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Viinikainen K, Isohanni P, Kanerva J, Lönnqvist T, Lauronen L. Without ENMG, detecting pediatric vincristine neuropathy is a challenge. Clin Neurophysiol Pract 2024; 9:94-101. [PMID: 38440119 PMCID: PMC10910158 DOI: 10.1016/j.cnp.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 03/06/2024] Open
Abstract
Objective Vincristine, a widely used anticancer chemotherapy drug, may cause polyneuropathy (PNP), potentially resulting in permanent functional impairment. We characterized the occurrence and development of vincristine-induced neuropathy (VIPN) in early treatment of childhood leukemia. Methods This prospective study of 35 pediatric acute lymphoblastic leukemia (ALL) patients comprised systematic clinical and electrophysiological studies at both the time of diagnosis and at least one time point during the first months of treatment. Results After vincristine treatment, all patients had axonal sensorimotor PNP on electroneuromyography (ENMG) In 34/35 patients, the motor and in 24/35 the sensory responses were decreased. Interestingly, in 3 patients PNP was most prominent in the upper limb. However, some children had no PNP symptoms despite moderate ENMG findings, and not all clinical symptoms were correlated with abnormal ENMG. Conclusions Pediatric VIPN is a sensorimotor, predominantly motor axonal neuropathy. VIPN can be detected even in its early phase by ENMG, but it is difficult to detect by symptoms and clinical examination only. Significance Pediatric ALL patients treated with vincristine are at risk of developing VIPN. Since the clinical signs of PNP in acutely ill children are difficult to identify, VIPN can easily be overlooked if ENMG is not performed.
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Affiliation(s)
- Kreeta Viinikainen
- Department of Child Neurology, Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
| | - Pirjo Isohanni
- Department of Child Neurology, Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jukka Kanerva
- Department of Pediatrics, Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuula Lönnqvist
- Department of Child Neurology, Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
| | - Leena Lauronen
- Department of Clinical Neurophysiology, Children’s Hospital, HUH Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Li T, Kandula T, Cohn RJ, Kiernan MC, Park SB, Farrar MA. Prospective assessment of vincristine-induced peripheral neuropathy in paediatric acute lymphoblastic leukemia. Clin Neurophysiol 2023; 154:157-168. [PMID: 37633123 DOI: 10.1016/j.clinph.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE Vincristine is a mainstay treatment for paediatric cancers, particularly acute lymphoblastic leukemia (ALL), with common toxicity including vincristine-induced peripheral neuropathy (VIPN). The present study comprehensively assessed VIPN outcomes in patients receiving vincristine treatment for ALL. METHODS Children diagnosed with ALL commencing vincristine treatment were prospectively evaluated (baseline, post-induction, pre-reinduction, post-reinduction, follow-up). VIPN was examined clinically using the Balis sensory/motor scale, neurophysiologically using axonal excitability techniques and quality-of-life using Pediatric Quality of Life Inventory. RESULTS Thirty-one patients were recruited to this study (age = 6.8 ± 4.4; 61.3% female). Incidence of motor VIPN (motor Balis grade > 0) symptoms were higher than sensory VIPN (sensory Balis grade > 0) at post-induction (92.0% vs 36.0%) and post-reinduction (81.8% vs 22.7%) vincristine treatment. Neurophysiological assessment also demonstrated greater change in motor axonal excitability parameters compared to sensory parameters including changes in depolarising threshold electrotonus (P < 0.0125), superexcitability and subexcitability parameters (all P < 0.0125). Follow-up assessment demonstrated persisting VIPN symptoms with reduced quality-of-life scores compared to baseline. CONCLUSIONS Clinical and neurophysiological evaluation of VIPN suggests vincristine produces a motor-prominent sensorimotor neuropathy in children which persisted at follow-up. SIGNIFICANCE VIPN signs and symptoms develop early in the treatment course, in line with axonal excitability profiles. Early detection of significant nerve changes may support timely implementation of neuroprotection strategies.
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Affiliation(s)
- Tiffany Li
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Tejaswi Kandula
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia; Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, New South Wales, Australia; Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Susanna B Park
- Faculty of Medicine and Health, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia.
| | - Michelle A Farrar
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia; Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, New South Wales, Australia
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Hernandez-Reynoso AG, Corona-Quintanilla DL, López-García K, Horbovetz AA, Castelán F, Zimmern P, Martínez-Gómez M, Romero-Ortega MI. Targeted neuromodulation of pelvic floor nerves in aging and multiparous rabbits improves continence. Sci Rep 2021; 11:10615. [PMID: 34011938 PMCID: PMC8136474 DOI: 10.1038/s41598-021-90088-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/30/2021] [Indexed: 02/03/2023] Open
Abstract
Pelvic floor muscle stretch injury during pregnancy and birth is associated with the incidence of stress urinary incontinence (SUI), a condition that affects 30-60% of the female population and is characterized by involuntary urine leakage during physical activity, further exacerbated by aging. Aging and multiparous rabbits suffer pelvic nerve and muscle damage, resulting in alterations in pelvic floor muscular contraction and low urethral pressure, resembling SUI. However, the extent of nerve injury is not fully understood. Here, we used electron microscopy analysis of pelvic and perineal nerves in multiparous rabbits to describe the extent of stretch nerve injury based on axon count, axon size, myelin-to-axon ratio, and elliptical ratio. Compared to young nulliparous controls, mid-age multiparous animals showed an increase in the density of unmyelinated axons and in myelin thickness in both nerves, albeit more significant in the bulbospongiosus nerve. This revealed a partial but sustained damage to these nerves, and the presence of some regenerated axons. Additionally, we tested whether electrical stimulation of the bulbospongiosus nerve would induce muscle contraction and urethral closure. Using a miniature wireless stimulator implanted on this perineal nerve in young nulliparous and middle age multiparous female rabbits, we confirmed that these partially damaged nerves can be acutely depolarized, either at low (2-5 Hz) or medium (10-20 Hz) frequencies, to induce a proportional increase in urethral pressure. Evaluation of micturition volume in the mid-age multiparous animals after perineal nerve stimulation, effectively reversed a baseline deficit, increasing it 2-fold (p = 0.02). These results support the notion that selective neuromodulation of pelvic floor muscles might serve as a potential treatment for SUI.
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Affiliation(s)
- Ana G Hernandez-Reynoso
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, 75080, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, 75390, USA
- Department of Biomedical Engineering and Biomedical Sciences, University of Houston, Houston, TX, 77204, USA
| | - Dora L Corona-Quintanilla
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, Tlaxcala, Mexico
| | - Kenia López-García
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones Biomédicas, Universidad Autónoma de México, Tlaxcala, Tlaxcala, Mexico
| | - Ana A Horbovetz
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Francisco Castelán
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, Tlaxcala, Mexico
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones Biomédicas, Universidad Autónoma de México, Tlaxcala, Tlaxcala, Mexico
| | - Philippe Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, 75390, USA
| | - Margarita Martínez-Gómez
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, Tlaxcala, Mexico
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones Biomédicas, Universidad Autónoma de México, Tlaxcala, Tlaxcala, Mexico
| | - Mario I Romero-Ortega
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, 75390, USA.
- Department of Biomedical Engineering and Biomedical Sciences, University of Houston, Houston, TX, 77204, USA.
- Department of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, 75390, USA.
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