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Zwicker HM, Fay-McClymont TB, Hou SHJ, Cho S, McDonald K, Guilcher GMT, Yeates KO, Brooks BL, Schulte FSM. Social adjustment in children diagnosed with sickle cell disease: A retrospective study. Pediatr Blood Cancer 2024; 71:e30807. [PMID: 38110802 DOI: 10.1002/pbc.30807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/29/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at risk for physical, psychological, and social adjustment challenges. This study sought to investigate social adjustment and related factors in children living with SCD. METHODS Data from 32 children (50% male, mean age = 10.32 years, SD = 3.27) were retrospectively collected from a neuropsychology clinic at a tertiary care pediatric hospital. Social adjustment was measured using the Behavior Assessment System for Children (BASC-3) parent-proxy, withdrawal subscale, and the Pediatric Quality of Life Inventory (PedsQL) Generic Module Social Functioning self- and parent-proxy subscales. Other measures captured executive functioning (i.e., Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) Parent Form) and non-disease-related associations with social adjustment, including number of years in Canada and family functioning (i.e., PedsQL Family Impact Module). RESULTS Sixteen percent of patients reported elevated social adjustment difficulties. Multiple linear regression found better family functioning [B = .48, t = 2.65, p = .016], and higher executive functioning [B = -.43, t = -2.39, p = .028] were related to higher scores on the PedsQL parent-proxy ratings of social adjustment [F(4,18) = 5.88, p = .003]. Male sex [B = .54, t = 3.08, p = .005], and having lived more years in Canada [B = .55, t = 2.81, p = .009], were related to higher PedsQL self-reported social adjustment [F(4,23) = 3.75, p = .017]. The model examining the BASC-3 withdrawal subscale was not statistically significant [F(4,16) = 1.63, p = .22]. IMPLICATIONS Social adjustment in children diagnosed with SCD warrants future research to understand the influence of executive function, and non-disease-related factors, particularly focusing on sociocultural factors.
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Affiliation(s)
- Hailey M Zwicker
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Taryn B Fay-McClymont
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Neuropsychology Services, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Psychology, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Sharon H J Hou
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Sara Cho
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaelyn McDonald
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keith O Yeates
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Neuropsychology Services, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Neuropsychology Services, Alberta Children's Hospital, Calgary, Alberta, Canada
- Child Brain and Mental Health, Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Fiona S M Schulte
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Vasserman M, Myers K, Brooks BL, Fay-McClymont TB, McColm L, Mish S, Becker N, MacAllister WS. Patterns of WISC-V Performance in Children with Congenital Heart Disease. Pediatr Cardiol 2024; 45:483-490. [PMID: 38214737 DOI: 10.1007/s00246-023-03367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024]
Abstract
Congenital heart disease (CHD) is one of the most common congenital birth defects. As surgical and interventional techniques have improved, the mortality has been greatly reduced and the focus has shifted to quality of life and long-term outcomes. The impact of CHD on development and cognition is becoming increasingly recognized. However, more research is needed to understand how children with CHD perform across various cognitive and intellectual domains. This study explored the performance of children with CHD on the newest version of the Wechsler Intelligence Scale for Children compared to normative controls. Children with CHD performed more poorly than normal controls across all indices and most subtests with large effect sizes. Additionally, we explored the patterns of impairment across indices and subtests, as well as the relationships between heard disease variables and WISC-V performance. Block design, Digit Span, and Similarities were the most commonly impaired scores in children with CHD, while Symbol Search, Picture Span, Figure Weights, and Vocabulary were least likely to be impaired.
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Affiliation(s)
- Marsha Vasserman
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada.
- Department of Pediatrics, University of Calgary, Calgary, Canada.
- Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Canada.
| | - Kimberly Myers
- Cardiology, Alberta Children's Hospital, Calgary, Canada
- Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Canada
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Canada
| | - Taryn B Fay-McClymont
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
- Private Practice, Kelowna, Canada
| | - Lisa McColm
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Sandra Mish
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Norma Becker
- Cardiology, Alberta Children's Hospital, Calgary, Canada
| | - William S MacAllister
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Canada
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Brooks BL, MacAllister WS, Fay-McClymont TB, Mish S, Vasserman M, Sherman EMS. Brief memory assessment in children: can the ChAMP Screening Index detect memory impairment? Child Neuropsychol 2023:1-11. [PMID: 37782220 DOI: 10.1080/09297049.2023.2259540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023]
Abstract
Abbreviated memory batteries play a role in some clinical and research assessments, but their validity and accuracy need to be well supported. The purpose of this study was to examine the accuracy of the ChAMP Screening Index for detecting memory impairment. The sample included N = 804 youths (ages 5-21 years) with medical and neurological diagnoses who were presented for a clinical neuropsychological assessment. All completed the full Child and Adolescent Memory Profile and had valid data. The ChAMP Screening Index contains the first two subtests of the battery (Lists and Objects) and takes about 10 min to administer (full ChAMP is about 35 min). Analyses to examine the accuracy of the ChAMP Screening Index with both the Total Memory Index and Delayed Memory Index included Intraclass correlations, Cohen's Kappa coefficients, receiver operating characteristics, and classification metrics (e.g., sensitivity, specificity, positive predictive values [PPV], and negative predictive values [NPV]). Very strong correlations, minimal mean difference scores, substantial agreement on kappa coefficients, and outstanding receiver operating characteristics all support the Screening Index accuracy. A cutoff score on the Screening Index of 70 provides a good balance between a high PPV (.91) and a high NPV (.96) for the Total Memory Index. When detecting impairment on the Delayed Memory Index, a Screening Index cutoff score of 65 provides a balance between a high PPV (.92) and a high NPV (.94). This study supports the accuracy, validity, and utility of the 10-min ChAMP Screening Index in those clinical and research situations where a brief evaluation of memory is desired.
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Affiliation(s)
- Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, AB, Canada
- Child Brain and Mental Health program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - William S MacAllister
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Child Brain and Mental Health program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Taryn B Fay-McClymont
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Child Brain and Mental Health program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of British Columbia Okanagan, Kelowna, BC, Canada
- Private Practice, Kelowna, BC, Canada
| | - Sandra Mish
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Marsha Vasserman
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Child Brain and Mental Health program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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Brooks BL, Fay-McClymont TB, MacAllister WS, Vasserman M, Mish S, Sherman EMS. New Child and Adolescent Memory Profile Embedded Performance Validity Test. Arch Clin Neuropsychol 2023:6972889. [PMID: 36617240 DOI: 10.1093/arclin/acac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE It is essential to interpret performance validity tests (PVTs) that are well-established and have strong psychometrics. This study evaluated the Child and Adolescent Memory Profile (ChAMP) Validity Indicator (VI) using a pediatric sample with traumatic brain injury (TBI). METHOD A cross-sectional sample of N = 110 youth (mean age = 15.1 years, standard deviation [SD] = 2.4 range = 8-18) on average 32.7 weeks (SD = 40.9) post TBI (71.8% mild/concussion; 3.6% complicated mild; 24.6% moderate-to-severe) were administered the ChAMP and two stand-alone PVTs. Criterion for valid performance was scores above cutoffs on both PVTs; criterion for invalid performance was scores below cutoffs on both PVTs. Classification statistics were used to evaluate the existing ChAMP VI and establish a new VI cutoff score if needed. RESULTS There were no significant differences in demographics or time since injury between those deemed valid (n = 96) or invalid (n = 14), but all ChAMP scores were significantly lower in those deemed invalid. The original ChAMP VI cutoff score was highly specific (no false positives) but also highly insensitive (sensitivity [SN] = .07, specificity [SP] = 1.0). Based on area under the curve (AUC) analysis (0.94), a new cutoff score was established using the sum of scaled scores (VI-SS). A ChAMP VI-SS score of 32 or lower achieved strong SN (86%) and SP (92%). Using a 15% base rate, positive predictive value was 64% and negative predictive value was 97%. CONCLUSIONS The originally proposed ChAMP VI has insufficient SN in pediatric TBI. However, this study yields a promising new ChAMP VI-SS, with classification metrics that exceed any other current embedded PVT in pediatrics.
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Affiliation(s)
- Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada.,Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Child Brain and Mental Health Section, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Taryn B Fay-McClymont
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada.,Child Brain and Mental Health Section, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Department of Psychology, University of British Columbia Okanagan, Kelowna, British Columbia V1V 1V7, Canada
| | - William S MacAllister
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada.,Child Brain and Mental Health Section, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Marsha Vasserman
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada.,Child Brain and Mental Health Section, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Sandra Mish
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada
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Fay-McClymont TB, Monagel DA, Singh G, Schulte F, Brooks BL, MacAllister WS, Désiré N, Mineyko A, Vasserman M, Leaker MT, Truong TH, Shah R, Lewis VA, Yeates KO, Guilcher GMT. Neuropsychological, behavioral, and quality-of-life outcomes in children and adolescents with sickle cell disease treated with nonmyeloablative matched sibling donor hematopoietic cell transplantation: A case series. Pediatr Blood Cancer 2022; 69:e29893. [PMID: 35891584 DOI: 10.1002/pbc.29893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/06/2022] [Accepted: 07/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND/OBJECTIVES Despite advances in the treatment of sickle cell disease (SCD), cerebrovascular and cognitive insults can have lifelong consequences. Hematopoietic cell transplantation (HCT) is an established curative therapy, and recent studies have demonstrated efficacy with reduced toxicity nonmyeloablative (NMA) regimens, but little is known about neuropsychological outcomes. The objective of this study was to describe neuropsychological, behavioral, and quality-of-life outcomes with medical correlates in children with SCD who received an NMA matched sibling donor (MSD) HCT. DESIGN/METHODS Retrospective cohort analysis of nine recipients with hemoglobin SS SCD who underwent MSD HCT using the National Institutes of Health (NIH) NMA protocol. RESULTS Mean full-scale intellectual functioning (FSIQ) was average pre-HCT (FSIQ = 92.1, SD 9.0; n = 8) and 2 years post-HCT (mean FSIQ = 96.6; SD 11.1; N = 9). Neuropsychological functioning was largely average across all cognitive domains, and no pre/post-HCT differences were found to be statistically significant given the small sample size. However, effect sizes revealed moderate improvements in processing speed (Cohen's d = .72) and verbal memory (Cohen's d = .60) post-HCT, and declines in measures of attention (Cohen's d = -.54) and fine motor speed and dexterity (Cohen's d = -.94). Parents endorsed better quality of life (Cohen's d = .91), less impact of SCD on their family, and less worry about their child's future (Cohen's d = 1.44). CONCLUSION Neuropsychological functioning in a sample of children and adolescents treated uniformly with NMA MSD HCT remained stable or improved in most cognitive domains, and improvements in quality of life and family functioning were observed.
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Affiliation(s)
- Taryn B Fay-McClymont
- Neuropsychology/Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, Irving K. Barber Faculty of Arts and Social Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Dania A Monagel
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Gurpreet Singh
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Schulte
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Neuropsychology/Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - William S MacAllister
- Neuropsychology/Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naddley Désiré
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aleksandra Mineyko
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Marsha Vasserman
- Neuropsychology/Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael T Leaker
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tony H Truong
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ravi Shah
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Victor A Lewis
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Stokoe M, Zwicker HM, Forbes C, Abu-Saris NEH, Fay-McClymont TB, Désiré N, Guilcher GM, Singh G, Leaker M, Yeates KO, Russel KB, Cho S, Carrels T, Rahamatullah I, Henry B, Dunnewold N, Schulte F. Health related quality of life in children with sickle cell disease: A systematic review and meta-analysis. Blood Rev 2022; 56:100982. [DOI: 10.1016/j.blre.2022.100982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/27/2022] [Accepted: 05/16/2022] [Indexed: 11/02/2022]
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David CV, Redekopp C, Fay-McClymont TB, MacAllister WS. Emotional functioning in pediatric epilepsy: Evidence of greater externalizing behavior with left hemisphere onset. Epilepsy Behav 2021; 117:107851. [PMID: 33640564 DOI: 10.1016/j.yebeh.2021.107851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
Though it is wellknown that psychiatric concerns are common in children with epilepsy, factors predicting such problems are not well understood. The present investigation studied rates of parent-reported psychological concerns in clinically referred children with epilepsy. Further, it investigated differences in psychological distress across epilepsy subtypes (i.e., focal, generalized, mixed), relationships with epilepsy severity variables, gender, and lateralization of seizure foci. The parents of 170 children and adolescents (ages 6-18 years, 78 girls, 92 boys) completed the Child Behavior Checklist (CBCL). Scale elevation frequencies (T-scores ≥ 65) were calculated and Chi square analyses examined rates of elevations between epilepsy groups. Internalizing problems (32.4%) were more common than externalizing problems (17.1%) for the sample, with attention problems being the most common concern across all epilepsy types (48.8%). While there were no significant relationships between epilepsy severity variables and CBCL broadband scales, the Total Problems scale was inversely related to intellectual functioning (r = -0.174, p = 0.023). Rates of anxiety and depression did not differ across epilepsy subtypes and no gender differences were found. Those with left-sided epilepsy had higher rates of externalizing problems (33.2%) than those with right (14.0%; χ2[1, 88] = 4.55, p = 0.03), with rule-breaking behaviors (15.4%) being more common in left-hemisphere epilepsy (15.4% versus 2.3%; χ2[1,88] = 4.66, p = 0.03). In summary, while no significant differences were found across epilepsy groups, the current study adds to the literature regarding lateralization effects and mood/behavior, with more externalizing problems in those with left hemisphere epilepsy.
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Affiliation(s)
- Claire V David
- Neuropsychology Service, Alberta Children's Hospital, 28 Oki Drive, Calgary, AB T3B6A8, Canada.
| | - Carlie Redekopp
- Neuropsychology Service, Alberta Children's Hospital, 28 Oki Drive, Calgary, AB T3B6A8, Canada.
| | - Taryn B Fay-McClymont
- Neuropsychology Service, Alberta Children's Hospital, 28 Oki Drive, Calgary, AB T3B6A8, Canada; Department of Pediatrics, University of Calgary, 2500 University Drive, Calgary, AB T2N1N4, Canada; Alberta Children's Hospital Research Institute, 28 Oki Drive, Calgary, AB T3B6A8, Canada.
| | - William S MacAllister
- Neuropsychology Service, Alberta Children's Hospital, 28 Oki Drive, Calgary, AB T3B6A8, Canada; Department of Pediatrics, University of Calgary, 2500 University Drive, Calgary, AB T2N1N4, Canada; Alberta Children's Hospital Research Institute, 28 Oki Drive, Calgary, AB T3B6A8, Canada; Department of Clinical Neurosciences, University of Calgary, 2500 University Drive, Calgary, AB T2N1N4, Canada.
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Erker C, Larouche V, Margol A, Cacciotti C, Perreault S, Cohen KJ, AbdelBaki MS, Hukin J, Rassekh SR, Eisenstat DD, Wilson B, Knipstein J, Hoppmann AL, Sandler ES, Dorris K, Fay-McClymont TB, Salloum R, Harrod VL, Crooks B, Finlay JL, Bouffet E, Lafay-Cousin L. MBCL-24. CAN YOUNG CHILDREN WITH RELAPSED MEDULLOBLASTOMA BE SALVAGED AFTER INITIAL IRRADIATION-SPARING APPROACHES? Neuro Oncol 2020. [PMCID: PMC7715107 DOI: 10.1093/neuonc/noaa222.500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Irradiation-sparing approaches are used in young children with medulloblastoma (MB) given the vulnerability of the developing brain to neurocognitive impairment. Limited data are available following relapse for these patients. We aimed to describe the management and outcomes of young children with MB who relapsed after initial treatment without craniospinal irradiation (CSI). METHODS International retrospective study including patients with MB diagnosed between 1995–2017, ≤ 72 months old, initially treated without CSI, who subsequently relapsed. RESULTS Data are available for 52 patients (32 male). Median age at initial diagnosis was 27 months (range, 6–72) with 24 being metastatic. Initial therapy included conventional chemotherapy alone or high-dose chemotherapy (HDC) in 21 and 31 subjects, respectively. Three received upfront focal irradiation. Molecular subgrouping, available for 24 tumors, included 9 SHH and 15 non-WNT/non-SHH. Median time to relapse was 13 months (range, 3–63). Relapse was local, disseminated or combined in 20, 15, and 16, respectively. Salvage therapy with curative intent was given in 42/52 patients, including CSI in 28 subjects (median dose 36Gy, 18–41.4) or focal irradiation in 5 others. Three received HDC only. At a median follow-up time of 46 months (range, 4–255), 25 (48%) were alive, including 7/9 SHH and 7/15 non-WNT/non-SHH. The 2- and 5-year OS was 67% and 56% (SE, 7%), respectively. Two of 3 patients with SHH who did not receive salvage radiotherapy are survivors. CONCLUSION A substantial proportion of young children who relapse following irradiation-sparing strategies can be salvaged. Neurocognitive and ototoxicity outcomes are being evaluated.
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Affiliation(s)
- Craig Erker
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Ashley Margol
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - Chantel Cacciotti
- Dana-Farber/ Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Sébastien Perreault
- Université de Montréal, Montreal, Québec, Canada
- CHU Sainte-Justine, Montreal, Québec, Canada
| | - Kenneth J Cohen
- The Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mohamed S AbdelBaki
- Ohio State University, Columbus, Ohio, USA
- Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Juliette Hukin
- University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Shahrad Rod Rassekh
- University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - David D Eisenstat
- University of Alberta, Edmonton, Alberta, Canada
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Beverly Wilson
- University of Alberta, Edmonton, Alberta, Canada
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Jeffrey Knipstein
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna L Hoppmann
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eric S Sandler
- Nemours Children’s Specialty Care, Jacksonville, Florida, USA
- Wolfson Children’s Hospital, Jacksonville, Florida, USA
| | - Kathleen Dorris
- University of Colorado School of Medicine, Aurora, Colorado, USA
- Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Taryn B Fay-McClymont
- University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Ralph Salloum
- University of Cincinnati, Cincinnati, Ohio, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Virginia L Harrod
- University of Texas, Dell Medical School, Austin, Texas, USA
- Dell Children’s Medical Center of Central Texas, Austin, Texas, USA
| | - Bruce Crooks
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jonathan L Finlay
- Ohio State University, Columbus, Ohio, USA
- Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Eric Bouffet
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lucie Lafay-Cousin
- University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital, Calgary, Alberta, Canada
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Erker C, Larouche V, Aguilera D, Margol A, Cacciotti C, Perreault S, Cohen KJ, AbdelBaki M, Hukin J, Rassekh SR, Eisenstat DD, Wilson B, Hoppman AL, Dhall G, Holly T, Knipstein J, Sandler ES, Klawinski D, Dorris K, Fay-McClymont TB, Salloum R, Harrod VL, Crooks B, Ramaswamy V, Finlay J, Bouffet E, Lafay-Cousin L. NCOG-47. CAN YOUNG CHILDREN WITH RELAPSED MEDULLOBLASTOMA BE SALVAGED AFTER INITIAL IRRADIATION-SPARING APPROACHES? Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Irradiation-sparing approaches are used in young children with medulloblastoma (MB) given the vulnerability of the developing brain to neurocognitive impairment. Limited data are available following relapse for these patients. We aimed to describe the management and outcomes of young children with MB who relapsed after initial treatment without craniospinal irradiation (CSI).
METHODS
International retrospective study including patients with MB diagnosed between 1995-2017, ≤ 72 months old, initially treated without CSI, who subsequently relapsed.
RESULTS
Data are available for 66 patients. The median age at initial diagnosis was 27 months (range, 6-72). At diagnosis, 27 patients had metastatic disease. Initial therapy included conventional chemotherapy or with high-dose chemotherapy (HDC) in 30 and 36 patients, respectively. Eight (12.1%) received upfront focal irradiation. Molecular subgrouping was available for 27 (41%) patients. Ten were SHH, five group 3, six group 4 and six others were non-WNT/non-SHH. The median time from initial diagnosis to relapse was 13 months (range, 3-63). Relapse was local, disseminated, or combined in 39%, 32%, and 29%, respectively. The median time to death from relapse was 18 months. Curative intent therapy was given in 53 patients with irradiation (81%), conventional chemotherapy without HDC (40%), and HDC (25%). For patients who received irradiation, 85% received CSI (median dose 33 Gy, 18-41.4) and 15% focal irradiation. Ten patients received chemotherapy without salvage irradiation. The median follow-up time was 44 months (range, 4-255), 33 (62%) patients who underwent curative-intent therapy were alive, including 8/10 SHH, 2/3 group 3, 2/6 group 4, and 4/5 non-WNT/non-SHH. Three of four patients with SHH and treated without salvage radiotherapy are survivors. The 5-year OS for curative intent was 70%.
CONCLUSION
A substantial proportion of young children who relapse following irradiation-sparing strategies can be salvaged. A proportion of children with SHH MB can be salvaged without salvage radiotherapy.
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Affiliation(s)
| | | | | | - Ashley Margol
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Chantel Cacciotti
- Dana-Farber/ Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA
| | | | - Kenneth J Cohen
- The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | | | | | | | | | - Anna L Hoppman
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Girish Dhall
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Taylor Holly
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Eric S Sandler
- Nemours Children’s Specialty Care, Jacksonville, FL, USA
| | | | | | | | - Ralph Salloum
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | - Jonathan Finlay
- Nationwide Children’s Hospital; The Ohio State University College of Medicine, Columbus, OH, USA
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Deschamps K, Yeates KO, Fay-McClymont TB, Twilt M, Westmacott R, Dropol A, Brooks BL, Kirton A, Gowdie P, Sheikh S, Benseler SM. Cognitive outcomes of childhood primary CNS vasculitis. Neuropsychology 2019; 33:462-469. [PMID: 30762375 DOI: 10.1037/neu0000513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To characterize the clinical cognitive phenotypes and severity of cognitive burden according to disease subtype in children with primary central nervous system vasculitis (cPACNS). METHOD This retrospective multicenter inflammatory brain disease database study examined the neuropsychological outcomes of 80 children (44 male; mean age = 7.89 years, SD = 4.17) consecutively diagnosed with primary CNS vasculitis between 1992 and 2016. Twenty-one children had small-vessel disease (AN_cPACNS), and 59 had large-vessel disease (including 49 nonprogressive [APNP_cPACNS] and 10 progressive [APP_cPACNS]). Neuroimaging revealed MRI abnormalities in 100% and 90% of children with large- and small-vessel vasculitis, respectively. The primary outcomes were Full Scale IQ (FSIQ) and the index scores from the Wechsler Intelligence Scale for Children-III (WISC-III, WISC-IV, and WISC-V). Analyses explored the effect of disease subtype. RESULTS Intellectual functioning was assessed on average 2.82 years after symptom onset. Children with small-vessel CNS vasculitis had significantly lower FSIQ scores than did those with large-vessel CNS vasculitis (Ms = 81.90 vs. 94.82; p = .04). Intellectual disability (FSIQ < 70) was more frequent in children with small-vessel disease (24% vs. 5%). All groups displayed lower Working Memory and Processing Speed index scores relative to Verbal Comprehension and Perceptual Reasoning index scores. Group differences in FSIQ remained significant after controlling for the presence of seizures. CONCLUSION Children with small-vessel CNS vasculitis are more likely to demonstrate deficits in intellectual functioning than are those with large-vessel disease, and children with both types of CNS vasculitis demonstrate relatively poor working memory and processing speed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, University of Calgary
| | | | - Marinka Twilt
- Section of Rheumatology, Department of Pediatrics, Alberta Children's Hospital
| | | | - Anastasia Dropol
- Department of Pediatrics, Cumming School of Medicine, University of Calgary
| | - Brian L Brooks
- Alberta Children's Hospital Research Institute, Department of Pediatrics
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Alberta Children's Hospital Research Institute, University of Calgary
| | - Peter Gowdie
- Rheumatology Service, Department of General Medicine, Royal Children's Hospital
| | - Shehla Sheikh
- Information Services, The Hospital for Sick Children
| | - Susanne M Benseler
- Alberta Children's Hospital Research Institute, Department of Pediatrics, Cumming School of Medicine, University of Calgary
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Brooks BL, Plourde V, Fay-McClymont TB, MacAllister WS, Sherman EMS. Factor structure of the CNS Vital Signs computerized cognitive battery in youth with neurological diagnoses. Child Neuropsychol 2019; 25:980-991. [DOI: 10.1080/09297049.2019.1569609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Brian L. Brooks
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Vickie Plourde
- Faculty St-Jean, University of Alberta, Edmonton, Canada
| | - Taryn B. Fay-McClymont
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Paediatrics, University of Calgary, Calgary, Canada
| | - William S. MacAllister
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Paediatrics, University of Calgary, Calgary, Canada
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Brooks BL, MacAllister WS, Fay-McClymont TB, Vasserman M, Sherman EMS. Derivation of New Embedded Performance Validity Indicators for the Child and Adolescent Memory Profile (ChAMP) Objects Subtest in Youth with Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2018; 34:531-538. [DOI: 10.1093/arclin/acy068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/19/2018] [Accepted: 07/19/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Brian L Brooks
- Neuropsychology Service, Alberta Children’s Hospital, Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - William S MacAllister
- Neuropsychology Service, Alberta Children’s Hospital; Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Taryn B Fay-McClymont
- Neuropsychology Service, Alberta Children’s Hospital, Department of Paediatrics, University of Calgary, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Marsha Vasserman
- Neuropsychology Service, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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Brooks BL, Fay-McClymont TB, MacAllister WS, Vasserman M, Sherman EM. A new kid on the block: The Memory Validity Profile (MVP) in children with neurological conditions. Child Neuropsychol 2018; 25:561-572. [DOI: 10.1080/09297049.2018.1477929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Brian L. Brooks
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Taryn B. Fay-McClymont
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Paediatrics, University of Calgary, Calgary, Canada
| | - William S. MacAllister
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Marsha Vasserman
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
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Hrabok M, Brooks BL, Fay-McClymont TB, Sherman EMS. Wechsler Intelligence Scale for Children-fourth edition (WISC-IV) short-form validity: a comparison study in pediatric epilepsy. Child Neuropsychol 2012; 20:49-59. [PMID: 23216421 DOI: 10.1080/09297049.2012.741225] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this article was to investigate the accuracy of the WISC-IV short forms in estimating Full Scale Intelligence Quotient (FSIQ) and General Ability Index (GAI) in pediatric epilepsy. METHODS One hundred and four children with epilepsy completed the WISC-IV as part of a neuropsychological assessment at a tertiary-level children's hospital. The clinical accuracy of eight short forms was assessed in two ways: (a) accuracy within +/- 5 index points of FSIQ and (b) the clinical classification rate according to Wechsler conventions. The sample was further subdivided into low FSIQ (≤ 80) and high FSIQ (> 80). RESULTS All short forms were significantly correlated with FSIQ. Seven-subtest (Crawford et al. [2010] FSIQ) and 5-subtest (BdSiCdVcLn) short forms yielded the highest clinical accuracy rates (77%-89%). Overall, a 2-subtest (VcMr) short form yielded the lowest clinical classification rates for FSIQ (35%-63%). The short form yielding the most accurate estimate of GAI was VcSiMrBd (73%-84%). CONCLUSIONS Short forms show promise as useful estimates. The 7-subtest (Crawford et al., 2010) and 5-subtest (BdSiVcLnCd) short forms yielded the most accurate estimates of FSIQ. VcSiMrBd yielded the most accurate estimate of GAI. Clinical recommendations are provided for use of short forms in pediatric epilepsy.
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Affiliation(s)
- Marianne Hrabok
- a Alberta Health Services and Alberta Children's Hospital Research Institute , Calgary , Alberta , Canada
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Sherman EMS, Brooks BL, Fay-McClymont TB, MacAllister WS. Detecting epilepsy-related cognitive problems in clinically referred children with epilepsy: Is the WISC-IV a useful tool? Epilepsia 2012; 53:1060-6. [PMID: 22554239 DOI: 10.1111/j.1528-1167.2012.03493.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Elisabeth M S Sherman
- Alberta Health Services and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
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Fay-McClymont TB, Hrabok M, Sherman EMS, Hader WJ, Connolly MB, Akdag S, Mohamed IS, Wiebe S. Systematic review and case series of neuropsychological functioning after epilepsy surgery in children with dysembryoplastic neuroepithelial tumors (DNET). Epilepsy Behav 2012; 23:481-6. [PMID: 22386912 DOI: 10.1016/j.yebeh.2011.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 12/22/2011] [Accepted: 12/25/2011] [Indexed: 11/15/2022]
Abstract
RATIONALE The purposes of this study were to 1) conduct a review of neuropsychological (NP) outcomes after epilepsy surgery for DNET and 2) present pre/post-surgical NP results from a series of children with DNET. METHODS First, a systematic literature review was conducted with specific inclusion criteria. Second, a review of DNET surgical patients seen at two tertiary-care hospitals using reliable change methods of NP functioning was conducted. RESULTS Of 300 citations retrieved, 7 studies met criteria. Studies reported low average to average pre-surgical IQ. Engel Class I outcome was approximately 85%. CASE SERIES Thirteen children completed pre/post-surgical NP assessments. Pre-surgically, children demonstrated low average to average functioning. Post-surgically, few patients showed reliable change. One-third of children demonstrated psychological improvement. CONCLUSIONS NP outcome following DNET has not been well-described. Children with DNET demonstrate low average to average NP functioning pre-surgically, good seizure outcome, and stable NP functioning post-surgically.
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Sherman EMS, Wiebe S, Fay-McClymont TB, Tellez-Zenteno J, Metcalfe A, Hernandez-Ronquillo L, Hader WJ, Jetté N. Neuropsychological outcomes after epilepsy surgery: Systematic review and pooled estimates. Epilepsia 2011; 52:857-69. [PMID: 21426331 DOI: 10.1111/j.1528-1167.2011.03022.x] [Citation(s) in RCA: 320] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Epilepsy surgery is a safe surgical procedure, but it may be associated with cognitive changes. Estimates of the risk of decline in specific neuropsychological domains after epilepsy surgery would assist surgical decision making in clinical practice. The goal of this study was to conduct a systematic review to derive pooled estimates of the rate of losses and gains in neuropsychological functions after epilepsy surgery, using empirically based methods for quantifying cognitive change. METHODS An extensive literature search using PubMed, EmBase, and the Cochrane database was conducted, yielding 5,061 articles on epilepsy surgery, with 193 on neuropsychological outcomes (IQ, memory, language, executive functioning, attention, and subjective cognitive changes). KEY FINDINGS Of these, 23 met final eligibility criteria, with 22 studies involving temporal surgery only. Key aspects of inclusion criteria were N ≥ 20 and use of reliable change index or standardized regression-based change estimates. In addition to the proportion of patients experiencing losses and gains in each individual test, a single pooled estimate of gains and losses for each cognitive domain was derived using a random effects model. Weighted estimates indicated a risk to verbal memory with left-sided temporal surgery of 44%, twice as high as the rate for right-sided surgery (20%). Naming was reduced in 34% of left-sided temporal patients, with almost no patients with gains (4%). Pooled data on IQ, executive functioning, and attention indicated few patients show declines post surgery, but a substantial rate of improvement in verbal fluency with left-sided temporal surgery (27%) was found. Self-reported cognitive declines after epilepsy surgery were uncommon, and gains were reported in some domains where losses were found on objective tests (i.e., verbal memory and language). Variations in surgical techniques did not appear to have a large effect on cognitive outcomes, except for naming outcomes, which appeared better with more conservative resections. Sensitivity to postoperative changes differed across visual memory tests, but not verbal memory tests. Few conclusions could be made regarding cognitive risks and benefits of extratemporal epilepsy surgery, or of epilepsy surgery in children. SIGNIFICANCE In sum, epilepsy surgery is associated with specific cognitive changes, but may also improve cognition in some patients. The results provide base rate estimates of expected cognitive gains and losses associated with epilepsy surgery that may prove useful in clinical settings.
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Affiliation(s)
- Elisabeth M S Sherman
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
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