Title : Clinical predictors of post-transplant seizures in children undergoing HSCT
Abstract:
Hematopoietic Stem Cell Transplantation (HSCT) serves as a vital therapeutic option for children with impaired bone marrow function. Despite advancements in transplantation medicine, neurological complications remain a significant concern, with seizures being the most frequent acute manifestation. This study aimed to evaluate seizure characteristics and identify clinical risk factors for seizure development following HSCT in pediatric patients.
A retrospective review was conducted on 431 children who underwent HSCT at Seoul St. Mary’s Hospital. Both allogeneic and autologous transplants were analyzed, and all patients received conditioning regimens before transplantation. Graft-versus-host disease (GVHD) prophylaxis included calcineurin inhibitors alone or in combination with methotrexate and other agents. Outcomes examined were seizure resolution, development of epilepsy, and mortality.
The incidence of post-HSCT seizures was 4.1%. Most seizures occurred within the first 100 days after transplantation, and generalized seizures were nearly twice as common as focal events. About 70% of patients achieved seizure freedom without long-term anti-seizure medication, while 20% progressed to epilepsy. Allogeneic HSCT was associated with a higher seizure risk compared with autologous HSCT (p=0.035). The combined use of calcineurin inhibitors and methotrexate showed a significantly increased seizure risk (p=0.001). Additionally, patients with grade 2–4 acute GVHD had a higher likelihood of developing seizures compared with those with grade 0–1 GVHD (p=0.005).
These findings highlight that intense immunosuppression—particularly allogeneic transplantation, calcineurin inhibitor plus methotrexate prophylaxis, and severe acute GVHD—increases seizure vulnerability in pediatric HSCT recipients. Early neurological monitoring and targeted management strategies may help improve long-term outcomes in this high-risk population.
