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Characterizing the phenotype of drug-resistant childhood epilepsy associated with leukemia: A case series

Elham Abushanab1, Elia Pestana Knight1, Ahsan N Moosa1

  • 1Cleveland Clinic, Epilepsy Center, Neurological Institute - Desk S50, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States.

Epilepsy & Behavior Reports
|April 26, 2021
PubMed

Insights

Children with leukemia can develop drug-resistant epilepsy. This study identified two main types: epileptic encephalopathy and focal epilepsy, with varying treatment responses.

Area of Science:

  • Pediatric Neurology
  • Oncology
  • Epileptology

Background:

  • Children with leukemia face increased epilepsy risk from the disease or its treatments.
  • Neurotoxic therapies and the primary disease can precipitate seizures in pediatric leukemia survivors.

Purpose of the Study:

  • To describe the phenotypes of drug-resistant epilepsy in children with a history of leukemia.
  • To analyze the characteristics and treatment outcomes of epilepsy in this specific pediatric population.

Main Methods:

  • Retrospective case series of 10 children with leukemia and drug-resistant epilepsy.
  • Phenotypic classification into Lennox-Gastaut syndrome features and focal epilepsy.
  • Review of treatment modalities including chemotherapy, radiation, corpus callosotomy, and temporal lobectomy.

Main Results:

  • Six patients presented with epileptic encephalopathy (features of Lennox-Gastaut syndrome), and four with focal epilepsy.
  • Mean age of epilepsy onset was 5 years for epileptic encephalopathy and 6.5 years for focal epilepsy.
  • Temporal lobectomy yielded favorable outcomes (Engel 1) in two patients with temporal lobe epilepsy, while palliative surgery response was variable.

Conclusions:

  • Two main phenotypes of refractory epilepsy, focal epilepsy and epileptic encephalopathy, are observed in children with prior leukemia.
  • Temporal lobe epilepsy in these patients responds well to temporal lobectomy.
  • Further research is needed to understand the underlying mechanisms and optimize management strategies.

Keywords:
Acute lymphocytic leukemiaChildhood leukemiaDrug-resistant epilepsyLennox-Gastaut syndromeMethotrexate

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