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Verhey LH, Kulkarni AV, Reeder RW, Riva-Cambrin J, Jensen H, Pollack IF, Rocque BG, Tamber MS, McDonald PJ, Krieger MD, Pindrik JA, Hauptman JS, Browd SR, Whitehead WE, Jackson EM, Wellons JC, Hankinson TC, Chu J, Limbrick DD, Strahle JM, Kestle JRW. A re-evaluation of the Endoscopic Third Ventriculostomy Success Score: a Hydrocephalus Clinical Research Network study. J Neurosurg Pediatr 2024; 33:417-427. [PMID: 38335514 DOI: 10.3171/2023.12.peds23401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/06/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE The Hydrocephalus Clinical Research Network (HCRN) conducted a prospective study 1) to determine if a new, better-performing version of the Endoscopic Third Ventriculostomy Success Score (ETVSS) could be developed, 2) to explore the performance characteristics of the original ETVSS in a modern endoscopic third ventriculostomy (ETV) cohort, and 3) to determine if the addition of radiological variables to the ETVSS improved its predictive abilities. METHODS From April 2008 to August 2019, children (corrected age ≤ 17.5 years) who underwent a first-time ETV for hydrocephalus were included in a prospective multicenter HCRN study. All children had at least 6 months of clinical follow-up and were followed since the index ETV in the HCRN Core Data Registry. Children who underwent choroid plexus cauterization were excluded. Outcome (ETV success) was defined as the lack of ETV failure within 6 months of the index procedure. Kaplan-Meier curves were constructed to evaluate time-dependent variables. Multivariable binary logistic models were built to evaluate predictors of ETV success. Model performance was evaluated with Hosmer-Lemeshow and Harrell's C statistics. RESULTS Seven hundred sixty-one children underwent a first-time ETV. The rate of 6-month ETV success was 76%. The Hosmer-Lemeshow and Harrell's C statistics of the logistic model containing more granular age and etiology categorizations did not differ significantly from a model containing the ETVSS categories. In children ≥ 12 months of age with ETVSSs of 50 or 60, the original ETVSS underestimated success, but this analysis was limited by a small sample size. Fronto-occipital horn ratio (p = 0.37), maximum width of the third ventricle (p = 0.39), and downward concavity of the floor of the third ventricle (p = 0.63) did not predict ETV success. A possible association between the degree of prepontine adhesions on preoperative MRI and ETV success was detected, but this did not reach statistical significance. CONCLUSIONS This modern, multicenter study of ETV success shows that the original ETVSS continues to demonstrate good predictive ability, which was not substantially improved with a new success score. There might be an association between preoperative prepontine adhesions and ETV success, and this needs to be evaluated in a future large prospective study.
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Affiliation(s)
- Leonard H Verhey
- 1Division of Neurosurgery, Department of Clinical Neurosciences, Spectrum Health, Michigan State University, Grand Rapids, Michigan
| | - Abhaya V Kulkarni
- 2Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Ron W Reeder
- 3Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Jay Riva-Cambrin
- 4Division of Neurosurgery, Alberta Children's Hospital, University of Calgary, Alberta, Canada
| | - Hailey Jensen
- 3Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Ian F Pollack
- 5Department of Neurosurgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania
| | - Brandon G Rocque
- 6Department of Neurosurgery, Children's of Alabama, University of Alabama, Birmingham, Alabama
| | - Mandeep S Tamber
- 7Division of Neurosurgery, UBC Department of Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Patrick J McDonald
- 8Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark D Krieger
- 9Department of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jonathan A Pindrik
- 10Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jason S Hauptman
- 11Department of Neurological Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Samuel R Browd
- 11Department of Neurological Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - William E Whitehead
- 12Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Eric M Jackson
- 13Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - John C Wellons
- 14Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd C Hankinson
- 15Department of Neurosurgery, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Jason Chu
- 9Department of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - David D Limbrick
- 16Department of Neurosurgery, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, Missouri; and
| | - Jennifer M Strahle
- 16Department of Neurosurgery, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, Missouri; and
| | - John R W Kestle
- 17Department of Neurosurgery, University of Utah, Salt Lake City, Utah
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Verhey LH, Orozco AR, Oliver M, Lyons L, Sewell AP, Tsai JPC, Mazaris P, Khan M, Singer JA. Transradial versus transfemoral access for mechanical thrombectomy in acute ischemic stroke: A retrospective cohort study. J Stroke Cerebrovasc Dis 2023; 32:107282. [PMID: 37659190 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND The objective of this study was to compare procedural and clinical outcomes in patients with acute ischemic stroke (AIS) treated via transradial access (TRA) mechanical thrombectomy (MT) versus conventional transfemoral access (TFA). METHODS We performed a retrospective analysis of consecutive patients with AIS treated with TRA versus TFA MT at our tertiary comprehensive stroke center. Access choice was individualized based on occlusion site, aortic and arch anatomy. Outcomes were extracted from our institutional stroke registry and included procedural time, Thrombolysis in Cerebral Infarction (TICI) reperfusion score, NIHSS, 90-day mRS and 90-day mortality. Comparisons were performed using Student t-Test and Fischer's exact test as appropriate. RESULTS 175 mechanical thrombectomies were performed during the study interval; 39 (22%) were performed via TRA and 136 (79%) TFA. Access to reperfusion time was 36.3 ± 24.5 minutes in the TRA group and 21.9 ± 17.6 in the TFA group (p<0.001). The proportion of patients with a TICI reperfusion score of 2b or 3 was similar in both groups (TRA: 34 (87%) vs. TFA: 121 (89%) p=0.559. The median 90-day mRS was similar between both groups (p=0.170), as was the 90-day mortality (p = 0.509). CONCLUSIONS While TFA is faster in our cohort, TFA and TRA are both safe and effective for MT in acute ischemic stroke. While TFA remains mainstay, TRA can be valuable in variant anatomy despite its technical limitations. Individualizing access based on advanced imaging and patient factors may improve practice; however, updates in catheter and access technology are necessary to optimize outcomes with TRA.
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Affiliation(s)
- Leonard H Verhey
- Division of Neurological Surgery, Spectrum Health, Grand Rapids, MI, USA; Department of Clinical Neurosciences, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Andres Restrepo Orozco
- Division of Neurological Surgery, Spectrum Health, Grand Rapids, MI, USA; Department of Clinical Neurosciences, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Marion Oliver
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | - Leah Lyons
- Division of Neurological Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Andrea P Sewell
- Division of Neurological Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Jenny P-C Tsai
- Department of Clinical Neurosciences, Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Division of Neurology, Spectrum Health, Grand Rapids, MI, USA
| | - Paul Mazaris
- Division of Neurological Surgery, Spectrum Health, Grand Rapids, MI, USA; Department of Clinical Neurosciences, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Muhib Khan
- Department of Clinical Neurosciences, Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Division of Neurology, Spectrum Health, Grand Rapids, MI, USA
| | - Justin A Singer
- Division of Neurological Surgery, Spectrum Health, Grand Rapids, MI, USA; Department of Clinical Neurosciences, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
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3
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Pinheiro AC, Nogueira RG, Grandfield RM, Lin SP, Majjhoo AQ, Aghaebrahim AN, Abraham MG, Mazaris P, Singer JA, Al-Bayati AR, Verhey LH, Lin E, Haussen DC. Push and Fluff technique for optimization of clot integration with stent-retriever: An in vitro model. Interv Neuroradiol 2023:15910199231175348. [PMID: 37198900 DOI: 10.1177/15910199231175348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND For stent-retriever (SR) thrombectomy, technical developments such as the Push and Fluff technique (PFT) appear to have a significant impact on procedural success. This study aimed to (1) quantify the enhancement in clot traction when using PFT as compared to the standard unsheathing technique (SUT) and (2) to evaluate the performance of PFT in new versus established users of the technique. METHODS Operators were divided between established PFT and SUT users. Each experiment was labeled according to the SR size, utilized technique, and operator experience. A three-dimensional-printed chamber with a clot simulant was used. After each retriever deployment, the SR wire was connected to a force gauge. Tension was applied by pulling the gauge until clot disengagement. The maximal force was recorded. RESULTS A total of 167 experiments were performed. The median overall force to disengage the clot was 1.11 pounds for PFT and 0.70 pounds for SUT (an overall 59.1% increment with PFT; p < 0.001). The PFT effect was consistent across different retriever sizes (69% enhancement with the 3 × 32mm device, 52% with the 4 × 28mm, 65% with the 4 × 41mm, 47% with the 6 × 37mm). The ratio of tension required for clot disengagement with PFT versus SUT was comparable between physicians who were PFT versus SUT operators (1.595 [0.844] vs. 1.448 [1.021]; p: 0.424). The PFT/SUT traction ratio remained consistent from passes 1 to 4 of each technique in SUT users. CONCLUSION PFT led to reproduceable improvement in clot engagement with an average ∼60% increase in clot traction in this model and was found not to have a significant learning curve.
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Affiliation(s)
- Agostinho C Pinheiro
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Raul G Nogueira
- UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Shao-Pow Lin
- PIH Health and LA Imaging and Interventional Consultants, Whittier, CA, USA
| | - Aniel Q Majjhoo
- McLaren Flint Hospital, Flint, MI and McLaren Macomb Hospital, Mount Clemens, MI, USA
| | | | - Michael G Abraham
- Departments of Neurology and Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Paul Mazaris
- Department of Neurological Surgery, Spectrum Health, Michigan State University, Grand Rapids, MI, USA
| | - Justin A Singer
- Department of Neurological Surgery, Spectrum Health, Michigan State University, Grand Rapids, MI, USA
| | - Alhamza R Al-Bayati
- UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Leonard H Verhey
- Department of Neurological Surgery, Spectrum Health, Michigan State University, Grand Rapids, MI, USA
| | - Eugene Lin
- Mercy Health, St Vincent Medical Center, Toledo, OH, USA
| | - Diogo C Haussen
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
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Verhey LH, Maharaj A, Patel N, Manoranjan B, Ajani O, Fleming A, Farrokhyar F, Singh SK, Yarascavitch B. External ventricular drainage in the management of pediatric patients with posterior fossa tumors and hydrocephalus: a retrospective cohort study. Childs Nerv Syst 2023; 39:887-894. [PMID: 36633680 DOI: 10.1007/s00381-022-05818-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine whether intraoperative adjunctive EVD placement in patients with a posterior fossa tumor (PFT) led to improved surgical, radiographic, and clinical outcomes compared to those who did not receive an EVD. METHODS Patients were grouped as those who underwent routine intraoperative adjunctive EVD insertion and those who did not at time of PFT resection. Patients who pre-operatively required a clinically indicated EVD insertion were excluded. Comparative analyses between both groups were conducted to evaluate clinical, radiological, and pathological outcomes. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were computed for post-operative outcomes. RESULTS Fifty-five selected patients were included, 15 who had an EVD placed at the time of PFT resection surgery, and 40 who did not. Children without an EVD did not experience a higher rate of complications or poorer post-operative outcomes compared to those with an EVD placed during resection surgery. There was no significant difference in the degree of gross total resection (p = 0.129), post-operative CSF leak (p = 1.000), and post-operative hemorrhage (p = 0.554) between those with an EVD and those without. The frequency of new cranial nerve deficits post-operatively was higher in those with an EVD (40%) compared to those without (3%, p = 0.001). There was a trend towards more frequently observed post-operative hydrocephalus in the EVD group (p = 0.057). CONCLUSION The routine use of EVD as an intraoperative adjunct in clinically stable pediatric patients with posterior fossa tumors and hydrocephalus may not be associated with improved radiological or clinical outcomes.
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Affiliation(s)
- Leonard H Verhey
- Division of Neurosurgery, Michigan State University, Spectrum Health, Grand Rapids, MI, USA.,McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, ON, Canada
| | - Arjuna Maharaj
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, ON, Canada
| | - Nikunj Patel
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, ON, Canada
| | - Branavan Manoranjan
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, ON, Canada.,Section of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Olufemi Ajani
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada.,Division of Pediatric Neurosurgery, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Adam Fleming
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Forough Farrokhyar
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methodology, McMaster University, Hamilton, ON, Canada
| | - Sheila K Singh
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada.,Division of Pediatric Neurosurgery, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Blake Yarascavitch
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, ON, Canada. .,Department of Surgery, McMaster University, Hamilton, ON, Canada. .,Division of Pediatric Neurosurgery, McMaster Children's Hospital, Hamilton, ON, Canada.
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Hatcher S, Verhey LH, Restrepo Orozco A, Abouelleil M, Boyce HM. A novel case of refractory hiccups following epidural thoracic spinal cord stimulator implantation for chronic low back pain. Interdisciplinary Neurosurgery 2022. [DOI: 10.1016/j.inat.2022.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Elder TA, Verhey LH, Schultz H, Smith ES, Adel JG. Cervical carotid occlusion in acute ischemic stroke: Should we give tPA? Surg Neurol Int 2022; 13:177. [PMID: 35509556 PMCID: PMC9063023 DOI: 10.25259/sni_176_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Acute ischemic stroke (AIS) due to cervical internal carotid artery (cICA) occlusion is challenging to treat, with the lower revascularization rates, higher risk for complications, and poor response to thrombolytic therapy compared to isolated intracranial occlusions. While emergent revascularization through mechanical thrombectomy (MT) improves outcomes, the impact of tissue plasminogen activator (tPA) on outcomes in this subgroup of patients remains unclear. The objective of this study is to report our preliminary experience in treating AIS with cICA occlusions secondary to severe atherosclerotic stenosis and to establish the need for further clinical studies to determine the optimal intervention strategy for these lesions. Methods: Data were collected on patients who presented with acute cICA occlusion who underwent MT and either acute or staged carotid angioplasty and stenting. We compare patients who received tPA to those who did not, analyzing revascularization times, outcomes, and complications between the two populations, and discuss how this influenced our preferred treatment approach. Results: Twenty-one patients met inclusion criteria, seven of who received tPA and 14 did not receive tPA before surgical intervention. Procedural and functional outcomes were similar between the two populations. TPA administration correlated with a higher rate of vessel reocclusion in staged procedures and trended toward higher rates of symptomatic ICH and 90-day mortality. Conclusion: Emergent revascularization with acute cICA stenting carries advantages, but its safety is precluded by tPA administration. We suggest a trial which randomizes patients with cICA occlusions to receiving either tPA or dual antiplatelet therapy before surgical intervention, aiming to ultimately improved outcomes in these patients.
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Affiliation(s)
- Theresa A. Elder
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio,
| | - Leonard H. Verhey
- Department of Clinical Neurosciences, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids,
| | - Haritha Schultz
- Department of Internal Medicine, Central Michigan University College of Medicine,
| | - Eleanor S. Smith
- Department of Neurosurgery, Central Michigan University College of Medicine,
| | - Joseph G. Adel
- Department of Neuroscience, Ascension St Mary’s Hospital, Saginaw, Michigan, United States
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Orozco AR, Verhey LH, Chakravarthi S, Lyons L, Madura C, Bercu MM, Singer JA. Minimally-Invasive Transsulcal Parafascicular Resection of Subcortical Lesions in Pediatric Patients. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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8
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Verhey LH, Singer JA. Book Review. World Neurosurg 2020. [DOI: 10.1016/j.wneu.2019.08.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Elder TA, Verhey LH, Simon DB, Smith EC, Adel JG. Endovascular treatment of a basilar tip aneurysm via a persistent primitive proatlantal intersegmental artery. Interdisciplinary Neurosurgery 2019. [DOI: 10.1016/j.inat.2019.100543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Verhey LH, Elder TA, Adel JG. Iatrogenic cortical pseudoaneurysm following ventriculoperitoneal shunt insertion presenting with intraventricular hemorrhage. Surg Neurol Int 2019; 10:179. [PMID: 31583176 PMCID: PMC6763671 DOI: 10.25259/sni_36_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 08/30/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Cerebral pseudoaneurysm formation associated with ventricular catheterization is an exceedingly rare complication that results from direct catheter-induced injury to a vessel. We report a case of intracerebral pseudoaneurysm formation associated with ventricular catheterization in a patient with hydrocephalus following aneurysmal subarachnoid hemorrhage. Case Description: The patient presented with aneurysmal subarachnoid hemorrhage and underwent partial endovascular embolization of the offending wide-necked basilar tip aneurysm with the plan for a Stage 2 stent-assisted coiling after initial recovery. Before discharge, a ventriculoperitoneal shunt (VPS) was placed for postaneurysmal hydrocephalus. Three weeks later, she presented with intraparenchymal and intraventricular hemorrhage. Angiography revealed a cortical aneurysm contiguous to the ventricular catheter of the VPS. She underwent microsurgical excision of the aneurysm, and a new VPS was placed after resolution of the intraventricular hemorrhage. She later underwent the second stage of the treatment and had an excellent neurological recovery to an independent state. Conclusion: Iatrogenic intracerebral pseudoaneurysm formation is an exceedingly rare complication of ventricular catheterization but is associated with significant mortality. Identifying a pseudoaneurysm in this context warrants prompt and definitive treatment with microsurgical or endovascular treatment.
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Affiliation(s)
- Leonard H Verhey
- Department of Clinical Neuroscience, Division of Neurological Surgery, Spectrum Health, Michigan State University, Departments of Neurosurgery
| | - Theresa A Elder
- College of Medicine, Central Michigan University, Mt. Pleasant
| | - Joseph G Adel
- College of Medicine, Central Michigan University, Mt. Pleasant.,Ascension St. Mary's Hospital Neurosurgery Associates, Saginaw.,Field Neuroscience Institute, Saginaw, Michigan, USA
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Maharaj A, Manoranjan B, Verhey LH, Fleming AJ, Farrokhyar F, Almenawer S, Singh SK, Yarascavitch B. Predictive measures and outcomes of extent of resection in juvenile pilocytic astrocytoma. J Clin Neurosci 2019; 70:79-84. [PMID: 31466905 DOI: 10.1016/j.jocn.2019.08.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The present study aims to determine the tumor-related, clinical, and demographic factors associated with extent of resection (EOR) and post-operative outcomes in JPA patients. METHODS All patients with JPA, identified from a single-center brain tumour data base, were included in this retrospective analysis. Pre-operative MRI scans were reviewed by a single neurosurgeon blinded to the EOR. JPA cases that exhibited no residual tumor post-operatively were assigned to the GTR group, all other tumors were assigned to the <GTR group. Tumor-related, clinical and demographic variables as well as perioperative morbidities were compared between both groups. RESULTS Of the 28 patients included, 15 had a GTR (46% male; median age: 7.5 years; range: 1.16-14.9) and 13 had <GTR (69.2% male; median age: 10.6 years; range: 0.66-17.68). Tumor location reached statistical significance, as there were significantly more cerebellar tumors in the GTR group (86.7%) compared to the <GTR group (38.5%) (p = 0.016). GTR cases had a significantly longer average follow-up interval (6.6 months) than <GTR cases (4.5 months) (p = 0.031). All demographic variables, clinical variables and tumor-related factors showed no significant differences between the two groups. There were no differences between GTR and <GTR cases in terms of perioperative outcomes. CONCLUSIONS This study shows other than location of the lesion in the cerebellum, demographic, clinical and tumor-related variables are not associated with EOR in children with JPA. GTR was associated with an extended follow-up interval but not with increased perioperative morbidities compared to those with <GTR.
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Affiliation(s)
- Arjuna Maharaj
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada
| | - Branavan Manoranjan
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada
| | - Leonard H Verhey
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada
| | - Adam J Fleming
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada; Department of Paediatrics, Division of Hematology and Oncology, McMaster University, Hamilton, Canada
| | - Forough Farrokhyar
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Saleh Almenawer
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada
| | - Sheila K Singh
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada; Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada
| | - Blake Yarascavitch
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada; Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada.
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12
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Verhey LH, Wang W, Adel JG. True Cortical Saccular Aneurysm Presenting as an Acute Subdural Hematoma. World Neurosurg 2018; 113:58-61. [DOI: 10.1016/j.wneu.2018.01.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/25/2018] [Accepted: 01/27/2018] [Indexed: 11/28/2022]
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Aubert-Broche B, Weier K, Longoni G, Fonov VS, Bar-Or A, Marrie RA, Yeh EA, Narayanan S, Arnold DL, Verhey LH, Banwell B, Collins DL. Monophasic demyelination reduces brain growth in children. Neurology 2017; 88:1744-1750. [PMID: 28381515 DOI: 10.1212/wnl.0000000000003884] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 01/23/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate how monophasic acquired demyelinating syndromes (ADS) affect age-expected brain growth over time. METHODS We analyzed 83 pediatric patients imaged serially from initial demyelinating attack: 18 with acute disseminated encephalomyelitis (ADEM) and 65 with other monophasic ADS presentations (monoADS). We further subdivided the monoADS group by the presence (n = 33; monoADSlesion) or absence (n = 32; monoADSnolesion) of T2 lesions involving the brain at onset. We used normative data to compare brain volumes and calculate age- and sex-specific z scores, and used mixed-effect models to investigate their relationship with time from demyelinating illness. RESULTS Children with monophasic demyelination (ADEM, non-ADEM with brain lesions, and those without brain involvement) demonstrated reduced age-expected brain growth on serial images, driven by reduced age-expected white matter growth. Cortical gray matter volumes were not reduced at onset but demonstrated reduced age-expected growth afterwards in all groups. Brain volumes differed from age- and sex-expected values to the greatest extent in children with ADEM. All patient groups failed to recover age-expected brain growth trajectories. CONCLUSIONS Brain volume, and more importantly age-expected brain growth, is negatively affected by acquired demyelination, even in the absence of chronicity, implicating factors other than active inflammation as operative in this process.
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Affiliation(s)
- Bérengère Aubert-Broche
- From the McConnell Brain Imaging Center (B.A.-B., K.W., V.S.F., S.N., D.L.A., D.L.C.) and Department of Neurology and Neurosurgery and Experimental Therapeutics Program (A.B.-O.), Montreal Neurological Institute, McGill University; The Hospital for Sick Children (G.L., E.A.Y., L.H.V.), University of Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; and Children's Hospital of Philadelphia (B.B.), Perelman School of Medicine, University of Pennsylvania.
| | - Katrin Weier
- From the McConnell Brain Imaging Center (B.A.-B., K.W., V.S.F., S.N., D.L.A., D.L.C.) and Department of Neurology and Neurosurgery and Experimental Therapeutics Program (A.B.-O.), Montreal Neurological Institute, McGill University; The Hospital for Sick Children (G.L., E.A.Y., L.H.V.), University of Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; and Children's Hospital of Philadelphia (B.B.), Perelman School of Medicine, University of Pennsylvania
| | - Giulia Longoni
- From the McConnell Brain Imaging Center (B.A.-B., K.W., V.S.F., S.N., D.L.A., D.L.C.) and Department of Neurology and Neurosurgery and Experimental Therapeutics Program (A.B.-O.), Montreal Neurological Institute, McGill University; The Hospital for Sick Children (G.L., E.A.Y., L.H.V.), University of Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; and Children's Hospital of Philadelphia (B.B.), Perelman School of Medicine, University of Pennsylvania
| | - Vladimir S Fonov
- From the McConnell Brain Imaging Center (B.A.-B., K.W., V.S.F., S.N., D.L.A., D.L.C.) and Department of Neurology and Neurosurgery and Experimental Therapeutics Program (A.B.-O.), Montreal Neurological Institute, McGill University; The Hospital for Sick Children (G.L., E.A.Y., L.H.V.), University of Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; and Children's Hospital of Philadelphia (B.B.), Perelman School of Medicine, University of Pennsylvania
| | - Amit Bar-Or
- From the McConnell Brain Imaging Center (B.A.-B., K.W., V.S.F., S.N., D.L.A., D.L.C.) and Department of Neurology and Neurosurgery and Experimental Therapeutics Program (A.B.-O.), Montreal Neurological Institute, McGill University; The Hospital for Sick Children (G.L., E.A.Y., L.H.V.), University of Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; and Children's Hospital of Philadelphia (B.B.), Perelman School of Medicine, University of Pennsylvania
| | - Ruth Ann Marrie
- From the McConnell Brain Imaging Center (B.A.-B., K.W., V.S.F., S.N., D.L.A., D.L.C.) and Department of Neurology and Neurosurgery and Experimental Therapeutics Program (A.B.-O.), Montreal Neurological Institute, McGill University; The Hospital for Sick Children (G.L., E.A.Y., L.H.V.), University of Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; and Children's Hospital of Philadelphia (B.B.), Perelman School of Medicine, University of Pennsylvania
| | - E Ann Yeh
- From the McConnell Brain Imaging Center (B.A.-B., K.W., V.S.F., S.N., D.L.A., D.L.C.) and Department of Neurology and Neurosurgery and Experimental Therapeutics Program (A.B.-O.), Montreal Neurological Institute, McGill University; The Hospital for Sick Children (G.L., E.A.Y., L.H.V.), University of Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; and Children's Hospital of Philadelphia (B.B.), Perelman School of Medicine, University of Pennsylvania
| | - Sridar Narayanan
- From the McConnell Brain Imaging Center (B.A.-B., K.W., V.S.F., S.N., D.L.A., D.L.C.) and Department of Neurology and Neurosurgery and Experimental Therapeutics Program (A.B.-O.), Montreal Neurological Institute, McGill University; The Hospital for Sick Children (G.L., E.A.Y., L.H.V.), University of Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; and Children's Hospital of Philadelphia (B.B.), Perelman School of Medicine, University of Pennsylvania
| | - Douglas L Arnold
- From the McConnell Brain Imaging Center (B.A.-B., K.W., V.S.F., S.N., D.L.A., D.L.C.) and Department of Neurology and Neurosurgery and Experimental Therapeutics Program (A.B.-O.), Montreal Neurological Institute, McGill University; The Hospital for Sick Children (G.L., E.A.Y., L.H.V.), University of Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; and Children's Hospital of Philadelphia (B.B.), Perelman School of Medicine, University of Pennsylvania
| | - Leonard H Verhey
- From the McConnell Brain Imaging Center (B.A.-B., K.W., V.S.F., S.N., D.L.A., D.L.C.) and Department of Neurology and Neurosurgery and Experimental Therapeutics Program (A.B.-O.), Montreal Neurological Institute, McGill University; The Hospital for Sick Children (G.L., E.A.Y., L.H.V.), University of Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; and Children's Hospital of Philadelphia (B.B.), Perelman School of Medicine, University of Pennsylvania
| | - Brenda Banwell
- From the McConnell Brain Imaging Center (B.A.-B., K.W., V.S.F., S.N., D.L.A., D.L.C.) and Department of Neurology and Neurosurgery and Experimental Therapeutics Program (A.B.-O.), Montreal Neurological Institute, McGill University; The Hospital for Sick Children (G.L., E.A.Y., L.H.V.), University of Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; and Children's Hospital of Philadelphia (B.B.), Perelman School of Medicine, University of Pennsylvania
| | - D Louis Collins
- From the McConnell Brain Imaging Center (B.A.-B., K.W., V.S.F., S.N., D.L.A., D.L.C.) and Department of Neurology and Neurosurgery and Experimental Therapeutics Program (A.B.-O.), Montreal Neurological Institute, McGill University; The Hospital for Sick Children (G.L., E.A.Y., L.H.V.), University of Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; and Children's Hospital of Philadelphia (B.B.), Perelman School of Medicine, University of Pennsylvania
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14
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Yiu EM, Laughlin S, Verhey LH, Banwell BL. Clinical and magnetic resonance imaging (MRI) distinctions between tumefactive demyelination and brain tumors in children. J Child Neurol 2014; 29:654-65. [PMID: 24092896 DOI: 10.1177/0883073813500713] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tumefactive demyelinating lesions can be difficult to distinguish from tumors. Clinical and magnetic resonance imaging features of children with tumefactive demyelination and supratentorial brain tumors were compared. Patients were identified through a 23-site national demyelinating disease study, and from a single-site neuroradiology database. For inclusion, lesions met at least 1 of 3 criteria: maximal cross-sectional diameter >20 mm, local or global cerebral mass effect, or presence of perilesional edema. Thirty-one children with tumefactive demyelination (5 with solitary lesions) were identified: 27 of 189 (14.3%) from the demyelinating disease study and 4 from the database. Thirty-three children with tumors were identified. Children with tumefactive demyelination were more likely to have an abnormal neurologic examination and polyfocal neurologic deficits compared to children with tumors. Tumefactive demyelination was distinguished from tumor by the presence of multiple lesions, absence of cortical involvement, and decrease in lesion size or detection of new lesions on serial imaging.
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Affiliation(s)
- Eppie M Yiu
- 1Children's Neuroscience Centre, Royal Children's Hospital Melbourne, Parkville, Australia
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15
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Ronen GM, Streiner DL, Boyle MH, Cunningham CE, Lach L, Verhey LH, Fayed N, Chen K, Rosenbaum PL, Connolly M, Bello-Espinosa LE, Rafay MF, Appendino JP, Shevell M, Carmant L. Outcomes trajectories in children with epilepsy: hypotheses and methodology of a Canadian longitudinal observational study. Pediatr Neurol 2014; 50:38-48. [PMID: 24370172 DOI: 10.1016/j.pediatrneurol.2013.08.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 08/13/2013] [Accepted: 08/21/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The impact of childhood epilepsy can only be appreciated by understanding that epilepsy comprises a set of complex neurobehavioral conditions with significant social consequences, and not simply disorders of recurrent seizures. Our objective is to describe the hypotheses and methodology behind a large prospective longitudinal study that is based on a conceptual framework for understanding health outcomes. The study will quantify the specific influences--direct, mediating or moderating--that various epilepsy, comorbid, child, and family variables exert on health over the early life course. METHODS The target population is 8- to 14-year-old children with epilepsy and their caregivers from across Canada. Children, caregivers, and health professionals are completing 17 measures at five visits over a 28-month period. We have selected measures based on content, the source of the items, psychometric properties, and provisions for child self-report. Our cross-sectional and longitudinal design includes a relational model for structural equation modeling of specific biomedical and psychosocial variables with hierarchical direction of influence. To measure change over time, we will use hierarchical linear modeling. SIGNIFICANCE This article reports the framework for interpreting future data. We believe that it will help researchers consider their methodology and encourage them to plan and execute longitudinal studies. Furthermore, the article will help clinical readers identify what to look for when evaluating outcomes research. It is our belief that the next generation of research to understand life-course effect in the lives of children and youth with chronic conditions and their families must occur over real time.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Michael H Boyle
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Charles E Cunningham
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lucyna Lach
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Leonard H Verhey
- Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nora Fayed
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Karen Chen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Peter L Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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16
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Verhey LH, Narayanan S, Banwell B. Standardized magnetic resonance imaging acquisition and reporting in pediatric multiple sclerosis. Neuroimaging Clin N Am 2013; 23:217-26.e1-7. [PMID: 23608686 DOI: 10.1016/j.nic.2012.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Magnetic resonance (MR) imaging is one of the most important paraclinical tools for the diagnosis of multiple sclerosis (MS), and monitoring of disease progression and treatment response. This article provides clinicians and neuroradiologists caring for children with demyelinating disorders with a suggested standard MR imaging acquisition and reporting protocol, and defines a standard lexicon for lesion features typical of MS in children. As there is considerable overlap between the MR imaging features of pediatric- and adult-onset MS, the recommendations provided herein may be of relevance to radiologists and clinicians caring for adults with multiple sclerosis.
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Affiliation(s)
- Leonard H Verhey
- Pediatric Demyelinating Disease Program, The Hospital for Sick Children, Toronto, ON, Canada
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17
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Verhey LH, Signori A, Arnold DL, Bar-Or A, Sadovnick AD, Marrie RA, Banwell B, Sormani MP. Clinical and MRI activity as determinants of sample size for pediatric multiple sclerosis trials. Neurology 2013; 81:1215-21. [PMID: 23966255 DOI: 10.1212/wnl.0b013e3182a6cb9b] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To estimate sample sizes for pediatric multiple sclerosis (MS) trials using new T2 lesion count, annualized relapse rate (ARR), and time to first relapse (TTFR) endpoints. METHODS Poisson and negative binomial models were fit to new T2 lesion and relapse count data, and negative binomial time-to-event and exponential models were fit to TTFR data of 42 children with MS enrolled in a national prospective cohort study. Simulations were performed by resampling from the best-fitting model of new T2 lesion count, number of relapses, or TTFR, under various assumptions of the effect size, trial duration, and model parameters. RESULTS Assuming a 50% reduction in new T2 lesions over 6 months, 90 patients/arm are required, whereas 165 patients/arm are required for a 40% treatment effect. Sample sizes for 2-year trials using relapse-related endpoints are lower than that for 1-year trials. For 2-year trials and a conservative assumption of overdispersion (ϑ), sample sizes range from 70 patients/arm (using ARR) to 105 patients/arm (TTFR) for a 50% reduction in relapses, and 230 patients/arm (ARR) to 365 patients/arm (TTFR) for a 30% relapse reduction. Assuming a less conservative ϑ, 2-year trials using ARR require 45 patients/arm (60 patients/arm for TTFR) for a 50% reduction in relapses and 145 patients/arm (200 patients/arm for TTFR) for a 30% reduction. CONCLUSION Six-month phase II trials using new T2 lesion count as an endpoint are feasible in the pediatric MS population; however, trials powered on ARR or TTFR will need to be 2 years in duration and will require multicentered collaboration.
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Affiliation(s)
- Leonard H Verhey
- From the Pediatric Demyelinating Disease Program (L.H.V.), Program in Neuroscience & Mental Health, The Hospital for Sick Children, University of Toronto, Canada; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genova, Italy; Department of Neurology & Neurosurgery (D.L.A., A.B.-O.), Montreal Neurological Institute and Hospital, McGill University, Montreal; Department of Neurology and Division of Medical Genetics (A.D.S.), University of British Columbia, Vancouver; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Winnipeg Health Sciences Centre, University of Manitoba, Winnipeg, Canada; and Division of Neurology (B.B.), Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania
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18
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Verhey LH, van Pelt-Gravesteijn ED, Ketelslegers IA, Neuteboom RF, Catsman-Berrevoets CE, Feldman BM, Streiner DL, Sled JG, Hintzen RQ, Banwell B. Validation of MRI predictors of multiple sclerosis diagnosis in children with acute CNS demyelination. Mult Scler Relat Disord 2013; 2:193-9. [PMID: 25877725 DOI: 10.1016/j.msard.2012.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 12/05/2012] [Accepted: 12/11/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND In a recent Canadian prospective study of children with acute demyelinating syndromes (ADS), we demonstrated that the presence of T2 periventricular and T1-hypointense lesions predicted MS diagnosis. We aimed to validate these predictors in a Dutch cohort of children with ADS. METHODS Participants with ADS were identified from a prospective cohort or archived dataset. MS was diagnosed based on clinical or MRI evidence of relapsing disease. Baseline MRI scans were evaluated for the presence of the two predictive parameters. Sensitivity, specificity, positive (LR+) and negative likelihood ratios (LR-), and positive (PPV) and negative predictive value (NPV) were calculated to evaluate the performance of the MRI parameters at classifying children as having MS or monophasic demyelination. FINDINGS Of 115 children identified with ADS between December 1993 and December 2009, MRI scans from 87 children (45 prospective; 47 archived) were evaluated; scans of 28 children were excluded due to incomplete or poor quality imaging. Mean duration of observation was longer in the archived group (7.1 years, SD 3.5) than the prospective cohort (3.3 years, SD 1.4). 30 children were diagnosed with MS. Performance of the parameters was not statistically different between the prospective cohort (sensitivity 93.3% [68.1-99.8]; specificity 86.7% [69.3-96.2]; LR+ 7.0 [2.8-17.6]; LR- 0.08 [0.01-0.5]; PPV 77.8% [52.4-93.6]; NPV 96.3% [81.0-99.9]) and archived group (sensitivity 66.7% [38.4-88.2]; specificity 85.2% [66.3-95.8]; LR+ 4.5 [1.7-11.9]; LR- 0.4 [0.2-0.8]; PPV 71.4% [41.9-91.6]; NPV 82.1% [63.1-93.9]). INTERPRETATION In an independent Dutch cohort, we confirm that the presence of ≥1 T2 periventricular and ≥1 T1-hypointense lesions reliably identifies children with MS. FUNDING Dutch MS Research Foundation.
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Affiliation(s)
- L H Verhey
- Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | | | | | - R F Neuteboom
- Department of Pediatric Neurology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C E Catsman-Berrevoets
- Department of Pediatric Neurology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - B M Feldman
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - D L Streiner
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - J G Sled
- Department of Medical Biophysics, University of Toronto, Toronto, Canada; Program in Physiology & Experimental Medicine, The Hospital for Sick Children, Toronto, Canada
| | - R Q Hintzen
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands; Department of Pediatric Neurology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - B Banwell
- Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA.
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19
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Verhey LH, Branson HM, Laughlin S, Shroff MM, Benseler SM, Feldman BM, Streiner DL, Sled JG, Banwell B. Development of a standardized MRI scoring tool for CNS demyelination in children. AJNR Am J Neuroradiol 2013; 34:1271-7. [PMID: 23348761 DOI: 10.3174/ajnr.a3382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE The degree to which MR imaging is useful in the diagnosis of MS is predicated on standardized and reliable evaluation of MR imaging parameters. We aimed to devise items for an MR imaging scoring tool that would have high inter-rater agreement and would be straightforward to apply. MATERIALS AND METHODS On the basis of a literature search and consensus of an expert panel, we identified 48 parameters that describe acute CNS demyelination, predict MS diagnosis, or characterize demyelinating disorder mimics. MR images of children with clinically confirmed MS, monophasic ADEM, and angiography-negative biopsy-positive small-vessel primary angiitis of the CNS were scored by 2 neuroradiologists independently, using the preliminary 48-parameter tool. Parameters with Cohen κ ≥ 0.6 and deemed important in predicting diagnosis were retained. Parameters not visualized on routine clinical imaging or not important in differentiating MS, ADEM, and SV-cPACNS were discarded. RESULTS Of 65 eligible patients, 55 children were enrolled (16 with monophasic ADEM, 27 with MS, 12 with SV-cPACNS); 10 were excluded (6 had hard-copy films, 4 did not meet MR imaging quality requirements). Of the 48 parameters, 16 were retained in the final scoring tool. The remaining 28 parameters were discarded: 4 had κ < 0.6 and were not deemed useful in predicting diagnosis; 9 were not visible on routinely acquired clinical images; and 15 had inter-rater agreement ≥0.6 but were not useful in differentiating monophasic ADEM, MS, and SV-cPACNS. CONCLUSIONS We propose a 16-parameter MR imaging scoring tool that is straightforward to apply in the clinical setting and demonstrates high inter-rater agreement.
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Affiliation(s)
- L H Verhey
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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20
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Verhey LH, Shroff M, Banwell B. Pediatric multiple sclerosis: pathobiological, clinical, and magnetic resonance imaging features. Neuroimaging Clin N Am 2013; 23:227-43. [PMID: 23608687 DOI: 10.1016/j.nic.2012.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this article, the pathobiological, clinical, and treatment aspects of pediatric-onset multiple sclerosis (MS) are summarized, and the conventional magnetic resonance (MR) imaging (ie, T1-weighted, proton-density, and T2-weighted imaging) features of MS in children are discussed, as well as the application of MR imaging in the diagnosis of pediatric-onset MS and in prediction of MS in children with an incident central nervous system demyelination. Insights gained from studies comparing MR imaging features of pediatric-onset and adult-onset MS are presented.
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Affiliation(s)
- Leonard H Verhey
- Pediatric Demyelinating Disease Program, The Hospital for Sick Children, Toronto, Ontario, Canada
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21
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Abstract
This review summarizes results from studies that have applied advanced magnetic resonance (MR) imaging techniques to patients with pediatric-onset multiple sclerosis (MS), and includes a discussion of cortical imaging techniques, volumetry, magnetization transfer and diffusion tensor imaging, proton magnetic resonance spectroscopy, and functional MR imaging. Multicenter studies on the sensitivity of these techniques to natural history of disease and treatment response are required before their implementation into clinical practice.
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22
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Manor L, Streiner DL, Yam WKL, Rosenbaum PL, Verhey LH, Lach L, Ronen GM. Age-related variables in childhood epilepsy: how do they relate to each other and to quality of life? Epilepsy Behav 2013; 26:71-4. [PMID: 23220463 DOI: 10.1016/j.yebeh.2012.10.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/01/2012] [Accepted: 10/04/2012] [Indexed: 11/30/2022]
Abstract
How do age of onset and duration of epilepsy correlate with each other and with patient-reported outcomes? To address this question, we explored whether age of onset, duration, and proportion of life with epilepsy are either similar or relatively independent variables that can be used as markers on how children experience the complexity of epilepsy and adjustment. Three hundred ninety-one Canadian and 266 Hong Kong youth with epilepsy completed the childhood epilepsy-specific quality of life (QOL) measure (CHEQOL-25). Each cohort was separately stratified by tertiles for age of onset, life proportion with epilepsy, and duration of epilepsy. Pearson's r was used for correlation analysis. The epilepsy age-related variables correlated strongly with each other among children with epilepsy onset ≤4 years (r = 0.53-0.66). The correlation between these variables was weaker with an onset ≥9 years (r =0.22-0.35). Correlation with QOL was clinically non-significant. These variables appear to measure the same phenomenon only in children with early epilepsy onset (<4 years) and explain little variance in QOL.
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Sadaka Y, Verhey LH, Shroff MM, Branson HM, Arnold DL, Narayanan S, Sled JG, Bar-Or A, Sadovnick AD, McGowan M, Marrie RA, Banwell B. 2010 McDonald criteria for diagnosing pediatric multiple sclerosis. Ann Neurol 2012; 72:211-23. [PMID: 22926854 DOI: 10.1002/ana.23575] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Yair Sadaka
- Division of Neurology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
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24
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Thomas T, Branson HM, Verhey LH, Shroff M, Stephens D, Magalhaes S, Banwell B. The demographic, clinical, and magnetic resonance imaging (MRI) features of transverse myelitis in children. J Child Neurol 2012; 27:11-21. [PMID: 21968984 DOI: 10.1177/0883073811420495] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The authors collected demographic, clinical, and neuroimaging data prospectively on 38 children with transverse myelitis. One child died during the illness. The female:male ratio was 1.2:1 for children under age 10 years and 2.6:1 over age 10 years. Twenty-eight (74%) reported a prodromal event. Twenty-two patients (58%) had longitudinally extensive transverse myelitis, 9 (24%) had focal lesions, and 5 (13%) had both. Twenty of 33 with brain imaging (61%) had brain lesions; 7 fulfilled McDonald criteria for dissemination in space. Seven of 22 (36%) tested had cerebrospinal fluid oligoclonal banding, 6 of whom had brain lesions. Serum neuromyelitis optica IgG antibodies were absent in all 20 of the children for whom this test was available. At follow-up (mean 3.2 ± 2.0 years), 16% are wheelchair-dependent, 22% have persisting bladder dysfunction, and 13% have been diagnosed with multiple sclerosis.
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Affiliation(s)
- Terrence Thomas
- Neurology Service, Department of Pediatrics, KK Women's & Children's Hospital, Singapore
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25
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Verhey LH, Branson HM, Shroff MM, Callen DJ, Sled JG, Narayanan S, Sadovnick AD, Bar-Or A, Arnold DL, Marrie RA, Banwell B. MRI parameters for prediction of multiple sclerosis diagnosis in children with acute CNS demyelination: a prospective national cohort study. Lancet Neurol 2011; 10:1065-73. [PMID: 22067635 DOI: 10.1016/s1474-4422(11)70250-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) diagnostic criteria incorporate MRI features that can be used to predict later diagnosis of MS in adults with acute CNS demyelination. To identify MRI predictors of a subsequent MS diagnosis in a paediatric population, we created a standardised scoring method and applied it to MRI scans from a national prospective incidence cohort of children with CNS demyelination. METHODS Clinical and MRI examinations were done at the onset of acute CNS demyelination and every 3 months in the first year after that, and at the time of a second demyelinating attack. MS was diagnosed on the basis of clinical or MRI evidence of relapsing disease. Baseline MRI scans were assessed for the presence of 14 binary response parameters. Parameters were assessed with a multiple tetrachoric correlation matrix. Univariate analyses and multivariable Cox proportional hazards models were used to identify predictors of MS. FINDINGS Between Sept 1, 2004, and June 30, 2010, 332 children and adolescents were assessed for eligibility. 1139 scans were available from 284 eligible participants who had been followed up for 3·9 (SD 1·7) years. 57 (20%) were diagnosed with MS after a median of 188 (IQR 144-337) days. Seven of 14 binary response parameters were retained. The presence of either one or more T1-weighted hypointense lesions (hazard ratio 20·6, 95% CI 5·46-78·0) or one or more periventricular lesions (3·34, 1·27-8·83) was associated with an increased likelihood of MS diagnosis (sensitivity 84%, specificity 93%, positive predictive value 76%, negative predictive value 96%). Risk for MS diagnosis was highest when both parameters were present (34·27, 16·69-70·38). Although the presence of contrast enhancement, cerebral white matter, intracallosal, and brainstem lesions was associated with MS in the univariate analyses, these parameters were not retained in the multivariable models. INTERPRETATION Specific MRI parameters can be used to predict diagnosis of MS in children with incident demyelination of the CNS. The ability to promptly identify children with MS will enhance timely access to care and will be important for future clinical trials in paediatric MS. FUNDING Canadian Multiple Sclerosis Scientific Research Foundation.
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Affiliation(s)
- Leonard H Verhey
- Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, University of Toronto, ON, Canada
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Verhey LH, Branson HM, Makhija M, Shroff M, Banwell B. Magnetic resonance imaging features of the spinal cord in pediatric multiple sclerosis: a preliminary study. Neuroradiology 2010; 52:1153-62. [PMID: 20721543 DOI: 10.1007/s00234-010-0755-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 07/28/2010] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Spinal cord lesions in adults with multiple sclerosis (MS) are thought to contribute to disability. The magnetic resonance imaging (MRI) appearance and clinical correlates of spinal cord lesions in children with MS have not been reported. METHODS T1-weighted pre- and post-gadolinium and T2-weighted TSE/FSE spine MR images of 36 children (age, 14.3 ± 3.3) with relapsing-remitting MS (annualized relapse rate, 0.7; disease duration, 7.5 ± 3.3 years) were analyzed for total lesion count, lesion location and length, intramedullary extent, and gadolinium enhancement. Clinical, demographic, laboratory, and MRI data were correlated. RESULTS Lesions preferentially involved the cervical region, were predominantly focal, and involved only a portion of the transverse cord diameter. However, ten of 36 patients demonstrated longitudinally extensive lesions. Children with the highest clinical relapse rate also tended to have more spinal cord lesions and were more likely to accrue new lesions on serial spinal scans. CONCLUSION These preliminary data suggest that MS lesions of the spinal cord in children are radiographically similar to that of adult-onset MS--supporting a common biology of pediatric- and adult-onset disease. However, children with relapsing-remitting MS can also develop longitudinally extensive lesions, suggesting that such lesions may be less specific for diseases such as neuromyelitis optica in pediatric patients. All patients recovered well from spinal cord attacks, and the presence of spinal cord lesions in the first few years of disease did not correlate with physical disability. Measures of spinal cord atrophy and longer periods of observation are required to determine the impact of spinal cord involvement in pediatric-onset MS.
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Affiliation(s)
- Leonard H Verhey
- Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
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Ronen GM, Streiner DL, Verhey LH, Lach L, Boyle MH, Cunningham CE, Rosenbaum PL. Disease characteristics and psychosocial factors: explaining the expression of quality of life in childhood epilepsy. Epilepsy Behav 2010; 18:88-93. [PMID: 20478747 DOI: 10.1016/j.yebeh.2010.02.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 02/24/2010] [Accepted: 02/25/2010] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To explore, identify and understand the contribution that biomedical and psychosocial factors make to the assessment of health-related quality of life (HRQL) of children and youth with epilepsy using the CHEQOL-25. METHODS We identified and measured variables that may influence HRQL; grouped the variables into four conceptual categories; and used simple and hierarchical linear regressions to model CHEQOL-25 as a function of these variable groupings. Participants were 8-15year olds with epilepsy and their parents. RESULTS 131 child and parent pairs participated. Overall, the unique variances associated with the biomedical and psychosocial variables are R(2)=0.22 and 0.29, respectively, for child self-reported HRQL and R(2)=0.11 and 0.13, respectively, for parent-proxy report. CONCLUSIONS This study increases our understanding of factors that contribute to the expression of HRQL in this population. These results should be interpreted with caution due to the limited sample size and large number of variables.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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Verhey LH, Kulik DM, Ronen GM, Rosenbaum P, Lach L, Streiner DL. Quality of life in childhood epilepsy: what is the level of agreement between youth and their parents? Epilepsy Behav 2009; 14:407-10. [PMID: 19126437 DOI: 10.1016/j.yebeh.2008.12.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 11/29/2008] [Accepted: 12/13/2008] [Indexed: 11/17/2022]
Abstract
Children and parents evaluate the child's quality of life (QOL) from their own perspectives; therefore, responses may differ, especially in abstract domains. We examined differences between self- and proxy-reported QOL of children with epilepsy. Children with active epilepsy (N=375) and their parents (N=378) separately completed the CHEQOL-25, a condition-specific QOL measure. The intraclass correlation coefficient was used to determine interrater agreement. Concordance on the Total CHEQOL-25 was 0.45 (P<0.01). Discrepancies were greatest for the subscales of Secrecy (0.24, P<0.01) and Present Concerns (0.32, P<0.01). School placement correlated with discrepancy in the Intrapersonal/Emotional subscale (r=0.19, P<0.05), and the child's age at testing correlated with discrepancy of the Total measure (r=0.15, P<0.01). This study demonstrates that parent perspectives alone are insufficient to measure their child's QOL. The CHEQOL-25 is a practical tool, with complementary parent and child versions, which can be used to determine health-related quality of life in children with epilepsy.
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Affiliation(s)
- L H Verhey
- Department of Paediatrics, McMaster University, Hamilton, Ont, Canada.
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Ramchandar K, Verhey LH, Jha NK, Murty NK, McMillan W. Intracranial Hodgkin's lymphoma in an HIV positive patient. J Neurooncol 2008; 89:69-71. [PMID: 18398570 DOI: 10.1007/s11060-008-9587-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Accepted: 03/28/2008] [Indexed: 11/27/2022]
Abstract
Intracranial Hodgkin's lymphoma (ICHL) in the HIV positive population is a rarely reported event with only three prior cases reported in the literature. In these prior reports, the outcome of the patients was uncertain or very poor. We report here the case of an HIV seropositive patient with an isolated intracranial recurrence of Hodgkin's Lymphoma (HL) who achieved long-term control of his cranial disease and continues to have a high performance status more than 3 years following treatment.
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Affiliation(s)
- Kevin Ramchandar
- Department of Radiation Oncology, Juravinski Cancer Centre, 699 Concession Street, Hamilton, Ontario, Canada.
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