Positron emission tomographic studies of regional cerebral metabolic rate for glucose (rCMRGlc) and cerebral blood flow were performed in 7 vegetative and 3 locked-in patients to determine objectively the level of brain function underlying these clinical states. Cortical gray rCMRGlc in the vegetative patients was 2.73 +/- 0.13 (mean +/- SEM) mg/100 gm/min, less than half the normal value of 6.82 +/- 0.23 (p less than 0.001). Cerebral blood flow exhibited similar but more variable reductions. By contrast, cortical rCMRGlc in the locked-in patients was 5.08 +/- 0.69, a 25% reduction (p less than 0.02) from normal. The massive reduction in vegetative rCMRGlc involved not only the cerebral cortex but also the basal nuclei and cerebellum. Such metabolic hypoactivity has precedent only in deep anesthesia and supports clinical evidence that cerebral cognitive function is lost in the vegetative state, leaving a body that can no longer think or experience pain.

Unidirectional blood-to-brain and blood-to-tumor transport rate constants for rubidium 82 were determined using dynamic positron emission tomography in patients with primary or metastatic brain tumors. Regional influx rate constants (K1) and plasma water volume (Vp) were estimated from the time course of blood and brain radioactivity following a bolus injection of tracer. Eight patients were studied before and 24 to 72 hours after treatment using pharmacological doses of dexamethasone, and 6 additional patients with metastatic brain tumors were studied before and within 60 to 90 minutes after 200- to 600-rad whole-brain radiation therapy. Steroid treatment was associated with a 9 to 48% decrease in tumor K1 and a 21% mean decrease in tumor Vp. No consistent changes in K1 or Vp were observed in control brain regions. Tumor K1 and Vp did not increase in patients undergoing whole-brain radiation therapy, all of whom were taking dexamethasone at the time of study. These data suggest that corticosteroids decrease the permeability of tumor capillaries to small hydrophilic molecules (including those of some chemotherapeutic agents) and that steroid pretreatment prevents acute, and potentially dangerous, increases in tumor capillary permeability following cranial irradiation.

Background It is recommended that people with gliomas engage in rehabilitation, but high-quality evidence to support this recommendation is lacking. Objective This study assesses the effectiveness of a physical therapy– and occupational therapy–based rehabilitation intervention compared with usual rehabilitation care for quality of life (QoL) during active anticancer treatment. Design This study was a randomized controlled trial. Setting The study took place in Odense University Hospital, Denmark. Participants The trial included people with gliomas who were functionally independent. Intervention The participants were randomly assigned to a supervised rehabilitation intervention or usual rehabilitation care during the active anticancer period. The supervised rehabilitation included physical therapy and occupational therapy-based interventions. Measurements The primary outcome was the between-group difference in the overall QoL from baseline to the 6-week follow-up. It was self-rated with the global health status (GHS)/QoL domains from the European Organization for Research and Treatment of Cancer Questionnaire. Eighty-eight participants per group were required to find a 10% between-group difference from baseline to the 6-week follow-up. Secondary outcomes were the health-related QoL domains, symptomatology, and functional performance. Results A total of 64 participants were included (32 in the intervention group and 32 in the control group). At follow-up, the intervention group self-rated a nonsignificantly better score for GHS/QoL than the control group (adjusted mean difference = 8.7% [95% confidence interval = −4.36 to 21.79]). Compared with the control group, the intervention group had consistently better results on self-rated secondary outcomes, including cognitive functioning (β = 16.2) and fatigue (β = −13.4), and objectively measured aerobic power (β = 2.6). Limitations The number of participants and duration of follow-up were inadequate to determine if the intervention was superior to the current usual rehabilitation care. Conclusions The physical therapy– and occupational therapy–based rehabilitation intervention did not affect GHS/QoL. However, the trial found promising significant effects on both objective and self-reported secondary outcomes, making rehabilitation efforts during active anticancer treatment promising.

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