Levetiracetam as monotherapy for seizures in a neonate with acute lymphoblastic leukemia
Levetiracetam as monotherapy for seizures in a neonate with acute lymphoblastic leukemia
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DOI：
10.1016/j.ejpn.2008.12.007
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发表时间：
2010-01-01
影响因子：
3.1
通讯作者：
Morris, E. Brannon
中科院分区：
文献类型：
--
作者：
Ledet, Davonna S.;Wheless, James W.;Morris, E. Brannon
先天性急性淋巴细胞白血病（ALL）是一种相对罕见的疾病，其特征是频繁的中枢神经系统受累，可能会增加癫痫发作的风险。在该年龄组中，尚未确定与正在进行的肿瘤治疗相关的抗惊厥治疗的适当选择。我们报告了一个急性淋巴细胞白血病的新生儿谁是成功地治疗癫痫与左乙拉西坦单一疗法。这个足月男孩做得很好，直到3天的年龄时，他有一个发作的左侧肢体抽搐（07/06/07）。头部计算机断层扫描显示广泛的多灶性脑实质内肿块。初始EEG显示多灶性癫痫样活动。患者接受20 mg/kg苯巴比妥负荷。全血细胞计数显示白细胞增多（78 x 103/mm（3））。外周血涂片含有胚细胞，DNA分析证实为B细胞ALL。同一天报告了第二次局灶性癫痫发作，患者重新接受苯巴比妥治疗。开始苯巴比妥维持给药，未观察到进一步癫痫发作。2007年7月10日复查EEG仍异常，多灶性尖波过多。建议继续抗惊厥治疗。考虑到苯巴比妥与计划化疗方案之间的相互作用，肿瘤科要求使用非酶诱导抗惊厥药。随后停用苯巴比妥，并以40 mg/kg/天剂量开始左乙拉西坦单药治疗（2007年10月7日）。目前，患者在8个月大时接受左乙拉西坦单药治疗时无癫痫发作。左乙拉西坦作为新生儿单药治疗的使用尚未得到正式评价，经验有限。我们报告了一名患有白血病和定位相关癫痫的新生儿在苯巴比妥负荷后成功使用左乙拉西坦单药治疗。(C)2008年欧洲儿科神经病学学会。由爱思唯尔有限公司出版。保留所有权利。
Congenital acute lymphoblastic leukemia (ALL) is a relatively rare disorder that is characterized by frequent central nervous system involvement that may increase the risk for seizures. Appropriate choice of anticonvulsant therapy with respect to ongoing oncologic treatment is not established in this age group. We report the case of a neonate with ALL who was successfully treated for seizures with levetiracetam monotherapy.This full-term boy did well until 3 days of age when he had an episode of left extremity jerking (07/06/07). Computed tomography of the head demonstrated extensive multifocal intraparenchymal hemorrhages. Initial EEG demonstrated multifocal epileptiform activity. Patient was loaded with Phenobarbital at 20 mg/kg. Complete blood count revealed leukocytosis (78 x 103/mm(3)). Peripheral blood smear contained blastocytes and DNA analysis confirmed B-cell ALL. A second focal seizure was reported on the same day and he was re-loaded with Phenobarbital. Maintenance dosing of Phenobarbital was initiated and no further seizures were noted. A repeat EEG on 7/10/07 remained abnormal with excessive multifocal sharp waves.Continuation of anticonvulsant therapy was recommended. Given concern for interaction between Phenobarbital and planned chemotherapy regimen, oncology requested a non-enzyme inducing anticonvulsant. Phenobarbital was subsequently weaned and Levetiracetam monotherapy initiated at 40 mg/kg/day (07/10/2007). Currently, the patient is seizure free at 8 months of age on Levetiracetam monotherapy. The use of Levetiracetam as monotherapy in neonates has not been formally evaluated and experience is limited. We report the successful use of levetiracetam monotherapy after Phenobarbital load in a neonate with leukemia and localization-related epilepsy. (C) 2008 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.