(mentions CMT) The Natural History of Vincristine-Induced Laryngeal Paralysis in

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Arch Otolaryngol Head Neck Surg. 2009 Jan;135(1):101-105.

The Natural History of Vincristine-Induced Laryngeal Paralysis in

Children.

Kuruvilla G, S, B, El-Hakim H.

FRCS(Ed), FRCS(ORL), Pediatric Otolaryngology Service, Division of

Pediatric Surgery, The Stollery Children's Hospital, 2C3.57 Walter

MacKenzie Centre, Edmonton, AB T6G 2R7, Canada.

OBJECTIVE: To outline the natural history of vincristine-induced

laryngeal paralysis (VLP) in children.

DESIGN: Retrospective case series and review of reported cases in the

English-language literature.

SETTING: Tertiary pediatric center.

PATIENTS: The study included all children with a confirmed diagnosis

of VLP by inspection and with complete clinical information. The

sources for patient identification were a prospectively kept database

and a review of the English-language literature, conducted on PubMed

since 1966, as well as a bibliography search.

MAIN OUTCOME MEASURES: Charts and literature were reviewed for

demographics, primary diagnosis, other diagnoses, and duration and

method of treatment. The prevalence of VLP, locally, was also

calculated.

RESULTS: Four children (3 boys and 1 girl) were identified in our

database over a 5(1/2)-year period, and 10 children (1 girl, 8 boys,

and 1 with sex omitted) were described in the English-language

literature. Four children had unilateral vocal fold paralysis only,

all left-sided. The median age was 2.6 years. Acute lymphoblastic

leukemia was the underlying diagnosis in 8 patients. Two patients had

Down syndrome, and 1 patient had Charcot-Marie-Tooth disease, type 1.

Only 2 patients required tracheotomies, and 1 patient was treated

temporarily with bilevel positive-pressure ventilation. The median

duration of paralysis was 6.8 weeks. The prevalence of VLP was 1.36%.

CONCLUSIONS: The data suggest that VLP is probably underreported and

possibly underdiagnosed. Endoscopic inspection is a must in all

patients with airway symptoms who are receiving vicristine therapy.

Early recognition of VLP is mandatory, as it is reversible, has a

good prognosis, and usually needs only interruption of vincristine

therapy and conservative treatment.