Gaggero Roberto, Haupt Riccardo, Paola Fondelli Maria, De Vescovi Raffaella, Marino Alessia, Lanino Edoardo, Dallorso Sandro, Faraci Maura
Child Neurology Department, Gaslini Children's Research Institute, Genova, Italy.
J Child Neurol. 2006 Oct;21(10):861-6. doi: 10.1177/08830738060210100501.
The long-term evolution to intractable epilepsy in children treated with cyclosporine administered for graft-versus-host-disease after hematopoietic stem cell transplantation was evaluated. In a group of 185 children treated with cyclosporine after bone marrow transplantation, 15 (8%) presented with acute seizures that were generalized in 7 and focal in 7 and had absence status in 1. Electroencephalography (EEG) and neuroimaging showed predominant abnormalities in the occipital regions. One patient died shortly after the seizure; in seven cases, seizures remitted, whereas relapses were observed in seven others. After the first year, seizures persisted chronically in four cases and evolved to intractable epilepsy. Focal temporal epilepsy was diagnosed in three cases, whereas in the fourth case, a multifocal epilepsy was observed. Magnetic resonance imaging (MRI) detected mesial temporal sclerosis in all of these cases. The risk factors associated with evolution to epilepsy included lower age at transplantation (3-5 years), more than one relapsing seizure in the first year after transplantation, and longer treatment with cyclosporine. Not only can cyclosporine cause acute central nervous system toxicity, it can also determine intractable epilepsy associated with mesial temporal sclerosis.
对接受造血干细胞移植后因移植物抗宿主病而使用环孢素治疗的儿童发生难治性癫痫的长期演变情况进行了评估。在一组185例骨髓移植后接受环孢素治疗的儿童中，15例（8%）出现急性癫痫发作，其中7例为全身性发作，7例为局灶性发作，1例为失神状态。脑电图（EEG）和神经影像学检查显示枕叶区域主要存在异常。1例患者在癫痫发作后不久死亡；7例患者的癫痫发作缓解，而另外7例出现复发。第一年过后，4例患者的癫痫发作持续存在并演变为难治性癫痫。3例被诊断为颞叶局灶性癫痫，而在第4例中，观察到多灶性癫痫。磁共振成像（MRI）在所有这些病例中均检测到内侧颞叶硬化。与癫痫演变相关的危险因素包括移植时年龄较小（3 - 5岁）、移植后第一年出现不止一次复发性癫痫发作以及使用环孢素的治疗时间较长。环孢素不仅可导致急性中枢神经系统毒性，还可引发与内侧颞叶硬化相关的难治性癫痫。
