title: Peri-ictal pseudoprogression in patients with brain tumor.
abstract: Recent advances in the treatment of malignant gliomas have highlighted the fact that the appearance of new contrast-enhancing lesions on magnetic resonance imaging (MRI) is not always indicative of tumor recurrence. It has been suggested that transient seizure-related MRI changes could mimic disease progression (peri-ictal pseudoprogression [PIPG]). However, the clinical and MRI features associated with this situation have not been well described. Here, we consulted the databases of 6 institutions to identify patients with brain tumor who presented during the follow-up period transient MRI lesions wrongly suggesting tumor progression in a context of epileptic seizures. Ten patients were identified. All patients but 1 were long-term survivors who had initially been treated with radiotherapy. The PIPG episode occurred after a median interval of 11 years after radiotherapy. MRI features were highly similar across patients and consisted of transient focal cortical and/or leptomeningeal enhancing lesions that erroneously suggested tumor progression. All patients improved after adjustment of their antiepileptic drugs and transient oral corticosteroids, and MRI findings were normalized 3 months after the PIPG episode. Two patients demonstrated several seizure relapses with the same clinicoradiological pattern. After a median follow-up period of 3.5 years after the initial PIPG episode, only 1 patient presented with a tumor recurrence. In conclusion, in patients with brain tumor, especially in long-term survivors of radiotherapy, the appearance of new cortical and/or leptomeningeal contrast-enhancing lesions in a context of frequent seizures should raise the suspicion of PIPG. This phenomenon is important to recognize in order to avoid futile therapeutic escalation.
authors: Service de Neuro-Oncologie, Hospices Civils de Lyon, 59 boulevard Pinel, 69003 Lyon, France.
authors: Sylvain
authors: S
authors: Rheims
authors: Damien
authors: D
authors: Ricard
authors: Martin
authors: M
authors: van den Bent
authors: Luc
authors: L
authors: Taillandier
authors: Véronique
authors: V
authors: Bourg
authors: Virginie
authors: V
authors: Désestret
authors: Stéphanie
authors: S
authors: Cartalat-Carel
authors: Marc
authors: M
authors: Hermier
authors: Annick
authors: A
authors: Monjour
authors: Jean-Yves
authors: JY
authors: Delattre
authors: Marc
authors: M
authors: Sanson
authors: Jérôme
authors: J
authors: Honnorat
authors: François
authors: F
authors: Ducray
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D018450:Disease Progression; D005260:Female; D005910:Glioma / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy / Q000209:etiology; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants