Shivram Kumar1, Giuseppe Lanzino2, Kelly D Flemming3. 1. Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. 2. Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. 3. Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. flemming.Kelly@mayo.edu.
Abstract
BACKGROUND: Brainstem cavernous malformations (CM) carry high risks of hemorrhage and neurologic morbidity. While much is published on physical effects of brainstem CM, very little is known about these patients' quality of life. This study aimed to assess the quality of life PROMIS-29 health domains of brainstem CM patients and identify quality of life predictors. METHODS: This was a cross-sectional study of adult patients with at least one brainstem CM identified by advertising on the Angioma Alliance website and from our institutional CM registry. A web-based questionnaire was administered and included self-reported information about the patient, cavernous malformation, residual clinical symptoms, and treatment. In addition, patients filled out the PROMIS-29 (version 1.0). The PROMIS-29 has 7 health domains and is standardized against the general population. We defined impaired quality of life as at least one out of 7 abnormal domains and used a 1 standard deviation cutoff for abnormal. We verified clinical and radiographic data to self-reported data in 28.8% of patients. RESULTS: A total of 104 patients (mean age of 46.5 ± 11.5 years; 77.9% females) were recruited. Most (82.7%) reported at least one symptomatic hemorrhagic event and 36.5% reported at least 1 surgical procedure. At least one abnormal PROMIS domain was present in 64.4% of patients with fatigue (34.6%), anxiety (35.6%), social (28.2%), and physical (27.9%) domains being the most common. Among patients with a Rankin Score of 0-2, 55% had at least one abnormal domain. Gait difficulty, but not age, sex, or surgery predicted impaired quality of life. CONCLUSION: More than half of patients with brainstem CM have impaired quality of life. Fatigue, anxiety, and social function, in addition to physical dysfunction, are common; practitioners should be aware of these concerns. PROMIS-29 provides additional information than modified Rankin Score and should be considered in clinical trials and when assessing treatment outcomes until a disease-specific outcome tool is available.
BACKGROUND:Brainstem cavernous malformations (CM) carry high risks of hemorrhage and neurologic morbidity. While much is published on physical effects of brainstem CM, very little is known about these patients' quality of life. This study aimed to assess the quality of life PROMIS-29 health domains of brainstem CM patients and identify quality of life predictors. METHODS: This was a cross-sectional study of adult patients with at least one brainstem CM identified by advertising on the Angioma Alliance website and from our institutional CM registry. A web-based questionnaire was administered and included self-reported information about the patient, cavernous malformation, residual clinical symptoms, and treatment. In addition, patients filled out the PROMIS-29 (version 1.0). The PROMIS-29 has 7 health domains and is standardized against the general population. We defined impaired quality of life as at least one out of 7 abnormal domains and used a 1 standard deviation cutoff for abnormal. We verified clinical and radiographic data to self-reported data in 28.8% of patients. RESULTS: A total of 104 patients (mean age of 46.5 ± 11.5 years; 77.9% females) were recruited. Most (82.7%) reported at least one symptomatic hemorrhagic event and 36.5% reported at least 1 surgical procedure. At least one abnormal PROMIS domain was present in 64.4% of patients with fatigue (34.6%), anxiety (35.6%), social (28.2%), and physical (27.9%) domains being the most common. Among patients with a Rankin Score of 0-2, 55% had at least one abnormal domain. Gait difficulty, but not age, sex, or surgery predicted impaired quality of life. CONCLUSION: More than half of patients with brainstem CM have impaired quality of life. Fatigue, anxiety, and social function, in addition to physical dysfunction, are common; practitioners should be aware of these concerns. PROMIS-29 provides additional information than modified Rankin Score and should be considered in clinical trials and when assessing treatment outcomes until a disease-specific outcome tool is available.
Entities:
Keywords:
Cavernous angioma; Cavernous malformation; PROMIS-29; Quality of life
Authors: Helen Kim; Kelly D Flemming; Jeffrey A Nelson; Avery Lui; Jennifer J Majersik; Michael Dela Cruz; Joseph Zabramski; Odilette Trevizo; Giuseppe Lanzino; Atif Zafar; Michel Torbey; Marc C Mabray; Myranda Robinson; Jared Narvid; Janine Lupo; Richard E Thompson; Daniel F Hanley; Nichol McBee; Kevin Treine; Noeleen Ostapkovich; Agnieszka Stadnik; Kristina Piedad; Nicholas Hobson; Timothy Carroll; Abdallah Shkoukani; Julián Carrión-Penagos; Carolina Mendoza-Puccini; James I Koenig; Issam Awad Journal: Stroke Date: 2021-09-16 Impact factor: 7.914