NEW YORK--Personality and brain function can change after brain
surgery, yet patients and their families may not know what to expect
or what to do about it, said Stanford University neuropsychologist
Harriet Katz Zeiner, PhD, during a Cancer Care teleconference.
"There is an incredible silence about what happens after brain
tumor surgery. The worst thing that can happen is that the family
sees that something is not right and wonders if the patient is losing
his or her mind," said Dr. Zeiner, assistant clinical professor
in physical medicine and rehabilitation at Stanford and a clinical
neuropsychologist in inpatient rehabilitation at Palo Alto Veterans
Health Care System.
Dr. Zeiner said that it can take 18 to 24 months for the brain to
heal after brain tumor surgery. "It can take that long to clear
up damaged areas and to re-organize how information is handled,"
she said, but unlike Alzheimers disease or other dementias, the
worst brain effects of surgery often improve over time.
The primary results of brain tissue damage include attention deficits
such as difficulty staying awake, focusing, or shifting focus;
spatial ability deficits, including the inability to tell where one
is in space; a slower rate of thinking; and decreased ability to
learn and recall. It is unlikely that any individual patient will
have all of these problems, she said.
The family of a person with attention deficits may think the person
has become less intelligent. "There is a tendency for the family
to speak to them slowly," Dr. Zeiner said. "But if you
speak slowly, the person is going to recognize the change and have an
She suggests that family members pause occasionally when talking to
the patient. "Its like taking a handful of commas and
throwing them into speech, so that the listener can catch up."
People interacting with someone recovering from brain tumor surgery
should also be aware that the persons ability to learn and
remember will change from day to day, and that lapses in attention
are not caused by some act of obstinacy.
Tips for Survivors of Brain Cancer (and Their Families)
Know your strengths and weaknesses by getting a neuropyschologic
If you cannot retrain memory, learn to use a notebook or organizer.
If you have memory problems, ask people to remind you of the topic at
Know who to go to in your family as a resource to help you solve problems.
Family members should become acquainted with the possible
As a result of defective spatial ability, brain tumor survivors may
not be able to read emotions. They may not be able to put together
the complex interactions of the human features that convey feeling.
"In some cases, they will only know what another person is
feeling if the other person tells them," Dr. Zeiner said.
Some people after brain surgery may not be aware of their own
emotions. "They may be unable to monitor themselves and the
environment at the same time," she said. "It may seem as if
they are not doing things efficiently or have poor judgment, but that
is because of the loss of an observing ego."
Brain tumor patients may react to information overload, exhibiting
what is known as the "catastrophic reaction." There are
four types, Dr. Zeiner said. An individual patient will show only one
of them, and it will always be the same one.
Crying. Some individuals with brain injury will cry when they
have to process too much information. But this reaction should not be
confused with depression. "If you simplify the environment, the
reaction quickly disappears. Its very important to have a
neuropsychologist distinguish between the crying reaction and
depression," Dr. Zeiner said.
Withdrawing. The individual may leave the room or shut down
and become very passive in response to information overload.
Laughing incontrollably is a third type of catastrophic reaction.
Expressing rage. The fourth and worst type of catastrophic
reaction in terms of how it will affect the patient is rage, Dr.
Zeiner said. "It is the worst because people around a person
expressing rage will likely just go away. That means the situation
simplifies, so it tends to reinforce anger as a way of simplifying a
too complex situation," she said. "The patient who gives a
catastrophic response of anger whenever there is overload is going to
end up socially isolated. The family is going to turn on this person."
Keeping to a Routine
Almost all the effects of neurologic impairment can be helped by
routine. Doing things at the same time makes them similar and
therefore more simple, she said.
Getting enough sleep is important because being tired makes brain
surgery effects worse. Going to sleep and rising at a set time every
day can compensate for the fact that the brain may have lost the
ability to regulate the day/night cycle.
Family members should not smother survivors with too much help but
just give them the amount they need for the problem they are having,
Dr. Zeiner advised. That way, their feelings of independence and
competence will not be compromised.