Weaver Lauren, Samkari Ayman
From the Section of Neurology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA.
Section of Oncology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA.
Semin Pediatr Neurol. 2017 Feb;24(1):60-69. doi: 10.1016/j.spen.2016.12.005. Epub 2016 Dec 23.
Though the treatment of pediatric cancers has come a long way, acute and chronic effects of cancer are still affecting the life of many children. These effects may be caused not only by the malignancy itself but also by the interventions used for the purpose of treatment. This article focuses primarily on the indirect effects of pediatric cancers and their treatment on the central and peripheral nervous system. Chemotherapy, radiation, and stem cell transplantation cause an immune-compromised state and place the patient at risk of infection, the leading cause of mortality in pediatric cancer. The underlying cancer and the treatments also cause neurovascular changes that may lead to neurological sequelae immediately or many years in the future. Chemotherapy and radiation have both immediate and long-term neurotoxic effects on the central and peripheral nervous system. Cancers may also trigger an immune response that damages nervous system components, leading to altered mental status, seizures, abnormal movements, and even psychosis. Knowledge of these effects can help the practitioner be more vigilant for the signs and symptoms of potential neurological complications during the management of pediatric cancers.
尽管儿童癌症的治疗已经取得了长足的进步，但癌症的急性和慢性影响仍在影响着许多儿童的生活。这些影响不仅可能由恶性肿瘤本身引起，还可能由用于治疗目的的干预措施导致。本文主要关注儿童癌症及其治疗对中枢和外周神经系统的间接影响。化疗、放疗和干细胞移植会导致免疫功能低下状态，使患者面临感染风险，而感染是儿童癌症死亡的主要原因。潜在的癌症和治疗方法也会引起神经血管变化，这可能会立即或在未来许多年导致神经后遗症。化疗和放疗对中枢和外周神经系统都有即时和长期的神经毒性作用。癌症还可能引发免疫反应，损害神经系统成分，导致精神状态改变、癫痫发作、异常运动，甚至精神病。了解这些影响有助于医生在儿童癌症管理过程中对潜在神经并发症的体征和症状更加警惕。
