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Busulfan neurotoxicity and EEG abnormalities: a case report
C La Morgia1, S Mondini, M Guarino
1Neurology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, I-40138 Bologna, Italy. chiara.lamorgia@virgilio.it
Summary
Busulfan (BU), used in bone marrow transplantation (BMT), can cause seizures and EEG abnormalities. Regular EEG monitoring is crucial for detecting and managing this busulfan neurotoxicity in BMT patients.
Area of Science:
- Neuroscience
- Hematology
- Pharmacology
Background:
- Bone marrow transplantation (BMT) is a critical treatment for acute lymphoblastic leukemia.
- Conditioning regimens often involve chemotherapy agents like busulfan (BU) and cyclophosphamide (Cy).
- Neurotoxicity is a potential complication of conditioning agents used in BMT.
Observation:
- A 21-year-old woman developed a generalized tonic-clonic seizure the day after initiating BU treatment for BMT.
- Electroencephalography (EEG) revealed diffuse polyspikes and spike-and-wave discharges post-seizure.
- Persistent EEG abnormalities, including slowed background activity and slow waves, were observed for approximately 20 days.
Findings:
- Busulfan (BU) administration was temporally associated with the onset of seizures and significant EEG abnormalities.
- The observed EEG changes indicated a neurotoxic effect potentially linked to busulfan.
- Complete EEG normalization occurred within one month post-seizure, suggesting a reversible process.
Implications:
- This case highlights the potential neurotoxicity of busulfan (BU), particularly its association with seizures and EEG changes.
- Routine EEG monitoring before and after bone marrow transplantation (BMT) is recommended to detect busulfan-induced neurotoxicity.
- Early identification and management of BU neurotoxicity can improve patient outcomes following BMT.