Epilepsy in children and adolescents with B-cell acute lymphoblastic leukemia

This study aims to evaluate seizure outcomes and identify predisposing factors for epilepsy in patients diagnosed with B-cell acute lymphoblastic leukemia (B-ALL).

This was a retrospective study conducted at a tertiary care hospital. Inclusion criteria were: age younger than 18 years at the time of B-ALL diagnosis, and occurrence of seizures at any point after B-ALL diagnosis.

A total of 23 patients met the inclusion criteria. The mean age at B-ALL diagnosis was 6.1 years, and 21.7 % received prophylactic brain irradiation. The mean age at first seizure was 8.5 years, with a mean latency of 28 months from B-ALL diagnosis. Of the 23 patients, 17 (73.9 %) experienced provoked seizures, most commonly related to acute or subacute methotrexate (MTX) neurotoxicity. Overall, seven patients (30.4 %) developed epilepsy, and five (21.7 %) had drug-resistant epilepsy (two with focal intractable epilepsy and three with Lennox-Gastaut syndrome). Patients who developed epilepsy had a significantly older age of seizure onset compared to those with only provoked seizures (p = 0.012), suggesting that older age at seizure onset may be a predisposing factor for epilepsy.

Most seizures in patients with B-ALL were provoked and resolved without the need for long-term antiseizure medication treatment. Acute or subacute MTX neurotoxicity accounted for the majority of provoked seizures. However, these rarely progressed to epilepsy. Long-term neurological surveillance is important in B-ALL survivors, especially those with delayed seizure onset or magnetic resonance imaging evidence of leukoencephalopathy.