Epileptic Seizures After Allogeneic Hematopoietic Stem Cell Transplantation

Wang, Zhuo; Zhao, Munan; Gao, Sujun

doi:10.3389/fneur.2021.675756

Cited by 3 publications

(2 citation statements)

References 103 publications

(160 reference statements)

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“…Transplanted patients who develop seizures often have poorer outcomes, lower quality of life, and higher mortality 15 . Outcomes in children are more difficult to assess than in adults; this is especially the case for HSCT performed at a very young age, due to neural plasticity and the fact that sequelae may not become apparent for years.…”

Section: Introductionmentioning

confidence: 99%

Seizures in children undergoing stem cell transplantation

Turón‐Viñas,

López‐Torija,

Coca‐Fernández

et al. 2023

Pediatric Transplantation

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BackgroundNeurological complications (NCs) are of major concern following hematological stem cell transplantation (HSCT), most of which present with seizures.ProceduresWe performed a retrospective study (2002–2018) of patients undergoing HSCT in order to analyze the incidence and aetiologies related to seizures.ResultsOf 155 children undergoing HSCT, 27 (17.4%) developed seizures at some point in 2 years of follow‐up. The most frequent etiologies were central nervous system (CNS) infection (n = 10), drug toxicity (n = 8), and vascular disease (n = 5). A statistically significant association was found between seizure and the HSCT type (lower risk for a related identical donor, p = .010), prophylactic or therapeutic mycophenolate use (p = .043 and .046, respectively), steroid use (p = .023), selective CD45RA+ depletion (p = .002), pre‐engraftment syndrome (p = .007), and chronic graft‐versus‐host disease (GVHD) severity (p = .030). Seizures predicted evolution to life‐threatening complications and admission to intensive care (p < .001) and higher mortality (p = .023). A statistically significant association was also found between seizures and sequelae in survivors (p = .029). Children who developed seizures had a higher risk of CNS infection and vascular disease (odds ratio 37.25 [95% CI: 7.45–186.05] and 12.95 [95% CI 2.24–74.80], respectively).ConclusionsNeurological complications highly impact survival and outcomes and need to be addressed when facing an HSCT procedure.

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Section: Introductionmentioning

confidence: 99%

Seizures in children undergoing stem cell transplantation

Turón‐Viñas,

López‐Torija,

Coca‐Fernández

et al. 2023

Pediatric Transplantation

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“…Phenytoin has been widely used for many years as a drug to prevent seizures induced by busulfan, although a double-blind randomized clinical trial to prove effectivity is missing ( 4 , 7 ). Despite its effectiveness as an antiepileptic drug, phenytoin has its drawbacks, among others the non-linear pharmacokinetic metabolism, making the elimination very unpredictable with possible consequent toxicity, as well as bothersome side effects (nystagmus, tremors, and myoclonus) ( 8 , 9 ). Furthermore, phenytoin can cause serious drug-drug interactions, a.o.…”

Section: Introductionmentioning

confidence: 99%

Phenytoin as seizure prophylaxis in hematopoietic stem cell transplantation with busulfan conditioning

2022

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BackgroundPhenytoin is widely used as primary seizure prophylaxis in hematopoietic stem cell transplantation in patients undergoing myeloablative conditioning with busulfan. Because of the negative side effects of phenytoin, we abandoned phenytoin use in these patients. To assess the effect of this change, we performed a retrospective cohort study on all patients receiving busulfan.MethodsWe included 139 patients who underwent conditioning with busulfan for hematopoietic stem cell therapy. We registered the use of phenytoin, as well as the occurrence of seizures, until 7 days after busulfan administration. We compared seizure incidence between patients who received phenytoin and those who did not.ResultsOf the 43 patients who received phenytoin prophylaxis, four patients (9.3%) had a seizure during the conditioning regimen, of which two patients had cerebral non-Hodgkin lymphoma. Furthermore, all these 4 patients had very high levels of phenytoin (intoxication). Of the 96 patients that did not receive phenytoin prophylaxis, three patients (3.1%) had a seizure, and one of these patients had an undefined cerebral lesion. Phenytoin did not relate to seizure prevention in a logistic regression analysis.ConclusionWe conclude that phenytoin prophylaxis in patients treated with busulfan is obsolete and possibly harmful, as phenytoin intoxication can occur. We recommend discontinuing the use of phenytoin as primary seizure prophylaxis in these patients.

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Unprovoked Atypical Absence Status Epilepticus in a Patient With Allogeneic Stem Cell Transplantation

Banerjee,

Chaudhry,

Brewer

et al. 2024

Cureus

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Absence status epilepticus (ASE) is a rare but treatable condition, and when present in older adults, it can be misinterpreted as encephalopathy or behavioral changes. Our case discusses a 63-year-old patient with myelofibrosis and allogeneic stem cell transplant with late-onset de novo status epilepticus. This case report adds to the rare body of literature discussing de novo ASE whose clinical presentation can be indistinguishable from other encephalopathic or behavioral conditions. Moreover, its occurrence during oncologic treatment warrants clinicians to be on the lookout for similar presentations and encourages future

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Epileptic Seizures After Allogeneic Hematopoietic Stem Cell Transplantation

Cited by 3 publications

References 103 publications

Seizures in children undergoing stem cell transplantation

Seizures in children undergoing stem cell transplantation

Phenytoin as seizure prophylaxis in hematopoietic stem cell transplantation with busulfan conditioning

Unprovoked Atypical Absence Status Epilepticus in a Patient With Allogeneic Stem Cell Transplantation

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