Diffuse Midline Glioma (DMG)

Previously known as a diffuse intrinsic pontine glioma (DIPG), a diffuse midline glioma (DMG) is an aggressive type of brain tumor. It occurs in the midline locations of the central nervous system, such as the thalamus gland, spinal cord, and a region of the brainstorm called the pons. DMGs are malignant (cancerous) tumors that can grow and spread quickly. They mainly affect children, most often between ages 5 and 7.

At Boston Children’s Hospital, we care for children with DMGs through the Glioma Program in our Brain Tumor Center. Our glioma specialists — a team of neuro-oncologists, neurosurgeons, neurologists, pathologists, and radiation oncologists — focus solely on the care of children diagnosed with gliomas, including DMGs. We are world leaders in basic, translational, and clinical research on DMGs, and our work has laid the groundwork for several national and international clinical trials.

Because DMGs grow quickly, symptoms are usually present by the time a child is diagnosed. Although every child is different, DMG symptoms can include some or all of the following:

• Double vision or abnormal eye movements
• Slurred speech
• Trouble swallowing 
• Weakness on one or both sides of the body
• Balance difficulties
• Facial drooping
• Fatigue
• Vomiting 
• Headaches

Most DMGs involve changes in certain genes. However, DMG tumors are not hereditary, and we don’t yet fully understand why some children develop these brain tumors.

DMGs are typically diagnosed based on a child’s symptoms and the results of brain imaging, including magnetic resonance imaging (MRI). In some cases, a biopsy or surgical resection of the tumor may confirm a DMG diagnosis.

DMGs can be challenging to treat because of their location in the central nervous system. Depending on your child’s individual situation, a neurosurgeon may remove as much as the tumor as possible without affecting nearby areas of the brain and nervous system, which could result in loss of function and other side effects. At Boston Children’s, a neuropathologist will comprehensively molecularly analyze the portion of tumor that has been surgically biopsied.

Based on the pathology results, we will make treatment recommendation for your child. These may include:

• Radiation
• Chemotherapy

The Brain Tumor Center runs several DMG-specific clinical trials through major research groups (such as PNOC, CONNECT, COG, and PBTC), and also has investigator-driven clinical trials designed and conducted by our own physicians and physician-scientists. Your child’s physician will discuss eligibility with you.