Antineoplastics
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Reactions 1283 - 9 Jan 2010 S Antineoplastics Posterior leukoencephalopathy and occipital lobe seizures in a child: case report A male child developed posterior leukoencephalopathy, and occipital lobe seizures as part of multifocal epilepsy, after receiving antineoplastics [dosages not stated] and radiotherapy for acute lymphoblastic leukaemia (ALL). After diagnosis with ALL at age 20 months, the boy underwent radiotherapy and received induction treatment with vincristine and cytarabine. This was followed by 2 years of maintenance therapy with asparaginase, oral and intrathecal methotrexate, mercaptopurine, cyclosphosphamide, cytarabine and prednisolone. At age 6 years, there was evidence of leukoencephalopathy due to radio- and chemotherapy. At 8 years, he began experiencing visual seizures, and at age 10, an MRI showed bilateral, periventricular white matter hyper-intensities in the parieto-occipital regions. Antiepileptic drug treatment was unsuccessful, but the periventricular abnormalities resolved at age 13. At age 15 years, he developed type 2 focal seizures. These gradually worsened over 8 months, and by 16 years they occurred every 2 hours. His daily functioning was greatly affected and he required constant supervision. An MRI revealed cerebral cavernous malformations that had not been present on an MRI 3 years earlier. The boy underwent a right mesial frontal lesionectomy of a partially thrombosed cavernous angioma, which showed evidence of having previously haemorrhaged. Twenty-two months later, the frontal seizures had resolved, but he continued to have daily visual auras due to occipital lobe seizures. His quality of life had improved markedly, and he had been able to resume a normal and independent life. Author comment: "Toxic leukoencephalopathy may occur secondary to radiotherapy or chemotherapy. . . The severity may be more severe where chemotherapy is administered intrathecally or intravenously in combination with radiotherapy. Intrathecal methotrexate in particular may be associated with leukoencephalopathy." "The patient also had occipital lobe seizures associated with MRI abnormalities thought to be delayed sequelae of chemotherapy or radiotherapy." Radhakrishnan A, et al. Multifocal epilepsy: the role of palliative resection - intractable frontal and occipital lobe epilepsy secondary to radiotherapy for acute lymphoblastic leukaemia. Epileptic Disorders 10: 362-370, No. 4, Dec 2008 - Australia 801158091 1 Reactions 9 Jan 2010 No. 1283 0114-9954/10/1283-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1283 - 9 Jan 2010
SAntineoplastics
Posterior leukoencephalopathy and occipital lobeseizures in a child: case report
A male child developed posterior leukoencephalopathy,and occipital lobe seizures as part of multifocal epilepsy,after receiving antineoplastics [dosages not stated] andradiotherapy for acute lymphoblastic leukaemia (ALL).
After diagnosis with ALL at age 20 months, the boyunderwent radiotherapy and received induction treatmentwith vincristine and cytarabine. This was followed by2 years of maintenance therapy with asparaginase, oral andintrathecal methotrexate, mercaptopurine,cyclosphosphamide, cytarabine and prednisolone. At age6 years, there was evidence of leukoencephalopathy due toradio- and chemotherapy. At 8 years, he beganexperiencing visual seizures, and at age 10, an MRI showedbilateral, periventricular white matter hyper-intensities inthe parieto-occipital regions. Antiepileptic drug treatmentwas unsuccessful, but the periventricular abnormalitiesresolved at age 13. At age 15 years, he developed type 2focal seizures. These gradually worsened over 8 months,and by 16 years they occurred every 2 hours. His dailyfunctioning was greatly affected and he required constantsupervision. An MRI revealed cerebral cavernousmalformations that had not been present on an MRI 3 yearsearlier.
The boy underwent a right mesial frontal lesionectomy ofa partially thrombosed cavernous angioma, which showedevidence of having previously haemorrhaged. Twenty-twomonths later, the frontal seizures had resolved, but hecontinued to have daily visual auras due to occipital lobeseizures. His quality of life had improved markedly, and hehad been able to resume a normal and independent life.
Author comment: "Toxic leukoencephalopathy may occursecondary to radiotherapy or chemotherapy. . . The severitymay be more severe where chemotherapy is administeredintrathecally or intravenously in combination withradiotherapy. Intrathecal methotrexate in particular may beassociated with leukoencephalopathy." "The patient also had occipital lobe seizures associated withMRI abnormalities thought to be delayed sequelae ofchemotherapy or radiotherapy."Radhakrishnan A, et al. Multifocal epilepsy: the role of palliative resection -intractable frontal and occipital lobe epilepsy secondary to radiotherapy for acutelymphoblastic leukaemia. Epileptic Disorders 10: 362-370, No. 4, Dec 2008 -Australia 801158091
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Reactions 9 Jan 2010 No. 12830114-9954/10/1283-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
