ENCEPHALOPATHY WITH PARKINSONIAN FEATURES IN CHILDREN FOLLOWING BONE-MARROW TRANSPLANTATIONS AND HIGH-DOSE AMPHOTERICIN-B

Encephalopathy, leukoencephalopathy, and secondary parkinsonism occurr ed in 3 children with refractory leukemia undergoing allogenic bone ma rrow transplantation (BMT) who were treated with high-dose amphoterici n B for pulmonary aspergillosis or sinus aspergillosis that did not in volve the nervous system. Treatment included high-dose cytosine arabin oside, cyclophosphamide, and total body irradiation prior to the BMT. The children developed a progressively worsening encephalopathy and pa rkinsonian features, characterized by resting tremor, cogwheel rigidit y, and masklike facies. Neuroimaging studies showed cerebellar, cerebr al, and basal ganglia atrophy, as well as frontal and temporal lobe wh ite matter involvement. Two of the 3 patients recovered, although 1 ha s residual intellectual impairment. The third succumbed to non-central nervous system Epstein-Barr virus-lymphoproliferative disease and had autopsy-confirmed leukoenephalopathy.