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After treatment and remission

Nervous system

The nervous system is made up of the brain, the spinal cord and the nerves that reach throughout the body. This topic explains which long-term effects leukaemia treatment can have on the nervous system, their signs and how they are monitored.

Last updated: ~3 min read
A network of light from the brain to the hands and feet.
Figure 1.The nervous system runs from the brain through the whole body.

01Short answer

The nervous system has two parts: the central nervous system (brain and spinal cord) and the peripheral nervous system (nerves to the arms, legs and organs). Some parts of leukaemia treatment can affect it. The central nervous system is affected mainly by chemotherapy given into the spinal fluid (intrathecal), high-dose methotrexate and cytarabine, and cranial radiation; these are used especially in ALL treatment. Possible late effects include memory and attention difficulties (see topic “Memory and attention”), headaches and, rarely, seizures, stroke or small blood vessel changes years after cranial radiation. Peripheral nerves can be affected by medicines such as vincristine and bortezomib, causing neuropathy — tingling, numbness, pain or weakness in the hands and feet (topic “Neuropathy”). Many of these effects improve over time. The COG recommends a yearly neurological check for people at risk. Tell your doctor about new or worsening signs.

02Simple explanation

The nervous system is the brain, spinal cord and nerves.

Treatments with risk: intrathecal chemotherapy, cranial radiation, vincristine.

Possible effects: neuropathy, memory, headaches.

Many effects improve over time.

Follow-up: a yearly check.

03Scientific explanation

Central effects: according to the NCI, intrathecal methotrexate, high-dose methotrexate/cytarabine and cranial radiation raise the risk of neurocognitive late effects; radiation dose and young age affect the risk.

Blood vessel effects: the COG notes a slightly higher risk of stroke and small vessel changes years after cranial radiation.

Peripheral neuropathy: according to NINDS, nerve damage causes tingling, numbness, burning pain and weakness; vincristine-related neuropathy often improves after the medicine is stopped.

Modern treatment: most ALL protocols now use cranial radiation very rarely, which reduces late effects (ACS).

04What happens in the body?

How does the nervous system work?

The brain sends and receives signals; they travel along nerves to muscles, skin and organs.

A pulse of light travelling along a fibre.
Figure 2.Nerves carry signals.

Which treatment affects it?

Chemotherapy into the spinal fluid, high-dose methotrexate and cytarabine, cranial radiation (brain) and medicines such as vincristine (peripheral nerves).

Possible signs

Tingling or numbness in the hands and feet, balance problems, muscle weakness, headaches, memory and attention difficulties; rarely, seizures.

How is it monitored?

The doctor does a neurological exam (reflexes, strength, sensation, balance). If needed, an MRI, nerve conduction study or neuropsychological assessment.

A dome of light around a brain shape.
Figure 3.The brain is protected during and after treatment.

Support

Physiotherapy, occupational therapy, pain management and adjustments at school or work make daily life easier.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05Nervous system follow-up

Steps.

Notice — Tingling, numbness, headaches.1NoticeTingling, numbness, headaches.
Tell — Note symptoms and tell your doctor.2TellNote symptoms and tell your doctor.
Exam — Neurological exam, MRI if needed.3ExamNeurological exam, MRI if needed.
Support — Physiotherapy, rehabilitation.4SupportPhysiotherapy, rehabilitation.
BrainFunction is monitored.
SensationNeuropathy eases.
MovementBalance is restored.

06Late effects on the nervous system (simplified)

EffectMain causeWhat is done
Peripheral neuropathyVincristine, bortezomibExam, physiotherapy
Memory and attentionIntrathecal chemotherapy, cranial radiationNeuropsychological assessment
SeizuresEffects on the brain (rare)Neurologist, treatment
Stroke riskCranial radiation (years later)Control of risk factors

* Your doctor decides which checks you need.

07Key terms

Central nervous system
The brain and spinal cord.
Peripheral nerve
A nerve to the arms, legs or organs.
Intrathecal
Given into the spinal fluid.
Neuropathy
Nerve damage.
Neurocognitive
Related to memory, attention and thinking.
MRI
Magnetic imaging of the brain.

08Key points

  • Treatment can affect the nervous system.
  • Many effects improve over time.
  • Report tingling.
  • Have a yearly check.
  • Rehabilitation helps.
  • Call emergency services for stroke signs.

09Frequently asked questions

Will the tingling in my feet go away?

It often eases over time; your doctor will monitor it.

I had cranial radiation — what should I do?

Regular checks and control of blood pressure and cholesterol.

Are headaches normal?

Tell your doctor about any new or worsening headache.

Which specialist can help?

A neurologist, physiotherapist or neuropsychologist.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Will the tingling in my feet go away?

  2. I had cranial radiation — what should I do?

  3. Are headaches normal?

  4. Which specialist can help?

  5. Does this information replace medical advice?

My questions

12Sources

  1. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers
  2. National Cancer Institute (NCI). Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version
  3. National Institute of Neurological Disorders and Stroke. Peripheral Neuropathy
  4. MedlinePlus (U.S. National Library of Medicine). Seizures
  5. MedlinePlus (U.S. National Library of Medicine). Stroke
  6. National Cancer Institute (NCI). Follow-Up Medical Care
  7. National Cancer Institute (NCI). Cancer Survivorship
  8. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  9. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
  10. NHS. Physical activity guidelines for adults aged 19 to 64
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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