Bromocriptine for the treatment of postoperative cerebellar mutism syndrome in pediatric patients: Three case reports

Amor-García, Miguel Ángel; Fernández-Llamazares, Cecilia M.; Manrique-Rodríguez, Silvia; Narrillos-Moraza, Álvaro; García‐Morín, Marina; Huerta-Aragonés, Jorge; Sanjurjo‐Sáez, María

doi:10.1177/1078155220982046

Cited by 9 publications

(1 citation statement)

References 15 publications

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“…Fluoxetine 3 (Akhaddar et al, 2012;Amor-García et al, 2021) Bromocriptine 9 (Echiverri et al, 1988;Caner et al, 1999;Adachi et al, 2005 Frontiers in Cell and Developmental Biology frontiersin.org grammatical and syntactic elements. The articulation is not dysarthria, but slow and monotonous, devoid of prosody.…”

Section: Treatment Number Of Cases Referencesmentioning

confidence: 99%

Cerebellar mutism syndrome: From pathophysiology to rehabilitation

Fabozzi

Margoni

Andreozzi

et al. 2022

Front. Cell Dev. Biol.

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Cerebellar mutism syndrome (CMS) is a common complication following surgical resection of childhood tumors arising in the posterior fossa. Alteration of linguistic production, up to muteness and emotional lability, generally reported at least 24 h after the intervention, is the hallmark of post-operative CMS. Other associated traits include hypotonia and other cerebellar motor signs, cerebellar cognitive-affective syndrome, motor deficits from the involvement of the long pathways, and cranial neuropathies. Recovery usually takes 6 months, but most children are burdened with long-term residual deficits. The pathogenic mechanism is likely due to the damage occurring to the proximal efferent cerebellar pathway, including the dentate nucleus, the superior cerebellar peduncle, and its decussation in the mesencephalic tegmentum. Proven risk factors include brain stem invasion, diagnosis of medulloblastoma, midline localization, tumor size, invasion of the fourth ventricle, invasion of the superior cerebellar peduncle, left-handedness, and incision of the vermis. Currently, rehabilitation is the cornerstone of the treatment of patients with cerebellar mutism syndrome, and it must consider the three main impaired domains, namely speech, cognition/behavior, and movement.

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Section: Treatment Number Of Cases Referencesmentioning

confidence: 99%

Cerebellar mutism syndrome: From pathophysiology to rehabilitation

Fabozzi

Margoni

Andreozzi

et al. 2022

Front. Cell Dev. Biol.

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The medical therapy for cerebellar mutism syndrome: a case report and literature review

et al. 2021

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National multicentered retrospective review of clinical and intraoperative factors associated with the development of cerebellar mutism after pediatric posterior fossa tumor resection

Kameda-Smith,

Ragulojan,

Elliott

et al. 2024

Childs Nerv Syst

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BackgroundCerebellar mutism (CM) is characterized by a signi cant loss of speech in children following posterior fossa (PF) surgery. The biological origin of CM remains unclear and is the subject of ongoing debate.Signi cant recovery from CM is less likely than previously described despite rigorous multidisciplinary neuro-rehabilitational efforts. MethodsA national multi-centered retrospective review of all children undergoing PF resection in 4 midsized Canadian academic pediatric institutions was undertaken. Patient, tumor, and surgical factors associated with the post-operative development of CM were reviewed. Retrospective identi cation of PF surgery patients including those developing and those that did not (internal control). ResultsThe study identi ed 258 patients across the 4 centers between 2010-2020 (mean age 6.73 years; 42.2 female). Overall, CM was experienced in 19.5% of patients (N = 50). Amongst children who developed CM histopathology included medulloblastoma (35.7%), pilocytic astrocytoma (32.6%), and ependymoma (17.1%). Intraoperative impression of adherence to the oor of the 4th ventricle was positive in 36.8%.Intraoperative abrupt changes in blood pressure and/or heart rate were identi ed in 19.4% and 17.8% of cases. The clinical resolution of CM was rated to be complete, signi cant resolution, slight improvement, no improvement, and deterioration in 56.0%, 8.0%, 20.0%, 14.0%, 2.0%, respectively. In the cohort of children who experienced post-operative CM as compared to their no-CM counterpart, proportionally more tumors were felt to be adherent to the oor of the 4th ventricle (56.0% vs 49.5%), intraoperative extent of resection was a GTR (74% vs 68.8%), and changes in heart rate were noted (≥ 20% from baseline) (26.0% vs 15.9%). However, a logistic regression for experiencing CM identi ed only intraoperative impression of adherence to the oor of the 4th ventricle (OR 2.32, p = 0.011), abrupt changes in intraoperative HR (> 20% from baseline) (OR 2.34, p = 0.028), and medulloblastoma histology (OR 3.77, p = 0.001) to signi cantly associated with development of post-operative CM. ConclusionAs a devastating surgical complication, identifying and understanding the biological origin of CM is the rst step to complication avoidance. Maximal safe resection irrespective of intraoperative pathology remains the strategy to minimize the devastating post-operative development of CM.

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Bromocriptine for the treatment of postoperative cerebellar mutism syndrome in pediatric patients: Three case reports

Cited by 9 publications

References 15 publications

Cerebellar mutism syndrome: From pathophysiology to rehabilitation

Cerebellar mutism syndrome: From pathophysiology to rehabilitation

The medical therapy for cerebellar mutism syndrome: a case report and literature review

National multicentered retrospective review of clinical and intraoperative factors associated with the development of cerebellar mutism after pediatric posterior fossa tumor resection

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