Maytal J, Grossman R, Yusuf F H, Shende A C, Karayalycin G, Lanzkowsky P, Schaul N, Eviatar L
Division of Pediatric Neurology, Schneider Children's Hospital, New Hyde Park, NY 11042, USA.
Epilepsia. 1995 Aug;36(8):831-6. doi: 10.1111/j.1528-1157.1995.tb01622.x.
We reviewed the records of 127 consecutive pediatric patients with acute lymphoblastic leukemia (ALL) to determine the incidence, timing, etiologies, and recurrence rate of seizures in this population. Patients with ALL and seizures were identified retrospectively by review of the records of all pediatric ALL patients who were diagnosed and treated during the years 1983 through March 1993 in a large tertiary-care hospital. Seventeen patients (13%) developed one or more seizures. In 16 patients, seizures occurred during antileukemic treatment, and in almost all of them seizures were related to intrathecal methotrexate (IT MTX) or subcutaneous L-asparaginase treatment. One patient who developed a seizure while not receiving chemotherapy had a history of cerebral infarctions. In 8 patients, (47%), the initial seizure episode was associated with a cerebral lesion. One or more seizures recurred in 6 patients. Four of these patients had an isolated recurrence, in 3 patients < or = 3 months and in 1 patient < or = 6 months after the initial event. Two patients (12%) with static encephalopathy and neurological deficits developed a chronic seizure disorder. There is a significant risk of acute symptomatic seizures in pediatric ALL patients. Most seizures in these patients occur during the acute treatment phase and are most frequently related to side effects of chemotherapy. The long-term recurrence risk is low; recurrence occurs most often in patients with evidence of cerebral structural lesions and neurological deficits. Long-term antiepileptic drug (AED) therapy should be restricted to such patients.
我们回顾了127例连续性小儿急性淋巴细胞白血病（ALL）患者的记录，以确定该人群中癫痫发作的发生率、发作时间、病因及复发率。通过回顾1983年至1993年3月在一家大型三级护理医院诊断和治疗的所有小儿ALL患者的记录，对患有ALL和癫痫的患者进行了回顾性识别。17例患者（13%）发生了一次或多次癫痫发作。16例患者在抗白血病治疗期间发生癫痫发作，几乎所有患者的癫痫发作都与鞘内注射甲氨蝶呤（IT MTX）或皮下注射L-天冬酰胺酶治疗有关。1例在未接受化疗时发生癫痫发作的患者有脑梗死病史。8例患者（47%）的首次癫痫发作与脑病变有关。6例患者癫痫复发一次或多次。其中4例患者为孤立性复发，3例在首次发作后≤3个月复发，1例在首次发作后≤6个月复发。2例（12%）患有静止性脑病和神经功能缺损的患者发生了慢性癫痫障碍。小儿ALL患者有发生急性症状性癫痫的显著风险。这些患者的大多数癫痫发作发生在急性治疗阶段，最常见的与化疗副作用有关。长期复发风险较低；复发最常发生在有脑结构病变和神经功能缺损证据的患者中。长期抗癫痫药物（AED）治疗应仅限于此类患者。
