Seizures in lung transplant recipients.
OBJECTIVE
We wished to assess organ transplant recipients, who incur a significant risk for seizures.


METHODS
We reviewed 85 lung transplants performed in 81 patients at the University of North Carolina hospitals between 1991 and 1994. All patients were reviewed for age, reason for transplant, detailed description of seizures, neurological examination, medications, and laboratory results, including cyclosporine level, EEG, and brain imaging.


RESULTS
Eighteen of 81 (22%) patients experienced seizures. Patients aged < 25 years had the greatest risk of seizures and 15 of the 18 patients had cystic fibrosis. Sixteen of the 18 (89%) patients, by history, had partial-onset seizures. Eleven of the 18 (61%) patients had seizures < or = 10 days after initiation of intravenous methylprednisolone for allograft rejection. Two patients had seizures associated with sustained hypertension: 1 of these patients was simultaneously being treated for rejection. Four patients had strokes (1 before transplant) and seizures. Two patients were receiving imipenem. Magnetic resonance imaging (MRI) of the brain demonstrated areas of increased T2 signal in 8 of 9 patients.


CONCLUSIONS
Our findings demonstrate multiple etiologies for seizures in our transplant recipients. However, we believe that patients, especially those aged < 25 years, being treated with intravenous methylprednisolone for rejection may be at increased risk of seizures. We hypothesize that the focal loss of blood-brain barrier (BBB) may play a significant role in the development of partial seizures in lung transplant recipients.
Vaughn
B V
BV
Department of Neurology, University of North Carolina at Chapel Hill, 27599-7025, USA.
Ali
I I
II
Olivier
K N
KN
Lackner
R P
RP
Robertson
K R
KR
Messenheimer
J A
JA
Paradowski
L J
LJ
Egan
T M
TM
D000367:Age Factors; D001812:Blood-Brain Barrier; D001921:Brain / Q000473:pathology; D015897:Comorbidity; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D003550:Cystic Fibrosis / Q000453:epidemiology; D004828:Epilepsies, Partial / Q000453:epidemiology / Q000209:etiology; D006084:Graft Rejection / Q000517:prevention & control; D006086:Graft vs Host Disease / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016040:Lung Transplantation; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D014184:Transplantation, Homologous
D016572:Cyclosporine; D008775:Methylprednisolone