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Controlling Cerebral Edema

Cerebral edema is a potentially life-threatening form of inflammation in the brain.  Unlike other organs the brain is almost entirely surrounded by bone, because of this inflammation and swelling literally have nowhere to go.  Edema, the fluid associated with swelling, very quickly deforms the delicate structures of the brain and causes intracranial pressure to rise.  This in turn causes a host of severe symptoms including: headaches, nausea, seizures, focal paralysis, hallucinations and potentially death.

Causes of cerebral edema (eg. concussions, brain abscesses, poisoning  and strokes)  are typically medical emergencies in and of themselves.  Treating the underlying condition resolves the cerebral edema.  However, in the case of cerebral edema from brain tumors one of the main treatments, radiation therapy, can also cause lasting cerebral edema.

The standard treatment for cerebral edema is oral steroids, typically dexamethasone. Given the potentially life-threatening nature of cerebral edema, brain cancer patients are asked to tolerate the side-effects of dexamethasone (eg. immunosuppresion, muscle wasting, insulin resistance, personality changes, and osteoporosis).  Another unfortunate side-effect of oral steroids is ability to increase cancer cell’s resistance to radiation and chemotherapy.   This fact combined with the negative side-effect profile has caused some oncologists to begin looking for alternative treatments for cerebra edema.

One of the agents that is being studied is Boswellia serrata, commonly known as Indian Frankincense or Salai.  A botanical cousin of the Frankincense that is used in incense, Boswellia serrata has a long history of use in Ayurvedic medicine.  In Western medicine, boswellia has demonstrated strong actions as an anti-inflammatory, reducing inflammation in asthma, arthritis and several digestive diseases.

In 2001, a very small clinical trial treated 12 patients with progressive cerebral edema with boswellia.  Half of the patients in the trial had cerebral edema associated with a progressing brain tumor; for those patients, boswellia did not demonstrate a strong benefit.  The other half of the patients had cerebral edema secondary to their treatment.  Within four weeks of beginning supplementation with boswellia, these patients saw a reduction in their cerebral edema.  Most of the patients were able to discontinue their use of dexamethasone, while seeing a reduction in symptoms.

More recently, a second trial looked at the use of Boswellia serrata concurrently with whole brain radiation therapy.  This trial randomized 45 people to receive standard whole brain radiation therapy or standard whole brain radiation therapy with boswellia.  60% of the patients who received bowellia experienced a large (75% or greater) reduction in their cerebral edema compared to 26% of the patients who received standard radiation alone. No significant differences were noted between the two groups in terms of dexamethasone usage or quality of life.  Interestingly, the study reported that patient in the boswellia arm seemed to have a greater response to radiation therapy; unfortunately, the study was not designed to study changes in treatment response.

Boswellia serrata is a natural anti-inflammatory that appears to have a significant effect on controlling and reducing cerebral edema.  It appears to be fairly well tolerated, with minimal side-effects, and is compatible with radiation therapy and standard therapies for cerebral edema.  This promising plant will need to be studied further before it gains wide acceptance in the treatment of brain cancers and their sequlae.

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