Prise en charge des douleurs associées aux méningites néoplasiques en pédiatrie

Neoplastic meningitis is the result of seeding of the leptomeninges by malignant cells. Epidemiology in child is not well known and their incidence is increasing as cancer patients live longer. When oncologic treatments are not efficient, neoplastic meningitis might lead to intensive and refractory pain with complex mechanisms and treatments. The treatments have several objectives: to delay neurological degradation, to control pain and increase quality of life. To homogenise therapeutic practice for child and adolescent with neoplastic meningitis within the Société française des cancers et leucémies de l'enfant (SFCE), the “pain” working group has written the current revue on neoplastic meningitis management. Several therapeutic options and their respective uses are described. Surgery might be used to implant an intraventricular reservoir, derivate cerebrospinal fluid or suppress a tumour mass responsible of neurological deficit or intracranial hypertension. Focal radiotherapy might also have this debulking function, and irradiation and reirradiation should be discussed. The place of systemic chemotherapy and even more of intrathecal chemotherapy remains to explore further and to better define. Side effects due to steroids question the validity of steroids use in neoplastic meningitis. Analgesic treatments are the cornerstone of neoplastic meningitis care. It requires a precise description, evaluation and re-evaluations of pain symptoms. Systemic treatments include morphine derivates and drugs against neuropathic pain (antidepressants, anti-epileptics, anti-NMDA). Intrathecal analgesia use is beginning and should be further explored in pediatrics.