Medical management of patients with brain tumors.
The most common medical problems in brain tumor patients include the management of seizures, peritumoral edema, medication side effects, venous thromboembolism (VTE), fatigue and cognitive dysfunction. Despite their importance, there are relatively few studies specifically addressing these issues. There is increasing evidence that brain tumor patients who have not had a seizure do not benefit from prophylactic antiepileptic medications. Patients on corticosteroids are at greater risk of Pneumocystis jerovecii pneumonia and may benefit from prophylactic therapy. There is also growing evidence suggesting that anticoagulation may be more effective than inferior vena cava IVC) filtration devices for treating VTE in brain tumor patients and the risk of hemorrhage with anticoagulation is relatively small. Low-molecular weight heparin may be more effective than coumadin. Medications such as modafinil and methylphenidate have assumed an increasing role in the treatment of fatigue, while donepezil and memantine may be helpful with memory loss.
Wen
Patrick Y
PY
Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital and Center for Neuro-Oncology, Dana-Farber Brigham and Women's Cancer Center, SW430D, 44 Binney Street, Boston, MA 02115, USA. pwen@partners.org
Schiff
David
D
Kesari
Santosh
S
Drappatz
Jan
J
Gigas
Debra C
DC
Doherty
Lisa
L
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D001929:Brain Edema / Q000209:etiology* / Q000517:prevention & control; D001932:Brain Neoplasms / Q000150:complications* / Q000628:therapy; D003072:Cognition Disorders / Q000209:etiology / Q000628:therapy; D003866:Depressive Disorder / Q000209:etiology / Q000628:therapy; D004827:Epilepsy / Q000209:etiology* / Q000628:therapy; D005221:Fatigue / Q000209:etiology / Q000628:therapy; D006801:Humans; D010347:Patient Care Planning; D020246:Venous Thrombosis / Q000209:etiology* / Q000628:therapy
D000305:Adrenal Cortex Hormones; D000925:Anticoagulants; D000927:Anticonvulsants