Peripheral Neuropathy, Sensory Processing, and Balance in Survivors of Acute Lymphoblastic Leukemia

Abstract

Purpose To compare peripheral nervous system function and balance between adult survivors of childhood acute lymphoblastic leukemia (ALL) and matched controls and to determine associations between peripheral neuropathy (PN) and limitations in static balance, mobility, walking endurance, and quality of life (QoL) among survivors. Patients and Methods Three hundred sixty-five adult survivors of childhood ALL and 365 controls with no cancer history completed assessments of PN (modified Total Neuropathy Score [mTNS]), static balance (Sensory Organization Test [SOT]), mobility (Timed Up and Go), walking endurance (6-minute walk test), QoL (Medical Outcomes Study 36-Item Short Form Survey), and visual-motor processing speed (Wechsler Adult Intelligence Scale). Results PN, but not impairments, in performance on SOT was more common in survivors than controls (41.4% v 9.5%, respectively; P < .001). In multivariable models, higher mTNS scores were associated with longer time to complete the Timed Up and Go (β = 0.15; 95% CI, 0.06 to 0.23; P < .001), shorter distance walked in 6 minutes (β = -4.39; 95% CI, -8.63 to -0.14; P = .04), and reduced QoL (β = -1.33; 95% CI, -1.79 to -0.87; P < .001 for physical functioning; β = -1.16; 95% CI, -1.64 to -0.67; P < .001 for role physical; and β = -0.88; 95% CI, -1.34 to -0.42; P < .001 for general health). Processing speed (β = 1.69; 95% CI, 0.98 to 2.40; P < .001), but not mTNS score, was associated with anterior-posterior sway on the SOT. Conclusion PN in long-term ALL survivors is associated with movement, including mobility and walking endurance, but not with static standing balance. The association between processing speed and sway suggests that static balance impairment in ALL survivors may be influenced by problems with CNS function, including the processing of sensory information.

Chemotherapy-induced peripheral neuropathy: longitudinal analysis of predictors for postural control

“…Several studies investigated static postural control in cancer patients in response to neurotoxic treatments, applying quantitative center of pressure (COP) analyses using a force plate 3 – 10 . However, available data are heterogeneous as to the time point of COP analysis, and the investigation of risk or protective factors.…”

A review of movement disorders in chemotherapy-induced neurotoxicity

“…Researchers investigating the relationship between increased postural sway and peripheral sensory neuropathy relied on various measures to assess the state of the peripheral sensory system, including subjective reports of sensory symptoms (e.g., severity of numbness/tingling, Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-neurotoxicity (FACT&GOG-Ntx), and CIPN 20-item quality of life questionnaire (CIPN20)) [ 21 , 29 , 32 , 33 , 40 ], vibration perception threshold [ 29 , 40 ], and conduction studies of peripheral nerves [ 33 ]. Composite scores that combine subjective symptoms and objective measures of sensory signs and reflexes (e.g., modified Total Neuropathy Score (mTNS)) [ 24 , 41 ] were also used [ 33 ]. Zahiri et al 2019 identified a significant correlation between the ML sway and plantar vibration perception threshold in patients reporting feet numbness/tingling [ 29 ].…”

“…Both studies quantified a composite score of postural sway during six standing conditions and mTNS. Wampler et al found a significant association between the composite score and the mTNS score in a group of breast cancer patients, but Varedi et al studying a cohort of adult survivors of childhood acute lymphoblastic leukemia did not find the same association [ 24 , 41 ]. Although different measures of postural sway and neuropathy were used in these correlational studies, the majority support an association of excessive postural sway with peripheral sensory deficits.…”

“…CIPN+ had greater ML sway deficits compared to CIPN−, particularly during rigid surface conditions. Varedi 2018 [ 41 ] Adult survivors of childhood acute lymphoblastic leukemia: N = 365 Sex-, race-, and age- (within 5 years) matched controls: N = 365 Dynamic posturography implemented the Sensory Organization Test (SOT) SOT score, somatosensory ratio, vision ratio and vestibular ratio TUG 6MWT quality of life mTNS AROM of DF and PF Visual-motor processing speed SOT score was not different between PAT and CT. Higher mTNS score was associated with longer TUG, shorter 6MWT, and reduced quality of life. Poorer visual-motor processing speed was associated with poorer SOT, TUG, and quality of life.…”

Balance deficits in long-term pediatric ALL survivors

“…In a recent study of long-term childhood ALL survivors [5], we examined the potential effect of peripheral neuropathy on static and dynamic measures of balance. As hypothesized, the level of peripheral neuropathy was associated with poorer performance on dynamic measures of mobility (i.e., Timed Up and Go test) and endurance (i.e., 6-Minute Walk test); however the level of peripheral neuropathy was not associated with sway values for maintaining an upright posture on a dynamic posturography device.…”