Skip to main content
SpringerLink
Log in

Clinical neurological findings of children with acute lymphoblastic leukaemia at diagnosis and during treatment

  • Hematology/Oncology
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Serial neurological evaluation was performed on 40 consecutive children with acute lymphoblastic leukaemia (ALL) at the time of diagnosis and during treatment. Abnormal neurological signs were found in 23% of the patients, including some without neurological symptoms on admission. Six patients (15%) had abnormal funduscopy findings, papilloedema or preretinal haemorrhages, and 3 of them had increased intracranial pressure measured in connection with a diagnostic lumbar puncture but without blasts in their CSF. The reason for the increased intracranial pressure remained unclear. The development of neurological symptoms caused by peripheral neuropathy during induction therapy was related to the total dose and duration of vincristine therapy. The most severe walking difficulties, patients moving about on all fours for as long as 6 weeks–5 months, occurred in a group who were significantly younger than the other children (P<0.03). Fine and gross motor disturbances occurred in 18% and 30% of the whole patient group, respectively, after 2–3 years of therapy. Impaired short-term memory was observed in 21% of the patients after 2–3 years of therapy, indicating impaired CNS function. The results indicate that chemotherapy also seems to influence CNS abilities, since there was no significant difference between the patients treated with or without cranial irradiation. Neurological evaluation of children with ALL at diagnosis and during treatment is of value with respect to abnormal findings which persist and are not caused by leukaemia, in order to determine the types of difficulties involved and to consider intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

ALL:

acute lymphoblastic leukaemia

HR:

high risk

IR:

intermediate risk

SR:

standard risk

References

  1. Allen JC (1978) The effects of cancer therapy on the nervous system. J Pediatr 93:903–909

    PubMed  Google Scholar 

  2. Appleton RE, Farrell K, Zaide J, Rogers P (1990) Decline in head growth and cognitive impairment in survivors of acute lymphoblastic leukaemia. Arch Dis Child 65:530–534

    PubMed  Google Scholar 

  3. Band PR, Holland JF, Bernard J, Weil M, Walker M, Rall D (1973) Treatment of central nervous system leukemia with intrathecal cytosine arabinoside. Cancer 32:744–748

    PubMed  Google Scholar 

  4. Bradley WG, Lassman LP, Pearce GW, Walton JN (1970) The neuromyopathy of vincristine in man. Clinical, electrophysiological and pathological studies. J Neurol Sci 10:107–131

    PubMed  Google Scholar 

  5. Brouwers P, Riccardi R, Fedio P, Poplack DG (1985) Long-term neuropsychologic sequelae of childhood leukemia: Correlation with CT brain scan abnormalities. J Pediatr 106:723–728

    PubMed  Google Scholar 

  6. Casey EB, Jellife AM, Le Quesne PM, Millett YL (1973) Vincristine neuropathy: clinical and electrophysiological observations. Brain 96:69–86

    PubMed  Google Scholar 

  7. Chessells JM, Cox TCS, Kendall B, Cavanagh NPC, Jannoun L, Richards S (1990) Neurotoxicity in lymphoblastic leukaemia: comparison of oral and intramuscular methotrexate and two doses of radiation Arch Dis Child 65:416–422

    PubMed  Google Scholar 

  8. Duttera MJ, Bleyer WA, Pomeroy TC, Leventhal CM, Leventhal BG (1973) Irradiation, methotrexate toxicity, and the treatment of meningeal leukaemia. Lancet II:703–707

    Google Scholar 

  9. Geiser CF, Bishop Y, Jaffe N, Furman L, Traggis D, Frei E III (1975) Adverse effects of intrathecal methotrexate in children with acute leukemia in remission. Blood 45:189–195

    PubMed  Google Scholar 

  10. Gerrard MP, Eden OB, Lilleyman JS (1986) Acute encephalopathy during induction therapy for acute lymphoblastic leukemia. Pediatr Hematol Oncol 3:49–58

    PubMed  Google Scholar 

  11. Gribbin MA, Hardisty RM, Chessels JM (1977) Long-term control of central nervous system leukaemia. Arch Dis Child 52:673–678

    PubMed  Google Scholar 

  12. Gustafsson G, Garwicz S, Hertz H, Johanesson G, Jonmundsson G, Moe PJ, Salmi T, Seip M, Siimes MA, Yssing M, Åhström L (1987) A population-based study of childhood acute lymphoblastic leukemia diagnosed from July 1981 through June 1985 in the five Nordic countries. Incidence, patient characteristics and treatment results. Acta Paediatr Scand 76:781–788

    PubMed  Google Scholar 

  13. Gustafsson G, Berglund G, Garwicz S, Hertz H, Jonmundsson G, Moe PJ, Salmi TT, Seip M, Siimes MA, Yssing M (1989) A population-based study of children with standard risk acute lymphoblastic leukemia in the five Nordic countries Acta Paediatr Scand 78:104–109

    PubMed  Google Scholar 

  14. Hanefeld F, Riehm H (1980) Therapy of acute lymphoblastic leukaemia in childhood: Effects on the nervous system. Neuropädiatrie 11:3–16

    Google Scholar 

  15. Harten G, Stephani U, Henze G, Langermann H-J, Riehm H, Hanefeld F (1984) Slight impairment of psychomotor skills in children after treatment of acute lymphoblastic leukemia. Eur J Pediatr 142:189–197

    PubMed  Google Scholar 

  16. Hyman CB, Bogle JM, Brubaker CA, Williams K, Hammond D (1965) Central nervous system involvement by leukemia in children. I. Relationship to systemic leukemia and description of clinical and laboratory manifestations Blood 25:1–12

    PubMed  Google Scholar 

  17. Ingram LC, Fairclough DL, Furman WL, Sandlund JT, Kun LE, Rivera GK, Pui C-H (1991) Cranial nerve palsy in childhood acute lymphoblastic leukemia and non-Hodgkin's lymphoma. Cancer 67:2262–2268

    PubMed  Google Scholar 

  18. Johnson FL, Bernstein ID, Hartmann JR, Chard RL Jr (1973) Seizures associated with vincristine sulfate therapy. J Pediatr 82:699–702

    PubMed  Google Scholar 

  19. Kay HEM, Knapton PJ, O'Sullivan JP, Wells DG, Harris RF, Innes EM, Stuart J, Schwartz FCM, Thompson EN (1972) Encephalopathy in acute leukaemia associated with methotrexate therapy. Arch Dis Child 47:344–354

    PubMed  Google Scholar 

  20. Korkman M (1988) NEPSY. A proposed neuropsychological test battery for young developmentally disabled children. Academic Dissertation. Yliopistopaino, Helsinki

    Google Scholar 

  21. Kreuger A, Garwicz S, Hertz H, Jonmundsson G, Lanning M, Lie SO, Moe PJ, Salmi TT, Schröder H, Siimes MA, Wesenberg F, Yssing M, Åhström L, Gustafsson G (1991) Central nervous system disease in childhood acute lymphoblastic leukemia: prognostic factors and results of treatment. Pediatr Hematol Oncol 8:291–299

    PubMed  Google Scholar 

  22. McIntosh S, Klatskin EH, O'Brien RT, Aspnes GT, Kammerer BL, Snead C, Kalavsky SM, Pearson HA (1976) Chronic neurologic disturbance in childhood leukemia. Cancer 37:853–857

    PubMed  Google Scholar 

  23. Meadows AT, Gordon J, Massari DJ, Littman P, Fergusson J, Moss K (1981) Declines in IQ scores and cognitive dysfunctions in children with acute lymphocytic leukaemia treated with cranial irradiation. Lancet II:1015–1018

    Google Scholar 

  24. Mulhern RK, Fairclough D, Ochs J (1991) A prospective comparison of neuropsychologic performance of children surviving leukemia who received 18-Gy, 24-Gy, or no cranial irradiation. J Clin Oncol 9:1348–1356

    PubMed  Google Scholar 

  25. Naiman JL, Rupprecht LM, Tanyeri G, Philippidis P (1970) Intrathecal methotrexate. Lancet I:571

    Google Scholar 

  26. Ochs JJ, Bowman WP, Pui C-H, Abromowitch M, Mason C, Simone JV (1984) Seizures in childhood lymphoblastic leukaemia patients. Lancet II:1422–1424

    Google Scholar 

  27. Paryani SB, Donaldson SS, Amylon MD, Link MP (1983) Cranial nerve involvement in children with leukemia and lymphoma. J Clin Oncol 1:542–545

    PubMed  Google Scholar 

  28. Peckham VC, Meadows AT, Bartel N, Marrero O (1988) Educational late effects in long-term survivors of childhood acute lymphocytic leukemia. Pediatrics 81:127–133

    PubMed  Google Scholar 

  29. Pinkerton CR, Chessells JM (1984) Failed central nervous system prophylaxis in children with acute lumphoblastic leukaemia: treatment and outcome. Br J Haematol 57:553–561

    PubMed  Google Scholar 

  30. Pochedly C (1975) Neurologic manifestations in acute leukemia. I. Symptoms due to increased cerebrospinal fluid pressure and hemorrhage NY State J Med 75:575–580

    Google Scholar 

  31. Reihm H, Reiter A, Schrappe M, Berthold F, Dopfer R, Gerein V, Ludwig R, Ritter J, Stollmann B, Henze G (1987) Die Corticosteroid-abhängige Dezimierung der Leukämiezellzahl im Blut als Prognosefaktor bei der akuten lymphoblastischen Leukämie im Kindesalter (Therapiestudie ALL-BFM 83). Klin Pädiatr 199:151–160

    Google Scholar 

  32. Russell NH, Lewis IJ, Martin J (1985) Acute lymphoblastic leukaemia presenting with raised intracranial pressure. Arch Dis Child 60:575–577

    PubMed  Google Scholar 

  33. Stephani U, Harten G, Langermann H-J, Riehm H, Hanefeld F, Habermalz E, Habermalz H-J (1983) Cranial computed tomography of 64 children in continous complete remission of leukemia II: Relations to patient data and neurological complications. Neuropediatrics 14:149–154

    PubMed  Google Scholar 

  34. Touwen BCL (1979) Examination of the child with minor neurological dysfunction, 2nd edn. Clinics in developmental medicine No 71. Heinemann Medical, London

    Google Scholar 

  35. Vainionpää L, Laitinen J, Lanning M (1992) Cranial computed tomographic findings in children with newly diagnosed acute lymphoblastic leukemia: a prospective follow-up study during treatment. Med Pediatr Oncol 20:273–278

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatrics, University of Oulu, Kajaanintie 52A, SF-90220, Oulu, Finland

    L. Vainionpää

Authors
  1. L. Vainionpää
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vainionpää, L. Clinical neurological findings of children with acute lymphoblastic leukaemia at diagnosis and during treatment. Eur J Pediatr 152, 115–119 (1993). https://doi.org/10.1007/BF02072486

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02072486

Key words

Search

Navigation