Abstracts

RATIONALE: 10-13% of children diagnosed with ALL develop seizures. Initial seizure rates in patients with continued complete remission may in part be related to the method of CNS prophylaxis, particularly using parenteral methotrexate. While prognosis is generally good with low risk for late sequelae, neurologic deficits rarely do occur. No reports of mesial temporal sclerosis (MTS) in these patients have been previously reported.
METHODS: We present 3 patients with leukemia who subsequently developed persistent neurological deficits with associated mesial temporal sclerosis.
RESULTS: Case 1 is an 18-year-old male diagnosed with AML at 12 years of age. He received induction with four courses of chemotherapy without methotrexate, as well as a subsequent bone marrow transplant 4 months after diagnosis. Two months after transplant, he developed complex partial seizures and memory difficulties. The initial MRI was normal, but an MRI 10 months after seizure onset showed left MTS. Seizures are now completely controlled but memory difficulties persist. Case 2 is a 17-year-old male diagnosed with ALL at 2 years of age. He received chemotherapy with asparaginase and both oral and intrathecal methotrexate. He developed intractable complex partial seizures 9 years later. An MRI 2 years after seizure onset showed right MTS. Case 3 is a 7-year-old male diagnosed with ALL at 4 years of age. He required prolonged chemotherapy regimen with asparaginase and oral/intrathecal methotrexate. He suffered a CNS relapse 17 months post-therapy and underwent reinitiation with chemotherapy and craniospinal irradiation. He developed intractable complex partial seizures during relapse and right MTS was noted 2 years later.
CONCLUSIONS: Mesial temporal sclerosis may occur in children as a consequence of chemotherapy, cranial irradiation, and/or seizures. Methotrexate, and cranial irradiation are two possible contributing factors. As in Case 1, isolated memory problems may persist despite complete seizure control.