Predicting epilepsy in patients diagnosed with intracranial meningiomas: A systematic review and meta-analysis of clinical and anatomical risk factors.
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INTRODUCTION: Meningiomas comprise 40% of all central nervous system neoplasms, with peak prevalence occurring in the fifth and sixth decades of life. Presenting symptoms vary between patients and are location-dependent, but new-onset seizures bring a subset of patients to clinical attention. OBJECTIVE: The present meta-analysis aims to identify the clinical features and tumor characteristics most associated with seizures at diagnosis of intracranial meningioma. METHODS: The PubMed, Scopus, and Embase databases were queried for all primary retrospectives (case-control studies, cohort studies, and case series) reporting the presence versus absence of seizures in patients with newly diagnosed meningioma. Data on tumor location, baseline neurological exam, and presenting signs and symptoms were collected. Meta-analysis was performed using the Mantel-Haenszel method to identify statistically significant associations between primary and secondary variables and seizures in patients diagnosed with meningioma. P-values < 0.05 were regarded as statistically significant. RESULTS: Ultimately, 4,129 studies were identified, of which 33 were included for quantitative analysis - 18 case-control, four retrospective cohort studies, and 11 case series. Among the 8,221 meningioma patients analyzed, 26 % (n = 2137) presented with seizures at diagnosis. The presence of seizures was associated with pediatric age group (p < 0.05), male sex (p < 0.001), non-skull base location (p < 0.001), presence of peritumoral vasogenic edema (p < 0.001), and presence of pre-intervention neurological deficits (p < 0.001). Of note, headaches (p < 0.001) were less common at presentation in patients with preoperative seizures. CONCLUSION: In the present meta-analysis of 33 studies comprising 8,221 patients, new-onset seizures were reported by 26% of newly diagnosed meningioma patients. Male sex, youth, non-skull base location, presence of peritumoral edema, neurological deficits, and headaches predicted the occurrence of seizures in the pre-diagnosis and/or pre-operative period. Population-level data are necessary to confirm these findings. Further considerations going forward will involve leveraging next-generation AI and biomarker-based medicine to predict the risk for progression of asymptomatic, incidental meningiomas so that radiosurgery or surgical resection is offered prior to symptomatic onset (including onset of seizure).