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A study of pediatric brain tumors and their association with epilepsy and anticonvulsant use
J G Gurney1, B A Mueller, S Preston-Martin
1Department of Community Health, School of Public Health, Saint Louis University, Mo. 63108-3342, USA. gurneyj@wpogate.slu.edu
Insights
Epilepsy is linked to a higher risk of childhood brain tumors, even years after diagnosis. Anticonvulsant use did not significantly alter this association, suggesting epilepsy itself may be a risk factor.
Area of Science:
- Pediatric Neurology
- Neuro-oncology
- Epidemiology
Background:
- Epilepsy is a known symptom of brain tumors.
- The relationship between epilepsy, anticonvulsant use, and pediatric brain tumor risk requires further investigation.
Purpose of the Study:
- To evaluate the association between childhood brain tumor occurrence and prior epilepsy.
- To assess the impact of anticonvulsant medication on this association.
Main Methods:
- A multicenter case-control study involving 540 pediatric brain tumor cases and 801 controls.
- Maternal reports were used to collect data on epilepsy and medication use (including barbiturates) prior to diagnosis.
Main Results:
- A significant association was found between epilepsy and brain tumor occurrence (OR=6.2).
- This association persisted even with a 10-year interval between epilepsy and tumor diagnosis (OR=4.7).
- Elevated odds ratios were observed for children treated with barbiturate-containing anticonvulsants (OR=5.8) and those not treated (OR=7.9).
Conclusions:
- While some risk may be due to undetected tumors, the persistent association years after epilepsy diagnosis is noteworthy.
- Epilepsy, independent of anticonvulsant treatment, appears to be a risk factor for pediatric brain tumors.
Objectives:
To evaluate the risk of childhood brain tumor occurrence in relation to epilepsy and anticonvulsant use.
Study Design:
As part of a multicenter case-control study of pediatric brain tumors, maternal report on epilepsy occurrence before diagnosis of her child's brain tumor was collected for 540 cases and compared with 801 control children. Mothers also reported on any long-term (> or = 2 weeks) use of medications by her child before the date of tumor diagnosis (or a comparable reference date for controls) and these medications were classified according to whether they contained barbiturates.
Results:
As expected, because seizures are often an early brain tumor symptom, a strong association was observed between epilepsy and brain tumor occurrence (odds ratio, OR = 6.2; 95% confidence limit, CL = 2.9, 14). The association remained elevated even after a > or = 10-year interval between diagnoses of epilepsy and brain tumor (OR = 4.7; CL = 0.8, 48). Elevated odds ratios were observed both for epileptic children who were treated with anticonvulsants containing barbiturates (OR = 5.8; CL = 2.2, 18) and for those not treated with barbiturates (OR = 7.9; CL = 1.7, 74), relative to nonepileptic children.
Conclusion:
Whereas most of the brain tumor risk associated with epilepsy may be due to occult tumors, the finding of an elevated risk many years after diagnosis of epilepsy is of interest.