MRI Findings in Patients with Malignant Gliomas with and without Seizures (P03.140)

Abstract

Objective: This study investigates MRI changes that may predict which brain tumor patients are at increased risk for seizures. Background The 2000 AAN practice parameter states that prophylactic anticonvulsants should not be used in patients with newly diagnosed brain tumors. Many physicians still administer prophylactic anticonvulsants. Design/Methods: A retrospective chart review compared primary brain tumor patients presenting with seizures to those who did not. A neuro-radiologist blinded to seizure status read initial MRIs. Imaging factors such as lesion type, presence of necrosis, mass effect (ME), tumor enhancement (TE) and cortical involvement (CI) were measured. Degree of TE was rated 0-4+. Cortical involvement was rated of 0-3. Results: Of the 40 patients included in the study, 19 presented with seizures. All patients were diagnosed with high-grade gliomas (GBM = 37, AG =2), except 1 patient (had oligodendroglioma). Lesion type (seizure/non-seizure): multifocal (26.3%/19.1%), single (47.7%/71.4%), single with satellites (21.1%/9.5%). Necrosis (seizure/non-seizure): 63.2%/95.2%. ME (seizure/non-seizure): no ME (42.1%/9.52%), mild ME (36.8%/23.6%), mild-moderate ME (5.3%/28.6%), moderate (15.8%/33.3%). TE (seizure/non-seizure): 0(25%/0%), 1+(10.5%/4.8%), 2+(10.5%/4.8%), 3+(26.3%/19.0%), 4+(36.8%/71.4%). CI (seizure/non-seizure): 0(0%/19.0%), 1(5.3%/4.8%), 2(0%/14.3%), 3(94.7%/61.9%), 4(0%/0%). Conclusions: Patients with seizures were more likely to have multifocal or single lesions with satellites, no necrosis, no or mild ME, less TE and more CI than patients without seizures. Seizures likely occur from cortical involvement unless necrosis is present and there is loss of neurons. These imaging findings need to be validated in larger patient population and suggest that there may be imaging factors that can guide physicians on which primary brain tumor patients to treat with anti-convulsants. Disclosure: Dr. Coffino has nothing to disclose. Dr. Carroll has nothing to disclose. Dr. Grimm has nothing to disclose. Dr. Raizer has received personal compensation for activities with Genentech, Merck, and Enzon as a speaker and advisory board member. Dr. Raizer has received research support from Genentech Inc., Novartis, Lilly, Myriad, Arno, and Med-Immune. Dr. Futterer has nothing to disclose.