By Daniel Hoch, PhD, MD
Editor, AAN.com for Patients and Caregivers
The relatively benign tumor of the brain’s coverings called a meningioma has been in the news lately due to Mary Tyler Moore’s recent diagnosis and treatment.
As an epilepsy specialist, I frequently see patients with meningiomas in my practice. Not long after the Massachusetts General Hospital established its specialty epilepsy service, we set up a specialty clinic to help people who have had a first ever seizure. A typical patient presents later in life, perhaps at age 55 or so, with a seizure, having never had one before. They usually have no other symptoms and have a normal neurological examination. We spend much of our effort trying to find something that caused the seizure, questioning new medicines, looking for abnormal blood tests, and even wondering if it actually was a seizure and not just a fainting spell. Of course, in this day and age, there is always an imaging study of the brain, usually an MRI. That’s when we find the meningiomas.
Our dilemma is always to decide if the meningioma is actually the cause of the seizure, and to try to decide if that person is at risk for more seizures. People are justifiably worried when they learn that there is something growing inside their skull. They often assume it must certainly have caused the seizure, and worse, they need to have an operation soon.
In fact, surgery is rarely the next step. First, the older we get, the more potential reasons we can have for having a seizure. Small, silent strokes, tiny areas of bleeding from high blood pressure or abnormal proteins, and many other things cause seizures as people age. Further, if you look closely, completely asymptomatic meningiomas are found in a lot of people. In series of MRIs and also at autopsy, they can be found to have been present for years, never causing problems and of no real importance. There is also controversy about how to respond to these findings and much has been written about this topic, including an article in the AAN publication Neurology [http://www.neurology.org/content/70/5/384.abstract?sid=21790fa2-b257-4b7e-b7ac-970368d34715]
For more information about meningiomas you can visit the National Brain Tumor Society at http://www.braintumor.org/patients-family-friends/about-brain-tumors/tumor-types/Meningioma.html or at the Brigham and Women’s Hospital here in Boston http://www.brighamandwomens.org/Departments_and_Services/neurosurgery/Meningioma/Meningiomafacts.aspx.
There’s also a good section on brain tumors in general at the National Cancer Institute at http://www.cancer.gov/cancertopics/wyntk/brain/page4