Clinical Analysis of Childhood Acute Lymphoblastic Leukemia With Epilepsy Seizures

Abstract

ObjectiveIn order to analyze the clinical characteristics of epileptic seizures in children with acute lymphoblastic leukemia (ALL) during treatment.MethodsThe clinical and imaging data of children diagnosed as ALL with epilepsy seizures from January 2013 to December 2020 were retrospectively analyzed.ResultsA total of 2217 children with ALL were admitted during the study, of whom 229 (10.33%) had epileptic seizures after ALL treatment. Among them, 45 (19.65%) were in the high-risk group and 184 (80.35%) were in the low-risk group. Epileptic seizures mainly occurred in the induction remission period (24.02%), maintenance treatment period (25.33%) and after bone marrow transplantation (21.40%). The common causes were MTX-related demyelinating encephalopathy (34.06%) and reversible posterior encephalopathy syndrome (PRES) (25.3%). The first symptom was mainly convulsion (34.50%). The first attack had a comprehensive attack and partial attack. Most patients stop themselves. 30 cases (13.10%) had acute recurrence of epilepsy (recurrence within 3 months after the first attack), and 49 cases (25.76%) had neurological dysfunction after follow-up. 36 cases developed symptomatic epilepsy. Among the 130 children who completed the follow-up, 78 (60.00%) had no obvious neurological sequelae, and 52 (40.0%) had neurological sequelae. Among the 52 cases, there were 34 cases of mild sequelae and 18 cases of severe sequelae, including 8 cases of epilepsy combined with cognitive impairment.ConclusionEpileptic seizure is a common neurological complication during ALL treatment. The etiology and associated manifestations of the first epileptic seizure are diverse. Early neuroimaging and EEG examination are helpful for early diagnosis and treatment.

No role for electroencephalogram in the initial work-up of pediatric acute lymphoblastic leukemia

“…A total of 18 patients (7.4%) with non-pathologic initial EEG developed symptomatic seizures. This observation is in line with previous studies reporting that approximately 5–10% of children with ALL develop a seizure during treatment [ 13 , 8 ]. The majority of these events occurred early in the course of therapy and could be attributed to well-known triggers such as sinus venous thrombosis or cytotoxic agents, e.g., methotrexate [ 14 , 7 ].…”

“…This population includes 39 patients (16.1%) with mild general abnormalities such as non-epileptic intermittent general background slowing, which might be attributed to the reduced general condition of the patient as well as to diagnostic and therapeutic interventions such as sedation for lumbar puncture or methotrexate administration into the CSF. The fact that we did not include unspecific EEG findings in our analysis could explain, at least in part, the differences between our results and previous studies, but it can also be speculated whether different technical equipment and different handling of sedating medications [13,8]. The majority of these events occurred early in the course of therapy and could be attributed to well-known triggers such as sinus venous thrombosis or cytotoxic agents, e.g., methotrexate [14,7].…”

“…Our data show that neurological abnormalities, in particular seizures, are not uncommon during treatment of children with ALL [ 7 , 8 ] and that patients do not benefit from an EEG performed during initial work-up. In our retrospective analysis, EEG revealed pathologic findings in 6 patients (2.5%).…”

No Role for Electroencephalogram in the Initial Work-Up of Pediatric Acute Lymphoblastic Leukemia

“…A total of 18 patients (7.4%) with non-pathologic initial EEG developed symptomatic seizures. This observation is in line with previous studies reporting that approximately 5-10% of children with ALL develop a seizure during treatment [12,7]. The majority of these events occurred early in the course of therapy and could be attributed to well-known triggers such as sinus venous thrombosis or cytotoxic agents, e.g., methotrexate [13,6].…”