Expert: Claes-Gustaf Nordquist, M.D. - 2/26/2010

Question
Hi,

This is regarding my Dad, Mr.Bipin Unadkat based in India.

After observing certain unusual symptoms like Speech and Neurological Problems, confusions, consistent headaches for a few weeks in him, we had approached a Neurologist. An MRI was essential and He was detected with Glioblastoma Multiforme, Grade IV Brain Tumor in Left Fronto-Temporal-Parietal Region. Size (6.1 x 4.1 x 5.4 cms)

He was operated on 10/9/09 - Left Temoporal Craniotomy and Anterior Temporal Lobectomy with Tumor Decompression.

From 7/10/09 to 18/11/09 he had taken 30 Sittings of Radiotherapy with concurrent Temozolamide – 120mg (Oral Chemotherapy).

He is also on a 6mg a day dose of Dexa since the day of operation. He has tremendous swelling on his feet due to water deposition. Is it due to the Steroid only or can it be a sign of hydrocephalus ?

We were warned on Seizures/Convulsions and he was under a dose of Valparin (500mg) twice a day (1-0-1) from date of discharge, i.e. 1000mg a day.

He had his first seizure on 12/12/09, even though he was having a drug to prevent it since 3 months.

The first Post Operative, Post Radiotherapy MRI was taken on the day he got the seizure, 12-12-09. The MRI showed drastic improvement, Tumor size reduced to about half. (4.9 x 2.7 x 5.1 cms)

However, His dose was then doubled - Valparin (500mg) thrice a day (1-1-2) to 2000 mg a day.

In spite of this he got another seizure today, exactly a month after the last seizure, 12/01/10.

He was then Put on Frisium (10 mg), thrice a day i.e. 30mg a day.

Since then he has not had any seizure. But his Neurological Problems are Increasing, Motor skills are limited, sleepiness is throughout the day. Doctors say it may be due to oedema or side effects of radiotherapy or side effects of high dose of anti-convulsions.
What may be the reason for the same ?

Its been more than 5 months now, and I have no clue why He is facing these problems ? what I can expect hereon ? Can anyone please clarify ??

He just got an MRI done which shows increased tumor size and increased oedema. Is the case out of our hands now ? Where to find clinical trials, any reliable sources ?

Can I read some Case Studies anywhere ? Can I get any help ?

Regards,
Maulik
+91 98200 65632


Answer
I'm sorry to read about his - & your - problems! The prognosis of a GBM grade 4 is VERY bad regardless of treatment. All what any treatment can do at most is to temporarily decrease symptoms and to prolong survival to some extent. I estimate his remaining survival time to be at most some months. This is true anywhere and everywhere. That he is sleeping so much is not a good sign. The swelling of his feet is due to his steroids. Since his tumour seems to be regrowing his neurological signs and symptoms will increase. I'm sorry I have nothing better to tell you!



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