Diencephalic Syndrome: Misleading Clinical Onset of Low-Grade Glioma

Round 1

Reviewer 1 Report

In this paper, the authors introduce Diencephalic Syndrome (DS) and emphasize the significance of a multidisciplinary evaluation and early diagnosis, and the attention to DS, which causes poor weight gain in childhood by describing 4 patient cases with diencephalic syndrome and low-grade gliomas.

However, I have a few concerns regarding the manuscript:

 

1. Lack of focus on the association of DS with low-grade gliomas: While the authors stress the importance of attention on DS, there is limited discussion on the relationship between DS and low-grade gliomas. It would be helpful to provide more clarity on this, including any existing research.
2. The paper describes 4 cases. Is it enough? Would you also consider including control cases for comparison?
3. Some sentences in the manuscript may require re-editing for improved clarity, It would be helpful to revise these sentences to avoid redundancy. Bottom of Form

1. Some sentences in the manuscript may require re-editing for improved clarity, It would be helpful to revise these sentences to avoid redundancy.

Author Response

Dear Reviewer,

Thanks for the time spent on our manuscript and for your precious suggestions. Here is our reply:

Request	Reply
Lack of focus on the association of DS with low-grade gliomas: While the authors stress the importance of attention on DS, there is limited discussion on the relationship between DS and low-grade gliomas. It would be helpful to provide more clarity on this, including any existing research.	Thank you for the suggestion; we modified the discussion adding considerations on the the relationship between DS and other psychiatric disorders and low-grade gliomas (lines 273-280 and 292-295). Two references have been added (current # 5 and 8)
The paper describes 4 cases. Is it enough? Would you also consider including control cases for comparison?	We describe 4 cases that have been observed during the last 6 years; our study is retrospective, therefore there are no control cases; however we thank the reviewer for the suggestion, and modified the material and method section and mentioned the number of 48 cases of brain tumor diagnosed in the same time interval, with a total of 16 Low Grade Gliomas, 12 of which had no signs of diencephalic syndrome.
Some sentences in the manuscript may require re-editing for improved clarity, It would be helpful to revise these sentences to avoid redundancy	We made a general review of the manuscript to avoid redundancy and improve the language

Reviewer 2 Report

This manuscript is well written. I agree with authors on the point that early DS diagnosis may give better outcomes. For rare conditions like this published case reports will draw pediatricians attention.  

English language is fine. I request authors to check manuscript thoroughly for any spelling mistakes.

Author Response

Dear Reviewer,

thank you for the time spent on our manuscript and for you comments

Reviewer 3 Report

In this manuscript, La Spina et al. aimed to emphasize the importance of early diagnosis of DS which otherwise cause misleading and delayed diagnosis of low-grade glioma. They presented 4 different cases with low-grade gliomas at different locations and associated DS to show that early diagnosis of DS is crucial both for the prognosis and the quality of life. They underline the need to focus the attention of pediatricians, child psychologists, and neuropsychiatrists on DS to plan careful clinical-neurological monitoring, carrying out a complete eye examination, neuroendocrine evaluation, and possibly a brain magnetic resonance when the symptoms persist without a diagnosis. In terms of putting emphasis on DS in association with low-grade gliomas for early diagnosis and efficient treatment, this manuscript is very valuable.

 

 

 

Author Response

Dear Reviewer,

thank you for the time spent on our manuscript and for the comments.

Reviewer 4 Report

The manuscript is clear and well written.

It highlights the clinical features of Diencephalic Syndrome, which is often misdiagnosed, causing a diagnostic delay with all the implications in oncological patients.

Each case was exhaustively reported and I found particularly intriguing the relationship with eating disorder in female young patients, which could be a presentation of DS itself or a comorbidity. It could be interesting if the Authors can write something more about this aspect within the discussion.

Methods should be improved.

 

Author Response

Dear Reviewer,

thank you for the time spent on our manuscript and for the comments.

Here is our reply:

Request	Reply
The manuscript is clear and well written. It highlights the clinical features of Diencephalic Syndrome, which is often misdiagnosed, causing a diagnostic delay with all the implications in oncological patients.	Thank you for the comment
Each case was exhaustively reported and I found particularly intriguing the relationship with eating disorder in female young patients, which could be a presentation of DS itself or a comorbidity. It could be interesting if the Authors can write something more about this aspect within the discussion.	Thank you for the suggestion; we modified the discussion adding considerations on the the relationship between DS and other psychiatric disorders and low-grade gliomas (lines 273-280 and 292-295). Two references have been added (current # 5 and 8)
Methods should be improved.	The whole section has been modified and more details have been used