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Do you use NMES for kids with peripheral neuropathy

I see kids with leukemia who often get PN due to chemotherapy. The parents are often asking about muscle stim. I tend to stay away from it with malignancy but in the case of leukemia there is no solid tumor. I also have a kid right now who had a PN (foot drop) with no known cause (still being worked up) and I am wondering about muscle stim for him.

Thanks

Chiara Singh

8 months ago

Back to General Electrotherapy

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Prof Gad Alon
Prof Gad Alon

from my research portfolio: Linkov G, Branski RC, Amin M, Chernichenko N, Chen C-H, Alon G, Langmore S, Richard Wong R, Kraus D. A murine model of neuromuscular electrical stimulation on subcutaneous squamous cell carcinoma: Potential implications for dysphagia therapy. Head Neck. 2012;34:1428-1433.

Nonetheless I would consult with the oncologist or neurologist to see if they have a reason not to apply NMES. Assuming no objection, screening for candidacy for NMES should be attempted.

chiara.singh360
chiara.singh360

Thank you. I will review the article. Chiara

Prof Tim Watson
Prof Tim Watson

In compete agreement with Cliff and Liisa. It is not contraindicated as an intervention, has been used in this patient population to good effect and if I were the patient, or indeed, it was one of my kids, and there was a treatment option with demonstrated benefit, I would rather like the therapist to be giving it a try at the very least There is a lot of confusion re the use of electro modalities in a cancer patient group and we did a session on it at the last WCPT meeting in Cape Town. The paper identified by Liisa would be a great read in this context Tim

L.Laakso335
L.Laakso335

Hi Chiara. Understandable to question this matter. The ‘traditional’ contra-indication/risk is theoretical / hypothetical only with no convincing evidence one way or the other. You might like to take a look at Laakso and Young (2010) Physical Therapy Reviews, 15(4) 334-343: “EPAs for symptom control in cancer - what is the evidence?”

Based on evidence, my feeling is that it could be used safely for the purpose (foot drop) you’ve described. If you’re particularly concerned, then apply the electrodes closer together then you otherwise might over the tib ant muscle belly to limit the depth to which the current might flow (thus limiting stimulation of bone marrow). Beware not to apply electrodes too close however, as you’ll limit the efficacy of the treatment.

The other thing you might want to reflect on is that if your patients are concurrently undergoing chemo, any theoretical risk of stimulating cancer cells should be obviated during active cancer treatment. Just beware of skin sensitivity as a result of any whole body irradiation or skin side effects from chemo agents in leukaemias. Ensure exemplary skin and electrode hygiene, give very clear warnings about unwanted sensations, and keep a careful eye during treatments especially with children. Maybe start with minimal motor contraction and short periods to evaluate these factors.

Hope this helps. Can I urge you to keep a photographic log and good Clinical notes and perhaps write this up as a case study for publication? Cheers, Liisa

Cliff Eaton
Cliff Eaton

Hi Chiara There is nothing to suggest that NMES will cause harm in these cases. Malignancy is not contraindicated for NMES. There is a wealth of evidence supporting the use of NMES as an adjunct in the treatment of Neuropathies, especially drop foot, so if this was my patiet I would choose to use it Cliff

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