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Klin Padiatr 2006; 218(6): 350-354
DOI: 10.1055/s-2006-942276
Case Report

© Georg Thieme Verlag Stuttgart · New York

Acute Ascending Motoric Paraplegia Following Intrathecal Chemotherapy for Treatment of Acute Lymphoblastic Leukemia in Children: Case Reports and Review of the Literature

Akute aszendierende motorische Paraplegie nach intrathekaler Chemotherapie im Rahmen der Behandlung einer akuten lymphoblastischen Leukämie bei Kindern: Fallberichte und LiteraturübersichtN. Rolf1 , H. Boehm2 , A. M. Kaindl3 , I. Lauterbach1 , M. Suttorp1
  • 1University Children's Hospital, Technical University of Dresden, Germany
  • 2Children's Hospital Josefinum, Augsburg, Germany
  • 3Department of Pediatric Neurology, Charité, University Medicine Berlin, Germany
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Publication History

Publication Date:
02 November 2006 (online)

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Abstract

Severe side effects of chemotherapy in pediatric patients with acute lymphoblastic leukemia are rare, but well-known. We present two pediatric patients who developed ascending motoric paraplegia (AMP) following intrathecal chemotherapy. Both patients suffered from progressive weakness of their lower extremities, neurogenic bladder dysfunction, autonomous neural dysregulation and minor sensory deficits. Despite an initially similar clinical picture, progression and outcome were fairly different. There is convincing evidence that AMP is caused by spinal cord toxicity of intrathecally applied toxic agents such as cytarabin and/or methotrexate leading to spinal demyelinisation as demonstrated by elevated myelin basic protein in cerebrospinal fluid.

Zusammenfassung

Bei pädiatrischen Patienten mit akuter lymphoblastischer Leukämie sind schwere Nebenwirkungen der Chemotherapie selten, aber gut bekannt. Wir berichten über zwei Kinder, die im Anschluss an eine intrathekale Applikation von Chemotherapeutika eine aszendierende motorische Paraplegie (AMP) entwickelten. Beide Patienten zeigten eine progressive Muskelschwäche der unteren Extremitäten, eine neurogene Blasenfunktionsstörung, autonome Dysregulationen und leichte Sensibilitätsdefizite. Trotz anfangs ähnlicher klinischer Symptomatik war der weitere Krankheitsverlauf deutlich unterschiedlich. Es gibt überzeugende Hinweise, dass eine AMP durch die spinale Toxizität von intrathekal verabreichten Chemotherapeutika wie Cytarabin und/oder Methotrexat verursacht wird. Eine resultierende spinale Demyelinisierung kann anhand erhöhter Myelin-Basic-Protein-Werte im Liquor nachgewiesen werden.

Key words

ascending motoric paraplegia - spinal cord toxicity - intrathecal chemotherapy - leukemia - children

Schlüsselwörter

aszendierende motorische Paraplegie - Rückenmarktoxizität - intrathekale Chemotherapie - Leukämie - Kinder

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Dr. med. N. Rolf

University Children's Hospital · Pediatric Hematology and Oncology · Technical University of Dresden

Fetscherstr. 74

01307 Dresden

Germany

Phone: +49/3 51/4 58 35 22

Fax: +49/3 51/4 58 57 88

Email: nina.rolf@uniklinikum-dresden.de

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