Chemotherapy for acute lymphoblastic leukemia may cause subtle changes of the spinal cord detectable by somatosensory evoked potentials

Vainionpää, Leena; Kovala, Tero; Tolonen, U.; Lanning, Marjatta

doi:10.1002/(sici)1096-911x(199701)28:1<41::aid-mpo8>3.0.co;2-t

Cited by 29 publications

(23 citation statements)

References 35 publications

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“…The frequency of reported neurological symptoms and signs corresponds with the results of other studies on neurological function in children treated for ALL with chemotherapy only, with gross motor difficulties, abnormal deep tendon reflexes, dysdiadochokinesia and0or fine motor problems being reported in 30-50% of children after the end of treatment (Harila-Saari et al, 1998;Harila-Saari et al, 2001;Reinders-Messelink et al, 1996) and still detectable in 8-30% of children 5 years after cessation of therapy (Lehtinen et al, 2002). Results of sensory and motor evoked potential studies suggest that neurological abnormalities are associated with demyelinative injury to central as well as peripheral nerve tracts (Harila-Saari et al, 2001;Lehtinen et al, 2002;Vainionpaa et al, 1997). In their studies on motor performance in children with ALL, ReindersMesselink et al (1996ReindersMesselink et al ( , 1999ReindersMesselink et al ( , 2001 found that problems with balance and gross motor performance occurred mainly during treatment and improved with time, while fine motor problems appeared after treatment.…”

Section: Discussionmentioning

confidence: 93%

“…Motor and somatosensory evoked potential studies have shown that there is a central nervous system component in motor and sensory dysfunction in children with ALL (HarilaSaari et al, 1998(HarilaSaari et al, , 2001Vainionpaa et al, 1997). CNSdirected chemotherapy for ALL, consisting of intrathecal methotrexate, alone or in combination with cytarabine and corticosteroids, and of systemic methotrexate and corticosteroids, is associated with central neurotoxicity (Kerr et al, 2001;Surtees et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

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Visuomotor control in survivors of childhood acute lymphoblastic leukemia treated with chemotherapy only

Buizer

Sonneville

Heuvel‐Eibrink

et al. 2005

J. Inter. Neuropsych. Soc.

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Treatment for childhood acute lymphoblastic leukemia (ALL), which includes CNS prophylaxis, is associated with central and peripheral neurotoxicity. The purpose of the present study was to analyze the effects of chemotherapy on various levels of visuomotor control in survivors of childhood ALL treated without cranial irradiation, and to identify risk factors for possible deficits. Visuomotor function was compared between children after treatment for ALL (n 5 34), children after treatment for Wilms tumor, which consists of non-CNS directed chemotherapy (n 5 38), and healthy controls (n 5 151). Three tasks were administered: a simple visual reaction time task and two tasks measuring visuomotor control with one requiring a higher level of cognitive control than the other. Visuomotor deficits were detected only in the ALL group, with poorer performance restricted to the condition requiring the highest level of control. Significant risk factors for poorer performance were female gender and a short time since end of treatment, and a trend was found for a young age at diagnosis. A high cumulative methotrexate dose was an adverse predictive factor in girls. The results indicate that chemotherapy-induced central neurotoxicity in childhood ALL treatment is associated with higher order visuomotor control deficits. Girls appear to be particularly vulnerable. (JINS, 2005, 11, 554-565.)

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Visuomotor control in survivors of childhood acute lymphoblastic leukemia treated with chemotherapy only

Buizer

Sonneville

Heuvel‐Eibrink

et al. 2005

J. Inter. Neuropsych. Soc.

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“…19 Methotrexate-related changes in myelin metabolism have been hypothesized to cause accumulation of interstitial fluid in the splitting myelin and the vacuoles, 20 and demyelination may be the result of damage to the oligodendroglial cells or secondary to ischemia. 21 However, the methotrexate-related changes are known to have a certain reversibility; therefore, the white matter changes observed on MRI may be transient and disappear during followup.…”

Section: Discussionmentioning

confidence: 99%

Motor nervous system impairment persists in long‐term survivors of childhood acute lymphoblastic leukemia

Lehtinen

Huuskonen

Harila‐Saari

et al. 2002

Cancer

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“…Even though the poor prognostic impact of traumatic lumbar puncture can be abolished by intensive systemic and intrathecal therapy, 15 every effort should be made to prevent its occurrence because intrathecal therapy can also adversely affect neuropsychologic and spinal cord functions. 32,33 Since recognition of the adverse consequences of traumatic lumbar puncture, 34 we correct thrombocytopenia before the diagnostic lumbar puncture, which is followed immediately by intrathecal treatment. Finally, intrathecal therapy is routinely performed by the most experienced clinician in our center, with patients under deep sedation or general anesthesia.…”

Section: Intrathecal Therapymentioning

confidence: 99%

Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment

Pui

2006

Hematology

105

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Improved treatment for acute lymphoblastic leukemia (ALL) has virtually eliminated testicular relapse. However, the control of central nervous system (CNS) leukemia remains a therapeutic challenge in childhood ALL, partly because of the late complications arising from cranial irradiation. In most current pediatric protocols, cranial irradiation (12 to 18 Gy) is given to 5% to 25% of patients—those with T-cell ALL, overt CNS disease (CNS3 status) or high-risk cytogenetics. CNS control is a less urgent concern in adults with ALL, in whom systemic relapse remains the major problem. With current approaches, approximately 2% to 10% of patients can be expected to develop CNS relapse. Children with B-cell precursor ALL who have a late CNS relapse (after an initial remission of 18 months or more) and did not receive cranial irradiation have an excellent outcome after retrieval therapy, with a 5-year event-free survival (EFS) rate approaching that in newly diagnosed patients. Innovative treatment options are needed for children who develop CNS relapses after a short initial remission or after receiving cranial irradiation, and in any adults with CNS leukemia at diagnosis or relapse.

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Chemotherapy for acute lymphoblastic leukemia may cause subtle changes of the spinal cord detectable by somatosensory evoked potentials

Cited by 29 publications

References 35 publications

Visuomotor control in survivors of childhood acute lymphoblastic leukemia treated with chemotherapy only

Visuomotor control in survivors of childhood acute lymphoblastic leukemia treated with chemotherapy only

Motor nervous system impairment persists in long‐term survivors of childhood acute lymphoblastic leukemia

Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment

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