Hi all
I just went to see a little 6 yr old boy with a diagnosis of Post. Fossa
medullablastoma which was surgically removed Feb ‘98. He has just
finished 2 mths of radiation therapy and has just started what will be 9
mths of chemo ( 8 cycles)( vincristine, cytoblastin). His referring
diagnosis was foot drop+ dysmetria.
On presentation he walks indep. with a slightly inc. step height and a
little foot drop bilat…. his parents describe him as "clumsy" with
difficulty running. He also has a visual deficit which he is being
assessed for an eye patch, his R. eye tends to drift medially. On muscle
testing( as best I could do with a 6 yr old), he didn’t seem to have any
specific weaknesses and had intact sensation to light touch all
extremities. No c/o pain - he could also have some proprioceptive
deficits ( per Dr)
His parent were told this foot drop was a side effect of the chemo and
muscle weakness is listed as a side effect.
A web search netted lots of info on toxic drug induced peripheral
neuropathies but all the info was on adults and not peds…..most pts
described distal extremity sensory and pain probs rather than muscular
weakness
My questions to the group are:
1.The parents want to know at what point should they get worried about
these side effects…the Dr’s want to give him as high a dose as possible
but the parents are worried about lasting nerve damage. From the info I
read on adults, some of their neuropathies did not improve after
stopping chemo, do any of the pedi. PT’s have experience with this ?
2. I don’t know if there is much I can offer him in way of therapy..he
is attending school, plays with his friends..cannot bike ride due to his
hickman line and risk of falling. He has already been shown the usual DF
+ PF exs by a therapist in the hospital..any suggestions??
3. His foot drop is not at the point where orthotics are needed….my
main goal was to gather info for his parents and get feedback from
others specialised in this field
Thanks in advance
Mags
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