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Symptomatic epilepsy associated with intracranial calcifications in children with acute lymphoblastic leukemia (ALL)
1Department of Pediatrics, Division of Neuropediatrics, University Hospital Center Zagreb, Zagreb, Croatia.
Insights
Central nervous system (CNS) prophylaxis for childhood acute lymphoblastic leukemia (ALL) can lead to early-onset seizures and intracranial calcifications. These neurological side effects may occur sooner than previously documented.
Area of Science:
- Pediatric Oncology
- Neurology
- Radiotherapy
Background:
- Central nervous system (CNS) prophylaxis is crucial in treating childhood acute lymphoblastic leukemia (ALL).
- Standard treatments involve irradiation and intrathecal chemotherapy, carrying risks of long-term neurological sequelae.
- Reported complications include vasculopathies, leukoencephalopathies, and cognitive impairments.
Observation:
- Two pediatric patients, aged 5 and 8 years, developed epilepsy and intracranial calcifications.
- These neurological manifestations appeared 2-4 years post-ALL diagnosis, earlier than typically reported.
- Brain imaging (CT) and electroencephalography (EEG) were normal prior to seizure onset.
Findings:
- The observed epilepsy was symptomatic, linked to intracranial calcifications and persistent EEG abnormalities.
- Both children achieved seizure freedom with anticonvulsant medications, including carbamazepine, valproate, and vigabatrine.
- This suggests a potential earlier onset of neurological side effects from CNS prophylactic treatments.
Implications:
- Early recognition of these neurological side effects is vital for timely intervention in pediatric ALL survivors.
- The findings may necessitate re-evaluation of current CNS prophylaxis protocols and long-term monitoring strategies.
- Understanding these earlier-onset complications can improve the quality of life for childhood cancer survivors.
Abstract:
Acute and long-term sequels of central nervous system (CNS) prophylaxis with irradiation and intrathecal chemotherapy in children suffering from acute lymphoblastic leukemia (ALL) include vasculopathies, leucoencephalopathies, intracranial calcifications, intellectual and neurological impairment. We report two children at the age 5 and 8 years who manifested partial motor or complex seizures and intracranial calcifications 2-4 years after the diagnosis of ALL had been established. The occurrence of these disorders was much earlier than reported in the literature. Both children received prophylactic CNS treatment with irradiation and intrathecal methotrexate (MTX). Their brain CT scans and EEG had been normal before the first epileptic seizure was registered. Children are now seizure free on carbamazepine, and a boy with complex partial and myoclonic seizures is also on valproate and vigabatrine. Symptomatic epilepsy associated with intracranial calcifications and persisting EEG changes might occur as side effects of ALL treatment.