New-onset epilepsy: considerations for initial and follow-up MRI to detect brain tumor

Abstract

Evaluation of: Khan T, Akhtar W, Wotton CJ, Hart Y, Turner M, Goldacre MJ. Epilepsy and the subsequent risk of cerebral tumour: record linkage retrospective cohort study. J. Neurol. Neurosurg. Psychiatry DOI: 10.11136/jnnp.2010.228130 (2011) (Epub ahead of print).

Seizures are often the presenting symptoms of a cerebral tumor and may precede its diagnosis by many years. The article under evaluation searched two large English registries for patients admitted for new-onset epilepsy. The risk of subsequently being diagnosed with a malignant brain tumor was found to be 26-fold higher compared with controls, persisted over many years and was accentuated in young patients. Recently, surgical advances have led to a significant decrease in surgical morbidities, making surgery the first treatment option for gliomas, especially low-grade gliomas. This paradigm shift warrants a consequent diagnostic workup (MRI) in patients at risk for low-grade glioma – that is, patients with new-onset epilepsy. The study is discussed in the context of the ongoing debate on neuroimaging after new-onset epilepsy.

Keywords::

• awake surgery
• epilepsy
• intraoperative electrical mapping
• low-grade glioma
• MRI

Financial & competing interests disclosure

Philippe Schucht has received consulting fees from Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.