Sensory hypo- and hypersensitivity in patients with brain tumors

OBJECTIVES

Hyper- and hyposensitivity in multiple modalities have been well-documented in subjects with autistic spectrum disorder (ASD) but not in subjects with acquired brain injury (ABI). The purpose of this study was to determine whether subjects with ABI experience altered sensory processing in multiple sensory modalities, and to examine the relationships between impaired sensory processing and the emotional state.

METHODS AND PROCEDURES

Sixty-eight patients with brain or spinal cord tumors participated in the study. Cognitive ability and emotional function were tested, and subjective changes were evaluated in two directions (hyper- and hyposensitivity) and five modalities (visual, auditory, tactile, olfactory, and gustatory) at two time points (after disease onset and after surgery).

RESULTS

One-fifth of the participants complained of hypersensitivity in the visual domain, and a similar proportion complained of hyposensitivity in the auditory and tactile domains. Additionally, one-third of participants complained of two or more sensory abnormalities after disease onset. A hierarchical regression analysis indicated that auditory and tactile sensory changes predicted a depressive state.

CONCLUSION

In conclusion, multimodal sensory changes occurred in patients with brain tumors, manifesting as hyper- or hyposensitivity. Sensory changes might be related to depressive state, but the results were inconclusive.

Individual Differences in the Change of Attentional Functions With Brief One-Time Focused Attention and Open Monitoring Meditations

Mindfulness meditation is increasingly used for clinical treatment and to improve well-being. One of the most fundamental benefits of mindfulness meditation is now considered as enhanced attentional control. Mindfulness meditation is a complex technique but most of its variants consist of a combination of two types of basic meditation practice: focused attention meditation (FAM) and open monitoring meditation (OMM). Although many studies have examined the effect of relatively long-term meditation on attention, some recent studies have focused on the effect of a brief one-time meditation on cognitive processing, including attentional functions. Furthermore, it is necessary to discuss the relationship between the effect of mindfulness meditation on attentional functions and personality traits (especially traits related to mindfulness). This study investigated whether attentional control is improved by a single 30-min FAM or OMM and whether the degree of improvement in attentional functions – alerting, orienting, and conflict monitoring – induced by the meditation varies according to the participant’s trait scores related to mindfulness measured by the Five Facets Mindfulness Questionnaire. Participants were randomly assigned to one of three groups, i.e., FAM, OMM, and no-meditation (noM) groups, and given an Attentional Network Test before and after each 30-min meditation session. Compared with the noM group, there was no overall improvement in attentional functions with either type of meditation. However, there were associations between the change of the alerting function’s score and the personality traits: in the FAM group, alerting scores were negatively associated with the nonreactivity facet of the FFMQ, and in the OMM group, alerting scores were positively associated with describing facet scores of the FFMQ. The results indicate that the effects of meditation methods on attentional functions could depend on the individual’s traits related to mindfulness and that mindfulness meditation could sometimes appear to have no impact on attentional functions.

Dissociation of the subjective and objective bodies: Out-of-body experiences following the development of a posterior cingulate lesion

An out‐of‐body experience (OBE) is a phenomenon whereby an individual views his/her body and the world from a location outside the physical body. Previous studies have suggested that the temporoparietal junction (TPJ), the brain region responsible for integrating multisensory signals, is responsible for OBE development. Here, however, we first present a case of OBE after brain tumour development in the posterior cingulate cortex (PCC). The patient was a 46‐year‐old right‐handed female; she underwent brain surgery. She reported that she had experienced OBEs several times monthly (during daily life) before surgery but never after surgery. She defined her OBEs explicitly; she drew pictures. Her OBEs exhibited phenomenological, overt dissociation of the subjective and objective bodies. We discuss the mechanisms underlying this phenomenon and the relationship between OBEs and the PCC in terms of anatomical and functional brain connectivity. Our case sheds some light on the mechanism involved in creating spatial (dis)unity between the self and the body.

Biased Recognition of Surprised Facial Expressions Following Awake Craniotomy of a Right Temporal Lobe Tumor

Lesion studies have shown that the right temporal lobe is crucial for recognition of facial expressions, particularly fear expressions. However, in previous studies, premorbid abilities of the patients were unknown and the effects of epileptic discharge could not be excluded. Herein, we report a case of a patient who underwent assessments of facial recognition before and after brain surgery and exhibited biased recognition of facial expressions. The patient was a 29-year-old right-handed male who underwent an awake craniotomy. Compared with the preoperative assessment, after the surgery, he showed biased recognition of surprised facial expressions, and his ability to recognize other facial expressions either improved or remained unchanged. These findings support the idea that the right temporal lobe is crucial for the recognition of facial expressions of surprise and that functional connectivity between various brain regions plays an important role in the ability to recognize facial expressions.

Preservation of cranial nerve function following awake surgery for benign brain tumors in 22 consecutive patients

BACKGROUND

Preservation of cranial nerve function in patients with benign tumors such as meningiomas and vestibular schwannomas remains difficult following microsurgery.

METHODS

In this study, awake surgery was performed in 22 consecutive patients with meningiomas or vestibular schwannomas that compressed cranial nerves (I-XII). Improved, unchanged, or deteriorated cranial nerve function after surgery was evaluated.

RESULTS

The function of 44 cranial nerves in 22 consecutive patients who underwent awake surgery for meningiomas or vestibular schwannomas improved, was unchanged, or deteriorated in eight, 35, and one nerves, respectively. Regarding the function of the olfactory (Ist) nerve, which is difficult to preserve, hyposmia improved after surgery in two patients with olfactory groove meningiomas. Regarding the auditory (VIIIth) nerve, which is also difficult to preserve, the function was improved, unchanged, or deteriorated after surgery in two, 11, and one patients, respectively, with cerebello-pontine angle meningiomas or vestibular schwannomas. In all patients with serviceable auditory function before surgery, function was preserved after surgery. In the same patients, the function of the facial (VIIth) nerve was also preserved after surgery in all patients.

CONCLUSIONS

These results suggest that awake surgery for benign brain tumors such as meningiomas and vestibular schwannomas is associated with low patient morbidity regarding cranial nerve function.

Measuring the sense of self in brain-damaged patients: A STROBE-compliant article

Recently, researchers have focused on the embodied sense of self (ESS), which consists of the minimal and narrative selves. Although a study demonstrated that the ESS is related to brain dysfunction empirically, the subjective aspects of the ESS, and a systematic approach to it, have not yet been examined in brain-damaged patients. To examine this, we measured the ESS of patients with brain tumors before and after awake craniotomy.A self-reported questionnaire called the Embodied Sense of Self Scale (ESSS) was used to measure the ESS in patients with brain tumors before and after surgery. For comparison, age-matched controls also completed the ESSS.The ESSS scores of the patients with brain tumors before surgery were higher than those of the controls and improved after surgery. Before surgery, patients with left hemispheric lesions had a poorer ESSS than those with right hemispheric lesions. Episodic memory disturbance was highly correlated with malfunction of narrative self and ownership.Brain lesions were associated with anomalous ESSS, associated with hemispheric laterality and cognitive dysfunction.

Voluntarily controlled but not merely observed visual feedback affects postural sway

Online stabilization of human standing posture utilizes multisensory afferences (e.g., vision). Whereas visual feedback of spontaneous postural sway can stabilize postural control especially when observers concentrate on their body and intend to minimize postural sway, the effect of intentional control of visual feedback on postural sway itself remains unclear. This study assessed quiet standing posture in healthy adults voluntarily controlling or merely observing visual feedback. The visual feedback (moving square) had either low or high gain and was either horizontally flipped or not. Participants in the voluntary-control group were instructed to minimize their postural sway while voluntarily controlling visual feedback, whereas those in the observation group were instructed to minimize their postural sway while merely observing visual feedback. As a result, magnified and flipped visual feedback increased postural sway only in the voluntary-control group. Furthermore, regardless of the instructions and feedback manipulations, the experienced sense of control over visual feedback positively correlated with the magnitude of postural sway. We suggest that voluntarily controlled, but not merely observed, visual feedback is incorporated into the feedback control system for posture and begins to affect postural sway.

Downward and Parallel Perspectives in an Experimental Study of Out-of-Body Experiences

Out-of-body experiences (OBEs) have been reported in patients with neurological or psychiatric disorders. According to these reports, the patients looked down on their body from overhead. Based on this phenomenon, we adopted a downward perspective in an experimentally induced OBE paradigm and compared responses to an OBE questionnaire (sensations of OBE) with self-location mapping (feelings of body drift). The results revealed a correlation between the sensation of an OBE and self-location under the downward-perspective condition but not under the parallel-perspective condition; however, no significant difference was observed between the two conditions. Thus, the effect of perspective on OBE illusion that has been reported in clinical research of OBE did not affect the results obtained in previous studies inducing OBE.

Preservation of hearing following awake surgery via the retrosigmoid approach for vestibular schwannomas in eight consecutive patients

BACKGROUND

Hearing preservation in patients with vestibular schwannomas remains difficult by microsurgery or radiosurgery.

METHOD

In this study, awake surgery via the retrosigmoid approach was performed for vestibular schwannomas (volume, 11.6 ± 11.2 ml; range, 1.3-26.4 ml) in eight consecutive patients with preoperative quartering of pure tone audiometry (PTA) of 53 ± 27 dB.

RESULTS

After surgery, hearing was preserved in seven patients and improved in one patient. The postoperative quartering PTA was 51 ± 21 dB. Serviceable hearing (class A + B + C) using the American Association of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification was preserved in all patients. Preoperative useful hearing (AAO-HNS class A + B) was observed in three patients, and useful hearing was preserved in all three of these patients after surgery. In addition, useful facial nerve function (House-Blackmann Grade 1) was preserved in all patients.

CONCLUSIONS

These results suggest that awake surgery for vestibular schwannomas is associated with low patient morbidity, including with respect to hearing and facial nerve function.

Operative Strategies during Awake Surgery Affect Deterioration of Paresis a Month after Surgery for Brain Lesions in the Primary Motor Area

Introduction We analyzed factors associated with worsened paresis at 1-month follow-up in patients with brain tumors located in the primary motor area (M1) to establish protocols for safe awake craniotomy for M1 lesions.

Methods Patients with M1 brain tumors who underwent awake surgery in our hospital (n = 61) were evaluated before, during, and immediately and 1 month after surgery for severity of paresis, tumor location, extent of resection, complications, preoperative motor strength, histology, and operative strategies (surgery stopped or continued after deterioration of motor function).

Results Worsened paresis at 1-month follow-up was significantly associated with worsened paresis immediately after surgery and also with operative strategy. Specifically, when motor function deteriorated during awake surgery and did not recover within 5 to 10 minutes, no deterioration was observed at 1-month follow-up in cases where we stopped surgery, whereas 6 of 13 cases showed deteriorated motor function at 1-month follow-up in cases where we continued surgery.

Conclusion Stopping tumor resection on deterioration of motor function during awake surgery may help prevent worsened paresis at 1-month follow-up.

Wandering behavior of a severely demented patient with frontotemporal dementia

Although wandering is a common behavioral problem in patients with dementia, information about wandering in patients with severe dementia is scarce. This study analyzed data about the wandering behavior of a 77-year-old woman with severe frontotemporal dementia. Due to severe atrophy of the anterior cortex, she was totally unable to act spontaneously. Nevertheless, she walked with her husband every day. Her walking pattern varied on a daily basis but it appeared to be random. However, a mathematical analysis showed that her walking pattern was not random. Our case suggests that even patients with severe atrophy in the anterior cortex may be able to orient themselves within their neighborhood if their posterior cortex is preserved.

Predicting sleepiness during an awake craniotomy

OBJECTIVE

An awake craniotomy is a safe neurological surgical technique that minimizes the risk of brain damage. During the course of this surgery, the patient is asked to perform motor or cognitive tasks, but some patients exhibit severe sleepiness. Thus, the present study investigated the predictive value of a patient's preoperative neuropsychological background in terms of sleepiness during an awake craniotomy.

METHODS

Thirty-seven patients with brain tumor who underwent awake craniotomy were included in this study. Prior to craniotomy, the patient evaluated cognitive status, and during the surgery, each patient's performance and attitude toward cognitive tasks were recorded by neuropsychologists.

RESULTS

The present findings showed that the construction and calculation abilities of the patients were moderately correlated with their sleepiness.

CONCLUSION

These results indicate that the preoperative cognitive functioning of patients was related to their sleepiness during the awake craniotomy procedure and that the patients who exhibited sleepiness during an awake craniotomy had previously experienced reduced functioning in the parietal lobe.

Awake craniotomy for brain lesions within and near the primary motor area: A retrospective analysis of factors associated with worsened paresis in 102 consecutive patients

Background:

We analyzed factors associated with worsened paresis in a large series of patients with brain lesions located within or near the primary motor area (M1) to establish protocols for safe, awake craniotomy of eloquent lesions.

Methods:

We studied patients with brain lesions involving M1, the premotor area (PMA) and the primary sensory area (S1), who underwent awake craniotomy (n = 102). In addition to evaluating paresis before, during, and one month after surgery, the following parameters were analyzed: Intraoperative complications; success or failure of awake surgery; tumor type (A or B), tumor location, tumor histology, tumor size, and completeness of resection.

Results:

Worsened paresis at one month of follow-up was significantly associated with failure of awake surgery, intraoperative complications and worsened paresis immediately after surgery, which in turn was significantly associated with intraoperative worsening of paresis. Intraoperative worsening of paresis was significantly related to preoperative paresis, type A tumor (motor tract running in close proximity to and compressed by the tumor), tumor location within or including M1 and partial removal (PR) of the tumor.

Conclusions:

Successful awake surgery and prevention of deterioration of paresis immediately after surgery without intraoperative complications may help prevent worsening of paresis at one month. Factors associated with intraoperative worsening of paresis were preoperative motor deficit, type A and tumor location in M1, possibly leading to PR of the tumor.

Factors predictive of response to interferon-alpha therapy in hepatitis C virus infection

To determine the patient-dependent and virus-related factors that may predict sustained response to interferon-alpha therapy, we prospectively evaluated 60 consecutive patients with chronic hepatitis C who received a standardized treatment schedule of interferon-alpha. Twenty-eight patients achieved a long-term sustained remission, 14 patients had temporary responses during treatment but relapsed after completing it and 14 patients did not respond. Four patients dropped out because of severe side effects and were excluded from evaluation of efficacy. Twenty-one variables were chosen as possible predictors of sustained response and were analyzed by means of multivariate analysis. Variables related to the hepatitis C virus included genotype and concentration in serum before treatment. The former was determined by means of the polymerase chain reaction with genotype-specific primers for genotypes PT, K1, K2a and K2b, which were deduced from nonstructural region 5 of the hepatitis C virus genome. The latter was measured with a competitive polymerase chain reaction technique. Three variables were statistically significant (p < 0.05) on univariate analysis: viral genotype, pretreatment level of viremia and Knodell's fibrosis score. In multivariate analysis viral genotype and Knodell's fibrosis score were correlated independently with a sustained response (p < 0.05 for both). Incidence of sustained response was 40% and 91% in patients with genotypes K1 and K2a, respectively. We conclude that with the treatment schedule used, viral genotype was the most useful predictor of a sustained response to treatment with interferon-alpha.