Nerve damage

Chemotherapy, particularly vincristine, often causes acute peripheral neuropathies. Usually these are characterized by foot drop (when the front of the foot does not lift while walking), problems with balance, winging out of lower legs when running, and poor coordination. For some survivors, these symptoms persist for months or years. Survivors have noted changes in both muscle strength and sensation.

Children who relapse and have higher total doses of chemotherapy are much more at risk for persistent nerve problems than children or teens who are treated once and cured.

Surgery anywhere in the body can damage nerves and thus affect function or sensation. For example, both spinal cord and urinary tract surgeries can leave the survivor incontinent (i.e., unable to control urination or bowel movements). Survivors of limb-salvage surgery sometimes are left with no sensation to touch in certain areas of the limb.

Pressure on nerves from a prosthesis, wheelchair, or crutches can also affect nerve functioning.

Survivors of Hodgkin lymphoma (formerly called Hodgkin’s disease) treated on older protocols, including high-dose radiation, can experience neuropathies that affect sensation and function. The neuropathies can also result from vincristine and vinblastine in the combination drug therapy they receive. They occur during treatment and may subside with time or persist.

Another rarely reported late-effect is numbness, tingling, and electrical sensations in arms and/or legs that worsen when bending or twisting the head or neck. These sensations usually occur within months of high-dose radiation that involves the spinal cord but can appear years afterwards. These symptoms usually resolve on their own within months.

A very rare late effect after radiation to the brain and intrathecal chemotherapy is atrophy or destruction of the optic nerve which can cause blindness. Another very rare complication of radiation to the head and neck is vocal cord palsy (the nerves that tell the muscles to control movement of your voice do not work). Pressure from tumors directly on nerves can also affect motion and function.

Signs and symptoms of nerve damage

• Twitching face

• Decreased strength in hands and feet

• Tripping frequently

• Poor coordination

• Pain

• Dulled or absent sensation

• Paralysis

• Decreased vision

• Changes in the voice

Screening and detection of nerve damage

A thorough follow-up visit should include a full neurological examination and a discussion about physical activities. Any indication that there may be damage to the nerves should result in a referral to a neurologist for further testing. Vision changes should be evaluated by an ophthalmologist. (See Chapter 11, Eyes and Ears)

Medical management of nerve damage

Survivors with nerve damage from treatment may benefit from a referral to physical therapy for help with coordination and strength problems. Occupational therapy (OT) is often helpful if hand/eye coordination and visual-spatial problems persist after treatment.