Nonconvulsive Seizure in Post Stem Cell Transplant Patients (IN8-1.010)

Abstract

Objective: We studied 10 cases of Nonconvulsive seizure (NCS) in liquid tumor patients who had stem cell transplant (SCT). Background NCS is difficult to diagnose clinically and can lead to significant morbidity and mortality if it is not treated promptly. Design/Methods: We retrospectively reviewed descriptive data of 10 cases of NCS in patients with SCT from available electronic medical records. Results: There were 8 women and 2 men aged 34-70 years. Seven patients developed NCS within 4 months following SCT. One patient had prior history of seizure. There were no clear neurologic findings other than altered sensorium. Six patients were taking Tacrolimus. Tacrolimus levels were not supratherapeutic. At the time of diagnosis of NCS, five patients were on Cefepime and 3 patients were on Meropenem. Eight patients had some degrees of renal insufficiency (GFR: 63.1 ml/min±30.8). Blood cultures were positive for bacteria in two, cytomegalovirus antigen in one and human herpesvirus-6 PCR in two patients. Cerebrospinal fluid (CSF) cytology and microbiology studies were negative. CSF showed elevated protein in 7 cases and WBC of 12 in one case. Brain MRI and CT scan showed posterior reversible encephalopathy syndrome in two patients. NCS was diagnosed with the first bedside 20 minute EEG in 7 patients, second EEG in 2 patients and third EEG in one patient. Seizure was treated and controlled with one anti-epileptic drug (AED) in all patients, except two patients who needed second AED for a brief time. The next day follow up EEG in one patient showed persistent NCS. Conclusions: NCS should be considered in a post SCT patient with altered mental status. Longer bedside EEG or frequent EEGs are useful to diagnose the NCS. NCS in post SCT patient is usually multifactorial and easily treatable with single AED. Disclosure: Dr. Zohrevand has nothing to disclose. Dr. Tummala has nothing to disclose.