Neurophysiological findings in long-term survivors of acute lymphoblastic leukaemia in childhood treated with the BFM protocol 81 SR-A/B |
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| Authors: | M A Ueberall G Skirl H M Straßburg D Wenzel H Hertzberg T Langer W Meier K Berger-Jones W J Huk R Korinthenberg J D Beck |
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| Institution: | (1) Neuropaediatric Department, University Hospital for Children and Adolescents, Loschgestrasse 15, D-91054 Erlangen, Germany, Tel.: 091310-853118; Fax: 09131-853113, DE;(2) Department for Paediatric Oncology and Immunology, University Hospital for Children and Adolescents, Erlangen, Germany, DE;(3) Hospital for Psychosomatic Diseases, Bad Wildungen, Germany, DE;(4) Kaiserin Auguste-Victoria Children's Hospital, University Berlin, Berlin, Germany, DE;(5) Neuroradiology Department, University Erlangen, Erlangen, Germany, DE;(6) Neuropaediatric Department, Children's Hospital, University Freiburg, Freiburg, Germany, DE;(7) Neuropaediatric Department, Children's Hospital, University Jena, Germany, DE;(8) Neuropaediatric Department, Children's Hospital, Würzburg, Germany, DE |
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| Abstract: | Monitoring of therapy-related late effects after acute lymphoblastic leukaemia (ALL) therapy in childhood has become an increasingly
important field in posttherapeutic patient surveillance. The usefulness of neurophysiological investigations (e.g. EEG, evoked
potentials (EP)) as part of these attempts is controversial. The present report focuses on this problem and the question whether
and to what extent routinely performed EEG recordings and visual evoked potentials (VEP) were correlated with further measures
of CNS integrity. EEGs and VEPs were recorded in 163 asymptomatic long-term survivors of ALL in childhood during a large retrospective
multicentre study evaluating CNS late sequelae following antileukaemic therapy. Fifty-two ALL long-term survivors (4.5–10.6
years after end of therapy, median: 8.8 years), who had been treated according to BFM-81 SR-A (n=30) or SR-B (n=22) were selected for this analysis focusing on therapy-related CNS late effects. Therapy protocols differed with regard
to the mode for CNS prophylaxis: SR-A, cranial irradiation with intrathecal methotrexate; SR-B, intrathecal and iv methotrexate.
Neurophysiological findings were correlated with illness- and treatment-related parameters, as well as with data on the morphological,
neurological and psychological status of the CNS. At the time of follow-up neurophysiological measures were abnormal in 28/52
cases (53.8%). Neither illness- nor therapy-specific differences in CNS prophylaxis showed any relationship to EEG/VEP outcome
any relationship to EEG/VEP outcome in this reduced group of the whole study population. Children with EEG/VEP abnormalities
showed a significantly higher incidence of structural CNS disturbances compared to those with inconspicuous neurophysiological
recordings (60.9% vs 31.8%). However, in this special subject group there was no specific neurophysiological finding for a
specific morphological substrate, neurological or psychological deficiency and vice versa.
Conclusion Routinely performed EEG/VEP investi gations are not very helpful measures to predict the presence or degree of behavioural
deficiencies, neuro‐logical disturbances, or morphological CNS abnor‐malities. Patients who received cranial irradiation or
systemic methotrexate applications showed the same incidence of neurophysiological disturbances without evidence for specific
neurotoxic correlates.
Received: 29 March 1996 / Accepted: 9 December 1996 |
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| Keywords: | Acute lymphoblastic leukaemia Neurophysiology CNS late effects Quality of life |
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