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Intractable Epilepsy Secondary to Cyclosporine Toxicity in Children Undergoing Allogeneic Hematopoietic Bone Marrow Transplantation

Epilepsy Unit, Child Neurology Department, Gaslini Children's Research Institute, Genova, Italy, robertogaggero{at}ospedale-gaslini.ge.it.

Riccardo Haupt, MD

Epidemiology and Biostatistics Section, Scientific Directorate, Gaslini Children's Research Institute, Genova, Italy

Maria Paola Fondelli, MD

Neuroradiology Unit, Galliera Hospital, Genova, Italy

Raffaella De Vescovi, MD

Pediatric Neurology Department, Burlo Garofolo Institute, Trieste, Italy

Alessia Marino, MD

Epilepsy Unit, Child Neurology Department, Gaslini Children's Research Institute, Genova, Italy

Edoardo Lanino, MD

Hematology-Oncology Department, Gaslini Children's Research Institute, Genova, Italy

Sandro Dallorso, MD

Hematology-Oncology Department, Gaslini Children's Research Institute, Genova, Italy

Maura Faraci, MD

Hematology-Oncology Department, Gaslini Children's Research Institute, Genova, Italy

The long-term evolution to intractable epilepsy in children treated with cyclosporine administered for graft-versus-host-disease after hematopoietic stem cell transplantation was evaluated. In a group of 185 children treated with cyclosporine after bone marrow transplantation, 15 (8%) presented with acute seizures that were generalized in 7 and focal in 7 and had absence status in 1. Electroencephalography (EEG) and neuroimaging showed predominant abnormalities in the occipital regions. One patient died shortly after the seizure; in seven cases, seizures remitted, whereas relapses were observed in seven others. After the first year, seizures persisted chronically in four cases and evolved to intractable epilepsy. Focal temporal epilepsy was diagnosed in three cases, whereas in the fourth case, a multifocal epilepsy was observed. Magnetic resonance imaging (MRI) detected mesial temporal sclerosis in all of these cases. The risk factors associated with evolution to epilepsy included lower age at transplantation (3—5 years), more than one relapsing seizure in the first year after transplantation, and longer treatment with cyclosporine. Not only can cyclosporine cause acute central nervous system toxicity, it can also determine intractable epilepsy associated with mesial temporal sclerosis. (J Child Neurol 2006;21:861—866; DOI 10.2310/7010.2006.00196).

Journal of Child Neurology, Vol. 21, No. 10, 861-866 (2006)
DOI: 10.1177/08830738060210100501


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