Evaluation of Epileptic Seizures Developed During Hematopoietic Stem Cell Transplantation: A Single Center Experience

INTRODUCTION: Hematopoietic Stem Cell Transplant (HSCT) is one of the most effective treatment for hematological malignancies but has some complications. Epileptic seizures are consciousness, motor and sensory symptoms caused by temporary central nervous system dysfunction caused by recurrent abnormal neuronal discharges. Epileptic seizures are one of the complications of HKHN and affect its prognosis poorly. Our aim is to determine the causes and risk factors of epileptic seizures that develop during HSCT, thus preventing the development of seizures and positively affecting the prognosis of HSCT, which has a high complication rate.
METHODS: Twelve patients who had seizures while being hospitalized at Erciyes University Bone Marrow Transplantion Unit were included between October 2018 and October 2019. Patients diagnosed with subacute sclerosing panencephalitis were excluded.
RESULTS: Nine patients (75%) received ASCT and 3 patients (25%) received allo-HSCT. Epileptic seizures were observed in 8.2% of ASCTs and 5.4% of allo-HSCTs. None of the patients had hypoglycemia or hyponatremia. Eight patients (66.6%) had hypophosphatemia, 6 (50%) had hypokalemia, 4 (33.3%) had hypomagnesemia. The median number of drugs is 8 ± 2.1 (6-14). The median number of drugs that lower the seizure threshold is 5.5 ± 1.4 (4-8). Among the drugs that lower the epileptic threshold, fluconazole 75% (n=9), Meropenem 58.3% (n=7), Metronidazole 60% (n=6), Isoniazid 33.3% (n=4) were used most frequently. One (8.3%) of our patients had died.
DISCUSSION AND CONCLUSION: The reason for developing epileptic seizures is thought to be correlated with multiple factors that co-exist and interact with each other in a complicated clinical situation after HSCT. Polypharmacy, especially the use of drugs that lower the seizure threshold and electrolyte imbalances such as hypophosphatemia and hypokalemia were common in our patients with epileptic seizures. Therefore, close monitoring of these two factors is seen as the most important approach in preventing epileptic seizure development after HSCT.

Hematopoetik Kök Hücre Nakli Sýrasýnda Geliþen Epileptik Nöbetlerin Deðerlendirilmesi: Tek Merkez Deneyimi

GÝRÝÞ ve AMAÇ: Hematopoetik Kök Hücre Nakli(HKHN), hematolojik maligniteler, bazý solid tümörler ve immün yetmezlik hastalýklarý için en etkili tedavi yöntemlerinden biridir ancak bazý komplikasyonlara sahiptir. Epileptik nöbetler tekrarlayan anormal nöronal deþarjlarýn neden olduðu geçici santral sinir sistemi iþlev bozukluðu sonucu oluþan bilinç, motor ve duysal belirtiler olup HKHN sonrasý gözlenen komplikasyonlardan biridir ve prognozu oldukça kötü etkilemektedir. Amacýmýz, HKHN sýrasýnda geliþen epileptik nöbetlerin sebeplerini ve risk faktörlerini saptamak böylece nöbet geliþimini engelleyerek halihazýrda komplikasyon oraný yüksek olan HKHN’in prognozunu olumlu yönde etkilemektir.
YÖNTEM ve GEREÇLER: Ekim 2018 ile Ekim 2019 yýllarý arasýnda Erciyes Üniversitesi Kemik Ýliði Nakli Ünitesinde nakil amacýyla yatýrýlýrken nöbet geçiren 12 hasta çalýþmaya dahil edildi. Hastalarýn verileri geriye dönük olarak incelendi. Subakut sklerozan panensefalit tanýsý konulan hastalar çalýþmaya dahil edilmedi.
BULGULAR: 9 hastaya (%75) Otolog HKHN (OKÝT), 3 hastaya (%25) ise Allogeneik HKHN (AKÝT) yapýldý. OKÝT’lerin %8.2’sinde, AKÝT’lerin %5.4’ünde epileptik nöbet gözlendi. Hastalarýn laboratuvar bulgularýnda hiçbirinde hipoglisemi, hiponatremi, böbrek ve karaciðer fonksiyon testi bozukluðu saptanmadý. Sekiz hastada (%66.6) hipofosfatemi, 6 (%50)’sýnda hipopotasemi, 4 (%33.3)’ünde hipomagnezemi ve 2 (%16.6)’sinde hipokalsemi gözlendi. Hastalarýn median toplam ilaç sayýsý 8 ± 2.1 (6-14) ’dir. Nöbet eþiðini düþüren median ilaç sayýsý ise 5.5 ± 1.4 (4-8)’dýr. Epileptik eþiði düþüren ilaçlardan Flukonazol 9 (%75), Meropenem 7 (%58.3), Metronidazol 6 (%60), Ýzoniazid 4 (%33.3) ve Siklosporin 3 (%25) hastada kullanýlmasýyla dikkat çekti. 9 (%75) hastanýn beslenme durumu total parental nutrisyon ile saðlanmaktaydý. 1 (%8.3) hastamýz exitus oldu.
TARTIÞMA ve SONUÇ: Epileptik nöbet geliþim sebebinin, HKHN sonrasý komplike klinik durumda ayný anda var olan ve birbirleriyle etkileþime giren çoklu faktörlerle korele olduðu düþünülmektedir. HKHN sýrasýnda epileptik nöbet geçiren hastalarýmýzda hipofosfatemi, hipopotasemi gibi elektrolit bozukluklarýnýn sýk olduðu ve polifarmasinin özellikle de nöbet eþiðini düþüren ilaç kullanýmýnýn fazla olduðu gözlendi. Bu nedenle bu iki faktörün yakýn takip edilmesi epileptik nöbet geliþimini önlemede en önemli yaklaþým olarak gözlenmektedir.