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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: Undiagnosed seizure activity, we need help!Forum: Neurology Forum
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Re: Undiagnosed seizure activity, we need help!Posted by ccf neuro M.D. on May 26, 1997 at 14:07:16: In Reply to: Undiagnosed seizure activity, we need help! posted by Doris Edwards on May 20, 1997 at 01:39:47:
: My daughter is being treated for relapsed leukemia. She began treatments in January/96 and suffered a stroke in Feb./96 on the left side of her brain. She began seizures on April 24/97 and we were told it was possible residue from last years stroke. A C.T. Scan, and M.R.A., revealed nothing new. However, while she was hooked up to an EEG, she had a seizure. This indicated the seizure activity was coming from the right side of the brain and not from the side of the stroke? She just turned fourteen and has been on chemotherapy for a year. So far, Ativan (4mg.) is given to stop the seizures. She is now receiving Dilantin and Vigabatrin but they are not controlling the seizures. She previously had Tegretol and Vigabatrin. It's been almost a month of seizures and the neurologist still can't tell us what's causing them and hasn't perscribed the proper drug yet to stop them. We are in desperate need of outside help. Has anyone on chemotherapy ever experienced seizure activity? What was the source and how were the seizures resolved? Please. email me as soon as possible. This is a very anxious and desperate situation. "Thank you." = Doris, Your daughters situation sounds very complex and I doubt I'll be able to give you any simple helpful answers to your questions; however, some chemotherapy medications can promote seizure activity, either directly by drug toxicity or sometimes indirectly by kidney damage and rewsultanat imbalances in salts and electrolytes. Unfortunately, another good cause of seizures in leukemic patients is leukemic meningitis, where leukemia cells reach the linings surrounding the brain called the meninges, and irritate the underlying brain. Typically, however, other symptoms like malfunction of the cranial nerves is also present, but does not have to be. Whatever injured your daughter's brain on the left side may have also produced a more subtle form of injury elsewhere in the brain, with consequent scarring or irritation or both, perhaps at a microscopic level undetectable by brain scans like MRI and CT even. A spinal tap (lumbar puncture) can help diagnose the presence of leukemic meningitis via a test called cytology, although often multiple samples of large aliquots of fluid are required. Other rare forms of INFECTIOUS chronic meningitis may also occur in patients with damaged immune systems, such as your daughters (from the leukemia itself and the chemotherapy agents), and include specifically infection by variou fungi, yeasts, and tuberculosis-like bacteria (so-called Mycobacteria). Spinal fluid tests can detect these as well if they are specifically looked for. There is no magic or "proper" drug to treat stubborn seizures like those your daughter appears to be suffering from. The most important thing in her case I think is to establish the underlying diagnosis--- and, of course, to treat it as appropriate and possible. Seizures are always the symptom of some underlying brain disease, although in many cases th ecause is genetic or unidentifiable by current medical technologic standards (so called "idiopathic" epilepsies). In your daughter's case, there is likely some more concrete cause. I hope this information is useful to you. If you are near Cleveland and are interested in a second opinion for your daughter's obviously complex case, the department of pediatric neurology's appointment number is 216-445-8125 or 1-800-223-2273 ext 58125; th esame 1-800 number operator could connect you to the oncology department (ask for a "liquid" tumor doctor).
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