In The Venue

Seizures are one example of the brain tumor symptoms that need treatment on their own terms.  25 to 40% of brain tumor patients will have a seizure at some time during their illness.  The seizure itself is the outward manifestation of abnormal electrical activity in the brain.  The body's nerve cells usually communicate with each other along carefully controlled bioelectric circuits, but during a seizure, an orderly flow is short-circuited into an undifferentiated mass of electricity.  Thousands of signals flow back and forth, sending instructions to all parts of the body. If the signals become too intense, a seizure results.  During the seizure, anything can happen.  The body moves in unaccustomed ways; the patient hears, according to Wikipedia, "unusual sounds, visions and sensations."  The unique characteristics of the seizure depend on which part of the brain is being subjected to the explosion of electricity,  

 

Overall, seizures are not dangerous, but they can be extremely embarrassing, and brain tumor patients, particularly those with meningiomas, need to be prepared for the experience.  One way they can do this is to become aware of the "aura,” a signal their bodies are sending them about an approaching seizure.  The aura can take the form of a headache, a mood change, a muscle twitch, or a particular smell.  A wise patient who notices the aura will take the time to sit or lie down until the seizure has passed.  Food must be removed from the mouth; water must be turned off in the shower.   Moreover, tumor patients with recurrent seizures who pay close attention to their environment and keep journals will eventually notice that some events act as "triggers."  These can include bright or flashing lights, fatigue, hunger, alcohol consumption, menstruation, or even new medications and dose changes.  These precautions won't make the tumor go away, but they can make life more bearable during the course of the disease. 

 

Another nasty symptom of brain tumors, in addition to seizures, is the edema, or the swelling of brain tissue. Edemas develop when the expanding tumor pushes up against the blood-brain barrier, eventually puncturing it, and the blood vessels surrounding the tumor leak their fluids through the breached barrier into the surrounding tissue.    Edemas can be even more dangerous than the tumors themselves, because they raise pressure in the brain and cause chronic headaches and drowsiness.

Corticosteroids -- a type of hormone ordinarily produced by the adrenal glands near the kidneys -- are an effective treatment for edemas.  They also provide a temporary sense of well being by improving neuron functioning and increasing appetite.  They can be administered intravenously or by injection into muscles, but most brain tumor patients take them orally, as tablets, during meals or with a glass of milk.  However, because they are hormones, corticosteroids must be administered with care and closely monitored for unpleasant side effects, such as weight gain, thinning of the skin, gastrointestinal upset; weakened thigh, shoulder and neck muscles, susceptibility to infections; mood swings; insomnia; pneumonia; and high blood sugar levels.  Steroids may also mask fevers.

 

Brain surgery is usually the front line of treatment for the tumor itself, especially a tumor that is easily accessible and can be removed without damaging the healthy parts of the brain.   Surgery is the tried and true method for removing either entire tumors or large sections of them, and for obtaining tumor tissue samples so the doctor can make an accurate diagnosis.  It can also relieve seizures, and provide access to the brain for chemotherapy, radiation, or genetic treatment.   One effective alternative, or supplement, to traditional surgery is "radiosurgery.”   Radiosurgeons may be able to kill the tumor with intense radiation, which they deliver to the brain without physically opening up the skull.

 

Conventional surgery or radiosurgery are not always the answer, however.   A tumor may be inoperable because it is lodged so deeply inside the brain -- in the brain stem or thalamus, for example -- that it cannot be removed without risking brain damage.   There may be multiple tumors in different parts of the brain.  The borders between the tumor and healthy brain tissue may be poorly defined, and thus difficult to remove completely.  Finally, the patient may already be frail because of a weak heart, lungs, or liver, or nerve damage caused by the tumor.  In these cases, one alternative to surgery, the shunt, may produce dramatic and quick improvement in symptoms. 

 

If a tumor, or an edema, is blocking the normal flow of fluids through the brain, pressure can build up inside the skull and cause symptoms such as constant headaches and drowsiness.    To ease these symptoms, the shunt -- a narrow, flexible tube -- can be inserted into the brain and threaded to the bottom of the scalp, down the neck and into the abdominal cavity.  It acts as a drainage system, moving excess cerebrospinal fluid (CSF) from the brain to other parts of the body.   

 

A shunt needs maintenance, so it doesn't get disconnected, or cause an infection.  Children with brain tumors are still growing, so they may need the shunt to be lengthened.    Maintenance is accomplished through a surgical procedure known as shunt revision.