Secondary recurrence of central nervous system leukemia complicated with epilepsy in children: a case report and literature review_Journal of Epilepsy

Authors：

HUANG Lingling , WANG Ningling , CHU Jinhua , XIE Zhiwei , WU Zhengyu , LIU Kangkang

Department of Pediatrics, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China;

Corresponding?author：

Keywords：

Relapse of nervous system leukemia; Epilepsy; Children

DOI：

10.7507/2096-0247.202302004

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Objective To investigate the clinical features, diagnosis and treatment of symptomatic epilepsy complicated with central nervous system leukemia (CNSL) recurrence after acute lymphoblastic leukemia (ALL) treatment in children. Methods The clinical data of a child with secondary recurrence of CNSL complicated with symptomatic epilepsy after ALL treatment admitted to the Department of Pediatrics of the Second Affiliated Hospital of Auhui Medical University from December 2020 to February 2023 were retrospectively analyzed, and the relevant literature was reviewed and discussed. Results Patient was ALL for nealy two years after treatment in the central nervous system leukemia relapse of concurrent symptomatic epilepsy, two of the central nervous system leukemia relapse when starting symptoms are seizure, the first recurrence was status epilepticus, second recurrence of concurrent limb hemiplegia symptoms, cerebrospinal fluid, cranial magnetic resonance (MRI) and abnormal changes of electroencephalogram and clinical features, the abnormal changes of brain MRI lesions and electroencephalogram did not disappear. Chemotherapy, intrathecal injection and radiotherapy were given for the primary treatment, follow up CAR-T immunotherapy, and the treatment was successively combined with nalproate and levetiracetam. Currently, the seizures were controlled. Conclusion For children with ALL, the recurrence of CNSL should be warned after the end of treatment. Cerebrospinal fluid, cranial imaging and electroencephalogram examination should be completed in time to confirm the diagnosis. If the crania imaging lesions persist after treatment and abnormal electroencephalogram discharge does not disappear, the possibility of CNSL recurrence should be warned when the epileptic seizures are repeated. On the basis of primary disease active treatment, combination of antiseizure medications is preferable.

Citation： HUANG Lingling, WANG Ningling, CHU Jinhua, XIE Zhiwei, WU Zhengyu, LIU Kangkang. Secondary recurrence of central nervous system leukemia complicated with epilepsy in children: a case report and literature review. Journal of Epilepsy, 2023, 9(3): 195-199. doi: 10.7507/2096-0247.202302004 Copy

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6.	金香淑, 楊嵐, 汪變紅, 等. 急性淋巴細胞白血病中樞神經系統白血病21例臨床特征與預后分析. 中國實驗血液學雜志, 2016, 24(6): 1675-1682.
7.	李竹強, 趙忠虎, 王娜. 兒童白血病中樞神經系統并發癥的CT及MRI表現. 影像研究與醫學應用, 2022, 6(3): 173-175.
8.	李蕊, 湯繼宏, 周文杰, 等. 兒童急性淋巴細胞白血病并發癲癇發作(附2例報告及文獻復習). 中國臨床神經病學雜志, 2021, 29(5): 557-564.
9.	Xie C, Edwards H, Xu X, et al. Mechanisms of synergistic antileukemic interactions between valproic acid and cytarabine in pediatric acute myeloid leukemia. Clin cancer Res, 2010, 16(22): 5499-5510.
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1. Correia CE, Schaff LR, Grommes C. Central nervous system lymphoma: approach to diagnosis and treatment. Cancer J, 2020, 26(3): 241-252.
2. 徐敏, 周文杰, 湯繼宏, 等. 兒童急性淋巴細胞白血病伴癲癇發作51例臨床分析. 臨床兒科雜志, 2022, 40(2): 118-122.
3. 張娜, 沈樹紅, 王寧玲, 等. 年長兒童及青少年急性淋巴細胞白血病多中心臨床研究. 中華血液學雜志, 2018, 39(9): 717-723.
4. Millan NC, Pastrana A, Guitter MR, et al. Acute and sub-acute neurological toxicity in children treated for acute lymphoblastic leukemia. Leuk Pes, 2018, 65(2): 86-93.
5. Graham MS, Pudusseri A, Helgager J, et al. A Woman in her 40s with headache and new-onset seizures. JAMA Neurol, 2017, 74(4): 476-480.
6. 金香淑, 楊嵐, 汪變紅, 等. 急性淋巴細胞白血病中樞神經系統白血病21例臨床特征與預后分析. 中國實驗血液學雜志, 2016, 24(6): 1675-1682.
7. 李竹強, 趙忠虎, 王娜. 兒童白血病中樞神經系統并發癥的CT及MRI表現. 影像研究與醫學應用, 2022, 6(3): 173-175.
8. 李蕊, 湯繼宏, 周文杰, 等. 兒童急性淋巴細胞白血病并發癲癇發作(附2例報告及文獻復習). 中國臨床神經病學雜志, 2021, 29(5): 557-564.
9. Xie C, Edwards H, Xu X, et al. Mechanisms of synergistic antileukemic interactions between valproic acid and cytarabine in pediatric acute myeloid leukemia. Clin cancer Res, 2010, 16(22): 5499-5510.
10. Hrebackova J, Hrabeta J, Eckschlager T. Valproic acid in the comple therapy of malignant tumors. Curr Drug Targets, 2010, 11(3): 361-379.

Journal of Epilepsy

Secondary recurrence of central nervous system leukemia complicated with epilepsy in children: a case report and literature review

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