Uncontrolled Seizures Predict Poor Functional Outcomes for Adult Survivors of Childhood Cancer
A poster session shed light on the unexplored issue of adult childhood survivors and the risk of seizures and cognitive impairment.
Adult survivors of childhood cancer with uncontrolled seizures may benefit from increased neurocognitive assessments and vocational rehabilitation services, according to data presented at the 2016 Annual Meeting of the American Academy of Neurology in Vancouver, British Columbia, Canada.1
A study was designed to assess the presence of seizures, seizure severity, and resolution of seizures on neurocognitive outcome, health-related quality of life (HRQOL), and social attainment.
Such seizures “impact neurocognitive outcome and employment, independent of prior cancer therapy, and should be a focus of clinical management,” noted Zsila Sadighi, MD, of the department of pediatric medicine at St. Jude Children's Research Hospital in Memphis, TN, during a presentation at the meeting.
Adult survivors of childhood cancer are at risk for seizures and reduced functional outcomes. This includes effects on neurocognitive outcome, such as executive function (eg, flexibility, fluency, working memory), memory (eg, learning, short-term, and long-term), and attention and processing speed; HRQOL; and social attainment, including educational attainment, employment, income, and marital status.
Antiepileptic drugs (AEDs) can also reduce functional outcomes, including task efficiency, memory, and emotional regulation.
Known risk factors for neurocognitive dysfunction in cancer survivors are female gender, young age at time of treatment, intensity of antimetabolite therapy, and cranial radiation.
However, “the direct impact of seizures on functional outcomes in cancer survivors has not been well explored,” noted Dr Sadighi.
To correlate seizure morbidity with functional outcomes, the study included adults 18 years and older with neurocognitive function and seizures diagnosed by electroencephalograph or a neurologist who were 10 years or more from cancer diagnosis. Those with pre-existing seizures or developmental disorders were excluded.
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Of 2710 subjects eligible, 2022 cancer survivors participated in the project, which included a detailed chart review. Seizure frequency and AEDs following cancer diagnosis were abstracted and reviewed by board-certified neurologists. To assess HRQOL and social attainment, survivors completed neurocognitive testing and surveys.
Regression analysis was used “to correlate seizure characteristics and functional outcomes, stratified by [central nervous system (CNS)] tumor diagnosis and adjusting for age, gender, and prior cancer therapy,” which included cranial radiation, intravenous antimetabolite therapy, and/or methotrexate.