Seizures in childhood lymphoblastic leukaemia patients
Ochs, J.J.; Bowman, W.P.; Pui, C.H.; Abromowitch, M.; Mason, C.; Simone, J.V.
Lancet 2(8417-8418): 1422-1424
1984
ISSN/ISBN: 0140-6736 PMID: 6151043 Document Number: 232318
Features of seizures in children with acute lymphoblastic leukemia were examined in relation to the type of treatment received for CNS prophylaxis. Of the 1289 patients in the study, 132 (10%) had experienced 1 or more seizures. In 96 the seizures had not been associated with any recognizable etiology and, with 3 exceptions, had been generalized or focal motor in type. Status epilepticus had occurred in 1/3 of the group with seizures. Initial seizure rates among patients in continuous complete remission were significantly related to the method of CNS prophylaxis. Those who had received intrathecal methotrexate repeatedly with or without moderate doses of methotrexate i.v. or prior prophylactic cranial irradiation had a 20-fold higher seizure risk during remission induction, and a 37-fold higher risk during the 6th to 12th mo. of therapy, than did those who had received irradiation and only 5 intrathecal injections of methotrexate early in the course of treatment. Other clinical factors associated with an increased frequency of seizures were escalation of i.v. methotrexate dosage following cranial irradiation and treatment of meningeal leukemia with intrathecal methotrexate. Parenterally administered methotrexate seems to increase susceptibility to seizure development in childhood leukemia patients.