Neuromodulation

ACTH, which binds to CNS melanocortin receptors (Wilberg et al. 2000), and steroids, can induce a neurologic remission (Pranzatelli 1996) A high-dose protocol is quite efficacious (Pranzatelli et al. 1998b). Relapse on withdrawal from ACTH or steroids is common unless other immunotherapies have been in stituted. Symptomatic treatment with neuropsycho-trophic drugs for ADD, rage attacks, and sleep disturbance is usually required for severe OMS and can be used in combination with immunotherapy. A study from the Pediatric Oncology Group (Russo et al. 1997) suggests that chemotherapy may decrease the likelihood of long-term neurologic deficits, while another recent report from the Children's Cancer Group (Rud-nick et al. 2001b) noted that children with more advanced stage disease had better outcomes with regard to late neurologic sequelae. Based on these series, the Children's Oncology Group is designing a prospective protocol for OMS patients whereby all patients will receive steroids and chemotherapy and treatment with gammaglobulin will be randomized.

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