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Busulfan Seizure Prophylaxis — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesBusulfan Seizure ProphylaxisSCE Medical Oncology

A 62-year-old man receiving IV busulfan conditioning before stem cell transplant develops seizures. What is the mechanism and prevention?

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Correct answer: A — Busulfan crosses the blood-brain barrier and has epileptogenic properties

IV busulfan is lipophilic and readily crosses the BBB, causing dose-dependent seizures in approximately 7-10% of patients without prophylaxis. Standard prevention: levetiracetam (preferred — no CYP450 interaction) or phenytoin (load 24h before busulfan, continue until 24h after last dose). Enzyme-inducing anticonvulsants (phenytoin, carbamazepine) can alter busulfan metabolism; therapeutic busulfan drug monitoring and dose adjustment are essential. Seizure prophylaxis is MANDATORY with high-dose busulfan conditioning.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer