title: Intractable epilepsy secondary to cyclosporine toxicity in children undergoing allogeneic hematopoietic bone marrow transplantation.
abstract: 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.
authors.affiliation: Child Neurology Department, Gaslini Children's Research Institute, Genova, Italy. robertogaggero@ospedale-gaslini.ge.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Gaggero
authors.forename: Riccardo
authors.initials: R
authors.lastname: Haupt
authors.forename: Maria
authors.initials: M
authors.lastname: Paola Fondelli
authors.forename: Raffaella
authors.initials: R
authors.lastname: De Vescovi
authors.forename: Alessia
authors.initials: A
authors.lastname: Marino
authors.forename: Edoardo
authors.initials: E
authors.lastname: Lanino
authors.forename: Sandro
authors.initials: S
authors.lastname: Dallorso
authors.forename: Maura
authors.initials: M
authors.lastname: Faraci
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D001927:Brain Diseases / Q000188:drug therapy / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects*; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000145:classification / Q000209:etiology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012307:Risk Factors; D013702:Temporal Lobe / Q000187:drug effects / Q000473:pathology; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects*
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine