Of 71 acute lymphoblastic leukemia survivors at our hospital over the past 10 years, 2 children developed mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). This is the first report to describe the clinical course of MTLE-HS observed longitudinally by EEG and MRI. Patient 1 experienced a seizure during chemotherapy involving intrathecal methotrexate. Postseizure MRI suggested methotrexate encephalopathy or leukemic invasion. Anticonvulsant therapy was initiated; subsequent EEGs and MRIs revealed normal results. Three years after chemotherapy, a diffuse, irregular spike-and-wave pattern was observed on interictal EEG. Five years after chemotherapy, the patient developed MTLE-HS comprising complex partial seizures, typical temporal spikes on EEG, and hippocampal sclerosis (HS). Patient 2 did not experience seizures during chemotherapy. Four years later, the patient started experiencing complex partial seizures, and a diffuse, irregular spike-and-wave pattern was observed on interictal EEG. A clinical picture of MTLE-HS developed 2 years later. In both patients, nonspecific EEG abnormalities (ie, diffuse, irregular spike-and-wave activity) preceded the appearance of HS on MRI by 2 years, suggesting an insidious advance of HS during the latent period. Such atypical EEG findings may indicate MTLE-HS during follow-up of leukemia patients. MTLE-HS develops several years after an initial precipitating incident such as prolonged seizures, central nervous system infection, and brain trauma. In our cases, the initial precipitating incident may have been chemotherapy and/or prolonged seizures. Thus, MTLE-HS associated with leukemia may not be as rare as generally believed. A large cohort study of late neurologic complications is warranted.
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July 2013
Case Report|
July 01 2013
Temporal Lobe Epilepsy With Hippocampal Sclerosis in Acute Lymphoblastic Leukemia
Emi Kasai-Yoshida, MD;
Departments of aPediatrics and
Departments of bNeuropediatrics and
Address correspondence to Emi Kasai-Yoshida, MD, Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo 183-0042, Japan. E-mail: kasai-sin@umin.ac.jp
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Masaaki Ogihara, MD;
Masaaki Ogihara, MD
Departments of aPediatrics and
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Miwa Ozawa, MD;
Miwa Ozawa, MD
Departments of aPediatrics and
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Taiki Nozaki, MD;
Taiki Nozaki, MD
cRadiology, St Luke’s International Hospital, Chuo-ku, Tokyo, Japan; and
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Michiharu Morino, MD;
Michiharu Morino, MD
dNeurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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Atsushi Manabe, MD;
Atsushi Manabe, MD
Departments of aPediatrics and
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Ryota Hosoya, MD
Ryota Hosoya, MD
Departments of aPediatrics and
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Address correspondence to Emi Kasai-Yoshida, MD, Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo 183-0042, Japan. E-mail: kasai-sin@umin.ac.jp
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2013) 132 (1): e252–e256.
Article history
Accepted:
March 13 2013
Citation
Emi Kasai-Yoshida, Masaaki Ogihara, Miwa Ozawa, Taiki Nozaki, Michiharu Morino, Atsushi Manabe, Ryota Hosoya; Temporal Lobe Epilepsy With Hippocampal Sclerosis in Acute Lymphoblastic Leukemia. Pediatrics July 2013; 132 (1): e252–e256. 10.1542/peds.2012-1420
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