The brainstem has three parts (pons, midbrain, and medulla); the pons controls critical functions such as breathing, making surgery on these extremely dangerous. Treatment
Treatment for brain gliomas depends on the location, the cell type, and the grade of malignancy. Often, treatment is a combined approach, using surgery, radiation therapy, and chemotherapy. A prolonged survival was observed when treating with radiotherapy and concomitant temozolomide. Radiotherapy was given for 5 days a week for 6 week, with a total of 60 Gy. Temozolomide was given daily during the treatment of radiotherapy, at a dose of 75 mg per square meter of body surface area per day. When radiotherapy ended additionally six cycles of temozolomide were given, for five days during each cycle of 28 days. The radiation therapy is in the form of external beam radiation or the stereotactic approach using radiosurgery. Spinal cord tumors can be treated by surgery and radiation. Temozolomide is a chemotherapy drug which can be administered easily in an outpatient setting and is able to cross the blood–brain barrier effectively. Treatment via immunotherapy may help some gliomas. Experimental therapies like oncolytic viruses have shown potential therapeutic benefits in clinical trials but has not been approved for use in clinic. Refractory disease
For recurrent high-grade glioblastoma, recent studies have taken advantage of angiogenic blockers such as bevacizumab in combination with conventional chemotherapy, with encouraging results. Relative effectiveness
A 2017 meta-analysis compared surgical resection versus biopsy as the initial surgical management option for a person with a low-grade glioma.
Side effects
Common adverse effects of acetazolamide include the following: paraesthesia, fatigue, drowsiness, depression, decreased libido, bitter or metallic taste, nausea, vomiting, abdominal cramps, diarrhea, black stool, polyuria, kidney stones, metabolic acidosis and electrolyte changes (hypokalemia, hyponatremia). Whereas less common adverse effects include Stevens–Johnson syndrome, anaphylaxis and blood dyscrasias. Contraindications
Contraindications include:
Hyperchloremic acidosis
Hypokalemia (low blood potassium)
Hyponatremia (low blood sodium)
Adrenal insufficiency
Impaired kidney function
Hypersensitivity to acetazolamide or other sulphonamides. Marked liver disease or impairment of liver function, including cirrhosis because of the risk of development of hepatic encephalopathy. Acetazolamide decreases ammonia clearance. Interactions
It is possible that it might interact with:
Amphetamines, because it increases the pH of the renal tubular urine, hence reducing the clearance of amphetamines. Other carbonic anhydrase inhibitors — potential for additive inhibitory effects on carbonic anhydrase and hence potential for toxicity. Ciclosporin, may increase plasma levels of ciclosporin. Antifolates such as trimethoprim, methotrexate, pemetrexed and raltitrexed. Hypoglycemics, acetazolamide can both increase or decrease blood glucose levels. Lithium, increases excretion, hence reducing therapeutic effect. Methenamine compounds, reduces the urinary excretion of methenamines. Phenytoin, reduces phenytoin excretion, hence increasing the potential for toxicity. Primidone, reduces plasma levels of primidone. Hence reducing anticonvulsant effect. Quinidine, reduces urinary excretion of quinidine, hence increasing the potential for toxicity. Salicylates, potential for severe toxicity. Sodium bicarbonate, potential for kidney stone formation. Anticoagulants, cardiac glycosides, may have their effects potentiated by acetazolamide. Mechanism of action
Acetazolamide is a carbonic anhydrase inhibitor, hence causing the accumulation of carbonic acid.