he experimented on 3000 different animals and also on himself. Having perused his publication and analysed his ideas, methods and results, we demonstrate his procedures and achievements with the help of examples. Results: AvH often drew precise and far-reaching conclusions of which an essential one was that there was no stable nerve excitability, but that it depended on numerous factors. However, perplexing observations are also discussed, such as the additive nature of his experiments and the absence of a systematic approach. AvH conducted his experiments with utmost skill strictly following the procedure of Observation – Experiment – Formal application of mathematics – Conclusion, which was by no means a common approach in physiology at the time. Conclusion: AvH's work must be seen in the context of contemporaneous schools of medical thought. Being influential in a number of areas, his major achievement was that he pioneered the exact scientific research methodology of the 19th century. His work reflects 19th c medicine in an enlightening way. doi:10.1016/j.jns.2013.07.2102
Abstracts / Journal of the Neurological Sciences 333 (2013) e579–e628
Diagnostics include using the Kato-Katz technique or a biopsy of the infected tissue. We report a case of a 32 year old female, with an isolated cerebral infection due to Schistosoma sp, who presented with newonset seizure, negative diagnostic tests, and necessitated brain tissue biopsy. Patient was subsequently treated with praziquantel 600 mg/tab twice a day. doi:10.1016/j.jns.2013.07.2099
Abstract - WCN 2013 No: 552 Topic: 36 - Other Topic Pseudobulbar affect (PBA) in multiple sclerosis (MS), Parkinson's disease (PD), stroke and amyotrophic lateral sclerosis (ALS) G.E. Rodriguez, N.S. Garretto, T. Arakaki, O. Garcea, N. Bohorquez, L. Gonzalez, C. Quarracino. Hospital de Agudos José María Ramos Mejía, Buenos Aires, Argentina Background: PBA is an affective disinhibition group of signs and symptoms characterized by uncontrollable episodes of laughing or crying. Its prevalence in ALS is 34%, in MS 8%, in PD 16% and in stroke 15%. There is currently no conclusive information about the involvement of the pyramidal or extrapyramidal tract in its pathogenesis. Objective: to diagnose PBA in ALS, MS, PD and non acute stroke. Materials and Methods: 10 patients with PD, non acute stroke (more than three months since the diagnosis), MS remission recurrence type and ALS that concurred spontaneously to a specialist follow-up between April and June 2012 were evaluated with the CNS-LS and PLACS PBA scales. Results: There were 23 men and 17 women. The mean age was 54 (±13.31) years for ALS, 37 (±12.14) for MS, 71 (±16.59) for stroke and 61 (±9.92) for PD. Sixteen patients were diagnosed of PBA with de CNS-LS (31.2% PD, 25% ALS, 25% Stroke and 18.8% MS). 9 were diagnosed with PLACS (33.3% Stroke, 33.3% ALS, 22.2% PD y 11.1% MS). Of them all, 75% had pyramidal tract dysfunction, 22.5% extrapyramidal and 5% none of the above. Between those diagnosed by CNS-LS, 75% had pyramidal signs and 25% extrapyramidal. With PLACS the percentages were 88.9 and 11.1 respectively. Conclusion: PD was the disease with most PBA diagnoses with CNS-LS. With PLACS were ALS and Stroke. MS had the lowest PBA diagnoses with both scales. PBA patients had the same frequency of pyramidal and extrapyramidal dysfunction as the general population interviewed. doi:10.1016/j.jns.2013.07.2100
Abstract - WCN 2013 No: 567 Topic: 36 - Other Topic Safety of bevacizumab with or without anticoagulant treatment in neuro-oncological patients: A systematic review G. Simonettia, E. Trevisanb, P. Gaviania, E. Lampertia, A. Salmaggia, A. Silvania. aDepartment of Neurooncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; bDepartment of Neuroscience, University and San Giovanni Battista Hospital, Turin, Italy Background: Neoangiogenesis has recently become a major target for the development of new antineoplastic drugs. The most serious adverse events linked to angiogenesis inhibitors are venous/arterial thromboembolism and hemorrhage. Thus, there is a need to define with more certainty the impact of these new drugs in terms of adverse effects in neurological patients. Objective: the aim of the study is to assess the risk of venousthromboembolism (VTE) and bleeding in neurooncological patients
treated with bevacizumab with or without concomitant anticoagulant therapy. Material and methods: a review of published literature was performed in Medline, from which we identified 476 records. We assessed for eligibility 27 full-text articles including retrospective analyses, retrospective reviews, and open label trials. The investigated drugs included bevacizumab alone, bevacizumab plus chemotherapy with/without concomitant radiation therapy; only two articles dealt with bevacizumab in association with anticoagulant treatment. Results: a total of 2208 neurooncological patients were identified and included in the analysis. Data confirmed that patients receiving bevacizumab had a major risk of developing VTE that increased when bevacizumab is associated with radio-chemotherapy (4.27% vs. 7.46%). Regarding bleeding, data showed that patients treated with anticoagulant had a significantly increased risk of severe intracranial bleeding compared to patients not receiving anticoagulant therapy (0.6% vs 8.2%). Conclusion: the use of bevacizumab combined with chemoradiotherapy is associated with a higher risk for VTE compared to patients receiving antiangiogenic therapy alone. The associated use of anticoagulants and bevacizumab far increases the risk of developing intra-extracranial bleeding higher than grade 3, compared to patients receiving bevacizumab alone. doi:10.1016/j.jns.2013.07.2101
Abstract - WCN 2013 No: 586 Topic: 36 - Other Topic Alexander von Humboldt and his medical research L. Harmsa, L.A. Dögnitzb. aDepartment of Neurology, Charité Universitätsmedizin Charité, Germany; bDepartment of Neurology, Jewish Hospital, Berlin, Germany Background: Medical research in the second half of the 18th c was characterised by a remarkable dynamism in theory construction and a turn towards hard science. For a long time Humboldt's (AvH) contribution to this was overshadowed by his other achievements. Objective: Inspired by Galvani's publication of Animal Electricity in 1791, AvH conducted numerous neurophysiologic experiments between 1792 and 1797. He published his results in “Experiments on stimulated muscular and nervous tissue” in 1797. How significant were his findings? Material and methods: In nearly 4000 stimulation tests by means of electrical power he experimented on 3000 different animals and also on himself. Having perused his publication and analysed his ideas, methods and results, we demonstrate his procedures and achievements with the help of examples. Results: AvH often drew precise and far-reaching conclusions of which an essential one was that there was no stable nerve excitability, but that it depended on numerous factors. However, perplexing observations are also discussed, such as the additive nature of his experiments and the absence of a systematic approach. AvH conducted his experiments with utmost skill strictly following the procedure of Observation – Experiment – Formal application of mathematics – Conclusion, which was by no means a common approach in physiology at the time. Conclusion: AvH's work must be seen in the context of contemporaneous schools of medical thought. Being influential in a number of areas, his major achievement was that he pioneered the exact scientific research methodology of the 19th century. His work reflects 19th c medicine in an enlightening way. doi:10.1016/j.jns.2013.07.2102