Division of Pediatric Neurology, Lurie Children's Hospital of Chicago, Chicago, Illinois.
Division of Hematology/Oncology, Lurie Children's Hospital of Chicago, Chicago, Illinois.
Pediatr Neurol. 2022 Feb;127:56-59. doi: 10.1016/j.pediatrneurol.2021.11.006. Epub 2021 Nov 19.
Seizures are a common complication of both primary central nervous system (CNS) tumors and other oncologic processes with CNS involvement. They occur most frequently during induction or consolidation therapy, but there is a growing body of evidence that they can also develop later in life. Refractory epilepsy can develop as a late complication for survivors of pediatric cancer with CNS involvement who undergo chemoradiation therapy.
We report three patients who presented with atypical nonconvulsive seizures (behavioral arrest, falls, nonsensical speech) up to 14 years after cancer diagnosis. All underwent whole-brain radiation in addition to chemotherapy. None had a prior epilepsy diagnosis or known prior seizures. One patient suddenly passed away of unclear causes five months after diagnosis, and the other two continued to have EEG findings consistent with cerebral dysfunction and epileptogenicity years after diagnosis.
We hypothesize that the development of refractory epilepsy may be a late effect of radiation treatment. Given the high morbidity and mortality associated with epilepsy, early identification is crucial to improve outcomes and quality of life for this vulnerable population. This is especially true for patients with medication-refractory epilepsy as there is an increasing breadth of effective surgical options.
癫痫是原发性中枢神经系统（CNS）肿瘤和其他涉及 CNS 的肿瘤过程的常见并发症。它们最常发生在诱导或巩固治疗期间，但越来越多的证据表明，它们也可能在以后的生活中发展。对于接受化疗和放疗的 CNS 受累儿童癌症幸存者，难治性癫痫可能是一种晚期并发症。
我们报告了 3 名患者，他们在癌症诊断后 14 年出现非典型非惊厥性发作（行为性发作、跌倒、语无伦次）。所有患者均接受了全脑放疗加化疗。他们均无癫痫诊断或已知癫痫发作史。其中一名患者在诊断后五个月突然不明原因死亡，另外两名患者在诊断后数年继续存在脑电图表现，提示大脑功能障碍和致痫性。
我们假设难治性癫痫的发生可能是放射治疗的一种晚期效应。鉴于癫痫相关的高发病率和死亡率，早期识别对于改善这一脆弱人群的预后和生活质量至关重要。对于药物难治性癫痫患者尤其如此，因为有效的手术选择越来越多。
