Neurocognitive outcomes among children who experienced seizures during treatment for acute lymphoblastic leukemia

Neurocognitive outcomes among children who experienced seizures during treatment for acute lymphoblastic leukemia
This article describes the incidence, risk factors, and neurocognitive outcomes for treatment-related seizures among children undergoing treatment for ALL and registered on the St. Jude Total Therapy XV protocol at three time points. This study omitted craniospinal radiation for all treatment groups. Patients with low-risk ALL received triple intrathecal therapy. This was a retrospective review of this patient cohort.
Prospective neuropsychological assessments and MRIs were planned for all patients treated on this protocol (498 patients). Each patient with treatment-related seizure was matched with two cohort patients who did not develop seizures.
Nineteen patients developed seizure (2-year cumulative risk of 3.82 ± 0.86% standard error) and 2 had a prior history of seizures. No risk factors for developing seizures were identified. The intensive chemotherapy on the standard/high-risk arm compared to the low-risk arm may be associated with seizure development but not found to be statistically significant. Problems with attention, working memory, and processing speed were more common in the seizure group. Cognitive deficits persisted 2 years after therapy. Increased rates of leukoencephalopathy on MRI were detected in the seizure group.
An important limitation is the retrospective design. The initial neuropsychological assessment was performed after a dose of high-dose methotrexate, which may not represent a true baseline.
Seizure development during treatment for ALL was found to be associated with neuropsychological changes, even at 2 years post treatment. There may be an association with more intensive therapy. These outcomes should be incorporated in a prospective treatment protocol. This study raises the question whether children who experienced seizures during therapy should be followed more closely by neuropsychology.