[Ifosfamide-induced neurotoxicity. Clinical characteristics in a pediatric case series]

Ifosfamide is an antineoplastic alkylating agent associated with neurotoxicity, which is conditioned by predisposing factors and manifests up to one week after infusion, with a variable clinical spectrum. The indications for complementary studies and treatment is controversial. The objective was to describe the clinical manifestations associated with ifosfamide, identify risk factors, evaluate complementary studies, and determine the need for treatment during the acute phase and/or prophylactically phase.

Observational and retrospective study of 10 cancer patients evaluated for neurotoxicity secondary to ifosfamide at the Comprehensive Care Center for Hematology- Oncology Patients during the period 2017-2021. Patients who received ifosfamide and developed neurological symptoms were included, while those with previous neurological pathology or symptoms secondary to another etiology were excluded.

Ten patients who manifested neurological symptoms associated with ifosfamide were evaluated, with symptoms occurring most frequently within the first six hours after infusion and after the third dose. Generalized motor seizures were the predominant manifestation, requiring anticonvulsants; two patients had recurrence. Neuroimaging was normal. Five electroencephalograms were performed, one of which was abnormal. No patient developed subsequent neurological comorbidity.

Treatment with ifosfamide is associated with acute and/or delayed neurological manifestations, with seizures being the most frequent, related to the number of doses and infusion time; risk factors include hypoalbuminemia and concomitant treatment with nephrotoxic drugs. Therefore, knowledge and early detection. Therefore, awareness and early detection are essential for proper treatment.