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Aboubakr O, Houillier C, Choquet S, Dupont S, Hoang-Xuan K, Mathon B. Epileptic seizures in patients with primary central nervous system lymphoma: A systematic review. Rev Neurol (Paris) 2023:S0035-3787(23)01116-5. [PMID: 38042665 DOI: 10.1016/j.neurol.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) accounts for less than 5% of primary brain tumors. Epileptic seizures are a common manifestation of brain tumors; however, literature on the prevalence, characteristics, and oncological implications of seizures in patients with PCNSL is limited, and the management of antiepileptic drugs (AEDs) is unclear. This review aimed to summarize the existing knowledge on seizures in PCNSL, their potential association with surgery, oncological treatment, survival rates, and management of AEDs. METHODS A systematic review was performed according to the PRISMA recommendations and included articles published between 1953 and 2023 describing seizures in patients with PCNSL. RESULTS The search identified 282 studies, of which 21 were included. Up to 33% of patients with PCNSL developed seizures, mostly at the initial presentation. Little information was found on changes in seizure incidence through the course of the disease, and no details were found on seizure frequency, the percentage of treatment-resistant patients, or the evolution of seizures at remission. Younger age, cortical location, and immunodeficiency have been identified as potential risk factors for seizures, but evidence is very limited. The growing use of vigorous treatments including intensive chemotherapy with autologous stem cell transplantation and immunotherapy with CAR-T cells is associated with a higher incidence of seizures. The association between seizure development and patient mortality in PCNSL remains unknown. There are no data on AED prophylaxis or the use of specific AEDs in PCNSL. CONCLUSIONS Further studies are needed to investigate seizures in larger cohorts of PCNSL, to clarify their prevalence, better characterize them, identify risk factors, analyze survival rates, and make recommendations on AED management. We recommend following general practice guidelines for seizures symptomatic of brain tumors and not to prescribe AED prophylaxis in PCNSL.
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Affiliation(s)
- O Aboubakr
- Sorbonne University, Department of Neurosurgery, la Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France
| | - C Houillier
- Department of Neurology 2 Mazarin, la Pitié-Salpêtrière Hospital, IHU, ICM, AP-HP, Sorbonne University, 75013 Paris, France
| | - S Choquet
- Department of Hematology, la Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France
| | - S Dupont
- Epileptology Unit, Department of Rehabilitation, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, 75013 Paris, France
| | - K Hoang-Xuan
- Department of Neurology 2 Mazarin, la Pitié-Salpêtrière Hospital, IHU, ICM, AP-HP, Sorbonne University, 75013 Paris, France
| | - B Mathon
- Sorbonne University, Department of Neurosurgery, la Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne University, UMRS 1127, 75013 Paris, France; GRC 23, Brain Machine Interface, la Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France.
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Desjardins C, Larrieu-Ciron D, Choquet S, Mokhtari K, Charlotte F, Nichelli L, Mathon B, Ahle G, Le Garff-Tavernier M, Morales-Martinez A, Dehais C, Hoang-Xuan K, Houillier C. Chemotherapy is an efficient treatment in primary CNS MALT lymphoma. J Neurooncol 2022; 159:151-161. [PMID: 35725885 DOI: 10.1007/s11060-022-04052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mucosae-associated lymphoid tissue (MALT) lymphomas are a rare and poorly understood form of primary central nervous system lymphoma (PCNSL). The aim of this study was to better describe these tumors, their management and their long-term prognosis. METHODS Patients with primary CNS MALT lymphoma (PCNSML) were retrospectively selected from the database on PCNSL of the Pitié-Salpêtrière Hospital. RESULTS Of 662 PCNSL, 11 (1.7%) PCNSML (9 females and 2 males, median age: 56 years) were selected. The median time from first symptoms to diagnosis was 13 months. Location was dural in 8 cases and parenchymal in 3 cases. The disease was multifocal/diffuse in 7 cases. In first line, all patients received chemotherapy (high-dose methotrexate (HD-MTX) based chemotherapy (n = 4) and non-HD-MTX-based chemotherapy (n = 7)), preceded by surgery in 4 cases. None received radiotherapy. According to the IPCG (International PCNSL Collaborative Group) criteria, the overall response rate was 7/11 (64%). At latest news, 5 patients had persistent contrast enhancement, stable with no treatment since a median of 57 months, raising the question of complete response despite persisting contrast enhancement. No patient developed neurotoxicity except for one patient who subsequently received radiotherapy. The median follow-up was 109 months. The median progression-free survival was 78.0 months and the 10-year overall survival rate was 90%. CONCLUSION This is the largest series demonstrating that chemotherapy is an efficient treatment in PCNSML, with an excellent long-term outcome and the absence of neurotoxicity, and calling into question the relevance of the IPCG criteria for the evaluation of response.
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Affiliation(s)
- Clément Desjardins
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Delphine Larrieu-Ciron
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France.,Neurology Department, Hôpital Pierre Paul Riquet, CHU de Toulouse Purpan, Toulouse, France
| | - Sylvain Choquet
- Clinical Hematology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Karima Mokhtari
- Neuropathology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Frédéric Charlotte
- Service d'Anatomie et Cytologie Pathologiques, Groupe Hospitalier Pitié-Salpétrière-Charles Foix, Sorbonne Université, Paris, France
| | - Lucia Nichelli
- Neuroradiology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Bertrand Mathon
- Neurosurgery Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Guido Ahle
- Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France
| | | | - Andrea Morales-Martinez
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Caroline Dehais
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Khê Hoang-Xuan
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Caroline Houillier
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France.
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Ali Mohamed D, Semedo A, Adeyemi B, Hessissen L, El Kababri M, Allali N, Chat L, El Haddad S. Reversible Encepahlopathy Induced by Ifosfamide with Brain Imaging. Glob Pediatr Health 2021; 8:2333794X211030415. [PMID: 34350307 PMCID: PMC8287358 DOI: 10.1177/2333794x211030415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
Chemotherapy may be responsible for central and/or peripheral neurotoxicity. These
neurological complications are frequent but little known. Some molecules are more
providers, responsible for acute or late complications, sometimes not reversible. Some
manifestations such as acute encephalopathy and acute reversible encephalopathy are
increasingly understood. We report here a case of acute ifosfamide-induced encephalopathy
(EII) with brain damage resolved after discontinuation of this treatment in a 13-years-old
child.
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Affiliation(s)
- Daoud Ali Mohamed
- Pediatric Radiology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Arthur Semedo
- Pediatric Radiology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Boris Adeyemi
- Pediatric Radiology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Leila Hessissen
- Hematology-Oncology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Maria El Kababri
- Hematology-Oncology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Nazik Allali
- Pediatric Radiology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Latifa Chat
- Pediatric Radiology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Siham El Haddad
- Pediatric Radiology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
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