Tremors of the hands

[nursejane1942]

Does anyone have an explanation the symptom tremors of the hands?  Pt has acute leukemia, AML. Symptoms are worse with exertion so I am thinking it is due to low oxygen levels.  Has anyone else experienced this?  Thank you

[nursejane1942]

Thank you once again.  She does not have diabetes nor pre-existing diabetes.  She is not eating well; no appetite but does eat a bit three times a day of good nutrition.  She only had the one round of chemo, a week's worth and she is on no other meds but for sleep, depression and blood pressure.  She is managing the tremors and they do improve at times.  Thank you for your help.  Sarah

[Ken_PA]

There are 2 approaches that I know:

- use of prescription drugs such as are used for epilepsy, etc (eg, Neurontin)
- use of the supplements as mentioned, which might not be as powerful but won't have the side effects that the drugs do

Since there are so many diabetics, and diabetes causes neuropathy (though via a different mechanism), research there is leading the way. I'd meant to ask if your Pt had pre-exisiting diabetes, which might account for the quick development of the possible neuropathy. Also, the corticosteroids (like prednisone and dexamethasone) that are sometimes given during chemo also can lead to diabetes if the Pt does not eat correctly. Corticosteroids increase insulin resistance and so lead to elevated serum glucose.

[nursejane1942]

Thank you very much.  Can anything be done about the neuropathy?

[Ken_PA]

The two common drugs for AML, cytarabine and an anthracycline, are not typically known for neuropathy. But maybe she had something different, or had an atypical reaction.

[nursejane1942]

Thank you.  I will find out what chemo they had started and I will look into a vitamin supplement.  S

[Ken_PA]

Well, since adverse side effect are the main cause of discontinuing chemotherapy, was that the case there? Because of the neuropathy?

Then you'd zero in on what particular chemo was used and see its reputation for causing neuropathy. If there was pre-exisitng diabetes, that maybe could have contributed.

There are the usual drugs but also a vitamin supplement approach, that I think was developed out of M D Anderson Cancer Center in Texas (which centered around B6 if I recall correctly).

[nursejane1942]

I think so.  She only had one week of chemo and then the treatment was discontinued.  The tremors did start about the same time and are getting worse.  Thank you for your help.

[Ken_PA]

Do you mean something different from motor neuropathy caused by certain chemo drugs?