Oxaliplatin-Induced Tonic-Clonic Seizures.

Ahmad K Rahal,K James Kallail,Phu V Truong

doi:10.1155/2015/879217

Abstract

Oxaliplatin is a common chemotherapy drug used for colon and gastric cancers. Common side effects are peripheral neuropathy, hematological toxicity, and allergic reactions. A rare side effect is seizures which are usually associated with posterior reversible leukoencephalopathy syndrome (PRES). A 50-year-old male patient presented with severe abdominal pain. CT scan of the abdomen showed acute appendicitis. Appendectomy was done and pathology showed mixed adenoneuroendocrine carcinoma. Adjuvant chemotherapy was started with Folinic acid, Fluorouracil, and Oxaliplatin (FOLFOX). During the third cycle of FOLFOX, the patient developed tonic-clonic seizures. Laboratory workup was within normal limits. EEG and MRI of the brain showed no acute abnormality. The patient was rechallenged with FOLFOX but he had tonic-clonic seizures for the second time. His chemotherapy regimen was switched to Folinic acid, Fluorouracil, and Irinotecan (FOLFIRI). After 5 cycles of FOLFIRI, the patient did not develop any seizures, making Oxaliplatin the most likely culprit for his seizures. Oxaliplatin-induced seizures rarely occur in the absence of PRES. One case report has been described in the literature. We present a rare case of tonic-clonic seizures in a patient receiving Oxaliplatin in the absence of PRES.

Highlights

Neoplasms of the appendix are rare [1]
The most common side reactions associated with Oxaliplatin are anorexia, nausea, vomiting, acute dysesthesias triggered or aggravated by cold, and persistent peripheral neuropathy [2]
We present a rare case of tonic-clonic seizures in a patient receiving Oxaliplatin in the absence of posterior reversible leukoencephalopathy syndrome (PRES)

Summary

Introduction

Neoplasms of the appendix are rare [1]. They are found in about 1 percent of appendectomy specimens. Appendiceal cancer is a severe disease, and prognosis depends on the type and size of the tumor and on the metastatic status of diagnosis. Surgery can be curative especially when the tumor is limited to the appendix with no metastasis. Oxaliplatin is an alkylating agent used in colorectal, pancreatic, and gastric cancers. Oxaliplatin can cause posterior reversible leukoencephalopathy syndrome (PRES), a rare condition that affects the brain. The diagnosis of PRES should be confirmed by brain imaging. Seizures due to Oxaliplatin are rarely seen without PRES.

Case Presentation

Findings

Discussion