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Seizures in children undergoing stem cell transplantation
Eulalia Turón-Viñas1,2, Iván López-Torija3, Elisabet Coca-Fernández1,2
1Child Neurology Unit, Pediatrics Service, Hospital Sant Pau, Barcelona, Spain.
Insights
Neurological complications, particularly seizures, are a significant concern after hematological stem cell transplantation (HSCT). Identifying risk factors and early interventions for seizures is crucial for improving patient outcomes and survival rates.
Area of Science:
- Hematology
- Neurology
- Pediatrics
Background:
- Neurological complications (NCs) are a major concern following hematological stem cell transplantation (HSCT).
- Seizures are a common presentation of NCs in patients undergoing HSCT.
Purpose of the Study:
- To analyze the incidence and etiologies of seizures in children undergoing HSCT.
- To identify risk factors and outcomes associated with seizures post-HSCT.
Main Methods:
- Retrospective study of 155 children undergoing HSCT between 2002 and 2018.
- Analysis of seizure incidence, causes, associated factors, and outcomes.
Main Results:
- 17.4% of children developed seizures within 2 years post-HSCT.
- Common etiologies included CNS infection, drug toxicity, and vascular disease.
- Seizures were associated with HSCT type, specific medications, and GVHD, and predicted adverse outcomes including mortality and sequelae.
Conclusions:
- Neurological complications, especially seizures, significantly impact survival and outcomes in HSCT patients.
- Addressing neurological complications is essential for improving HSCT procedures and patient management.
Background:
Neurological complications (NCs) are of major concern following hematological stem cell transplantation (HSCT), most of which present with seizures.
Procedures:
We performed a retrospective study (2002-2018) of patients undergoing HSCT in order to analyze the incidence and aetiologies related to seizures.
Results:
Of 155 children undergoing HSCT, 27 (17.4%) developed seizures at some point in 2 years of follow-up. The most frequent etiologies were central nervous system (CNS) infection (n = 10), drug toxicity (n = 8), and vascular disease (n = 5). A statistically significant association was found between seizure and the HSCT type (lower risk for a related identical donor, p = .010), prophylactic or therapeutic mycophenolate use (p = .043 and .046, respectively), steroid use (p = .023), selective CD45RA+ depletion (p = .002), pre-engraftment syndrome (p = .007), and chronic graft-versus-host disease (GVHD) severity (p = .030). Seizures predicted evolution to life-threatening complications and admission to intensive care (p < .001) and higher mortality (p = .023). A statistically significant association was also found between seizures and sequelae in survivors (p = .029). Children who developed seizures had a higher risk of CNS infection and vascular disease (odds ratio 37.25 [95% CI: 7.45-186.05] and 12.95 [95% CI 2.24-74.80], respectively).
Conclusions:
Neurological complications highly impact survival and outcomes and need to be addressed when facing an HSCT procedure.
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