| Objective:To explore and determine the timing, etiology, clinical profile, and prognosis of pediatric patients with ALL complicated by seizures.Method:We carried out an comprehensive review of all well documented cases who developed seizures during childhood ALL and8similar ones collected in our ward in Union hospital in Wuhan for patients’information, clinical characteristics, laboratory findings,neuroimagings,diagnosis,treatment of the period and prognosis. Statistics were then analyzed in a descriptive way.Results:A total of82pediatric patients with ALL and seizures were enrolled,in whom posterior reversible encephalopathy syndrome(30cases),cerebral vascular events (20cases) and MTX(21cases)induced encephalopathy prevailed as etiologies of their onsets. Most of them (79.2%) were under10years old when seizures occurred;57%were in induction chemotherapy;27%of the patients were initially diagnosed to be at high risk ALL status;15%were found to be suffering CNS infiltration and15.9%with preexisting structural brain changes at the onsets.18.3%had acute seizure recurrences after their first seizures,11%being neurologically abnormal at the end of the follow-up and4.9%died later within2months.Conclusion:a. seizures in pediatric ALL patients are closely associated with their chemotherapies,with induction remission being the most susceptible period;b. PRES,cerebral vascular events and MTX-induced encephalopathy as the main cause;c. The threshold of blood pressure for the onset of PRES is lower in child patients and effective blood control should be given full attention. Low level of plasma fibrinogen and AT Ⅲ are the risk factors for cerebral events among children with ALL;d. CNS prognosis varies with etiologies but has a close association with neuroimaging characteristics. |
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