INTRACTABLE PARTIAL EPILEPSY FOLLOWING LOW-DOSE SCALP IRRADIATION IN INFANCY

We report the development of intractable epilepsy in 3 patients treate d with irradiation to ''strawberry'' scalp nevi in infancy. Low-dose r adiation was used (12 and 13 Gy in 2 of the patients). The clinical ev olution suggested a recognizable and distinctive postradiation syndrom e. There was concordance between the site of radiation as shown by loc alized alopecia, the clinical features of the partial seizures, and el ectrographic abnormalities. The clinical picture was unlike delayed ce rebral radiation necrosis of adulthood, which is not thought to occur at doses below 50 Gy, in 2-Gy fractions. Neurological deficits were no t progressive and in 2 patients there was no evidence of parenchymal i njury on cranial magnetic resonance imaging scanning. These difference s suggest pathogenetic differences to cerebral radiation injury of adu lthood, probably relating to the interaction between nervous system de velopment, individual susceptibility, and the low doses of radiation e mployed.