Neurologic clinics
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In this article, the neuropsychology of dementia is discussed with special attention given to Alzheimer's disease. The clinical use of neuropsychological testing in neurologic practice is presented along with relevant recent research in the area.
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Patients with cancer commonly suffer neurologic disabilities. These neurologic disorders can be either metastatic to the brain, spinal cord, leptomeninges, or peripheral nerves or nonmetastatic including infections, vascular problems, metabolic abnormalities, side effects of therapy, or paraneoplastic syndromes. Careful diagnostic evaluation of patients with cancer and neurologic symptoms often indicates effective therapy.
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Recent progress in brain tumor biology research has helped us to understand the causes of our failure to improve patient survival with current therapeutic approaches. Present combination regimens of surgery, radiotherapy, and chemotherapy fail to address adequately two inherent biologic properties of brain tumors: tumor-induced host immunosuppression and tumor cell heterogeneity. Future success in immunotherapy will depend on our ability to dissect the mechanisms involved in tumor-host interactions. ⋯ As brain tumors evade immunosurveillance through active participation in inducing tumor-specific immunosuppression, successful immunotherapy, either passive serotherapy or active immunization, will be best achieved in patients with a slight or moderate immunosuppressive state. Alteration of immune status with various biologic response modifiers to boost host reactivity against tumors will be an important adjunct in our arsenal against brain tumors. IFNs, with their direct tumoricidal activity, and lymphokines (such as interleukin-2) may be such reagents with a promising future.
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The author contends that neutron radiation therapy coupled with radiation therapy or other forms of particle radiation therapy may play a role in the management of malignant gliomas. Improved survival, particularly for the patients with the diagnosis of glioblastoma, is discussed.