PROGNOSIS AND TREATMENT OF SEIZURES IN CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA

We reviewed the records of 127 consecutive pediatric patients with acu te lymphoblastic leukemia (ALL) to determine the incidence, timing, et iologies, and recurrence rate of seizures in this population. Patients with ALL and seizures were identified retrospectively by review of th e records of all pediatric ALL patients who were diagnosed and treated during the years 1983 through March 1993 in a large tertiary-care hos pital. Seventeen patients (13%) developed one or more seizures. In 16 patients, seizures occurred during antileukemic treatment, and in almo st all of them seizures were related to intrathecal methotrexate (IT M TX) or subcutaneous L-asparaginase treatment. One patient who develope d a seizure while not receiving chemotherapy had a history of cerebral infarctions, In 8 patients, (47%), the initial seizure episode was as sociated with a cerebral lesion. One or more seizures recurred in 6 pa tients. Four of these patients had an isolated recurrence, in 3 patien ts less than or equal to 3 months and in 1 patient less than or equal to 6 months after the initial event. Two patients (12%) with static en cephalopathy and neurological deficits developed a chronic seizure dis order. There is a significant risk of acute symptomatic seizures in pe diatric ALL patients. Most seizures in these patients occur during the acute treatment phase and are most frequently related to side effects of chemotherapy. The longterm recurrence risk is low; recurrence occu rs 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.