Background

Seizures occur in up to 13% of children with non-central nervous system (CNS) malignancies, but little is known about their causes and optimal diagnostic and therapeutic approaches. Here we sought to determine etiologies and clinical trajectories of new-onset seizures in this patient population.

Methods

A retrospective chart review over a 10-year period was conducted at the American University of Beirut Medical Center to identify children with non-CNS malignancies and at least one new-onset seizure. Data were collected on the underlying malignancy, seizure etiology, clinical course, treatments, electroencephalograms, and brain imaging.

Results

New-onset seizures occurred in 56 children (2-year median follow-up), most commonly in the context of acute lymphoblastic leukemia, lymphomas, and sarcomas. In 19 children, the first seizure consisted of status epilepticus. The most common etiologies were cerebrovascular accidents, posterior reversible encephalopathy syndrome, and metastasis. Forty-nine patients received anti-seizure medications (ASMs). Withdrawal of ASMs was successful in 19 children with normal initial or follow-up brain imaging but failed in three patients with persistent brain lesions. The remaining children, all of whom except two had structural brain abnormalities, received chronic ASMs and remained seizure free for a median period of 2 years at the last follow-up in survivors.

Conclusions

Not only are seizures in children with non-CNS cancers often indicative of a serious brain insult, but they can also be challenging in the form of status epilepticus. An urgent diagnostic evaluation is therefore needed to expedite treatment, which should be tailored to the chronicity of the underlying cause.

中文翻译：

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非中枢神经系统恶性肿瘤儿童新发癫痫发作的原因及其治疗：三级医疗中心的回顾性研究

背景

癫痫发作发生在多达 13% 的非中枢神经系统 (CNS) 恶性肿瘤儿童中，但对其病因和最佳诊断和治疗方法知之甚少。在这里，我们试图确定该患者人群中新发癫痫发作的病因和临床轨迹。

方法

贝鲁特美国大学医学中心进行了为期 10 年的回顾性图表审查，以确定患有非中枢神经系统恶性肿瘤和至少一次新发癫痫发作的儿童。收集了有关潜在恶性肿瘤、癫痫发作病因、临床病程、治疗、脑电图和脑成像的数据。

结果

56 名儿童出现新发癫痫发作（中位随访 2 年），最常见于急性淋巴细胞白血病、淋巴瘤和肉瘤。在 19 名儿童中，第一次癫痫发作包括癫痫持续状态。最常见的病因是脑血管意外、后部可逆性脑病综合征和转移。49 名患者接受了抗癫痫药物 (ASM)。19 名初始或后续脑成像正常的儿童成功撤除 ASM，但在 3 名持续性脑损伤患者中失败。其余的儿童，除两名儿童外，均有结构性脑部异常，接受慢性 ASMs，并在幸存者的最后一次随访中保持无癫痫发作的中位时间为 2 年。

结论

患有非中枢神经系统癌症的儿童的癫痫发作不仅通常预示着严重的脑损伤，而且它们还可能以癫痫持续状态的形式具有挑战性。因此，需要进行紧急诊断评估以加快治疗，治疗应根据潜在病因的长期性进行调整。