From the Guidelines
Total body irradiation can cause seizures, particularly at high doses, as part of the cerebrovascular syndrome that includes symptoms such as headache, impaired cognition, disorientation, ataxia, and prostration. This is evident from the study published in the Annals of Internal Medicine in 2004 1, which describes the acute radiation syndrome and its clinical components, including the hematopoietic, gastrointestinal, and cerebrovascular syndromes. The cerebrovascular syndrome, which includes seizures, typically occurs at higher doses of whole-body radiation.
Key Points to Consider
- The risk of seizures increases with higher doses of radiation and in patients with pre-existing neurological conditions.
- Seizures may be a manifestation of central nervous system toxicity from total body irradiation.
- Treatment of radiation-induced seizures typically involves anti-seizure medications, and prophylactic use may be considered for high-risk patients.
- The mechanism behind radiation-induced seizures involves inflammation, edema, and direct neuronal damage from oxidative stress caused by the radiation, as described in the context of acute radiation syndrome 1.
Management and Prevention
- Proper hydration and electrolyte balance monitoring are crucial during total body irradiation to reduce the risk of neurological complications, including seizures.
- Careful medication management is also essential to minimize the risk of seizures and other neurological side effects.
- The study 1 provides a framework for understanding the acute radiation syndrome and its various clinical manifestations, including the cerebrovascular syndrome that encompasses seizures.
From the Research
Total Body Irradiation and Seizures
- There is limited direct evidence on the relationship between total body irradiation and seizures.
- However, a study on long-term complications of total body irradiation in adults 2 does not mention seizures as a complication.
- Another study on the management of patients with malignant tumors of the brain undergoing radiation therapy 3 discusses the risk of seizures associated with cranial irradiation, but does not specifically address total body irradiation.
- Studies on levetiracetam for seizure prophylaxis 4, influence of levetiracetam on anticonvulsant efficacy 5, and safety and efficacy of levetiracetam for critically ill patients with seizures 6 provide information on seizure management, but do not directly address the relationship between total body irradiation and seizures.
Seizure Management
- Levetiracetam is commonly used for seizure prophylaxis in patients with intracerebral hemorrhage, traumatic brain injury, supratentorial neurosurgery, and spontaneous subarachnoid hemorrhage 4.
- The efficacy of levetiracetam in preventing seizures is still unclear, and more high-quality randomized trials are needed 4.
- Levetiracetam has been shown to have an additive anticonvulsant effect when administered in combination with some classical anticonvulsants 5.
- Levetiracetam appears to be safe for ICU patients when dosing is adjusted for renal function 6.