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The Role of Neuropsychiatry in Meningioma Care: A New Perspective


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The Role of Neuropsychiatry in Meningioma Care: A New Perspective

  1. 1. The Role of Neuropsychiatry in Meningioma Care: A New Perspective David Silbersweig M.D. Chairman, Department of Psychiatry Chairman, Institute for the Neurosciences Brigham and Women’s Hospital Stanley Cobb Professor of Psychiatry Harvard Medical School
  2. 2. Case Presentation • I present to you a case of woman in her 60s who had a life long history of depression treated with antidepressants and psychotherapy • In 2002, her depression significantly worsened prompting her first suicide attempt • Her psychiatrist requested a neurologic consultation and brain MRI to evaluate for neurologic causes of her mood decompensation Newsweek, 2007
  3. 3. Case Presentation • A small, 1cm meniongioma was detected but was thought to be asymptomatic and of little initial concern • Unfortunately, her condition further declined including two additional suicide attempts • By 2006, she made her fourth suicide attempt and was now additionally experiencing weakness, memory trouble and language disabilities and continued depression Newsweek, 2007
  4. 4. Case Presentation • There was now repeated concern for neurologic disease and a repeat MRI was obtained revealing a meningioma that had grown 6 times larger • Patient had surgery to remove her tumor • Her neurosurgeon wrote in follow-up: she has gone "from being completely unresponsive to a walking, talking, normal human being again." Newsweek, 2007
  5. 5. Case Presentation Newsweek, 2007 “I celebrated that the tumor caused depression was gone”
  6. 6. Lessons Learned • Neurologic disease can present with psychiatric symptoms • Psychiatric symptoms can sometimes be the first manifestation of neurologic disease including meningiomas • Neuropsychiatry can help provide a complete picture of mind-brain through an integrated understanding of Neurologic and Psychiatric disease
  7. 7. What is Neuropsychiatry? • Cognition • Emotion • Behavior • Perception • Experience Neuropsychiatrists seek to understand symptoms in domains In terms of: Localized brain dysfunction
  8. 8. What is Neuropsychiatry? • Basic Neuroscience • Human Functional Brain Imaging • Behavioral Neurology • Psychiatry • Cognitive psychology • Neuropsychology • Evolutionary psychology • Ethology Knowledge base drawn from variety of related fields…
  9. 9. Neuropsychiatry of Meningioma • Symptoms can be related to – Mass effect • Tumor, edema – Seizures – Hydrocephalus – Treatments • Post-surgical • Medical/pharmacological – Psychological reactions, stress – Pre-existing conditions
  10. 10. Frontal and Subcortical Neuropsychiatric Circuits
  11. 11. Frontal and Subcortical Neuropsychiatric Circuits
  12. 12. Neuropsychiatry of Meningioma • Example # 1: Meningiomas at the junction of the frontal, temporal, parietal lobes (sylvian) J.R.Coll.Surg.Edinb., 2001
  13. 13. Possible Symptoms 1. Mood Disturbance (depression, mania) 2. Impaired language production • Difficulty understanding language • Difficulty with the emotionality of language 3. Hallucinations (auditory) 4. Delusions 5. Weakness • Face or arm most common 6. Numbness (Laterality dependent)
  14. 14. Neuropsychiatry of Meningioma • Example # 2: Meningiomas at the olfactory groove R & S Physician, 2006
  15. 15. Possible Symptoms • Changes in Smell • Visual Disturbances • Personality Change • Disinhibited Behavior • Mood Changes (mania more commonly than depression) • State of Indifference (Apathy) • Urinary Incontinence • Slowed Movements
  16. 16. Neuropsychiatry of Meningioma • Example # 3: Midline (Parasagittal Meningioma) Mod Pathol., 2002
  17. 17. Possible Symptoms • Leg Weakness • Leg Numbness • State of Indifference (Apathy) • Urinary Incontinence • Slowed Movements • Mood Disturbances • Personality change
  18. 18. Treatment Options • Patient: – Psychopharmacology – Psychotherapy/Cognitive Behavioral Therapy – Neuromodulation (e.g. TMS) – Cognitive Rehabilitation • Family: – Improve disease understanding and coping – Targeted involvement of family in care of loved one – Evaluation and treatment for stress/anxiety/depression, if needed
  19. 19. BWH Institute for the Neurosciences • “One-stop-shopping” for integrated, interdisciplinary care – Comprehensive consultation and diagnostic evaluations • Neurology, neurosurgery, neuropsychiatry, neuroradiology, neuropsychology, neuropathology, social work, rehab medicine/occupational therapy – State-of-the-art, multi-faceted treatment plans • Medical, surgical, psychological, social – Access to new therapeutic trials • Unique scientific and educational brain-mind programs, led by world leading physician- scientists, at the interface of traditional academic medical fields
  20. 20. Questions?
  21. 21. Thank You