Abstract Details

Title Clinical Correlations of Ifosfamide Related Encephalopathy with EEG: A Case Series

Topic Neuro-oncology

Presentation(s) P07 - (-)

Poster/Presentation
Number 003

Objective

Background BACKGROUND: IFOS is an alkylating agent useful in the treatment of a wide range of cancers including sarcomas, lymphoma, gynecologic and testicular cancers. Encephalopathy has been reported in 10-30% of patients receiving high-dose IFOS.

Design/Methods DESIGN/METHODS: Retrospective chart review including clinical data and EEG recordings was made on five patients who developed IFOS related encephalopathy.

Results RESULTS: There were 2 female and 3 male patients aged 24-33 years. All of our patients (5/5) received combination chemotherapy including high dose IV IFOS (2-4g/m2/day) for different tumors. 1/5 had remote history of a convulsive event. '1/5 had hypoalbuminemia (2.9g/dL). 5/5 had normal levels of transaminases and GFR. 1/5 had malignant cells in the CSF. MRI of the brain was unremarkable except in 1/5; history of brain metastasis. All of these patients developed symptoms of encephalopathy soon after (12hours-3 days) receiving IFOS. 2/5 developed generalized convulsions. 2/5 experienced altered mental status. 1/5 developed continuous non-convulsive status epilepticus that required ICU admission and intubation. EEG showed multifocal epileptiform discharges in 2/5, triphasic waves in 1/5, and moderate degree diffuse generalized slowing in 2/5. Of the five patients, two received IV methylene blue. In one patient IV thiamine was administered. Seizure was treated and controlled with single anti-epileptic drug (AED) in all of these patients. None of our cohorts required long term AED as symptoms of encephalopathy abated within 1-7days after last IFOS administration. Two patients received subsequent dosing with high dose IV IFOS; one patient received prophylactic IV methylene blue. None of these patients developed further recurrence of IFOS related encephalopathy.

Conclusions CONCLUSIONS: Severity of IFOS related encephalopathy correlates with EEG changes. We suggest a timely EEG evaluation for patients receiving IFOS who develop features of encephalopathy.

Authors/Disclosures
Anteneh M. Feyissa, MD, MSc, FAAN (Mayo Clinic) PRESENTER	Dr. Feyissa has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurelis.
Sudhakar Tummala, MD, FAAN (MD Anderson Cancer Center)	Dr. Tummala has nothing to disclose.
Krzysztof W. Selmaj (University of Warmia and Mazury)	Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.
Kevin M. Biglan, MD (Eli Lilly)	Dr. Biglan has received personal compensation for serving as an employee of Eli Lilly. Dr. Biglan has received stock or an ownership interest from Eli Lilly.

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