Hemolytic uremic syndrome (HUS) is primarily a disorder of infants and young children and rarely occurs in adults. HUS may occur in women in the postpartum period or in women taking oral contraceptives. Cancer patients receiving mitomycin or cisplatin chemotherapy may also develop HUS. There is evidence to suggest a genetic susceptibility to the development of thrombotic microangiopathies in siblings.95–98
Prominent features of HUS include:
Microangiopathic hemolytic anemia is present in HUS, as in thrombotic thrombocytopenic purpura (TTP), but the thrombocytopenia is milder in HUS and neurologic abnormalities are not frequent.
Sheth and colleagues have shown that the most common neurologic manifestations are seizures, mainly generalized tonic-clonic convulsions, but occasionally focal ones.91 One study found seizures in approximately 40% of HUS patients observed.101
As with TTP, seizures can be associated with HUS for several reasons:
Seizure management and evaluation are the same as for TTP. An additional factor to consider in choosing an AED for a patient with HUS is how likely the drug is to be removed from plasma during hemodialysis (See Table: Risk of Drug Removal By Hemodialysis). Phenytoin is not significantly removed during hemodialysis, so no adjustment is needed. Twenty percent of lamotrigine is removed after 4 hours of hemodialysis. Phenobarbital, ethosuximide, and gabapentin need adjustment after dialysis (See Correction for drug loss during hemodialysis).
Reviewed and revised April 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.
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