Electrophysiological changes of peripheral neuropathy with vincristine after a physical therapy program in pediatric patients with acute lymphoblastic leukemia

Background: Vincristine is among the drugs used for the treatment of patients with acute lymphoblastic leukemia (ALL). Because it is time-and dose-dependent, it is a drug whose most-feared effect is affectation of the peripheral nerves. It produces long-term physical incapacity that limits activities of daily living. We undertook this study to demonstrate that ALL patients who were enrolled in a supervised program of physical therapy presented confirmed improvement using the nerve conduction velocity (NCV) test of motor and sensorial nerves. Methods: This was an experimental, comparative, longitudinal, and prospective study carried out in the Department of Rehabilitation of the Hospital Infantil of Mexico "Federico Gomez." Twenty four patients who fulfilled the inclusion criteria were included. Patients were divided into two groups: group 1-supervised group who received a program of regular, supervised physical therapy for 3 months and group 2-unsupervised group who received a regular program of physical therapy. In both groups, NCV studies were carried out prior to and subsequent to the physical therapy regime. Latency, amplitude and NCV of sensorial and motor nerves of the four extremities were compared. Results: The peroneal nerve was affected in 98% of the cases and axonal degeneration was the most frequent neuropathy appearing in 96% of subjects. Relationship of the results obtained in the NCV studies (both prior and subsequent) in both groups was statistically nonsignificant (P > 0.01), whereas the relationship of the NCV studies between groups was statistically significant (P < 0.01). Under appropriate supervision and monitoring, the physical therapy program for patients with leukemia and neuropathy treated regularly with vincristine displays major benefits that are able to be measured objectively by NCV studies.