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Somnolence after prophylactic cranial irradiation in children with acute lymphoblastic leukaemia
Insights
Cranial irradiation for acute lymphoblastic leukaemia can cause temporary somnolence and lethargy in children. These symptoms, indicative of transient radiation encephalopathy, resolve spontaneously without lasting neurological effects.
Area of Science:
- Pediatric Oncology
- Radiation Neurology
- Neuro-oncology
Background:
- Cranial irradiation is a key component of central nervous system (CNS) prophylaxis for acute lymphoblastic leukaemia (ALL).
- Post-irradiation neurological sequelae require careful monitoring in pediatric cancer survivors.
Purpose of the Study:
- To describe a transient cerebral disturbance observed in children following cranial irradiation for ALL.
- To investigate the nature and potential mechanisms of this post-irradiation syndrome.
Main Methods:
- Observational study of 28 children treated with cranial irradiation for ALL.
- Clinical assessment of neurological symptoms including somnolence, anorexia, and lethargy.
- Electroencephalogram (EEG) studies in affected children.
Main Results:
- 39% of children developed pronounced somnolence, anorexia, and lethargy approximately six weeks post-irradiation.
- An additional 39% experienced mild forms of these symptoms.
- All symptoms were transient, with spontaneous and complete recovery.
- EEG studies revealed diffuse, patchy abnormal activity over both hemispheres in somnolent children.
Conclusions:
- The syndrome appears to be a transient radiation encephalopathy, possibly related to temporary myelin synthesis disturbance.
- This condition is analogous to acute transient radiation myelopathy.
- The findings support the safety and transient nature of this neurological side effect in the context of ALL treatment.
Abstract:
A transient cerebral disturbance characterized by somnolence of varying degree is described in children after cranial irradiation given as part of central nervous system (C.N.S.) prophylaxis for acute lymphoblastic leukaemia in remission.Out of 28 such children receiving cranial irradiation as part of the Medical Research Council protocol for C.N.S. prophylaxis 11 (39%) developed pronounced symptoms of somnolence, anorexia, and lethargy some six weeks after the completion of cranial irradiation, and a further 11 (39%) developed these features in mild form. In all cases the symptoms were transient, no focal neurological abnormality was detected, and all children made a spontaneous and complete recovery. E.E.G. studies on five somnolent children showed similar abnormal activity of diffuse and patchy distribution over both hemispheres. Indirect evidence is presented to support the concept that this syndrome represents a transient radiation encephalopathy, analogous to acute transient radiation myelopathy, caused by temporary disturbance of myelin synthesis.