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Prospective neurophysiological study in children treated for acute lymphoblastic leukaemia: Serial EEG during treatment and long-term follow up with evoked potentials

  • Neuropediatrics
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Abstract

In 79 children treated for acute lymphoblastic leukaemia according to protocol ALL-BFM 81, serial EEG examinations were performed before, during and after therapy. Diffuse changes of the background activity were observed in 64% of the children at the time of diagnosis. During induction and reinduction treatment with vincristine andl-asparaginase, and with some delay after CNS irradiation, a marked slowing developed in up to 65% of patients. Children who had not been irradiated showed transient disturbances during treatment with medium-dose-methotrexate. Reinduction induced more abnormal EEGs in the children who had been irradiated. At the end of maintenance therapy, only slight EEG changes were found. No differences between the irradiated and non-irradiated group were then seen. Children with CNS leukaemia or seizures differed from those with an uncomplicated treatment in that they more often showed focal and persistent disturbances. In 39 patients who stayed in first remission for at least 18 months after the termination of treatment, a follow up investigation was performed. From the EEG examination, including power spectral analysis, no differences were found between irradiated and non-irradiated patients. Slowing of the dominant frequency was seen in the patients with more severe leukaemia and in those whose EEG had been markedly abnormal at diagnosis. The visually evoked potentials were normal in all groups of patients. In the brainstem auditory evoked potential, a prolongation of the latency of wave I and a decrease of the I–V interval was found in irradiated patients. We conclude that the diffuse EEG changes frequently emerging during treatment are reversible. Persistent or lateralized changes can indicate a neurological complication. Neurophysiological abnormalities found at long-term follow up, for the most part cannot be attributed to side-effects of the treatment but rather to disease related factors.

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Abbreviations

ALL:

acute lymphoblastic leukaemia

BAEP:

brainstem auditory evoked potential

ith-MTX:

intrathecal methotrexate

MD-MTX:

medium dose methotrexate

MR-HR:

moderate, high risk of recurrence

SR-A:

standard risk with cranial irradiation

SR-B:

standard risk without cranial irradiation

VEP:

visual evoked potential

References

  1. Allen JC (1978) The effects of cancer therapy on the nervous system. J Pediatr 93:903–909

    PubMed  Google Scholar 

  2. Amand G, Cornu G (1974) Aspects electroencephalographiques des complications centrales du traitement a la vincristine. Rev EEG Neurophysiol Clin 4:479–483

    Google Scholar 

  3. Brecher ML, Berger P, Freeman A, Krischer J, Boyett J, Glicksman AS, Foreman E, Harris M, Jones B, Cohen ME, Duffner PK, Rowland JH, Huang Y-P, Batnitzki S (1985) Computerized tompgraphy scan findings in children with acute lymphocytic leukemia treated with three different methods of central nervous system prophylaxis. Cancer 56:2430–2433

    PubMed  Google Scholar 

  4. Chiappa KH (1983) Evoked potentials in clinical medicine. Raven Press, New York

    Google Scholar 

  5. Ch'ien LT, Cavallo K, Pitner S, Lemmi H (1980) Longitudinal EEG studies in children with acute lymphocytic leukemia. Electroencephalogr Clin Neurophysiol 49:178P

    Google Scholar 

  6. Cohen ME, Duffner PK, Brecher ML, Diamond LS, Glicksman A, Forman E, Harris M, Jones B, Holland J, Glidewell O, Freeman A (1982) EEGs in disease free children with acute lymphocytic leukemia (ALL(. Proc Am Soc Clin Oncol 1:135

    Google Scholar 

  7. Digilio G, Iannetti F, Del Principe D, Multari G (1975) Alterazioni elettroencefalografiche e neurologiche in bambini sottoposti a profilassi endorachidea con ametopterina e metilprednisolone. Minerva Pediatr 27:721–722

    PubMed  Google Scholar 

  8. Epstein CM, Humphries LL, Alvarado CS, Kutner MH, Ragab AH (1985) Sequential quantitative EEG analysis in acute lymphocytic leukemia of children. Clin Electroencephalogr 16:208–212

    PubMed  Google Scholar 

  9. Fichsel H, Schallah OE (1972) EEG-Veränderungen bei zerebralen Manifestationen kindlicher Leukosen. Z EEG EMG 2:63–69

    Google Scholar 

  10. Garwicz S, Aronson AS, Elmqvist D, Landberg T (1975) Postirradiation syndrome and EEG findings in children with acute lymphoblastic leukaemia. Acta Paediatr Scand 64:399–403

    PubMed  Google Scholar 

  11. Hässler A, Metz O, Müller G, Hermann J (1976) EEG-Befunde bei Leukämie im Kindesalter. Kinderärztl Prax 44:481–487

    Google Scholar 

  12. Harten G, Stephani U, Henze G, Langermann H-J, Riehm H, Hanefeld F (1984) Slight impairment of psychomotor skills in children after treatment of acute lymphoblastic leukemia. Eur J Pediatr 142:189–197

    PubMed  Google Scholar 

  13. Janetti P, Multari G, Sabetta G, Pinies S, Digilio G (1975) Rilievi electtroencefalografici in bambini con leucosi linfatica in corso di trattamento con vincristina. Minerva Pediatr 27:727–728

    PubMed  Google Scholar 

  14. Jannoun L (1983) Are cognitive and educational development affected by age at which prophylactic therapy is given in acute lymphoblastic leukemia? Arch Dis Child 58:953–958

    PubMed  Google Scholar 

  15. Jung R (1953) Neurophysiologische Untersuchungsmethoden. In: Bergmann GV, Frey W, Schwiegk H (eds) Handbuch der Inneren Medizin Band V, Teil 1. Springer, Berlin Göttingen Heidelberg, pp 1216–1325

    Google Scholar 

  16. Kaleita TA, Shields WD, Feig SA, Nuwer MR (1984) Nervous system assessment with evoked potential tests in pediatric bone marrow transplant patients. Am J Pediatr Hematol Oncol 6:329–332

    PubMed  Google Scholar 

  17. Kaplan RS, Wiernik PH (1982) Neurotoxicity of antineoplastic drugs. Semin Oncol 9:103–130

    PubMed  Google Scholar 

  18. Korinthenberg R (1986) Leukämie und Nervensystem: das Hirnstrombild im Erkrankungs- und Behandlungsverlauf der akuten Leukämien des Kindesalters. Thieme, Stuttgart New York

    Google Scholar 

  19. Korinthenberg R, Palm D, Rübig A, Schellong G (1979) EEG-changes during intensified induction therapy of acute lymphoblastic leukemia. Neuropädiatrie 10:332–347

    Google Scholar 

  20. Korinthenberg R, Lütkenhöner B, Palm D, Ritter J (1982) EEG-Verlangsamung nach hochdosiertem Methotrexat mit Citrovorumfaktor-Schutz. Eine spektralanalytische Untersuchung. Z EEG EMG 13:22–27

    Google Scholar 

  21. Kotte W, Korth G, Von Löbbecke J, Todt H (1976) EEG-Befunde während der Vincristin-Therapie. Dtsch Gesundh Wesen 31:2476–2479

    Google Scholar 

  22. Lichter-Konecki U, Benninger C, Brandeis WE, Matthis P, Scheffner D (1987) Changes in the EEG background activity of children with acute lymphoblastic leukemia during cytotoxic therapy. Pediatr Hematol Oncol 4:77–85

    PubMed  Google Scholar 

  23. Lorenz HM (1975) EEG-Veränderungen durch Vincristin. Z EEG EMG 6:50

    Google Scholar 

  24. Mahoney DH, Britt CW, Kellaway P, Fernbach DJ (1981) Childhood leukemia: implications of EEG findings at time of diagnosis. J Pediatr 98:437–440

    PubMed  Google Scholar 

  25. Moure JMB, Whitecar JP, Bodey GP (1970) Electroencephalogram changes secondary to asparaginase. Arch Neurol 23:365–368

    PubMed  Google Scholar 

  26. Packer RJ, Meadows AT, Rorke LB, Goldwein JL, D'Angio G (1987) Long-term sequelae of cancer treatment on the central nervous system in childhood. Med Pediatr Oncol 15:241–253

    PubMed  Google Scholar 

  27. Rowland JH, Glidewell OJ, Sibley RF, Holland JC, Tull R, Berman A, Brecher ML, Harris M, Glicksman AS, Forman E, Jones B, Cohen ME, Duffner PK, Freeman AI (1984) Effects of different forms of central nervous system prophylaxis on neuropsychologic function in childhood leukemia. J Clin Oncol 2:1327–1335

    PubMed  Google Scholar 

  28. Russo A, Tomarchio S, Pero G, Consoli G, Marina R, Rizzari C, Schiliro G (1985) Abnormal visual evoked potentials in leukemic children after cranial radiation. Med Pediatr Oncol 13:313–317

    PubMed  Google Scholar 

  29. Schrappe M, Beck J, Brandeis WE, Feickert H-J, Gadner H, Graf N, Havers W, Henze G, Jobke A, Kornhuber B, Kühl J, Lampert F, Müller-Weihrich S, Niethammer D, Reiter A, Rister M, Ritter J, Schellong G, Tausch W, Weinel P, Riehm H (1987) Die Behandlung der akuten lymphoblastischen Leukämie im Kindes- und Jugendalter: Ergebnisse der multizentrischen Therapiestudie ALL-BFM 81. Klin Pädiat 199:133–150

    Google Scholar 

  30. Stephani U, Harten G, Langermann H-J, Riehm H, Hanefeld F, Habermalz E, Habermalz H-J (1983) Cranial computed tomography of 64 children in continuous complete remission of leukemia II: Relations to patient data and neurological complications. Neuropediatrics 14:149–154

    PubMed  Google Scholar 

  31. Stephani U, Rating D, Korinthenberg R, Siemes H, Riehm H, Hanefeld F (1983) Radiation-related disturbance of blood/brain barrier during therapy of acute lymphoblastic leukemia. Lancet II:1036–1037

    Google Scholar 

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Authors and Affiliations

  1. Universitätskinderklinik, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer, W-6800, Mannheim 1, Germany

    R. Korinthenberg

  2. Universitätskinderklinik, W-4400, Münster, Germany

    B. Igel

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  1. R. Korinthenberg
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  2. B. Igel
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Korinthenberg, R., Igel, B. Prospective neurophysiological study in children treated for acute lymphoblastic leukaemia: Serial EEG during treatment and long-term follow up with evoked potentials. Eur J Pediatr 150, 127–131 (1990). https://doi.org/10.1007/BF02072055

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  • DOI: https://doi.org/10.1007/BF02072055

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