소아 급성 림프모구 백혈병 치료 중 발생한 경련의 임상 양상과 예후에 미치는 영향
The Clinical Manifestations and the Effect on Prognosis of Seizures during Acute Lymphoblastic Leukemia Treatment in Children
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose : This study was designed to assess the clinical manifestations and the effect on prognosis of seizures in children with acute lymphoblastic leukemia(ALL). Methods : The study group consisted of 20 patients(10 males and 10 females) who experienced seizures out of the 198 pediatric ALL patients(117 males and 81 females) who were diagnosed and treated at the Department of Pediatrics, St. Mary's Hospital, the Catholic University of Korea. Results : The overall incidence of seizure developing after the diagnosis of ALL was 10.1% and in 11 patients(5.6%), seizure recurred one or more times. An average of 6.5±3.6 months(range 0-42 months) elapsed between the beginning of treatment and the new onset of seizures. In 13 patients(65%), the first seizure occurred during the induction or re-induction chemotherapy phase. Seizure type was partial seizure in 11 patients(55%), and generalized seizure in 9 patients(45%). In 15 patients(88.2%), brain imaging study showed abnormal findings and in 18 patients(90%), EEG revealed abnormal findings. 11 patients were diagnosed with epilepsy and were treated with long-term anticonvulsants. In these patients, 4 patients(36.4%) had no seizure recurrence, but 2 patients(18.2%) showed no response to anticonvulsants. The 5-year survival rate of the patients experiencing seizures was 47%, while the rate was 78% for those did not experience seizures (P<0.001). Conclusion : Seizures in pediatric patients with ALL was closely related to the 5-year survival rate. Therefore, these patients require early careful observation, evaluation and intensive care. Also, further studies such as ways to diminish the side effects of antileukemic agents are necessary to reduce the risk of seizure.
Abstract
Purpose : This study was designed to assess the clinical manifestations and the effect on prognosis of seizures in children with acute lymphoblastic leukemia(ALL). Methods : The study group consisted of 20 patients(10 males and 10 females) who experienced seizures out of the 198 pediatric ALL patients(117 males and 81 females) who were diagnosed and treated at the Department of Pediatrics, St. Mary's Hospital, the Catholic University of Korea. Results : The overall incidence of seizure developing after the diagnosis of ALL was 10.1% and in 11 patients(5.6%), seizure recurred one or more times. An average of 6.5±3.6 months(range 0-42 months) elapsed between the beginning of treatment and the new onset of seizures. In 13 patients(65%), the first seizure occurred during the induction or re-induction chemotherapy phase. Seizure type was partial seizure in 11 patients(55%), and generalized seizure in 9 patients(45%). In 15 patients(88.2%), brain imaging study showed abnormal findings and in 18 patients(90%), EEG revealed abnormal findings. 11 patients were diagnosed with epilepsy and were treated with long-term anticonvulsants. In these patients, 4 patients(36.4%) had no seizure recurrence, but 2 patients(18.2%) showed no response to anticonvulsants. The 5-year survival rate of the patients experiencing seizures was 47%, while the rate was 78% for those did not experience seizures (P<0.001). Conclusion : Seizures in pediatric patients with ALL was closely related to the 5-year survival rate. Therefore, these patients require early careful observation, evaluation and intensive care. Also, further studies such as ways to diminish the side effects of antileukemic agents are necessary to reduce the risk of seizure.
참고문헌 (26)
- Pui C.H., "Acute lymphoblastic leukemia", N Engl J Med, 339, pp.605~615 (1998)
- Pui C.H., "Treatment of acute lymphoblastic leukemia", N Engl J Med, 354, pp.166~178 (2006)
- Mahoney D.H., "Acute neurotoxicity in children with B-precursor acute lymphoid leukemia: an association with intermediate-dose intravenous methotrexate and intrathecal triple therapy--a Pediatric Oncology Group study", J Clin Oncol, 16, pp.1712~1722 (1998)
- Lo Nigro L., "Acute neurotoxicity in children with B-lineage acute lymphoblastic leukemia(B-ALL) treated with intermediate risk protocols", Med Pediatr Oncol, 35, pp.449~455 (2000)
- Ochs J.J., "Abromowitch M, Mason C, Simone JV. Seizures in childhood lymphoblastic leukaemia patients", Lancet, 2, pp.1422~1444 (1984)
- DiMario F.J., "Acute mental status changes in children with systemic cancer", Pediatrics, 85, pp.353~360 (1990)
- Maytal J., , Epilepsia, 36, pp.831~836 (1995)
- Antunes N.L., "Seizures in children with systemic cancer", Pediatr Neurol, 28, pp.190~193 (2003)
- Antunes N.L., "Neurologic consultations in children with systemic cancer", Pediatr Neurol, 20, pp.121~124 (1999)
- Cavalheiro E.A., "Spontaneous recurrent seizure in rats: amino acid and monoamine determination in the hippocampus", Epilepsia, 35, pp.1~11 (1994)
- Thurston J.H., "Prognosis in childhood epilepsy: additional follow-up of 148 children 15 to 23 years after withdrawal of anticonvulsant therapy", N Engl J Med, 306, pp.831~836 (1982)
- Micheal E.C., "Tumors of the brain and spinal cord, including leukemic involvement. In: Kenneth FS, Stephen A, Donna MF, editors. Pediatric neurology: principles & practice", pp.1687~1757 (2006), Philadelphia: Mosby Inc
- Kuskonmaz B., "The neurologic complications in pediatric acute lymphoblastic leukemia patients excluding leukemic infiltration", Leuk Res, 30, pp.537~541 (2006)
- Rao R.D., "Methotrexate induced seizures associated with acute reversible magnetic resonance imaging (MRI) changes in a patient with acute lymphoblastic leukemia", Leuk Lymphoma, 43, pp.1333~1336 (2002)
- Griffin T.W., "The effect of photon irradiation on blood-brain barrier permeability to methotrexate in mice", Cancer, 40, pp.1109~1111 (1997)
- Ohnuma T., "Biochemical and pharmacological studies with asparaginase in man", Cancer Res, 30, pp.2297~2305 (1970)
- Nowak-Gttl U., "Kuhn N, Wolff JE, Boos J, Kehrel B, Rath B, et al. Inhibition of hypercoagulation by antithrombin substitution in E. coli L-asparaginase-treated children", Eur J Haematol, 56, pp.35~38 (1996)
- Ko T.S., "Central nervous system disease, Pediatrics", pp.982~1054 (2007), Seoul: Daehan Printing & Publishing Co., Ltd
- Relling M.V., "Adverse effect of anticonvulsants on efficacy of chemotherapy for acute lymphoblastic leukaemia", Lancet, 356, pp.285~290 (2000)
- Evans O.B., "Hematologic monitoring in children with epilepsy treated with carbamazepine", J Child Neurol, 4, pp.286~290 (1989)
- Acharya S., "Hematologic toxicity of sodium valproate", J Pediat Hematol Oncol, 22, pp.62~65 (2000)
- Shorvon S.D., "Early prognosis of epilepsy", Br Med J, 285, pp.1699~1701 (1982)
- Elwes R.D., "The prognosis for seizure control in newly diagnosed epilepsy", N Engl J Med, 311, pp.944~947 (1984)
- Todt H., "The late prognosis of epilepsy in childhood: results of a prospective follow-up study", Epilepsia, 25, pp.137~144 (1984)
- Carol S.C., "Initiating drug therapy. In: Elaine W, editor. The treatment of epilepsy : principles and practice", pp.763~770 (1996), Baltimore : Williams & Wilkins
- Del Giudice E., "Unusual seizures with a benign course in a case of acute lymphoblastic leukemia of childhood", Ital J Neurol Sci, 14, pp.385~389 (1993)