Visuomotor control in survivors of childhood acute lymphoblastic leukemia treated with chemotherapy only

Abstract

Treatment for childhood acute lymphoblastic leukemia (ALL), which includes CNS prophylaxis, is associated with central and peripheral neurotoxicity. The purpose of the present study was to analyze the effects of chemotherapy on various levels of visuomotor control in survivors of childhood ALL treated without cranial irradiation, and to identify risk factors for possible deficits. Visuomotor function was compared between children after treatment for ALL (n 5 34), children after treatment for Wilms tumor, which consists of non-CNS directed chemotherapy (n 5 38), and healthy controls (n 5 151). Three tasks were administered: a simple visual reaction time task and two tasks measuring visuomotor control with one requiring a higher level of cognitive control than the other. Visuomotor deficits were detected only in the ALL group, with poorer performance restricted to the condition requiring the highest level of control. Significant risk factors for poorer performance were female gender and a short time since end of treatment, and a trend was found for a young age at diagnosis. A high cumulative methotrexate dose was an adverse predictive factor in girls. The results indicate that chemotherapy-induced central neurotoxicity in childhood ALL treatment is associated with higher order visuomotor control deficits. Girls appear to be particularly vulnerable. (JINS, 2005, 11, 554-565.)

Neuropsychological profile of patients with acute lymphoblastic leukemia.

“…However, we did observe lower scores, mainly in the number of correct responses on part 3 of the test that investigated selectivity/alternation, compared with the scores of healthy children in the same age group. These findings are consistent with the observations by Buizer et al (2005) who reported that children with ALL and who received standard treatment had similar performance as healthy children in attention and information processing, with the exception of attention flexibility. Mennes et al (2005) reported that their results, which were similar to the present results, disagreed with some findings obtained in children who were cured of ALL and experienced attention capacity problems.…”

“…According to Mulhern & Palmer (2003) and Buizer et al (2005), several of the core deficits exhibited by ALL survivors are defined by the term "executive function," characterized by the capacity to allocate attention resources and organize behavior and thinking, which rely on the integrity of the prefrontal cortex. We found that the lowest scores were in the group of children in treatment compared with the children off treatment.…”

“…The majority of these studies determined that the distribution and proliferation of white matter were the main factors associated with such deficits (Moleski, 2000;Carey et al, 2007;Campbell et al, 2009). One hypothesis is that developing areas are more susceptible to injuries or lesions than mature areas (Buizer et al, 2005).…”

Quantitative morphologic evaluation of magnetic resonance imaging during and after treatment of childhood leukemia

“…No differences were detected on any neurocognitive measure between patients treated on different doses of MTX. This study was discussed in the context of the reports by Buizer et al [98,99] who identified subtle deficits in attention and visuomotor control in ALL survivors who received higher doses of IV-MTX. ALL survivors also have more behavioral and educational problems [100].…”

Associating Physical Activity Levels with Motor Performance and Physical Function in Childhood Survivors of Acute Lymphoblastic Leukemia

“…However, a cancer diagnosis disrupts opportunities for normal development and PA participation because of hospitalization and treatment side effects, both of which contribute to physical impairments and reduced motivation. 12 Specific to ALL survivors, evidence has suggested that vincristine 13,14 and methotrexate 15 treatments directly relate to motor performance impairments during and after treatment. Anthracycline treatment has well-documented, potentially long-term cardiotoxic side effects, and it potentially limits physical function.…”