DISSOCIATIVE DISORDER

• DEFINITION:
  

We all get lost in a good book or movie. But someone with dissociative disorder escapes reality in ways that are involuntary and unhealthy. The symptoms of dissociative disorders — ranging from amnesia to alternate identities — usually develop as a reaction to trauma and help keep difficult memories at bay.

Treatment for dissociative disorders may include psychotherapy, hypnosis and medication. Although treating dissociative disorders can be difficult, many people with dissociative disorders are able to learn new ways of coping and lead healthy, productive lives.

• SYMPTOM
  

There are four major dissociative disorders:

• Dissociative amnesia
• Dissociative identity disorder
• Dissociative fugue
• Depersonalization disorder

Signs and symptoms common to all types of dissociative disorders include:

• Memory loss (amnesia) of certain time periods, events and people
• Mental health problems, including depression and anxiety
• A sense of being detached from yourself (depersonalization)
• A perception of the people and things around you as distorted and unreal (derealization)
• A blurred sense of identity

Dissociative disorder symptoms (depending on the type of disorder) may include:

• Dissociative amnesia. Memory loss that's more extensive than normal forgetfulness and can't be explained by a physical or neurological condition is the main symptom of this condition. Sudden-onset amnesia following a traumatic event, such as a car accident, is rare. More commonly, conscious recall of traumatic periods, events or people in your life — especially from childhood — is simply absent from your memory.
• Dissociative identity disorder. This condition, formerly known as multiple personality disorder, is characterized by "switching" to alternate identities when you're under stress. In dissociative identity disorder, you may feel the presence of one or more other people talking or living inside your head. Each of these identities may have name, personal history and characteristics, including marked differences in manner, voice, gender and even such physical qualities as the need for corrective eyewear. There often is considerable variation in each alternate personality's familiarity with the others. People with dissociative identity disorder typically also have dissociative amnesia.
• Dissociative fugue. People with this condition dissociate by putting real distance between themselves and their identity. For example, you may abruptly leave home or work and travel away, forgetting who you are and possibly adopting a new identity in a new location. People experiencing dissociative fugue may be very capable of blending in wherever they end up. A fugue episode may last only a few hours or, rarely, as long as many months. Dissociative fugue typically ends as abruptly as it begins. When it lifts, you may feel intensely disoriented, depressed and angry, with no recollection of what happened during the fugue or how you arrived in such unfamiliar circumstances.
• Depersonalization disorder. This disorder is characterized by a sudden sense of being outside yourself, observing your actions from a distance as though watching a movie. It may be accompanied by a perceived distortion of the size and shape of your body or of other people and objects around you. Time may seem to slow down, and the world may seem unreal. Symptoms may last only a few moments or may come and go over many years.

When to see a doctor
If you or someone you love has significant, unexplained memory loss or experiences a dramatic change in behavior when under stress, talk to a doctor. A chronic sense that your identity or the world around you is blurry or unreal also may be caused by a dissociative disorder. Effective treatment is available for these conditions. Seek medical help.

If you or your child experiences abuse or another traumatic situation, talk to a doctor as soon as possible. Early intervention and counseling may help prevent the formation of dissociative disorders.

• CAUSES
  

Dissociative disorders usually develop as a way to cope with trauma. The disorders most often form in children subjected to chronic physical, sexual or emotional abuse or, less frequently, a home environment that is otherwise frightening or highly unpredictable.

Personal identity is still forming during childhood, so a child is more able than is an adult to step outside herself or himself and observe trauma as though it's happening to a different person. A child who learns to dissociate in order to endure an extended period of his or her youth may use this coping mechanism in response to stressful situations throughout life.

Rarely, adults may develop dissociative disorders in response to severe trauma.

People who experience chronic physical, sexual or emotional abuse during childhood are at greatest risk of developing dissociative disorders. Children and adults who experience other traumatic events, including war, natural disasters, kidnapping, torture and invasive medical procedures, also may develop these conditions.

• COMPLICATION
  

People with a dissociative disorder are at increased risk of complications that include:

• Self-mutilation
• Suicide attempts
• Sexual dysfunction, including sexual addiction or avoidance
• Alcoholism and substance abuse
• Depression
• Sleep disorders, including nightmares, insomnia and sleepwalking
• Anxiety disorders
• Eating disorders
• Severe headaches

Dissociative disorders are also associated with significant difficulties in relationships and at work. People with these conditions often aren't able to cope well with emotional or professional stress, and their dissociative reactions — from tuning out to disappearing — may worry loved ones and cause colleagues to view them as unreliable.

• DIAGNOSIS
  

Doctors diagnose dissociative disorders based on a review of your symptoms and your personal history. As part of your evaluation, your doctor may perform tests to rule out physical conditions — including head injuries, certain brain diseases, sleep deprivation and intoxication — that can cause symptoms such as memory loss and a sense of unreality. If your doctor rules out physical causes, he or she will likely refer you to a mental health for an in-depth interview.

To help diagnose dissociative identity disorder, some doctors use medication or hypnosis. These may help your doctor identify alternate personalities or may help you describe repressed memories that played a role in the development of dissociative patterns.

To be diagnosed with a dissociative identity disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DMS), published by the American Psychiatric Association.

Criteria for dissociative amnesia to be diagnosed include:

• You have had one or more episodes in which you couldn't remember important personal information, usually something traumatic or stressful. This memory loss is too extensive to be explained by ordinary forgetfulness.
• Your episodes of memory loss do not occur only during the course of another disorder, such as dissociative identity disorder, dissociative fugue, posttraumatic stress disorder, acute stress disorder, or somatization disorder (a condition in which affected people have many recurring physical symptoms that cannot be fully explained by a physical disorder). Your symptoms also are not explained by the direct effects of a substance, such as a prescription medication or recreational drug, or by a neurological or other general medical condition, such as amnesia related to head trauma.
• Your symptoms cause you significant stress or problems in your relationships, work or other important areas of your life.

Criteria for dissociative identity disorder to be diagnosed include:

• You display the presence of two or more distinct identities or personalities, each with its own relatively stable pattern of perceiving, relating to, and thinking about yourself and the world.
• At least two of these identities or personality states recurrently take control of your behavior.
• You can't recall important personal information that is too extensive to be explained by ordinary forgetfulness.
• Your symptoms are not due to the direct effects of a substance, such as alcohol, or a general medical condition, such as complex partial seizures. In children, symptoms are not due to imaginary playmates or other fantasy play.

Criteria for dissociative fugue to be diagnosed include:

• You experience sudden, unexpected travel away from your home or place of work, and can't remember your past.
• During fugue episodes, you are confused about your personal identity or you assume a partially or completely new identity.
• Your episodes of fugue do not occur only during the course of dissociative identity disorder. Your symptoms also are not explained by the direct effects of a substance, such as a prescription medication or recreational drug, or a general medical condition, such as temporal lobe epilepsy.
• Your symptoms cause you significant stress or problems in your relationships, work or other important areas of your life

Criteria for depersonalization disorder to be diagnosed include:

• You have persistent or recurrent experiences of feeling detached from yourself, as if you are an outside observer of your mental processes or your body — you feel as though you are in a dream.
• While you are experiencing an episode of depersonalization, you are aware that your feeling of being outside yourself isn't reality.
• Your symptoms cause you significant stress or problems in your relationships, work or other important areas of your life.
• Your depersonalization symptoms do not occur only during the course of another mental disorder, such as schizophrenia, panic disorder, acute stress disorder, or another dissociative disorder. Your symptoms also are not explained by the direct effects of a substance, such as a prescription medication or recreational drug, or a general medical condition, such as temporal lobe epilepsy.

• TREATMENT
  

Psychotherapy is the primary treatment for dissociative disorders. This form of therapy, also known as talk therapy, counseling or psychosocial therapy, involves talking about your disorder and related issues with a mental health provider. Your therapist will work to help you understand the cause of your condition and to form new ways of coping with stressful circumstances.

Psychotherapy for dissociative disorders often involves techniques, such as hypnosis, that help you remember and work through the trauma that triggered your dissociative symptoms. The course of your psychotherapy may be long and painful, but this treatment approach often is very effective in treating dissociative disorders.

Other dissociative disorder treatment may include:

• Creative art therapy. This type of therapy uses the creative process to help people who might have difficulty expressing their thoughts and feelings. Creative arts can help you increase self-awareness, cope with symptoms and traumatic experiences, and foster positive changes. Creative art therapy includes art, dance and movement, drama, music, and poetry.
• Cognitive therapy. This type of talk therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts — not other people or situations — determine how you behave. Even if an unwanted situation has not changed, you can change the way you think and behave in a positive way.
• Medication. Although there are no medications that specifically treat dissociative disorders, your doctor may prescribe antidepressants, anti-anxiety medications or tranquilizers to help control the mental health symptoms associated with dissociative disorders.

HUNTER SYNDROME

• DEFINITION

Hunter syndrome is a rare genetic disorder that occurs when an enzyme your body needs is either missing or malfunctioning.

Because the body doesn't have adequate supplies of the enzyme to break down certain complex molecules, the molecules build up in harmful amounts in certain cells and tissues. The buildup that occurs in Hunter syndrome eventually causes permanent, progressive damage affecting appearance, mental development, organ function and physical abilities.

Hunter syndrome appears in children as young as age 2. It nearly always occurs in males, although it may occur in females.

Treatment of Hunter syndrome mostly involves management of your symptoms and complications. Enzyme replacement therapy and other emerging therapies may offer more help in the future.

• SYMPTOMS

Hunter syndrome is one type of a group of inherited metabolic disorders called mucopolysaccharidosis (MPS), and Hunter syndrome is referred to as MPS II. There are two subtypes of Hunter syndrome, MPS IIA and MPS IIB. Symptoms vary according to subtype.

Type MPS IIA (early onset)
Early-onset Hunter syndrome (MPS IIA) is the more severe of the two types and usually appears around age 2 and up to age 4. This form of the disorder may result in profound mental retardation by late childhood. Children with this form of the syndrome usually don't survive beyond their teens.

Signs and symptoms of MPS IIA include:

• A decline in development, which usually appears between ages 1 1/2 and 3, followed by a progressive loss of skills
• Coarse facial features, including thickening of the lips, tongue and nostrils
• Abnormal bone size or shape and other skeletal irregularities
• Enlarged internal organs, such as the liver and spleen, resulting in a distended abdomen
• Respiratory difficulties including sleep apnea, a condition in which breathing intermittently stops during sleep
• Cardiovascular disorders, such as progressive thickening of heart valves, high blood pressure (hypertension) and obstruction of blood vessels
• Vision loss or impairment from degeneration of cells that capture light and buildup of cellular debris in the brain causing pressure on the optic nerve and eye
• Skin lesions on the back and upper arms
• Progressive loss of hearing
• Aggressive behavior
• Stunted growth
• Joint stiffness
• Diarrhea

Type MPS IIB (late onset)
Late-onset Hunter syndrome (MPS IIB) is milder and causes less severe symptoms that appear much later. This form is usually diagnosed after age 10, and may not be detected until adulthood. Intellectual and social development usually is nearly normal, but the condition may affect verbal and reading skills. People with this type of Hunter syndrome can live into their 50s.

Signs and symptoms of MPS IIB include:

• Abnormal bone size or shape and other skeletal irregularities, but less severe than in MPS IIA
• Somewhat stunted growth
• Poor peripheral vision
• Joint stiffness
• Hearing loss
• Diarrhea
• Sleep apnea

When to see a doctor
Hunter syndrome isn't a common disorder, but if you notice changes in your child's facial appearance, a loss of previously acquired skills, or other signs or symptoms listed above, talk to your child's primary care doctor. He or she can perform an evaluation and help you decide if you need to see a specialist or seek out further testing.

• CAUSES

As with all types of MPS, Hunter syndrome is caused when a person lacks a specific enzyme his or her body needs to break down glycosaminoglycans — molecules formed from long chains of complex carbohydrates.

In unaffected people, these enzymes are found in cell components called lysosomes. Lysosomes break down the complex carbohydrates into nutrients, such as proteins and simpler molecules so that your body can use them at the cellular level. These nutrients help your body build bone, cartilage, tendons, corneas, skin and connective tissue, and are also found in the fluid that lubricates your joints. MPS disorders are also referred to as lysosomal storage disorders.

The lysosomes use enzymes to break down glycosaminoglycans, as part of the body's normal recycling and renewal process. In a person with Hunter syndrome or other form of MPS, these enzymes either are missing or don't work correctly.

These breaking-down tasks involve 11 different enzymes, and the particular enzyme that is missing or malfunctioning largely determines the type of MPS disorder. As a result of these enzyme malfunctions, undigested glycosaminoglycans collect in the cells, blood and connective tissues, causing permanent and progressive damage. In the case of Hunter syndrome, the missing or malfunctioning enzyme is called iduronate-2-sulfatase.

• RISK FACTORS

The risk of an unborn child acquiring Hunter syndrome is determined by the genetics of the child's mother.

Hunter syndrome is an X-linked recessive disease. This means that women carry the disease and pass it on — most often to their sons — but the mothers aren't affected by the disease themselves. Hunter syndrome is the only type of MPS that can be passed on by a defective gene in the mother alone. In all other types of MPS, the child inherits the syndrome because the same defective gene has been passed on by both parents.

In an X-linked recessive disorder, the mutated gene is located on the X chromosome. In this case, the mother is a carrier, which means she has one mutated gene and one normal gene for the condition.

Girls are less at risk of inheriting this disease because they have two X chromosomes. If one of the X chromosomes is defective, their normal X chromosome can provide a functioning gene. If the X chromosome of a boy is defective, however, there isn't another normal chromosome to compensate for the problem.

A man with an X-linked recessive disorder will pass his normal Y gene to his sons, and none will be affected. He will pass his mutated X gene to his daughters, and they will be carriers. These chances are the same in each pregnancy.

If you have a child with Hunter syndrome or other MPS syndrome, talk to your doctor or a genetic counselor before planning to have more children. If you're a sister or aunt of a person with Hunter syndrome, you may also be a carrier. There are tests for genetic carriers, so you may wish to seek genetic counseling before having children.

• TESTS & DIAGNOSIS

Confirmation of a diagnosis of Hunter syndrome requires tests performed on blood, urine or tissue samples. Your doctor will look for excess glycosaminoglycans in your child's urine or a deficiency of enzymes in your child's body fluids or cells.

Sometimes secondary health issues can lead to a diagnosis of Hunter syndrome. For example, if your child has recurrent pneumonia, a chest X-ray may show irregularly shaped vertebrae and ribs, a common sign of this syndrome. This finding could lead to further testing and an earlier diagnosis of the disease. However, because the disorder progresses slowly and its signs and symptoms overlap with a number of other disorders, definitive diagnosis may take some time.

Prenatal testing
Prenatal testing of the fluid that surrounds the baby (amniocentesis) or taking a tissue sample from the placenta (chorionic villus sampling) can verify if your child carries a copy of the defective gene or is affected with the disorder.

• TREATMENTS

Because there's no cure for Hunter syndrome, treatment focuses on managing signs, symptoms and complications to provide some relief for your child as the disease progresses. Treatment may involve the following:

• Relief for respiratory complications. Removal of tonsils and adenoids can open up your child's airway and relieve sleep apnea. But as the disease progresses, tissues continue to thicken and these problems can come back. Some types of breathing devices can help with upper airway obstructions and sleep apnea. Keeping your child's airway open can also avoid low blood oxygen levels (hypoxemia).
• Addressing heart complications. Your child's doctor will want to watch closely for cardiovascular complications, such as high blood pressure, heart murmur and leaky heart valves. If your child has severe cardiovascular problems, your doctor may recommend surgery to replace heart valves.

• Treatment for skeletal and connective tissue problems. Most children with Hunter syndrome don't heal well and often have complications from surgery. That limits options for addressing skeletal and connective tissue complications. For example, surgery to stabilize the spine using internal hardware is difficult when bones are fragile.

  Your child's joint flexibility can be improved with physical therapy, which helps address stiffness and maintain function. However, physical therapy can't prevent the progressive decline of mobility. Your child may eventually need to use a wheelchair because of pain and limited stamina.

  Surgery can repair hernias, but because of weakness in connective tissues, results usually aren't ideal. The procedure often needs to be repeated. One option is to manage your child's hernias with supportive trusses rather than surgery because of the risks of anesthesia and surgery.

• Managing neurological complications. Problems associated with the buildup of fluid and tissue around the brain and spinal cord are difficult to address because of the inherent risks in treating these parts of the body. Your child's doctor may recommend surgery to drain excess fluids or remove built-up tissue.

  If your child has seizures, your doctor may prescribe anticonvulsant medications.

• Managing behavioral problems. If your child develops abnormal behavior as a result of Hunter syndrome, providing a safe home environment is one of the most important ways you can manage this challenge. Treating behavior problems with medications has had limited success because most medications have negative effects on other manifestations of the disease.
• Addressing sleep issues. The sleep patterns of a child with Hunter syndrome become more and more disorganized, causing some children to be active around the clock. Medications including sedatives and especially melatonin can improve sleep. Keeping a strict bedtime schedule and making sure your child sleeps in a well-darkened room also can help. In addition, creating a safe environment in your child's bedroom — putting the mattress on the floor, padding the walls, removing all hard furniture, placing only soft, safe toys in the room — may help you rest easier if you know your child has less opportunity for injury.

Treatments in development
Although there's no cure for Hunter or other MPS syndromes, some treatments that are in their early stages have had some success in altering the natural course of the disease to slow its progress and lessen its severity.

These emerging treatments include:

• Bone marrow transplantation. If a healthy donor is found that matches your child's blood and tissue type, bone marrow transplantation can be used to treat some symptoms in milder forms of Hunter syndrome. Bone marrow is taken from the hip of the donor and transplanted to your child by injecting it into his or her veins (intravenously). This treatment can help ease the problems of breathing; mobility; and heart, liver and spleen function. It can also help prevent your child's mental regression. This treatment won't help with bone or vision problems.
• Cord blood transplantation. This treatment uses umbilical cord blood from an unrelated donor that's collected at the time of the donor's birth. The cord blood is transplanted intravenously. This treatment is designed to help your child's bone marrow and enzyme activity recover. It can also reduce the effects of the disease on facial and skin features, joint mobility, hearing, and enlargement of the liver and spleen.
• Enzyme therapy. This treatment uses man-made or genetically engineered enzymes, which are injected directly into your child's bloodstream to replace your child's missing or defective enzymes and ease the disease symptoms. The Food and Drug Administration gave its approval in July 2006 for the first human enzyme replacement therapy for Hunter syndrome. People involved in tests of the drug idursulfase (Elaprase) showed improvement in their ability to walk after a year of weekly treatments. The infusion has produced severe allergic reactions in some people, so your doctor will monitor your child closely if this treatment is chosen.

These therapies show promise, but they don't provide a cure. More research is needed.

BRAIN TUMOUR

DEFINATION

A brain tumor is a mass or growth of abnormal cells in your brain. Many different types of brain tumors exist. Some brain tumors are noncancerous (benign), and some brain tumors are cancerous (malignant). Brain tumors can begin in your brain (primary brain tumors), or cancer can begin in other parts of your body and spread to your brain (secondary, or metastatic brain tumors).

The number of brain tumors diagnosed each year is increasing. There's evidence the increase has been occurring for decades. But it's not clear why.

• CAUSES
  

Brain tumors that begin in the brain
Primary brain tumors originate in the brain or close to it, such as in the brain-covering membranes (meninges), cranial nerves, pituitary gland or pineal gland. Primary brain tumors begin when normal cells acquire errors (mutations) in their DNA. These mutations allow cells to grow and divide at increased rates and to continue living when healthy cells would die. The result is a mass of abnormal cells, which forms a tumor.

Primary brain tumors are much less common than are secondary brain tumors, in which cancer begins elsewhere and spreads to the brain. Many different types of primary brain tumors exist. Each gets its name from the type of cells involved. Examples include:

• Acoustic neuroma (schwannoma)
• Astrocytoma, also known as glioma, which includes anaplastic astrocytoma and glioblastoma
• Ependymoma
• Ependymoblastoma
• Medulloblastoma
• Meningioma
• Neuroblastoma
• Oligodendroglioma
• Pineoblastoma

Cancer that begins elsewhere and spreads to the brain
Secondary (metastatic) brain tumors are tumors that result from cancer that starts elsewhere in your body and then spreads (metastasizes) to your brain. In some cases you may have a history of cancer when a brain tumor is discovered. In other cases, a brain tumor is the first sign of cancer that began elsewhere in your body.

Secondary brain tumors are far more common than are primary brain tumors. Any cancer can spread to the brain, but the most common ones include:

• Breast cancer
• Colon cancer
• Kidney cancer
• Lung cancer
• Melanoma
• Neuroblastoma
• Sarcoma

• RISK FACTOR
  

Though doctors aren't sure what causes the genetic mutations that can lead to primary brain tumors, they've identified factors that may increase your risk of a brain tumor. Risk factors include:

• Your race. Brain tumors occur more frequently in whites than they do in others. One exception is meningioma, which occurs most frequently in blacks.
• Your age. Your risk of a brain tumor increases as you age. The majority of brain tumors occur in people 45 and older. However, a brain tumor can occur at any age. And certain types of brain tumors, such as medulloblastomas, occur almost exclusively in children.
• Exposure to radiation. People who have been exposed to a type of radiation called ionizing radiation have an increased risk of brain tumor. Examples of ionizing radiation include radiation therapy used to treat cancer and radiation exposure caused by atomic bombs. More-common forms of radiation, such as electromagnetic fields from power lines and radiofrequency radiation from cell phones and microwave ovens, have not been conclusively linked to brain tumors.
• Chemical exposure on the job. People working in certain industries have an increased risk of brain tumors, possibly because of the chemicals they're exposed to on the job. Studies don't always agree, but there is some evidence of an increased risk of brain tumor in certain industries, including agricultural, electrical, health care and oil refineries.
• Family history of brain tumors. A small portion of brain tumors occur in people with a family history of brain tumors or a family history of genetic syndromes that increase the risk of brain tumors.

• DIAGNOSIS
  

If it's suspected that you have a brain tumor, your doctor may recommend a number of tests and procedures, including:

• A neurological exam. A neurological exam may include, among other things, checking your vision, hearing, balance, coordination and reflexes. Difficulty in one or more areas may provide clues about the part of your brain that could be affected by a brain tumor.
• Imaging tests. Magnetic resonance imaging (MRI) is commonly used to help diagnose brain tumors. MRI uses magnetic fields and radio waves to generate images of the brain. In some cases a dye may be injected through a vein in your arm before your MRI. A number of specialized MRI scans may help your doctor in evaluation and treatment planning, including functional MRI, perfusion MRI and magnetic resonance spectroscopy.
• Tests to find cancer in other parts of your body. If it's suspected that your brain tumor may be a result of cancer that has spread from another area of your body, your doctor may recommend tests and procedures to determine where the cancer originated. One example might be a chest X-ray to look for signs of lung cancer.

• Collecting and testing a sample of abnormal tissue (biopsy). A biopsy can be performed as part of an operation to remove the brain tumor, or a biopsy can be performed using a needle. A stereotactic needle biopsy may be done for brain tumors in hard to reach areas or very sensitive areas within your brain that might be damaged by a more extensive operation. Your neurosurgeon drills a small hole, called a burr hole, into your skull. A narrow, thin needle is then inserted through the hole. Tissue is removed using the needle, which is frequently guided by computerized tomography (CT) or MRI scanning.

  The biopsy sample is then viewed under a microscope to determine if it is cancerous or benign. This information is helpful in guiding treatment.

• TREATMENT
  

Treatment for a brain tumor depends on the type, size and location of the tumor, as well as your overall health and your preferences. Your doctor can tailor treatment to fit your particular situation.

Surgery
If the brain tumor is located in a place that makes it accessible for an operation, your surgeon will work to remove as much of your brain tumor as possible. In some cases, tumors are small and easy to separate from surrounding brain tissue, which makes complete surgical removal possible. In other cases, tumors are located near sensitive areas in your brain, making surgery risky. In these situations your doctor may try to remove as much of the tumor as is safe. Even removing a portion of the brain tumor may help reduce signs and symptoms you experience. In some cases only a small biopsy is taken to confirm the diagnosis.

Surgery to remove a brain tumor carries risks, such as infection and bleeding. Other risks may depend on the part of your brain where your tumor is located. For instance, surgery on a tumor near nerves that connect to your eyes may carry a risk of vision loss.

Radiation therapy
Radiation therapy uses beams of high-energy particles, such as X-rays, to kill tumor cells. Radiation therapy can come from a machine outside your body (external beam radiation), or, in very rare cases, radiation can be placed inside your body close to your brain tumor (brachytherapy).

External beam radiation can focus just on the area of your brain where the tumor is located, or it can be applied to your entire brain (whole brain radiation). Whole brain radiation is sometimes used after surgery to kill tumor cells that might have been left behind. Whole brain radiation may also be an option if you have several brain tumors that can't be removed through surgery. Whole brain radiation is often used in situations where cancer has metastasized to the brain.

Side effects of radiation therapy will depend on the type and dose of radiation you receive. In general it can cause fatigue, headaches and scalp irritation.

Radiosurgery
Stereotactic radiosurgery is not a form of surgery in the traditional sense. Instead, radiosurgery uses multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumor cells in a very small area. Each beam of radiation isn't particularly powerful, but the point where all the beams meet — at the brain tumor — receives a very large dose of radiation to kill the tumor cells.

Radiosurgery may be an option if your brain tumor can't be removed with traditional surgery. Radiosurgery is typically done in one treatment, and in most cases you can go home the same day. Side effects may include fatigue, headache and nausea.

Chemotherapy
Chemotherapy uses drugs to kill tumor cells. Chemotherapy drugs can be taken orally or injected into a vein (intravenously) so that they travel throughout your body. Chemotherapy drugs can also be administered into your spinal column, so treatment affects only your central nervous system.

Another type of chemotherapy can be placed during surgery. When removing all or part of the brain tumor, your surgeon may place one or more disk-shaped wafers in the void left by the tumor. These wafers slowly release a chemotherapy drug over the next several days.

Chemotherapy side effects depend on the type and dose of drugs you receive. Systemic chemotherapy can cause nausea, vomiting and hair loss.

Targeted drug therapy
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Many targeted drug therapies are very new and still undergoing careful study in clinical trials.

One targeted drug therapy used to treat brain tumors is bevacizumab (Avastin). This drug, given through a vein (intravenously), stops the formation of new blood vessels, cutting off blood supply to a tumor and killing the tumor cells.

Clinical trials
Clinical trials are studies of the latest treatments, such as new drugs or new ways of using existing drugs and new surgical techniques. A clinical trial may offer you a chance at the latest treatment advances. But clinical trials can't guarantee a cure. And, in some cases, side effects of new treatments may not be fully known.

Talk to your doctor about clinical trials. Together you can discuss the benefits and risks and decide if a trial is appropriate for you.

Rehabilitation after treatment
Because brain tumors can develop in parts of the brain that control motor skills, speech, vision and thinking, rehabilitation may be a necessary part of recovery. The brain can sometimes heal itself after trauma from or treatment of a brain tumor — but this can take time and patience.

• Cognitive rehabilitation can help you cope with or regain lost cognitive abilities.
• Physical therapy can help you regain lost motor skills or muscle strength.
• Vocational therapy can help you get back to work after a brain tumor or other illness.
• Specialists in speech difficulties (speech pathologists) are just one of many types of therapists who can help you recover.

School-age children with brain tumors may especially benefit from tutoring as a part of their overall treatment plan. A brain tumor can cause changes in the brain that affect thinking and learning. The earlier these problems are identified, the earlier they can be addressed with strategies that provide the most benefits to the child