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Banerjee S, Chaudhry M, Brewer J, Chen Y, Khasiyev F, Soudagar Turkey M. Unprovoked Atypical Absence Status Epilepticus in a Patient With Allogeneic Stem Cell Transplantation. Cureus 2024; 16:e64842. [PMID: 39156368 PMCID: PMC11330277 DOI: 10.7759/cureus.64842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
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 reports of this condition in association with similar therapies. This case report provides value to providers treating patients with similar oncologic therapies and highlights the need for ASE to be further studied as it is a possible rare complication of allogeneic transplantation of stem cells.
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Affiliation(s)
- Sumona Banerjee
- Neurology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Maaria Chaudhry
- Neurology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Jonathan Brewer
- Neurology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Yongzhen Chen
- Neurology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Farid Khasiyev
- Neurology, Saint Louis University School of Medicine, Saint Louis, USA
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Turón-Viñas E, López-Torija I, Coca-Fernández E, Badell I, Sierra-Marcos A, Turón M, Ribosa-Nogué R, Boronat S. Seizures in children undergoing stem cell transplantation. Pediatr Transplant 2024; 28:e14619. [PMID: 37803946 DOI: 10.1111/petr.14619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/28/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Neurological complications (NCs) are of major concern following hematological stem cell transplantation (HSCT), most of which present with seizures. PROCEDURES We performed a retrospective study (2002-2018) of patients undergoing HSCT in order to analyze the incidence and aetiologies related to seizures. RESULTS Of 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). CONCLUSIONS Neurological complications highly impact survival and outcomes and need to be addressed when facing an HSCT procedure.
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Affiliation(s)
- Eulalia Turón-Viñas
- Child Neurology Unit, Pediatrics Service, Hospital Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain
| | - Iván López-Torija
- Pediatric Hematology and Stem Cell Transplant Unit, Pediatrics Service, Hospital Sant Pau, Barcelona, Spain
| | - Elisabet Coca-Fernández
- Child Neurology Unit, Pediatrics Service, Hospital Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain
| | - Isabel Badell
- Sant Pau Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain
- Pediatric Hematology and Stem Cell Transplant Unit, Pediatrics Service, Hospital Sant Pau, Barcelona, Spain
| | - Alba Sierra-Marcos
- Sant Pau Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain
- Epilepsy Unit, Neurology Service, Hospital Sant Pau, Barcelona, Spain
| | - Marc Turón
- Child Neurology Unit, Pediatrics Service, Hospital Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain
| | - Roser Ribosa-Nogué
- Sant Pau Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain
- Epilepsy Unit, Neurology Service, Hospital Sant Pau, Barcelona, Spain
| | - Susana Boronat
- Child Neurology Unit, Pediatrics Service, Hospital Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain
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Germeraad RS, Demandt AMP, Rouhl RPW. Phenytoin as seizure prophylaxis in hematopoietic stem cell transplantation with busulfan conditioning. Front Neurol 2022; 13:928550. [PMID: 36071908 PMCID: PMC9441567 DOI: 10.3389/fneur.2022.928550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background Phenytoin 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. Methods We 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. Results Of 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. Conclusion We 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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Affiliation(s)
- R. S. Germeraad
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - A. M. P. Demandt
- Division of Hematology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - R. P. W. Rouhl
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Centre, Maastricht, Netherlands
- *Correspondence: R. P. W. Rouhl
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