Cognitive Function and Fatigue After Brain Abscess
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: FDG-PET, EEG.
- Who it may be relevant to
- Registry conditions: Brain Abscess, Fatigue, Cognitive Dysfunction. Basic parameters: from 16 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Norway
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
Unsure about the terms? Read our patient guide →
Overview
Brain abscess is a focal bacterial or fungal infection of the brain. Treatment is neurosurgical drainage of pus followed by long-term antibiotic treatment. In spite of successful treatment of the infection, long-term cognitive problems or mental fatigue may ensue. The reason for this dysfunction may be a continuing inflammatory state or damage to brain tissue caused by the abscess. The investigators will evaluate these possibilities with the use of \[18F\]deoxyglucose-positron emission tomography (FDG-PET) and electroencephalography (EEG) in patients who have been treated for brain abscess and who experience cognitive problems and/or fatigue. FDG-PET may identify both inflammation and altered neuronal activity (the latter indicating damage to brain tissue), and EEG may identify altered neuronal activity, including changes in neuronal network activity.
Detailed description
Brain abscess is a focal bacterial or fungal infection of the brain, which results in a pus-filled cavity within the brain parenchyma. The incidence is approximately 1/100 000 per year, and all age groups are affected. Treatment is neurosurgical drainage of pus followed by long-term antibiotic treatment. Previously, the capsule that surrounds the pus was removed surgically; this is not usually done anymore. In spite of successful treatment of the infection, patients may experience long-lasting cognitive problems or mental fatigue. The reason for this brain dysfunction is not known.
The investigators formulated two hypotheses to explain why some patients experience long-lasting cognitive problems and/or fatigue: 1) The brain abscess caused damage to brain tissue, interrupting neuronal networks underlying cognition or 2) The abscess or the remaining capsule causes a long-lasting inflammatory state of the brain, affecting neurotransmission and cerebral function.
In this prospective study, the investigators evaluate brain abscess patients by cognitive examination by a neuropsychologist at 2 and 12 months after treatment. Participants then undergo \[18F\]deoxyglucose-positron emission tomography (FDG-PET). An inflammatory state in the abscess area would be identified by the FDG-PET signal. Likewise, a change in neuronal (neocortical) function would be detectable from a change in the FDG-PET signal. Participants also undergo EEG investigation to establish whether fatigue is related to alterations in EEG parameters: alpha, theta, and delta activity.
Importantly, brain damage caused by the abscess may be irreversible and functional improvement of the patient would probably have to rely on compensatory strategies, whereas an inflammatory state could probably be modified by anti-inflammatory treatment.
Further, the prognosis for the patients' cognitive problems and fatigue is probably different if the underlying cause is inflammation rather than tissue damage.
Interventions
- Other FDG-PET
\[18F\]Deoxyglucose-positron emission tomography at 0-10 years after brain abscess - Other EEG
Electroencephalography (EEG) at 0-10 years after brain abscess
Primary outcome measures
- A change in FDG-PET signal indicating inflammation [Time frame: When all patients have been followed up for at least 1 year.]
- A change in FDG-PET signal indicating a change in neuronal activity [Time frame: When all patients have been followed up for at least 1 year.]
- A change in EEG activity indicating a change in neuronal activity based on EEG power in alpha, theta, and delta frequencies. [Time frame: When all patients have been followed up for at least 1 year.]
Secondary outcome measures (2)
- Fatigue after brain abscess [Time frame: When all patients have been followed up for at least 1 year.]
- No fatigue after brain abscess [Time frame: When all patients have been followed up for at least 1 year.]
Eligibility criteria
Inclusion criteria
- Patients who have completed treatment for brain abscess and who agree to participate.
Exclusion criteria
- Patients who cannot undergo neuropsychological investigation due to unconsciousness
- Patients who cannot undergo neuropsychological investigation, being mentally too ill
- Patients who suffer from dementia
- Patients who cannot undergo FDG-PET due to claustrophobia
- Patients who cannot undergo EEG due to panic attacks
- Age under 16.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Case-only
Study locations
Norway · 1 center
- Oslo University Hospital — Oslo
Publications
- Rogne AG, Muller EG, Udnaes E, Sigurdardottir S, Raudeberg R, Connelly JP, Revheim ME, Hassel B, Dahlberg D. beta-Amyloid may accumulate in the human brain after focal bacterial infection: An 18 F-flutemetamol positron emission tomography study. Eur J Neurol. 2021 Mar;28(3):877-883. doi: 10.1111/ene.14622. Epub 2020 Nov 27. PMID 33131195
- Dahlberg D, Holm S, Sagen EML, Michelsen AE, Stensland M, de Souza GA, Muller EG, Connelly JP, Revheim ME, Halvorsen B, Hassel B. Bacterial Brain Abscesses Expand Despite Effective Antibiotic Treatment: A Process Powered by Osmosis Due to Neutrophil Cell Death. Neurosurgery. 2024 May 1;94(5):1079-1087. doi: 10.1227/neu.0000000000002792. Epub 2023 Dec 12. PMID 38084989
- Hassel B, Niehusmann P, Halvorsen B, Dahlberg D. Pro-inflammatory cytokines in cystic glioblastoma: A quantitative study with a comparison with bacterial brain abscesses. With an MRI investigation of displacement and destruction of the brain tissue surrounding a glioblastoma. Front Oncol. 2022 Jul 29;12:846674. doi: 10.3389/fonc.2022.846674. eCollection 2022. PMID 35965529
- Muller EG, Dahlberg D, Hassel B, Revheim ME, Connelly JP. Brain Abscess Causes Brain Damage With Long-Lasting Focal Cerebral Hypoactivity that Correlates With Abscess Size: A Cross-Sectional 18 F-Fluoro-Deoxyglucose Positron Emission Tomography Study. Neurosurgery. 2024 Nov 11;97(1):138-147. doi: 10.1227/neu.0000000000003268. PMID 39526777
Identifiers
NCT: NCT04938362 · Cognition/fatigue/brainabscess