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Acute mental status changes in children with systemic cancer
1Division of Neurology, Children's Hospital of Philadelphia.
Insights
Acute changes in mental status (AMS) affect 11% of children with cancer, often caused by seizures, encephalopathy, or stroke. Outcomes depend on the cause, with difficult-to-control seizures leading to long-term therapy needs.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Neurology
Background:
- Acute changes in mental status (AMS) are a significant complication in pediatric cancer patients.
- These changes stem from various cancer- and treatment-related factors.
- Understanding the incidence, causes, and outcomes of AMS is crucial for patient management.
Purpose of the Study:
- To determine the incidence of AMS in children with cancer.
- To identify the primary etiologies of AMS in this population.
- To evaluate the outcomes associated with different causes of AMS.
Main Methods:
- Retrospective review of medical records for children under 18 with systemic cancer (excluding primary CNS tumors) experiencing AMS.
- Data collected from 1981 to 1987.
- Analysis of cancer type, treatment, timing of AMS, etiology, and patient outcomes.
Main Results:
- AMS developed in 11% (89 of 815) of at-risk children.
- Seizures were the most common cause (60%), followed by encephalopathy (27%) and stroke syndrome (13%).
- Incidence varied by cancer type, with leukemia patients most affected (14%).
Conclusions:
- AMS is a notable complication in pediatric cancer patients, with diverse etiologies.
- The specific cause of AMS significantly influences neurological morbidity and mortality.
- Prompt identification and management of AMS, particularly seizures, are vital for improving patient outcomes.
Abstract:
Acute changes in mental status (AMS) develop in children with cancer from a multitude of cancer- and treatment-related complications. To determine the incidence, etiology, and outcome of children with cancer who had AMS, the medical records of all children under 18 years of age with systemic cancer (excluding primary central nervous system tumors) who had AMS in our institution during the years 1981 through 1987 were reviewed. AMS developed in 89 of 815 children at risk (11%). The AMS was caused by seizures in 53 (60%), an encephalopathy in 24 (27%), and a stroke syndrome in 12 (13%). AMS occurred in 42 of 305 (14%) with leukemia, 16 of 139 (12%) with lymphoma, 14 of 136 (10%) with sarcoma, 10 of 104 (9%) with neuroblastoma, and 7 of 104 (5%) with other malignancies. Children with acute lymphocytic leukemia were more prone to having seizures (61%), while children with nonacute lymphocytic leukemia were almost equally likely to have encephalopathies, strokes, or seizures. Children with lymphoma were admitted for treatment most often with an encephalopathy (44%). Etiologies for AMS were evaluated vigorously, and one or more etiologies were identified in 80 of 89 (89%) patients. Dependent on the type of tumor, the anticancer treatment used and, timing during the course of illness AMS occurred, specific diagnoses were more likely. Neurologic morbidity and mortality were dependent on the cause of AMS. Children with seizures that were initially difficult to control were more likely to require long-term anticonvulsant therapy.