SEIZURES IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA

Objectives: To establish the incidence and cause of seizures in children diagnosed with acute lymphoblastic leukemia (ALL) over a 20-year period.

Methods: Patients with ALL were reviewed to ascertain seizure occurrence and etiology. The CT findings, neurophysiology and outcome of patients with cancer-treatment related seizures were recorded.

Results: Between 1986 and 2005 378 children were diagnosed with ALL, 37 had seizures. Two children had seizures before diagnosis. Eight children had a cause established for their seizures: brain abcess (n=2), hypocalcemia (n=2), cranial hemorrhage (n=1), toxic encephalopathy (n=1), hypertension (n=1), hypoglycemia (n=1). Four had seizures as part of the terminal illness. Twenty-five children had presumed cancer-treatment related seizures (17 boys,8 girls). Fourteen children (56%) of these had their first seizure within 4 months of starting treatment with IT methotrexate and IM l-asparaginase. Fourteen children (56%) only had one seizure. Seizure type in the cancer-treatment related group was generalized (n=10), focal (n=9), multifocal (n=6). CT scans (n=23) showed: normal study (n=15), atrophy (n=4), atrophy and basal ganglion calcifications (n=1), frontoparietal infarcts (n=2), hemorrhage (n=1). EEG (n=18) was normal in 11 and showed nonspecific changes in the remainder. Eleven children died and 2 were lost to follow-up. The remaining twelve are in remission,1 currently on chemotherapy and anti-convulsants. Of the 11 children off chemotherapy only 1 remains on anti-convulsants. Conclusion: The incidence of seizures in this study was 9.8%. The majority of events were treatment related and isolated. Seiures occurred early in association with chemotherapy. EEG was unhelpful and over half the CTs were normal.