EEG-Changes During Intensified Induction-Therapy of Acute Lymphoblastic Leukemia

Abstract

In 49 children with acute lymphoblastic leukemia serial EEGs were performed during the course of treatment. Therapy in the first four weeks consisted of: Prednisone, vincristine, daunorubicine and L-asparaginase. In the second month 6-mercaptopurine, cytosin-arabinoside, cyclophosphamide, methotrexate-i. th. and cranial irradiation were administered. Maintenance-therapy consisted of 6-mercaptopurine, cyclophosphamide and methotrexate i.v. Before treatment only 24% of patients showed normal EEG-findings, whereas 57% presented sly induced by leukemic infiltrations and partly due to the impaired clinical state. At the end of the first phase of therapy, the combined toxicity of vincristine and L-asparaginase led to the finding of 23% severely and 37% moderately slowed EEGs. Slightly disturbed EEGs were found in 29% and normal ones in 11% of children. Regression occurred duirng the phase of CNS-prophylaxis. At its end 37% of recordings were normal and 57% slightly abnormal. After maintenance-therapy of 1/2 to 1 year duration, there were 65% normal findings. Moderate and severe disorders were no longer demonstrated. Paroxysmal activity developed twice, each during the first phase of therapy and accompnaying convulsions. In both cases we saw slowing of background-activity and signs of increased excitability still months after. In one of these patients, the probable cause was a vincristin-encephalopathy, the cause of the second case remained unknown. EEGs of two furtehr patients with rubella-encephalitis and subarachnoideal hemorrhage exhibited severe unspecific changes.

On the origin of EEG‐slowing and encephalopathy during induction treatment of acute lymphoblastic leukemia

“…Searching for a correlation between CSF glutamine concentration and the hematological data, we were not able to demonstrate a correlation between CSF glutamine, the WBC, the risk group or the duration of symptoms. Our study revealed significant worsening of the EEG during the induction treatment and near normalization during the subsequent consolidation treatment as has been shown in earlier studies [3][4][5][13][14][15]. However, in this study, the timing of the EEG investigations and the parallel analysis of CSF amino acids make further considerations on the etiology of the EEG changes and the underlying encephalopathy possible.…”

“…Toxic and metabolic effects of VCR and L-ASP have been discussed as the main cause of the EEG-slowing occurring during induction treatment [3,4,14,15]. The most frequent neurological side effect of VCR is peripheral axonal polyneuropathy [22].…”

CNS late effects after ALL therapy in childhood. Part II: Conventional EEG recordings in asymptomatic long-term survivors of childhood ALL- An evaluation of the interferences between neurophysiology, neurology, psychology, and CNS morphology

“…The present study joins intentions of a number of reports speculating on the correlation of neurophysiological abnormalities with psychological, neurological and morphological disturbances among clinically asymptomatic long-term survivors of childhood ALL [6,7,9,22]. Primary questions were whether CNS prophylaxis with cranial irradiation prior to or during methotrexate application induced greater neurotoxicity, measured by means of EEG, than treatment regimens with radiotherapy after methotrexate or methotrexate alone, and whether the assessed EEG abnormalities are associated with signs of neurological, morphological or psychological deficits.…”

“…Promoted by its importance for the surveillance of cerebral seizures and related CNS disturbances, the investigation of the brain electrical activity by means of neurophysiological techniques developed into one of the favoured instruments for functional CNS screening procedures in clinical practice. For several years, conventional EEG recordings have been widely used for the evaluation of patients with leukemia to assess either the prognosis [5], acute neurotoxic side effects of anticancer treatment [6,7], or to assist in the differential diagnosis of CNS involvement [8,9]. However, its usefulness has not been established for any of these purposes and no conformity exists either about its sensitivity or specificity, or its predictivity for further treatment-related abnormalities in CNS morphology and function.…”

Neurophysiological findings in long-term survivors of acute lymphoblastic leukaemia in childhood treated with the BFM protocol 81 SR-A/B

“…As others [8,9,14,15] we studied the correlation of neurophysiological abnormalities with psychological, neurological and morphological alterations among healthy long-term survivors of childhood ALL. The primary question was whether CNS prophylaxis consisting of CI and ith MTX induced a greater prevalence of neurophysiological abnormalities that the alternative regimen consisting of a combination of MD-MTX and ith MTX.…”