目的 分析儿童急性淋巴细胞白血病（ALL）治疗过程中出现癫痫发作的临床特点。方法 回顾性分析2011年1月至2019年6月诊断为ALL伴癫痫发作患儿的临床资料。结果 研究期间共收治ALL患儿978例,其中51例（5.2%）在ALL治疗后出现癫痫发作症状,男39例、女12例,中位年龄7.4（3.7~11.1）岁。其常见病因为化学药物神经毒性（12例）、颅内出血（7例）、低钠血症（6例）、白质脑病（5例）、热性惊厥（5例）、可逆性后部脑病综合征（4例）。首次发作以全面性发作相对多见,根据引起癫痫发作的病因不同,癫痫发作后常同时伴有意识障碍、局灶症状等表现。39例在首次癫痫发作后行神经影像学检查,27例异常;在完成随访的30例中,有14例影像学异常,其中8例复查结果提示多数病灶具有可逆性,4例后遗脑软化灶。39例首次癫痫发作后脑电图提示异常28例,以中-高波幅慢波发放为主。在完成随访的30例患儿中,18例无明显后遗症。结论 癫痫发作是ALL治疗期间较常见的神经系统并发症,首次癫痫发作的病因及其伴随表现具有多样性,尽早予神经影像学和脑电图检查有助于早期诊断及治疗。

Objective To analyze the clinical characteristics of seizures in children with acute lymphoblastic leukemia (ALL) during treatment. Methods The clinical data of children diagnosed with ALL complicated with seizures from January 2011 to June 2019 were analyzed retrospectively. Results A total of 978 children with ALL were admitted, of which 51 (5.2%) developed seizure symptoms after ALL treatment, 39 males and 12 females, with a median age of 7.4 years (3.7-11.1). Their common etiologies were chemical drug neurotoxicity (12 cases), intracranial hemorrhage (7 cases), hyponatremia (6 cases), white matter encephalopathy (5 cases), febrile convulsions (5 cases), and reversible posterior encephalopathy syndrome (4 cases). First seizures were relatively common with generalized seizures, and depending on the cause of the seizures, they were often accompanied by impaired consciousness, focal symptoms and other clinical features. A total of 39 children in this group underwent cranial CT or MRI after the first seizure, and 27 were abnormal. In the 30 cases with successful follow-up, 14 cases had abnormal imaging, including 8 cases with reversible foci and 4 cases with cerebral softening foci. Twenty-eight cases had abnormal EEG results after the first seizure, mainly with medium-high amplitude slow wave emission. Of the 30 children successfully followed up, 18 had no significant sequelae. Conclusion Seizures are common neurological complications in children with ALL during treatment. The etiology of the first seizure and its accompanying clinical characteristics are diverse. Timely neuroimaging and EEG examinations are helpful for early diagnosis and treatment.