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500 - A Boswellia a Day, Keeps the Doctor Away: A Case Report on the Use of Boswellia Supplements to Reduce Neuroinflammation in Patients with Radiation-Induced Cerebral Edema

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

DM

Daniel S. Marte, MD

PGY-2 Resident Physician
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Co-Author(s)

JM

Julia Marx, BS

Medical Student
Rutgers Robert Wood Johnson Medical School
New Brunswick, New Jersey, United States
AV

Alyssa M. Volmrich, MD

Assistant Professor
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Case Diagnosis: Radiation-Induced Cerebral Edema

Case Description: A 54-year-old man was admitted to acute rehabilitation due to the progression of his known underlying glioblastoma, which had previously been treated with an occipital craniotomy with tumor resection twice and multiple lines of chemotherapy and radiation. Before admission to rehab, the patient was on dexamethasone for treatment of cerebral edema secondary to radiation therapy. After weeks on high-dose dexamethasone, his neuro-oncology team initiated a steroid taper as he experienced several adverse effects, including hyperglycemia, throughout his admission. To assist in tapering the patient off of dexamethasone, neuro-oncology recommended starting a supplement called Boswellia, which is hypothesized to reduce neuroinflammation and would allow the patient to be completely tapered off of his dexamethasone once he was on the supplement consistently.

Discussions: Boswellia is an herbal supplement that can be used to treat inflammatory diseases like arthritis, asthma, and cerebral edema. It is hypothesized that it reduces inflammation by inhibiting the synthesis of leukotrienes and 5-lipoxygenase, molecules responsible for inflammation. Studies have shown diminished cerebral edema in patients taking Boswellia compared to placebo.

Conclusions: In neurorehabilitation, we frequently see patients with cerebral edema as a result of underlying brain injuries or as a consequence of other treatments, such as radiation. Typically patients are on steroid tapers, leaving patients vulnerable to the many side effects of steroids. While not FDA-approved for neuroinflammation at this time, the use of homeopathic medications like Boswellia may provide an alternative to patients who may not tolerate steroids or as an adjunct to allow for lower steroid dosing. Given the close monitoring available in rehab, providing this supplement to a patient who has given informed consent and understands its risks and benefits, may be beneficial to simultaneously get patients off of steroids while reducing neuroinflammation, all while monitoring patients for any potential reactions to this supplement.