Epileptic seizures temporally associated with recombinant human growth hormone therapy in children: A case series of three patients

We report three pediatric patients who developed epileptic seizures while receiving recombinant human growth hormone therapy. Case 1 was a 12-year-old girl with a history of febrile seizures and epilepsy whose seizures recurred after discontinuation of antiepileptic medication during ongoing recombinant human growth hormone therapy. Case 2 was an 11-year-old boy born extremely preterm who developed afebrile generalized tonic seizures during recombinant human growth hormone therapy but subsequently remained seizure-free without anticonvulsant treatment. Case 3 was a 6-year-old boy with developmental delay and a history of febrile seizures who was diagnosed with Noonan syndrome. He developed febrile status epilepticus following influenza infection several months after initiation of recombinant human growth hormone therapy and subsequently developed refractory epilepsy with progressive cerebral atrophy. All patients had pre-existing neurological or genetic risk factors for epilepsy. A direct causal relationship between recombinant human growth hormone therapy and seizure occurrence was not established. These cases suggest that seizures occurring during recombinant human growth hormone therapy were more likely related to underlying risk factors than to recombinant human growth hormone therapy itself. Careful neurological follow-up is recommended in children receiving growth hormone therapy, particularly those with established risk factors for epilepsy.