Neurological symptoms
Spinal cord compression
Spinal cord compression is an infrequent but serious complication of myeloma. It occurs as a result of vertebral collapse or from myeloma deposits expanding outside of the bone (extramedullary), causing pressure on the spinal cord.
The spinal cord may be affected at several levels. Symptoms of cord compression include pain, numbness, weakness or paralysis of the limbs, saddle anaesthesia (sensory loss in the perianal region) and/or bowel and bladder dysfunction.
Spinal cord compression is a medical emergency that requires prompt investigation, preferably with MRI scans, and rapid treatment if function is to recover. Treatment often includes steroids and radiotherapy with some patients requiring decompressive spinal surgery. Delay in treatment can be result in permanent paralysis (paraplegia, quadriplegia) and devastating loss of independence and quality of life, and markedly reduced survival.
Nurses must be aware of the local pathway for urgent referral of patients with suspected spinal cord compression. It is important that those with suspected spinal cord compression are handled carefully, be on a flat bed rest and log rolled (a collar should be considered if there is cervical involvement). Myeloma patients may not always be admitted into a cancer centre with the necessary imaging facilities and therefore rely on their healthcare team to be vigilant for the early signs of this condition and for referral to other centres where necessary, see example SOP from the Christie NHS Foundation Trust.
Further reading
NICE guideline: Spinal metastases and metastatic spinal cord compression. NG234. Published Sept 2023
Other neurological problems
Occasionally, the presence of paraprotein can cause peripheral neuropathy as it can accumulate and deposit on nerve tissue. There are also suggestions that paraprotein may be directly toxic to nerves, causing damage to the fatty myelin sheath surrounding the nerve cells.
It leads to symptoms such as:
- Tingling, numbness or pain
- Poor coordination or weakness
- Bowel/urinary incontinence or erectile dysfunction
- Muscle cramps
- Hearing loss
These symptoms and the causative peripheral neuropathy can be present at diagnosis but it is more commonly recognised as a side effect of certain anti-myeloma treatments, the management for which is often changes to the treatment regimen.