儿童中枢神经系统白血病2次复发并发癫痫病例报道并文献复习

Secondary recurrence of central nervous system leukemia complicated with epilepsy in children:a case report and literature review

目的探讨儿童急性淋巴细胞白血病(Acute lymphoblastic leukemia,ALL)治疗后出现中枢神经系统白血病(Central nervous system leukemia,CNSL)复发时并发症状性癫痫的临床特点和诊治方法。方法回顾性分析2020年12月—2023年2月安徽医科大学第二附属医院儿科收治的1例儿童ALL治疗后发生CNSL2次复发并发症状性癫痫的临床资料,结合相关文献复习进行讨论。结果患儿系ALL结疗后近2年出现中枢神经系统白血病复发并发症状性癫痫,2次中枢神经系统白血病复发时首发症状均为痫性发作,其中首次复发时呈癫痫持续状态,第二次复发时痫性发作并发肢体偏瘫症状,脑脊液、头颅核磁共振(Magnetic resonance imaging,MRI)及脑电图异常改变与临床特征相符合,期间动态监测头颅MRI病灶及脑电图异常改变均未能消失,给予原发病治疗化疗、鞘内注射及放疗,后续嵌合抗原受体T细胞免疫疗法(Chimeric antigen receptor T-cell immunotherapy,CAR-T),并先后联合丙戊酸、左乙拉西坦治疗,目前癫痫发作得到控制。结论对于儿童ALL患儿,在结疗后出现癫痫发作需警惕中枢神经系统白血病复发,及时完成脑脊液、头颅影像学及脑电图检查明确诊断,若治疗后头颅影像学病灶持续存在及脑电图异常放电不消失,痫性发作反复时需警惕中枢神经系统白血病二次复发可能,积极原发病治疗基础上联合抗癫痫发作药物治疗可取得较好疗效。

Objective To investigate the clinical features,diagnosis and treatment of symptomatic epilepsy complicated with central nervous system leukemia(CNSL)recurrence after acute lymphoblastic leukemia(ALL)treatment in children.Methods The clinical data of a child with secondary recurrence of CNSL complicated with symptomatic epilepsy after ALL treatment admitted to the Department of Pediatrics of the Second Affiliated Hospital of Auhui Medical University from December 2020 to February 2023 were retrospectively analyzed,and the relevant literature was reviewed and discussed.Results Patient was ALL for nealy two years after treatment in the central nervous system leukemia relapse of concurrent symptomatic epilepsy,two of the central nervous system leukemia relapse when starting symptoms are seizure,the first recurrence was status epilepticus,second recurrence of concurrent limb hemiplegia symptoms,cerebrospinal fluid,cranial magnetic resonance(MRI)and abnormal changes of electroencephalogram and clinical features,the abnormal changes of brain MRI lesions and electroencephalogram did not disappear.Chemotherapy,intrathecal injection and radiotherapy were given for the primary treatment,follow up CAR-T immunotherapy,and the treatment was successively combined with nalproate and levetiracetam.Currently,the seizures were controlled.Conclusion For children with ALL,the recurrence of CNSL should be warned after the end of treatment.Cerebrospinal fluid,cranial imaging and electroencephalogram examination should be completed in time to confirm the diagnosis.If the crania imaging lesions persist after treatment and abnormal electroencephalogram discharge does not disappear,the possibility of CNSL recurrence should be warned when the epileptic seizures are repeated.On the basis of primary disease active treatment,combination of antiseizure medications is preferable.