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We read with interest the study by O’Callaghan et al.1 The authors’ observations largely confirmed what was already known about giant cell astrocytomas (GCAs) in tuberous sclerosis (TSC). However, we have serious concerns about the methodology and several of the conclusions drawn.
Most importantly, the authors do not provide plausible evidence for their main clinical conclusion that screening for GCAs should not be undertaken—the direct opposite of current international consensus guidelines.2 At an NIH-funded consensus conference, an international expert panel recommended periodic cranial imaging every 1–3 years in children, generally up to the age of 21 years.2 The recommendations were based on evidence that neuroradiological surveillance, early detection and early surgical intervention for GCA in TSC were associated with better neurological, cognitive and behavioural outcome than in children with TSC who did not have surveillance for GCA.3–5 The consensus panel felt that surveillance was of particular importance given that those most at risk of GCA in TSC would be children, many of whom would have global intellectual disability (mental retardation), posing significant challenges for …
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