Neurological Improvements in Pediatric Diffuse Intrinsic Pontine Glioma After Intensive Neurorehabilitation
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1
Carrick Institute, United States
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2
Plasticity Brain Centers, United States
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3
Accelerate Multidisciplinary Neuroscience Research Center, College of Medicine, University of Central Florida, United States
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4
University of Central Florida, United States
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5
University of Central Florida College of Medicine, United States
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6
MGH Institute of Health Professions, United States
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7
Bedfordshire Centre for Mental Health Research, University of Cambridge, United Kingdom
Background: Pediatric Diffuse Intrinsic Pontine Gliomas (DIPG) are highly aggressive and difficult to treat brain tumors. Average age of diagnosis is 7 years old, and life expectancy is 12 months, depending on the effectiveness of treatment (Hong 2005). This report describes an anomalous 9-year-old female with non-progressing DIPG who was presented to Plasticity Brain Centers for evaluation and treatment of functional challenges relating to her confirmed diagnosis two years prior. Her symptoms included difficulty with oculomotor function, diplopia, headache, left-sided hemiparesis, balance difficulties, and academic challenges including difficulty with reading and reading comprehension, mathematics, and attention.
Findings: Upon intake, a Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed. Her average stability score was 52.97% (severely impaired). When her mother was asked to rate her symptoms on a modified graded symptom checklist (mGSC) (Simon 2017), her total symptom burden was 69/162 with a symptom count of 22. Smooth pursuit eye movements were analyzed on video oculography and found to be decreased in the gain in the horizontal plane with a gain of 0.28 on average, and 0.32 on average in the vertical plane. Saccadometry testing revealed dysmetria of fast eye movements as with mean dysmetria of 6.2º (ideally less than 2º).
Methods: A 5-day, multi-modal program of neurological exercises was administered in 10 one-hour treatment sessions similar to Carrick 2017. Each session consisted of repetitive peripheral somatosensory stimuli, neuromuscular reeducation exercises, vestibular rehabilitation exercises, orthoptic exercises, and off-vertical axis rotation utilizing a multi-axis rotational chair (MARC, ReNeuro Robotics, Dallas, TX, USA).
Outcome: Upon discharge, stability scores normalized, with the average stability score of 74.04% (+39.78%). The symptom severity score decreased to 12 (-82.61%) with a complete resolution of 15 symptoms (-68.18%). Video-oculography showed an improved gain of 0.60 (+44.44%) with horizontal pursuits and improved gain of 0.53 (+30.88%) with vertical pursuits. Saccadometry testing upon exit was more accurate with mean dysmetria of 3.6º (+50.0%).
Conclusion: This is a single case of a pediatric DIPG that demonstrated functional changes in response to a multi-modal, intensive neurorehabilitation program. Improvements were observed oculomotor function, decrease symptom severity scores, and increase stability scores. While the underlying condition of DIPG may not be affected, this type of treatment approach may improve the quality of life in patients afflicted with DIPG
References
Carrick FR, Clark JF, Pagnacco G, Antonucci MM, Hankir A, Zaman R and Oggero E (2017) Head–Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients. Front. Neurol. 8:414. doi: 10.3389/fneur.2017.00414
Hong, S., Kim, I. H., & Wang, K. C. (2005). Outcome and Prognostic Factors of Childhood Diffuse Brainstem Glioma. Cancer Research and Treatment,37(2), 109. doi:10.4143/crt.2005.37.2.109
Pagnacco G, Carrick FR, Wright CH, Oggero E. In-situ verification of accuracy, precision and resolution of force and balance platforms. Biomed Sciences instrumentation (2014) 50:171-8
Simon M, Maerlender A, Metzger K, Decoster L, Hollingworth A, McLeod TV. Reliability and Concurrent Validity of Select C3 Logix Test Components. Developmental Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25.
Keywords:
DIPG, diffuse intrinsic pontine glioma,
Oculomotor function,
pursuit system,
saccadometry,
Dysmetria,
Balance impairment
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Antonucci
MM,
Cozart
M,
Carrick
FR and
Kalambaheti
E
(2019). Neurological Improvements in Pediatric Diffuse Intrinsic Pontine Glioma After Intensive Neurorehabilitation.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00079
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Received:
18 May 2019;
Published Online:
27 Sep 2019.
*
Correspondence:
Dr. Matthew M Antonucci, Carrick Institute, Cape Canaveral, United States, drnucci@gmail.com