The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a patient with a spinal cord complication following radiation and chemotherapy.
Subjective measures:
(1) paresthesia (tingling sensation, shooting pains, Lhermitte's syndrome)
(2) sensory (numbness)
(3) motor (weakness)
(4) sphincter control
Objective measures:
(1) neurologic evaluation
Management measures:
(1) pain
(2) neurologic function
(3) incontinence
Analytic studies:
(1) MRI
(2) CT: assessment of swelling, edema, atrophy
(3) MRS: assessment of chemical spectra
(4) PET scan: assessment of metabolic activity
(5) serum myelin basic protein levels
(6) CSF for total protein and myelin basic protein levels
If no toxicity is present, then the 0 points are assigned.
If a toxicity is present, then the grade indicates the number of points to assign.
|
SOM |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
paresthesias |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
numbness |
minimal change |
mild unilateral sensory loss; works with some difficulties |
partial unilateral sensory loss; needs assistance with self-care |
total loss of sensation; danger of self-injury |
|
weakness |
minor loss of strength |
weakness interfering with normal activities |
persistent weakness preventing basic activities |
paralysis |
|
sphincter control |
occasional loss |
intermittent loss |
incomplete control |
complete incontinence |
|
neurologic evaluation |
barely detectable decrease in sensation or motor weakness on one side; no loss of function |
easily detectable decrease in sensation or motor weakness on one side; disturbs but does not prevent function |
full Brown-Sequard syndrome; loss of sphincter function; prevents function |
complete cord transection; disabling; requires continuous care |
|
management of pain |
occasional non-narcotic medication |
persistent non-narcotic medication; intermittent low dose steroids |
intermittent high dose steroids |
persistent high dose steroids |
|
management of neurologic function |
needs minor adaptation to continue working |
regular physiotherapy |
intensive physiotherapy plus regular supervision |
intensive nursing and/or life support |
|
management of incontinence |
occasional use of incontinence pads |
intermittent use of incontinence pads |
regular use of incontinence pads; self catheterization |
permanent use of incontinence pads; catheterization |
total score =
= SUM(points for all 8 items)
LENT score =
= (total score) / 8
|
Analytical |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
MRI findings |
edema |
localized demyelination |
extensive demyelination |
necrosis |
Interpretation:
• maximum total score: 32
• minimum LENT score: 0
• maximum LENT score: 4.0
Specialty: Hematology Oncology, Neurology
