Bruggers C S, Friedman H S, Tien R, Delong R
Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
Med Pediatr Oncol. 1994;23(4):380-3. doi: 10.1002/mpo.2950230412.
Ifosfamide, a nitrogen mustard derived alkylating agent commonly used in the treatment of solid tumors, has been associated with neurotoxicity in 5-33% of treated patients. Encephalopathy most often occurs during or shortly following drug administration, with increased drowsiness or irritability, confusion, hallucinations, visual blurring, extrapyramidal dysfunction, cranial nerve abnormalities, incontinence, generalized muscle twitching, seizures, and coma reported in infants, children, and older adults. While most reported neurologic abnormalities associated with ifosfamide have been reversible, encephalopathy resulting in death has occurred. We now report an infant who developed ifosfamide-induced encephalopathy, loss of developmental milestones, progressive brain atrophy, and cessation of cranial growth. This is the first case of cerebral atrophy and loss of developmental milestones that has been reported in a pediatric patient treated with ifosfamide. Given the efficacy of this anti-neoplastic agent and its increasing use in pediatrics, further investigation is indicated, especially in infants where brain growth is ongoing.
异环磷酰胺是一种常用于治疗实体瘤的氮芥类烷化剂，5%至33%接受治疗的患者会出现神经毒性。脑病最常发生在用药期间或用药后不久，婴儿、儿童和老年人中均有嗜睡或易怒、意识模糊、幻觉、视力模糊、锥体外系功能障碍、脑神经异常、失禁、全身性肌肉抽搐、癫痫发作和昏迷等症状的报告。虽然大多数与异环磷酰胺相关的神经异常是可逆的，但也有导致死亡的脑病发生。我们现在报告一名婴儿，其出现了异环磷酰胺诱导的脑病、发育里程碑丧失、进行性脑萎缩和颅骨生长停止。这是首例在用异环磷酰胺治疗的儿科患者中报告的脑萎缩和发育里程碑丧失的病例。鉴于这种抗肿瘤药物的疗效及其在儿科的使用日益增加，有必要进行进一步研究，尤其是在脑仍在生长的婴儿中。
