Motor function in survivors of pediatric acute lymphoblastic leukemia treated with chemotherapy-only

Eur J Paediatr Neurol. 2019 Mar;23(2):304-316. doi: 10.1016/j.ejpn.2018.12.005. Epub 2018 Dec 17.

Abstract

Background: Up to 43% of survivors of pediatric acute lymphoblastic leukemia (ALL) may exhibit fine-motor problems. Information on manual dexterity in this cohort is still limited.

Objectives: We tested survivors of childhood ALL treated with chemotherapy-only for fine-motor function in terms of drawing and handwriting abilities using a Digitizing Tablet (DT) with three tasks for drawing and handwriting of varying complexity, for ataxia using the International Cooperative Ataxia Rating Scale (ICARS), and for tremor and hand-eye coordination using the Nine Hole Steadiness Tester (NHST).

Results: We examined a cohort of non-irradiated survivors (n = 31) after a median time of 3.5 years after end of therapy. In all tasks of the DT the cohort demonstrated significant (p < 0.05) impairment of speed, automation, and variability in at least two tasks and significantly more pressure. Impaired speed (SPV) inversely correlated with lag time since end of therapy. Dexterity performance of six survivors (19%) lay below the 5th percentile. No survivor exhibited ataxia, tremor, or impaired hand-steadiness.

Conclusion: Despite the absence of gross ataxia, tremor, and impaired hand-eye coordination, we nevertheless detected significant fine-motor impairment in a relevant number of survivors of childhood ALL. Prospective studies are needed to reveal the pathophysiological underpinnings and genetic risk factors for development of such deficits due to ALL and its treatment.

Keywords: Ataxia; Chemotherapy-only; Childhood acute lymphoblastic leukemia; Fine-motor impairment; Hand-eye coordination; Tremor.

MeSH terms

  • Adolescent
  • Antineoplastic Agents / adverse effects*
  • Cancer Survivors*
  • Child
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Motor Skills Disorders / chemically induced*
  • Motor Skills Disorders / epidemiology*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Prospective Studies

Substances

  • Antineoplastic Agents