Jannick Brennum

Prognosis of medically treated trigeminal neuralgia patients is assumed to be poor, but the evidence is lacking. Thus, prospective real-life studies of medical management of trigeminal neuralgia are warranted. This was an observational study. Patients were consecutively enrolled in a structured management program at a specialist centre for facial pain. Optimisation of medical treatment, physiotherapy, psychotherapy, and advice from trained nurses, were parts of the program. Medically intractable patients were referred for neurosurgery. Data-collection was prospective using standardised schemes and patient surveys. The aim was to describe the two-year outcome of medical treatment at the specialist centre. The primary outcome was a 50% reduction in the overall burden of pain according to a Numerical Rating Scale (NRS) after two years. A total of 186 primary TN patients were enrolled in the program of which 103 patients remained medically managed and completed the two-year follow-up. Fifty patients were treated surgically within the first two years of follow-up. Half of the medically managed patients (53 (51%)), had more than a 50% reduction in the overall burden of pain over the two-year period. The overall burden of pain on NRS decreased from mean 5.34 to 3.00, p < 0.01. There was no significant association between primary outcome and sex, depression and/or anxiety, concomitant persistent pain, or neurovascular contact with morphological changes of the trigeminal nerve. Patients with trigeminal neuralgia improve over a two-year period when enrolled in a structured medical management program. Optimisation of drug treatment, continuous advice and education and support by the multidisciplinary team, referral of the medically intractable patients for surgery or the natural history of the disease, can be some of the reasons for the improvement. The favourable prognosis provides hope and optimism for medically managed TN patients. Current study was observational, and patients were offered standard clinical care and laboratory workups according to current American Academy of Neurology and European Federation of Neurological Societies treatment guidelines. The study has been registered at ClincalTrials.gov. ID: NCT03838393 .

Tumor mutational load (TML) is the number of nonsynonymous mutations in a tumor sample. TML has proved predictive of response to immune therapy (IT) in other TML-high tumors. Research in TML in glioblastoma (GBM) is limited and has to our knowledge not been done prospectively in paired samples before and after treatment. Over a 2-year period from February 2016 to March 2018, 27 patients with newly diagnosed GBM were included. All patients had one biopsy at diagnosis and another when having secondary surgery due to progression. Three patients had three surgeries. We noted clinical and pathological data. Blood samples were extracted and whole exome sequencing has been performed. We are now investigating TML including clonal and subclonal mutations, mutations in mismatch repair genes and the aberrant cell fraction. TML will be reported as per Megabase exome and will be adjusted for coverage in each sample. All the included patients had primary GBM with isocitrate dehydrogenase (IDH) wild type. O-6-methylguanine-DNA methyltransferase (MGMT) was methylated in 6 patients (22%) and the majority of patients have been treated with chemo/radiation with Temozolomide. Since the patients were included from our daily clinical oncological department, the clinical characteristics resembled the average GBM patient according to age, performance status, treatment, progression-free survival and overall survival. Analyses are forthgoing and will be ready at the time of the SNO-meeting. An agreement of how to report TML is strongly needed and TML should be included in future trials in GBM.

Balancing survival versus risk of inducing functional deficits is a challenge when resecting gliomas in or near eloquent areas. Our objectives were to assess deficits prior to and at 6 and 12 months after awake craniotomies with cortical and subcortical mapping in patients with suspected grade 2 gliomas in eloquent areas. We analyzed whether pre- and intraoperative factors were linked to an increased risk of postoperative deficits.

Introduction: Subarachnoid haemorrhage (SAH) is associated with a mortality rate of 30% and the survivors face significant morbidity including fatigue, isolation, depression and sleep disorders; factors affecting general health related quality of life (QoL). QoL is also known to be decreased in pituitary-hypothalamic insufficiency and tends to improve after treatment. SAH has been suggested to be a common cause of hypopituitarism by some whereas not by others. We aimed to investigate if aneurismal SAH results in changes in QoL and if these changes relate to the concentrations of pituitary hormones. Methods: We performed a cross-sectional evaluation including a subgroup with prospective follow-up. QoL measurements were performed at 12 months post-SAH in 62 patients with SAH and 30 healthy controls. Twenty-six of the patients were followed prospectively (3-, 6-, and 12-months) post-SAH. Full anterior pituitary assessments, including stimulation tests for growth hormone and adrenal insufficiencies, were performed on collected blood samples at all time points. QoL evaluation was assessed by using two generic questionnaires, the euroQoL-5D (EQ-5D) and Nottingham Health Profile (NHP) and one specific of growth hormone deficiency (GHD), the Quality of Life Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA). Results: Post-SAH patients scored significantly lower on all QoL questionnaires (NHP, EQ-5D and QoL-AGHDA) when compared to controls 12 months post-SAH (all patients), as well as at 3-, 6-, and 12 months (prospective subgroup). Pituitary hormone levels at 12 months were found to be within the normal range. No correlations between QoL measurements and pituitary hormone levels were found, and there were no significant differences in QoL between patients with the lowest and highest hormone levels, respectively (P>0.08 for all comparisons). Conclusion: SAH is associated with long term worsened QoL, but it appears to be independent of pituitary hormone concentration, and thus rather a consequence of the SAH per se.