Chemotherapy for acute lymphoblastic leukemia may cause subtle changes of the spinal cord detectable by somatosensory evoked potentials
✍ Scribed by Vainionpää, Leena; Kovala, Tero; Tolonen, Uolevi; Lanning, Marjatta
- Publisher
- John Wiley and Sons
- Year
- 1997
- Tongue
- English
- Weight
- 76 KB
- Volume
- 28
- Category
- Article
- ISSN
- 0098-1532
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✦ Synopsis
Intrathecal chemotherapy has been deter-ALL after receiving intrathecal methotrexate mined to cause transient or permanent parapare-therapy during the induction and CNS therapy sis due to myelopathy in patients with leukemia phases when compared with their controls. The or other malignancies. To systematically evalu-difference of the mean latencies was 1.45 ms ate the effect of methotrexate on spinal cord (95% CI 0.39-2.51;P Ͻ 0.01). There was no sigfunction, somatosensory evoked potentials (SEP) nificant delay in the median nerve SEP from were measured in children with acute lympho-the brain stem to the cortex, indicating that the blastic leukemia (ALL). A prospective evaluation conduction delay was in the area of the spinal was performed in 38 consecutive children aged cord exposed to intrathecal methotrexate. More-1.4-15.3 years with newly diagnosed ALL dur-over, the cortical amplitudes of the median nerve ing treatment. Intrathecal methotrexate therapy SEPs were significantly reduced when measured was included in the therapy schedule of all pa-immediately after intravenous and intrathecal tients as central nervous system (CNS) therapy methotrexate and compared to the amplitudes in addition to intravenous chemotherapy in 19 measured after induction therapy in standard standard risk patients and intravenous chemo-risk patients (P ϭ 0.001). Intrathecal methotrextherapy with cranial irradiation in 19 intermedi-ate with systemic chemotherapy causes a deteriate or high-risk patients. The measured conduc-oration in the somatosensory pathways within tion times were compared with those of 38 the CNS, suggesting also spinal cord dysfunction control children matched for age, height, and in children with ALL in addition to the cerebral sex. A significant increase in the conduction dysfunction described earlier. time of the tibial nerve SEP was found between ᮊ 1997 Wiley-Liss, Inc. the Th12 level and the cortex in children with