Clinical and Electrophysiological Characteristics of Vincristine Induced Peripheral Neuropathy in Children

Background: Vincristine is a chemotherapeutic agent frequently used in the treatment of childhood cancer.  Peripheral neuropathy is an important side effect of Vincristine.  We assessed the incidence, severity and type of peripheral neuropathy in children on Vincristine using clinical parameters and nerve conduction studies.  Methods: Children with cancer treated with Vincristine were enrolled.  Symptoms and signs of motor, sensory and autonomic peripheral neuropathy at baseline and at 3, 6 and 12 month follow up were documented. A modified total neuropathy score grading was undertaken. Nerve conduction studies (NCS) were undertaken and vitamin E levels measured at the time of these assessments.Results: 28 patients were enrolled over 12 months. 93% had evidence of neuropathy clinically and/or electrophysiologically. Weakness, pain and constipation were the most common symptoms and the most common sign was loss of ankle reflexes.  The peripheral neuropathy was mild in most cases. Plasma levels of vitamin E remained in the normal range, however they dropped significantly from the baseline value.Conclusions: Peripheral neuropathy assessed clinically and electrophysiologically, occurs in the majority of children on Vincristine treatment. The neuropathy is sensory-motor and generally mild.  There was a statistically significant drop in average vitamin E levels during treatment.  Keywords: Vincristine, peripheral neuropathy, vitamin E