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Ifosfamide Encephalopathy and Nonconvulsive Status Epilepticus

Published online by Cambridge University Press:  14 September 2018

Alberto Primavera
Affiliation:
Department of Neurological Sciences and Vision, University of Genova, Genova, Italy
Daniela Audenino
Affiliation:
Department of Neurological Sciences and Vision, University of Genova, Genova, Italy
Leonardo Cocito
Affiliation:
Department of Neurological Sciences and Vision, University of Genova, Genova, Italy
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Abstract:

Background:

Ifosfamide (IFX), an alkylating agent and isomer of cyclophosphamide, is used as a single agent or a component of multi-agent chemotherapy in the treatment of ovarian, testicular, head and neck cancers, sarcomas and lymphomas. Encephalopathy is manifested by cerebellar ataxia, confusional state, complex visual hallucinations, extrapyramidal signs, seizures, and mutism.

Case reports:

We report two patients with non-Hodgkin’s lymphoma presenting with mutism and confusional state after IFX infusion. Nonconvulsive status epilepticus (NCSE) as the cause of confusion was diagnosed on the basis of EEG pattern and the apparent improvement following intravenous administration of diazepam.

Conclusions:

Electroencephalogram abnormalities during IFX treatment have been described but recordings are only available in six cases. In three of them, paroxysmal alterations warranted the diagnosis of NCSE; however, most cases of IFX encephalopathy might have associated NCSE.

Résumé:

Résumé: Introduction:

L’ifosfamide (IFX), un agent alkylant isomère de la cyclophosphamide, est utilisé en monothérapie ou en thérapie combinée en chimiothérapie du cancer de l’ovaire, du testicule, de la tête et du cou, de sarcomes et de lymphomes. L’encéphalopathie se manifeste par une ataxie cérébelleuse, un état confusionnel, des hallucinations visuelles complexes, des signes extrapyramidaux, des crises convulsives et du mutisme.

Observation:

Nous rapportons le cas de deux patients atteints de lymphomes non hodgkiniens, qui ont présenté du mutisme et un état confusionnel après une infusion de IFX. Le diagnostic de status epilepticus non convulsif (SÉNC) comme étiologie de la confusion a été posé en se basant sur le tracé ÉEG et l’amélioration suite à l’administration intraveineuse de diazépam.

Conclusions:

Des anomalies ÉEG pendant le traitement à l’IFX ont été décrites, mais les tracés ne sont disponibles que dans six cas. Dans trois de ces cas, des altérations paroxystiques ont justifié le diagnostic de SÉNC. Cependant, la plupart des cas d’encéphalopathie à l’IFX pourraient être associés à un SÉNC.

Type
Case Reports
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

References

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