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A seizure is a transient involuntary alteration in consciousness, behavior, motor function, sensory function due to excessive neuronal discharge.

Seizures account for up to 60% of neurological consults on children with cancer.

Causes in oncology patients:

  • Underlying malignancy
    • Primary brain tumor
    • Metastatic disease to brain
    • Meningeal leukemia
  • Drugs
    • Intrathecal Cytarabine
    • Intrathecal Methotrexate
    • Vincristine (associated with inappropriate ADH and low serum Na)
  • Radiation induced damage
    • Leukoencephalopathy
    • Cerebral necrosis
    • Late effect associated with small vessel damage
  • Infection
    • Meningitis
    • Cerebral Abcess
  • Metabolic disturbance
  • Coagulopathy



  • Establish adequate ventilation and circulation
    • Lie patient on side
    • Establish Airway
  • Correct any metabolic abnormality
  • Anticonvulsant therapy if the seizure continues



When the situation is controlled, it is necessary to:

  • Take a history with questions such as:
    • Is there a previous history of seizures?
    • Is there a family history of seizures?
    • What medications is the patient taking?
    • Have there been any other symptoms?
  • Do a physical examination
  • Blood work - CBC. electrolytes (including magnesium, calcium and phosphorus), liver function tests and coagulation screen
  • If there is suspicion of a brain lesion then emergent CT or MR may be appropriate



Anticonvulsant therapy

If seizure not controlled initially

  • Diazepam - (0.2 - 0.5 mg per kg)
  • Lorazepam (0.05 - 0.1 mg per kg)

Long term oral control if necessary - phenytoin (20mg per kg)






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