Tibussek D, Distelmaier F, Schönberger S, Göbel U, Mayatepek E
Department of General Paediatrics, University Children's Hospital, Düsseldorf, Germany.
Klin Padiatr. 2006 Nov-Dec;218(6):340-9. doi: 10.1055/s-2006-942257.
Epileptic seizures are a common and clinically relevant problem in paediatric oncology. Attributable to the heterogeneity of this group of patients and a number of possible comorbidities antiepileptic treatment in paediatric oncology poses a number of diagnostic and therapeutic challenges. This requires a close interdisciplinary approach to the seizing child or adolescent. A prompt and detailed diagnostic work-up is needed in every case in order to establish the diagnosis and, equally important, to detect secondary aetiological factors, e. g. epileptogenic drugs or any acute underlying pathology, such as metabolic or toxic encephalopathies, CNS-infections or cerebrovascular events. This might offer the opportunity for a specific causative treatment and thus prevent unnecessary long-term antiepileptic drug (AED) treatment. If AED treatment is initiated several aspects have to be taken into account. Most importantly, AEDs and chemotherapeutic drugs (CTDs) may interact. Depending on the comedication this may result in reduced tumour or seizure control or unexpected toxicity of AEDs or CTDs. Understanding these interactions will allow to anticipate clinically relevant adverse effects. AED may be further complicated by side-effects, some of them of particular concern for children or adolescents, such as cognitive effects, myelotoxicity, serious rashes, endocrinological disturbances, and many more. Beside critically questioning the need for AED treatment it is therefore important to prefer AED with a good safety-profile in this population. Enzyme-inducing and inhibiting AED should be avoided if possible. Preliminary studies indicate that gabapentin and levetiracetam may provide good options in terms of efficacy and safety. However, more properly designed clinical studies are warranted to raise the level of evidence for robust clinical recommendations. Until that time, clinicians will need to continue to question current policies and adapt their daily practice to evolving scientific data.
癫痫发作在儿科肿瘤学中是一个常见且具有临床相关性的问题。由于这类患者的异质性以及多种可能的合并症，儿科肿瘤学中的抗癫痫治疗面临着诸多诊断和治疗挑战。这就需要对癫痫发作的儿童或青少年采取密切的多学科方法。每种情况下都需要迅速而详细的诊断检查，以便确立诊断，同样重要的是，检测继发性病因，例如致痫药物或任何急性潜在病变，如代谢性或中毒性脑病、中枢神经系统感染或脑血管事件。这可能为进行特异性病因治疗提供机会，从而避免不必要的长期抗癫痫药物（AED）治疗。如果开始进行AED治疗，必须考虑几个方面。最重要的是，AED和化疗药物（CTD）可能相互作用。根据合并用药情况，这可能导致肿瘤控制或癫痫发作控制降低，或者AED或CTD出现意外毒性。了解这些相互作用将有助于预测临床相关的不良反应。AED还可能因副作用而更加复杂，其中一些副作用对儿童或青少年尤为令人担忧，例如认知影响、骨髓毒性、严重皮疹、内分泌紊乱等等。因此，除了严格质疑AED治疗的必要性外，在这一人群中选择具有良好安全性的AED也很重要。应尽可能避免使用酶诱导和酶抑制性AED。初步研究表明，加巴喷丁和左乙拉西坦在疗效和安全性方面可能是不错的选择。然而，需要更合理设计的临床研究来提高有力临床建议的证据水平。在此之前，临床医生将需要继续质疑现行政策，并根据不断发展的科学数据调整日常实践。
