Department of Pediatrics, 5447Nicklaus Children's Hospital, Miami, FL, USA.
Division of Neurosurgery, 5447Nicklaus Children's Hospital, Miami, FL, USA.
J Child Neurol. 2022 Jun;37(7):609-616. doi: 10.1177/08830738221079476. Epub 2022 May 26.
Radiation treatment is widely used to address unresectable intracranial tumors. Owing to the nature of therapy, healthy tissue and diseased regions will be affected. New insights have shown that not only does this impact brain parenchyma but it causes changes in fluid status, myelination, and the integrity of the blood-brain barrier. This alters how peripheral and central immune systems interact, perpetuating neuroinflammation. Rare case reports in the adult literature have described multifocal, multiphasic demyelinating lesions after radiation. Here we describe 2 pediatric cases of relapsing demyelination after and in conjunction with radiation therapy for ependymoma, consistent with a multiple sclerosis phenotype. Insights into the underpinnings of multiple sclerosis show peripheral inflammation, blood-brain barrier disruption, and antigenic mimicry stimulating neuroinflammation. Here we investigate the role that radiation, tumor burden, and systemic inflammation may play in creating demyelinating disorders. We strive to elucidate common pathophysiology between radiation-induced brain injury and multiple sclerosis.
放射治疗被广泛用于治疗无法切除的颅内肿瘤。由于治疗的性质，健康组织和患病区域都会受到影响。新的研究表明，这不仅影响脑实质，还会导致脑内液状态、髓鞘形成和血脑屏障完整性的改变。这改变了外周和中枢免疫系统的相互作用方式，从而使神经炎症持续存在。成人文献中的罕见病例报告描述了在接受放射治疗后出现多灶性、多相脱髓鞘病变。在这里，我们描述了 2 例儿童病例，在室管膜瘤接受放射治疗后和同时发生复发性脱髓鞘，表现为多发性硬化症的表型。对多发性硬化症发病机制的深入了解表明，外周炎症、血脑屏障破坏和抗原模拟刺激神经炎症。在这里，我们研究了放射治疗、肿瘤负荷和全身炎症可能在导致脱髓鞘疾病中所起的作用。我们努力阐明放射诱导的脑损伤和多发性硬化症之间的共同病理生理学。
