Mesial temporal sclerosis – a late complication in four allogeneic pediatric recipients with persistent seizures after an acute episode of cyclosporine-A neurotoxicity

Abstract

Summary:Mesial temporal sclerosis (MTS) is a common finding in patients with intractable temporal lobe epilepsy (TLE). In this report, we retrospectively reviewed the neuroimaging results of four children who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT), and who developed recurrent, partial, intractable seizures following a first event caused by cyclosporine-A (CSA) neurotoxicity. Neuroradiologic findings of MTS were demonstrated in all these patients. We suggest that MTS may be a consequence of CSA neurotoxicity, which induces repeated seizures, associated with other predisposing conditions, as well as being a consequence of the underlying disease and its treatment, and of severe graft-versus-host disease (GvHD). Bone Marrow Transplantation (2003) 31, 919-922.

Chronic herpes simplex type-1 encephalitis with intractable epilepsy in an immunosuppressed patient

“…While there is mounting evidence that chronic HSE is a cause of intractable epilepsy (Table 1), we have found no previous reports of seizures resulting from chronic HSE without preceding acute HSE [1][2][3][4][5][6][7]. We propose that, in immunosuppressed individuals, chronic central nervous system infection can be a co-existing cause of intractable epilepsy in addition to drugs such as cyclosporine which are independently associated with seizures [8][9][10].…”

“…Cyclosporine, even in the conventional therapeutic range, has been associated with new onset seizures [8]. Generalized and focal seizures have both been reported, as well as mesial temporal sclerosis and intractable epilepsy [9,10]. Case reports exist of intractable and progressive epilepsy in the population receiving cyclosporine.…”

Mesial temporal sclerosis as a complication of hematologic cancer

“…Most frequent IPIs are febrile seizures, CNS infection or trauma, and perinatal hypoxia. Other well-documented IPIs that may occur in patients with cancer include the following: hypertensive encephalopathy or PRES [3][4][5], relapsing generalized seizures [6], limbic encephalitis [7], and chemotherapy toxicity [3,5,8]. In children, MTS has been reported as a complication of treatment for acute leukemia [3,5,8].…”

“…PRES usually reverses when precipitating factors are rapidly corrected. However long-term complications of this otherwise ''reversible'' syndrome occur, that include MTS [3][4][5]. Patient 2 developed MTS after recovering from a non-Hodgkin lymphoma.…”

Non-endocrine late complications in children after allogeneic haematopoietic SCT

“…18,49 Patients affected by predisposing conditions (neurotoxic treatment given in first-line therapy, CSA neurotoxicity, anoxic injury) may develop mesial temporal sclerosis with clinical finding of temporal intractable epilepsy. 52 Leukoencephalopathy, mineralizing microangiopathy, necrotizing leukoencephalopathy and brain atrophy 5,18,53 are diagnosed by magnetic resonance imaging of the brain. Hearing abnormalities and incidence of ototoxicity are increased in patients who are treated with cyclophosphamide, thiotepa, cisplatin and carboplatin either as a part of the chemotherapy or the conditioning regimen before HSCT.…”