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Journal of Neuro-Oncology

, Volume 125, Issue 2, pp 419–426 | Cite as

Cognitive rehabilitation training in patients with brain tumor-related epilepsy and cognitive deficits: a pilot study

  • Marta Maschio
  • Loredana Dinapoli
  • Alessandra Fabi
  • Diana Giannarelli
  • Tonino Cantelmi
Clinical Study

Abstract

The aim of this pilot observational study was to evaluate effect of cognitive rehabilitation training (RehabTr) on cognitive performances in patients with brain tumor-related epilepsy (BTRE) and cognitive disturbances. Medical inclusion criteria: patients (M/F) ≥18 years ≤75 with symptomatic seizures due to primary brain tumors or brain metastases in stable treatment with antiepileptic drugs; previous surgical resection or biopsy; >70 Karnofsky Performance Status; stable oncological disease. Eligible patients recruited from 100 consecutive patients with BTRE at first visit to our Center from 2011 to 2012. All recruited patients were administered battery of neuropsychological tests exploring various cognitive domains. Patients considered to have a neuropsychological deficit were those with at least one test score for a given domain indicative of impairment. Thirty patients out of 100 showed cognitive deficits, and were offered participation in RehabTr, of which 16 accepted (5 low grade glioma, 4 high grade glioma, 2 glioblastoma, 2 meningioma and 3 metastases) and 14 declined for various reasons. The RehabTr consisted of one weekly individual session of 1 h, for a total of 10 weeks, carried out by a trained psychologist. The functions trained were: memory, attention, visuo-spatial functions, language and reasoning by means of Training NeuroPsicologico (TNP®) software. To evaluate the effect of the RehabTr, the same battery of tests was administered directly after cognitive rehabilitation (T1), and at six-month follow-up (T2). Statistical analysis with Student T test for paired data showed that short-term verbal memory, episodic memory, fluency and long term visuo-spatial memory improved immediately after the T1 and remained stable at T2. At final follow-up all patients showed an improvement in at least one domain that had been lower than normal at baseline. Our results demonstrated a positive effect of rehabilitative training at different times, and, for these reasons, should encourage future research in this area with large, randomized clinical trials that evaluate the impact of a cognitive rehabilitation in patients with BTRE and cognitive deficits.

Keywords

Brain tumor Brain tumor-related epilepsy Cognitive deficits Cognitive rehabilitation Antiepileptic drugs 

Notes

Acknowledgments

The Authors wish to thank Ms. Lesley Pritikin for reviewing the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Gehring K, Aaronson NK, Taphoorn MJ, Sitskoorn MM (2010) Interventions for cognitive deficits in patients with a brain tumor: an update. Expert Rev Anticancer Ther 10:1779–1795CrossRefPubMedGoogle Scholar
  2. 2.
    Tucha O, Smely C, Preier M, Lange KW (2000) Cognitive deficits before treatment among patients with brain tumors. Neurosurgery 47:324–333 (discussion 333–334)CrossRefPubMedGoogle Scholar
  3. 3.
    Klein M, Taphoorn MJ, Heimans JJ, van der Ploeg HM, Vandertop WP, Smit EF, Leenstra S, Tulleken CA, Boogerd W, Belderbos JS, Cleijne W, Aaronson NK (2001) Neurobehavioral status and health-related quality of life in newly diagnosed high-grade glioma patients. J Clin Oncol 19:4037–4047PubMedGoogle Scholar
  4. 4.
    Meyers CA, Smith JA, Bezjak A, Mehta MP, Liebmann J, Illidge T, Kunkler I, Caudrelier JM, Eisenberg PD, Meerwaldt J, Siemers R, Carrie C, Gaspar LE, Curran W, Phan SC, Miller RA, Renschler MF (2004) Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. J Clin Oncol 22:157–165CrossRefPubMedGoogle Scholar
  5. 5.
    vanNieuwenhuizen D, Klein M, Stalpers LJ, Leenstra S, Heimans JJ, Reijneveld JC (2007) Differential effect of surgery and radiotherapy on neurocognitive functioning and health-related quality of life in WHO grade I meningioma patients. J Neurooncol 84:271–278CrossRefGoogle Scholar
  6. 6.
    Giovagnoli AR (2012) Investigation of cognitive impairments in people with brain tumors. J Neurooncol 108:277–283CrossRefPubMedGoogle Scholar
  7. 7.
    Zarghi A, Zali A, Tehranidost M, Zarindast MR, Ashrafi F, Khodadadi M (2012) Comparative assessment of neuro-cognitive impairments among patients with brain tumor and healthy adults. Turk Neurosurg 22:309–316PubMedGoogle Scholar
  8. 8.
    Meyers CA (2005) Functional outcomes. Symptom clusters that affect quality of functional outcomes. In: Berger MS, Prados MD (eds) Textbook of neuro-oncology. Elsevier Saunders, Philadelphia, pp 101–104CrossRefGoogle Scholar
  9. 9.
    Locke DE, Cerhan JH, Wu W, Malec JF, Clark MM, Rummans TA, Brown PD (2008) Cognitive rehabilitation and problem-solving to improve quality of life of patients with primary brain tumors: a pilot study. J Support Oncol 6:383–391PubMedGoogle Scholar
  10. 10.
    Hassler MR, Elandt K, Preusser M, Lehrner J, Binder P, Dieckmann K, Rottenfusser A, Marosi C (2010) Neurocognitive training in patients with high-grade glioma: a pilot study. J Neurooncol 97:109–115CrossRefPubMedGoogle Scholar
  11. 11.
    Gehring K, Sitskoorn MM, Gundy CM, Sikkes SA, Klein M, Postma TJ, van den Bent MJ, Beute GN, Enting RH, Kappelle AC, Boogerd W, Veninga T, Twijnstra A, Boerman DH, Taphoorn MJ, Aaronson NK (2009) Cognitive rehabilitation in patients with gliomas: a randomized, controlled trial. J Clin Oncol 27:3712–3722CrossRefPubMedGoogle Scholar
  12. 12.
    Zucchella C, Capone A, Codella V, De Nunzio AM, Vecchione C, Sandrini G, Pace A, Pierelli F, Bartolo M (2013) Cognitive rehabilitation for early post-surgery inpatients affected by primary brain tumor: a randomized, controlled trial. J Neurooncol 114:93–100CrossRefPubMedGoogle Scholar
  13. 13.
    Salas-Puig J, Gil-Nagel A, Serratosa JM, Sánchez-Alvarez JC, Elices E, Villanueva V, Carreño M, Alvarez-Carriles J, Porcel J (2009) Self-reported memory problems in everyday activities in patients with epilepsy treated with antiepileptic drugs. Epilepsy Behav 14:622–627CrossRefPubMedGoogle Scholar
  14. 14.
    Kleen JK, Scott RC, Lenck-Santini PP, Holmes GL (2012) Cognitive and behavioral co-morbidities of epilepsy in: jasper’s basic mechanisms of the epilepsies. In: Noebels JL, Avoli M, Rogawski MA, et al. (eds) Bethesda, 4th edn. http://www.ncbi.nlm.nih.gov/books/NBK98139/
  15. 15.
    Klein M, Engelberts NH, van der Ploeg HM, Kasteleijn-Nolst Trenité DG, Aaronson NK, Taphoorn MJ, Baaijen H, Vandertop WP, Muller M, Postma TJ, Heimans JJ (2003) Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life. Ann Neurol 54:514–520CrossRefPubMedGoogle Scholar
  16. 16.
    Maschio M, Dinapoli L, Sperati F, Pace A, Fabi A, Vidiri A, Muti P (2011) Levetiracetam monotherapy in patients with brain tumor-related epilepsy: seizure control, safety, and quality of life. J Neurooncol 104:205–214CrossRefPubMedGoogle Scholar
  17. 17.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMedGoogle Scholar
  18. 18.
    Giovagnoli AR, Del Pesce M, Mascheroni S, Simoncelli M, Laiacona M, Capitani E (1996) Trail making test: normative values from 287 normal adults controls. Ital J Neurol Sci 17:305–309CrossRefPubMedGoogle Scholar
  19. 19.
    Appollonio I, Leone M, Isella V, Piamarta F, Consoli T, Villa ML, Forapani E, Russo A, Nichelli P (2005) The frontal assessment battery (FAB): normative values in an Italia population sample. Neurol Sci 26:108–116CrossRefPubMedGoogle Scholar
  20. 20.
    Caffarra P, Vezzadini G, Zonato F, Copelli S, Venneri A (2003) A normative study of a shorter version of Raven’s progressive Matrices 1938. Neurol Sci 24:336–339CrossRefPubMedGoogle Scholar
  21. 21.
    Caffarra P, Vezzadini G, Dieci F, Zonato F, Venneri A (2002) Rey-Osterreith complex figure: normative values in an Italian population sample. Neurol Sci 22:443–447CrossRefPubMedGoogle Scholar
  22. 22.
    Ferrucci L, Cecchi F, Guralnik JM, Giampaoli S, Lo Noce C, Salani B, Bandinelli S, Baroni A (1996) Does the clock drawing test predict cognitive decline in older persons independent of the mini-mental state examination? The FINE Study Group. Finland, Italy, The Netherlands Elderly. J Am Geriatr Soc 44:1326–1331CrossRefPubMedGoogle Scholar
  23. 23.
    Orsini A, Grossi G, Capitani E, Laiacona M, Papagno C, Vallar G (1987) Verbal and spatial immediate memory span: normative data from 1355 adults and 1112 children. Ital J Neurol Sci 8:539–548CrossRefPubMedGoogle Scholar
  24. 24.
    Spinnler H, Tognoni G (1987) Standardizzazione e taratura italiana di test neuropsicologici. Gruppo italiano per lo studio neuropsicologico dell’invecchiamento. Ital J Neurol Sci 6(suppl. 8):1–120Google Scholar
  25. 25.
    Carlesimo GA, Caltagirone C, Gainotti G (1996) The mental deterioration battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment. The Group for the standardization of the mental deterioration battery. Eur Neurol 36:378–384CrossRefPubMedGoogle Scholar
  26. 26.
    Carlesimo GA, Buccione I, Fadda L, Graceffa A, Mauri M, Lo Russo S, Bevilacqua G, Caltagirone C (2012) Standardizzazione di due test di memoria per uso clinico: breve racconto e figura di Rey. Nuona Riv Neurol 12:1–13Google Scholar
  27. 27.
    Novelli G, Papagno C, Capitani E, Laiacona N, Vallar G, Cappa SF (1986) Tre test clinici di ricerca e produzione lessicale. Taratura su soggetti normali, Archivio di Psicologia, Neurologia e Psichiatria 47:477–506Google Scholar
  28. 28.
    Tonetta, M (1998), Riabilitazione Neuropsicologica e TNP (training neuropsicologico). Aspetti teorici e pragmatici, Trento: New MagazineGoogle Scholar
  29. 29.
    Tonetta M (1995) II TNP, un software che opera in ambiente Windows. Atti del 4 Convegno Nazionale Informatica, Didattica e Disabilità. Napoli, (in Italian)Google Scholar
  30. 30.
    Lezak M, Howievson D, Loring D (eds) (1995) Neuropsychological assessment, 3rd edn. Oxford University Press, New York, pp 129–130Google Scholar
  31. 31.
    Cipriani G, Bianchetti A, Trabucchi M (2006) Outcomes of a computer-based cognitive rehabilitation program on Alzheimer’s disease patients compared with those on patients affected by mild cognitive impairment. Arch Gerontol Geriatr 43:327–335CrossRefPubMedGoogle Scholar
  32. 32.
    Sinforiani E, Banchieri L, Zucchella C, Pacchetti C, Sandrini G (2004) Cognitive rehabilitation in Parkinson’s disease. Arch Gerontol Geriatr Suppl 9:387–391CrossRefPubMedGoogle Scholar
  33. 33.
    Rozzini L, Costardi D, Chilovi BV, Franzoni S, Trabucchi M, Padovani A (2007) Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors. Int J Geriatr Psychiatr 22:356–360CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Marta Maschio
    • 1
  • Loredana Dinapoli
    • 1
  • Alessandra Fabi
    • 2
  • Diana Giannarelli
    • 3
  • Tonino Cantelmi
    • 1
  1. 1.Center for Tumor-related Epilepsy, Area of Supporting CareRegina Elena National Cancer InstituteRomeItaly
  2. 2.Department of OncologyRegina Elena National Cancer InstituteRomeItaly
  3. 3.Biostatistic UnitRegina Elena National Cancer InstituteRomeItaly

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