Abstracts

Rationale: The development of epilepsy after treatment of childhood leukaemia or cancer following whole brain radiotherapy (WBRT) is rare and not well described. We report five cases of refractory epilepsy in this group and their clinical characteristics. All these patients received cranial irradiation prior to the age of 10. Methods: Patients were identified from three university hospitals in Dublin. The clinical features, electroencephalogram and brain imaging were reviewed. Results: All five patients had malignancy in childhood (four had acute lymphatic leukaemia (ALL) and one had medullary astrocytoma). Treatment included cranial irradiation (patients with ALL received whole brain irradiation and the patient with medullary astrocytoma received stereotactic radiotherapy) and intrathecal chemotherapy. Intractable seizures developed several years after treatment. The seizures were very frequent and included multiple types (complex partial seizures, clusters of atonic seizures (in three patients), spasms and convulsions rarely). Cognitive impairment was also observed. CT brain showed diffuse calcifications in three patients (figure 1). Two patients underwent surgical treatment for epilepsy (right temporal lobectomy for calcification, caveronma resection) and one patient is awaiting anterior corpus callosotomy. Conclusions: Cranial radiotherapy and in particular WBRT results in disabling epilepsy in adulthood. These patients have characteristic imaging findings, are resistant to multiple medications and may benefit from early consideration of surgical intervention, including resection and disconnection procedures. Funding: No