Acute Encephalopathy and Seizures

  • Jerome B. Posner
Conference paper
Part of the ESO Monographs book series (ESO MONOGRAPHS)

Abstract

Alterations of mental status are among the most common and feared complications of both systemic cancer and its therapy [1]. Many potentially promising chemotherapeutic agents are unusable because of central nervous system (CNS) toxicity. Others, which are usually not toxic to the nervous system may, in specific individuals and under specific circumstances, cause CNS toxicity. Among the varieties of CNS toxicity are seizures and encephalopathy. The term encephalopathy is used here to refer to a clinical syndrome of global confusion, disorientation and often somnolence (delirium) which may progress to stupor or coma. Focal neurological signs such as aphasia or hemiparesis may or may not accompany the delirium. Focal signs in the absence of delirium are not considered here. Encephalopathy and seizures may occur either together or separately and may be caused directly or indirectly by several antineoplastic agents.

Keywords

Toxicity Dementia Schizophrenia Oncol Interferon 

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References

  1. 1.
    Fleishman S, Lesko LM: Delerium and Dementia. In: Holland JC, Rowland JH (eds) Handbook of Psychooncology. Oxford University Press, Oxford, 1989 pp 343–355Google Scholar
  2. 2.
    Walker RW, Allen JC, Rosen G, Caparros B: Transient cerebral dysfunction secondary to highdose methotrexate. J Clin Oncol 1986 (4):1845–1850PubMedGoogle Scholar
  3. 3.
    Kaplan RS, Wiernik PH: Neurotoxicity of Antitumour Agents. In: Perry MC, Yarbro JW (eds) Toxicity of Chemotherapy. Grune &Stratton, Orlando 1984 pp 365–431Google Scholar
  4. 4.
    Weiss HD, Walker MD, Wiernik PH: Neurotoxicity of commonly used antineoplastic agents. New Engl J Med 1974 (291):75–133PubMedCrossRefGoogle Scholar
  5. 5.
    Delattre J-Y, Posner JB: Neurological complications of chemotherapy and radiation therapy. In: Aminoff MJ (ed) Neurology and General Medicine. Churchill Livingston, New York 1989 pp 365–387Google Scholar
  6. 6.
    Cohen N, Strauss G, Lew R, Silver D, Recht L: Should prophylactic anticonvulsants be administered to patients with newly-diagnosed cerebral metastases? A retrospective analysis. J Clin Oncol 1988 (6):1621–1624PubMedGoogle Scholar
  7. 7.
    Pagani JJ, Hayman LA, Bigelow RH, Libshitz HI, Lepke RA, Wallace S: Diazepam prophylaxis of contrast media-induced seizures during computed tomography of patients with brain metastases. Am J Neuroradiol 1983 (4):67–72Google Scholar
  8. 8.
    Appleton RE, Farrell K, Teal P, Hashimoto SA, Wong PKH: Complex partial status epilepticus associated with cyclosporin A therapy. J Neurol Neurosurg Psychiat 1989 (52):1068–1071PubMedCrossRefGoogle Scholar
  9. 9.
    Chalk JB, Ridgeway K, Brophy TRO’R, Yelland JDN, Eadie MJ: Phenytoin impairs the bioavailability of dexamethasone in neurological and neurosurgical patients. J Neurol Neurosurg Psychiat 1984 (47):1087–1090PubMedCrossRefGoogle Scholar
  10. 10.
    Grossman SA, Sheidler VR, Gilbert MR: Decreased phenytoin levels in patients receiving chemotherapy. Am J Med 1989 (87):505–510PubMedCrossRefGoogle Scholar
  11. 11.
    Jaffe N, Takaue Y, Anzai T, Robertson R: Transient neurological disturbances induced by high-dose methotrexate treatment. Cancer 1985 (56):1356–1360PubMedCrossRefGoogle Scholar
  12. 12.
    Kay HEM, Knapton PJ, O’Sullivan JP, Wells DG, Harris RF, Innes EM, Stuart J, Schwartz FCM, Thompson EN: Encephalopathy in acute leukaemia associated with methotrexate therapy. Arch Dis Child 1972 (47):344–354PubMedCrossRefGoogle Scholar
  13. 13.
    Leff RS, Thompson JM, Daly MB, Johnson DB, Harden EA, Mercier RJ, Messerschmidt GL: Acute neurologic dysfunction after high-dose etoposide therapy for malignant glioma. Cancer 1988 (62):32–35PubMedCrossRefGoogle Scholar
  14. 14.
    Berman IJ, Mann MP: Seizures and transient cortical blindness associated with cis-platinum (II) Diamminedichloride (PDD) therapy in a thirty-yearold man. Cancer 1980 (45):764–766PubMedCrossRefGoogle Scholar
  15. 15.
    Mead GM, Arnold AM, Green JA, Macbeth FR, Williams CJ, Whitehouse JM: Epileptic seizures associated with cisplatin administration. Cancer Treat Rep 1982 (66):1719–1722PubMedGoogle Scholar
  16. 16.
    Feun LG, Wallace S, Stewart DJ, Chuang VP, Yung W-KA, Leavens ME, Burgess MA, Savaraj N, Benjamin RS, Young SE, Tang RA, Hanel S, Mavligit G, Fields WS: Intracarotid infusion of cisdiamminedichloroplatinum in the treatment of recurrent malignant brain tumors. Cancer 1984 (54):794–799PubMedCrossRefGoogle Scholar
  17. 17.
    Johnson DL, Bernstein ID, Hartmann JR, Chard RL Jr: Seizures associated with vincristine sulfate therapy. J Pediatr 1973 (82):699–702PubMedCrossRefGoogle Scholar
  18. 18.
    Scheithauer W, Ludwig H, Maida E: Acute encephalopathy associated with continuous vincristine sulfate combination therapy: case report. Investigation New Drugs 1985 (3):315–318Google Scholar
  19. 19.
    Dallera F, Gamoletti R, Costa P: Unilateral seizures following vincristine intravenous injection. Tumori 1984 (70):243–244PubMedGoogle Scholar
  20. 20.
    Land VJ, Sutow WW, Gernbach DJ et al: Toxicity of L-asparaginase in children with advanced leukemia. Cancer 1972 (30):339–347PubMedCrossRefGoogle Scholar
  21. 21.
    Leonard JV, Kay JDS: Acute encephalopathy and hyperammonaemia complicating treatment of acute lymphoblastic leukaemia with asparaginase. Letter to the Editor. Lancet 1986 (i):162–163CrossRefGoogle Scholar
  22. 22.
    Bethlenfalvay NC, Bergin JJ: Severe cerebral toxicity after intravenous nitrogen mustard therapy. Cancer 1972 (29):366–369PubMedCrossRefGoogle Scholar
  23. 23.
    Burger PC, Kamenar E, Schold SC, Fay JW, Phillips GL, Herzig GP: Encephalomyelopathy following high-dose BCNU therapy. Cancer 1981 (48):1318–1327CrossRefGoogle Scholar
  24. 24.
    Gams RA, Carpenter JT: Central nervous system complications after combination treatment with adriamycin (NSC-123127) and 5-(3,3-dimethyl-1-triazeno)imidazole-4-carboxamide (NSC-45388). Cancer Chemother Rep 1974 (58):753–754PubMedGoogle Scholar
  25. 25.
    Wiley RG, Gralla RJ, Casper ES, Kemeny N: Neurotoxicity of the pyrimidine synthesis inhibitor N-Phosphonoacetyl-L-Aspartate. Ann Neurol 1982 (12):175–183PubMedCrossRefGoogle Scholar
  26. 26.
    Schein PS, Slavik M, Smythe T et al: Phase I clinical trial of spirogermanium. Cancer Treat Rep 1980 (64):1051–1056PubMedGoogle Scholar
  27. 27.
    Legha SS, Latrielle J, McCredie KB, Bodey GP: Neurological and cardiac rhythm abnormalities associated with 4’-(9-Acridinylamino) methane-sulfon-m-anisidide (AMSA) therapy. Cancer Treat Rep 1979 (63):2001–2003PubMedGoogle Scholar
  28. 28.
    Marcus RE, Goldman JM: Convulsions due to highdose busulphan. Letter to Editor. Lancet 1984 (ii):1463CrossRefGoogle Scholar
  29. 29.
    Walker RW, Brochstein JA: Neurologic complications of immunosuppressive agents. Neurologic Clinics 1988 (6):261–278PubMedGoogle Scholar
  30. 30.
    Saunders Ml, Dische S, Anderson P et al: The neurotoxicity of misonidazole and its relationship to dose, half-life and concentration in the serum. Br J Cancer 1978 (37):268–270Google Scholar
  31. 31.
    Schliamser SE, Broholm K-A, Liljedahl A-L, Norrby SR: Comparative neurotoxicity of benzylpenicillin, imipenem/cilastatin and FCE 22101, a new injectible penem. J Antimicrobial Chemotherapy 1988 (22):681–695Google Scholar
  32. 32.
    Boston Collaborative Drug Surveillance Program: Acute adverse reactions to prednisone in relation to dosage. Clin Pharmacol Therap 1972 (13):694–698.Google Scholar
  33. 33.
    Falk WE, Mahnke MW, Poskanger DC: Lithium prophylaxis of corticotropin-induced psychosis. JAMA 1979 (241 ):1011–1012PubMedCrossRefGoogle Scholar
  34. 34.
    Geiser CF, Bishop Y, Jaffe N et al: Adverse effects of intrathecal methotrexate in children with acute leukemia in remission. Blood 1975 (45):189–195PubMedGoogle Scholar
  35. 35.
    Walker RW, Allen JC, Rosen G, Caparros B: Transient cerebral dysfunction secondary to highdose methotrexate. J Clin Oncol 1986 (4):1845–1850PubMedGoogle Scholar
  36. 36.
    Phillips PC, Dhawan V, Strother SC et al: Reduced cerebral glucose metabolism and increased brain capillary permeability following high-dose methotrexate chemotherapy: a positron emission tomographic study. Ann Neurol 1987 (21):59–63PubMedCrossRefGoogle Scholar
  37. 37.
    Wernick R, Smith DL: Central nervous system toxicity associated with weekly low-dose methotrexate treatment. Arthritis and Rheumatism 1989 (32)770–775PubMedCrossRefGoogle Scholar
  38. 38.
    Cohen RJ, Cuneo RA, Cruciger MP, Jackman AE: Transient left homonymous hemianopsia and encephalopathy following treatment of testicular carcinoma with cisplatinum, vinblastine and bleomycin. J Clin Oncol 1983 (1):392–393PubMedGoogle Scholar
  39. 39.
    Walker RW, Cairncross JG, Posner JB: Cerebral herniation in patients receiving cisplatin. J Neuro-Oncol 1988 (6):61–65CrossRefGoogle Scholar
  40. 40.
    Robertson GL, Bhoopalam N, Zelkowitz LJ: Vincristine neurotoxicity and abnormal secretion of antidiuretic hormone. Arch Intern Med 1973 (132)717–720PubMedCrossRefGoogle Scholar
  41. 41.
    Gaidys WG, Dickerman JD, Walters CL, Young PC: Intrathecal vincristine. Report of a fatal case despite CNS washout. Cancer 1983 (52)799–801PubMedCrossRefGoogle Scholar
  42. 42.
    Muller LJ, Moorer-van Delft CM, Roubos EW: Snail neurons as a possible model for testing neurotoxic side effects of antitumor agents: paracrystal formation by vinca alkaloids. Cancer Res 1988 (48):7184–7188PubMedGoogle Scholar
  43. 43.
    Feinberg WM, Swenson MR: Cerebrovascular complications of L-asparaginase therapy. Neurology 1988 (38):127–133PubMedGoogle Scholar
  44. 44.
    Charney MWP, Ravindran A, Lewis DS: Manic psychosis associated with procarbazine. Br Med J 1982 (284):82CrossRefGoogle Scholar
  45. 45.
    Rodriguez LA, Prados M, Silver P, Levin VA: Reevaluation of procarbazine for the treatment of recurrent malignant central nervous system tumors. Cancer 1989 (64):2420–2423PubMedCrossRefGoogle Scholar
  46. 46.
    Lynch HT, Droszcz CP, Albano WA, Lynch JF: “Organic brain syndrome” secondary to 5Fluorouracil toxicity. Dis Colon Rectum 1981 (24):130–131PubMedCrossRefGoogle Scholar
  47. 47.
    Heier MS, Fossa SD: Wemicke-Korsakoff-like syndrome in patients with colorectal carcinoma treated with high-dose doxifuridine (5’-dFUrd). Acta Neurol Scand 1986 (73):449–457PubMedCrossRefGoogle Scholar
  48. 48.
    Gottlieb D, Bradstock K, Koutts J, Robertson T, Lee C, Castaldi P: The neurotoxicity of high-dose cytosine arabinoside is age-related. Cancer 1987 (60):1439–1441PubMedCrossRefGoogle Scholar
  49. 49.
    Rubin A, Kang H: Cerebral blindness and encephalopathy with cyclosporin A toxicity. Neurology 1987 (37):1072–1076PubMedGoogle Scholar
  50. 50.
    Denicoff KD, Rubinow DR, Papa MZ et al: The neuropsychiatric effects of treatment with interleukin-2 and lymphokine-activated killer cells. Ann Int Med 1987 (107):293–300PubMedGoogle Scholar
  51. 51.
    Gieron MA, Barak LS, Estrada J: Severe encephalopathy associated with ifosfamide administration in two children with metastatic tumors. J Neuro-Oncol 1988 (6):29–30CrossRefGoogle Scholar
  52. 52.
    Pratt CB, Green AA, Horowitz ME, Meyer WH, Etcubanas, Douglass, E, Hayes FA, Thompson E, Wilimas J, Igarashi M, Kovnar E: Central nervous system toxicity following the treatment of pediatric patients with ifosfamide/Mesna. J Neuro-Oncol 1986 (4):1253–1261Google Scholar
  53. 53.
    McCallum AK: Ifosfamide/Mesna encephalopathy. Letter to Editor. Lancet 1987 (i):987CrossRefGoogle Scholar
  54. 54.
    Husband DJ, Watkin SW: Fatal hypokalaemia associated with ifosfamide/Mesna chemotherapy. Letter to Editor. Lancet 1988 (i):1116CrossRefGoogle Scholar
  55. 55.
    Adams F, Fernandez F, Mavligit G: Interferoninduced organic mental disorders associated with unsuspected pre-existing neurological abnormalities. J Neuro-Oncol 1988 (6):355–359CrossRefGoogle Scholar
  56. 56.
    Renault PF, Hoofnagle JH, Park Y, Mullen KD, Peters M, Jones DB, Rustgi V, Jones E: Psychiatric complications of long-term interferon alfa therapy. Arch Intern Med 1987 (147): 1577–1580PubMedCrossRefGoogle Scholar
  57. 57.
    Suter CC, Westmoreland BF, Sharbrough FW, Hermann RC, Jr.: Electroencephalographs abnormalities in interferon encephalopathy: a preliminary report. Mayo Clin Proc 1984 (59):847–850PubMedGoogle Scholar
  58. 58.
    Love RR: Tamoxifen therapy in primary breast cancer: biology, efficacy, and side effects. J Clin Oncol 1989 (7):803–815PubMedGoogle Scholar
  59. 59.
    Pluss JL, DiBella NJ: Reversible central nervous system dysfunction due to tamoxifen in a patient with breast cancer. Ann Int Med 1984 (101):652PubMedGoogle Scholar
  60. 60.
    Mitchell RB, Wagner JE, Karp JE, Watson AJ, Brusilow SW, Santos GW, Burke PJ, Saral R: Syndrome of idiopathic hyperammonemia after highdose chemotherapy: review of nine cases. Am J Med 1988 (85):662–667PubMedCrossRefGoogle Scholar
  61. 61.
    Samuels BL, Vogelzang, Kennedy BJ: Vascular toxicity following vinblastine, bleomycin, and cisplatin therapy for germ cell tumours. Internat J Andrology 1987 (10):363–369CrossRefGoogle Scholar
  62. 62.
    Kukla LJ, McGuire WP, Lad T, Saltiel M: Acute vascular episodes associated with therapy for carcinomas of the upper aerodigestive tract with bleomycin, vincristine, and cisplatin. Cancer Treat Rep 1982 (66):369–370PubMedGoogle Scholar
  63. 63.
    Walker RW, Rosenblum MK, Kempin SJ, Christian MC: Carboplatin-associated thrombotic microangiopathic hemolytic anemia. Cancer 1989 (64):1017–1020PubMedCrossRefGoogle Scholar
  64. 64.
    Schachter S, Freeman R: Transient ischemic attack and adriamycin cardiomyopathy. Neurology 1982 (32):1380–1381PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • Jerome B. Posner
    • 1
  1. 1.Department of NeurologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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