[Results of psychological tests in children with long-term follow-up for Reye's syndrome]

Within a 10-year period the authors investigated the incidence of mental disorders in a group of 65 children with a history of Reye's syndrome. From the investigation ensues that the majority of mental disorders is temporary, followed by complete recovery. Most frequently neurotic disorders were observed, disorders of motor coordination, impaired attention. These disorders persisted longest during the follow-up of patients who had suffered previously from the most severe forms of Reye's syndrome. From the total number of 65 children all mental disorders disappeared in 52.3%; 43% of the children ceased sooner or later to attend examinations and only 4.7% of the original group have still, after five years, speech disorders, neurotic manifestations and an impaired motor coordination.

A sibling-controlled study of intelligence and academic performance following Reye syndrome

The authors compared the intellectual, cognitive and academic abilities of 22 survivors of Reye syndrome attending normal schools with the sibling nearest in age as control. The British Ability Scales, visual and verbal IQ, short-term memory scales and attainment tests were administered to all children. Reye syndrome children as a group differed significantly from the controls only on the basic number skills test. However, children with severe encephalopathy and those whose illness occurred in infancy had significant deficits on many of the tests. 18 children recovered without requiring 'additional educational provision'; the mean IQ of the 22 Reye syndrome children was 101. Nonetheless, these children's poor performance on the basic number skills test has important implications for teachers, and careful monitoring of future educational performance is essential.

Long-lasting memory deficits in children recovered from Reye's syndrome

Twenty-six children, ages 7-18 years, were tested for possible memory impairments following Reye's syndrome (RS). The RS group was matched to a normal control group on race, age, SES, and estimated IQ. The Wechsler Memory Scale (with delayed recall) and two depth-of-processing tests were administered. For the control group, the mean MQ-IQ difference was +2, while the MQ-IQ difference for the RS group was -14. This proved to be highly significant. Short-term memory and long-term memory scores were significantly lower for the RS group, with verbal memory tasks being most affected.

Adaptive behaviour of Reye's syndrome survivors

Adaptive behaviour was investigated in a group of 35 individuals who survived Reye's syndrome. Specifically, the association between three medical variables: age at onset of disease, months since medical recovery, and stage of coma, and current functioning level was assessed. Results indicated that these variables may be viable predictors for some of the behavioural domains. Sequelae related to this disease may include a diminished level in the rate of learning as well as long term maladaptive behaviours.

Transient intellectual and psychosocial regression during recovery phase of stage V Reye's syndrome

The outcome of stage V Reye's syndrome survivors has not been critically assessed. Three teenage survivors, who initially exhibited severe psychosocial and intellectual regression, are described. Findings support the observation that the neurological outcome from Reye's syndrome correlates with the duration of altered consciousness during the acute phase. Recovery of intellectual, psychosocial, learning and motor function is reported. A period of transient dementia was noted, which may be typical in recovery from stage V Reye's syndrome. Unlike other types of encephalopathies, complete resolution may be expected.

Intellectual and emotional sequelae of Reye's Syndrome

Previous reports on survivors of Reye's syndrome have indicated a high proportion of significant neurological and intellectual sequelae. However, increasingly sophisticated monitoring and therapeutic techniques have diminished both the mortality and morbidity of this disease. Our present study documented the relatively good intellectual and neurological prognosis for recent survivors of Reye's at our institution and explored the emotional impact of this illness on survivor's families. The significant emotional problems of the children and their families were in striking contrast to the relatively good intellectual and academic recovery. Nine of the 16 survivors showed emotional disruption (primarily somatic complaints, anxiety, and depression). Fourteen of 16 mothers interviewed continued to suffer from anxiety, depression, and overprotective behavior as long as 5 years after their child's illness. In many respects, the parents endured more prolonged and profound suffering than did the children. These findings have implications for the delivery of follow-up care to families of survivors.

Neuropathology, pathogenesis, and neuropsychiatric sequelae of Reye syndrome

A clinico-pathologic correlation can be established for those survivors of Reye syndrome in the higher clinical stages who have sustained irreversible and often major neuropsychiatric deficits. The neuropathologic substrate for the clinical manifestations of mental retardation, recurrent seizures, movement disorders, sensori-motor deficits, psychobiologic maladjustment, and mediocre performance in school and on formal psychometric tests consists of multifocal infarction and astrocytosis in cerebral cortex, diencephalon, basal ganglia, and brainstem. While the mortality rate of Reye syndrome in acute stages is still significantly high (25% in our 20 cases, 52% in the tabulated cases in the higher clinical grades), the occurrence of permanent psychomotor deficits is an equally tragic socioeconomic and medical problem. Of our 15 survivors, 3 have suffered major and 1 has sustained minor brain damage. From a review of the literature, over one-third of survivors are consigned to cerebral malfunction, hence their potential for full enjoyment of life and their intellectual, emotional, and economic contributions to their families and society are sadly curtailed.

Neuropsychologic consequences of Reye syndrome

Behavioral measurement of brain function was conducted in 40 children, one or more years after their recovery of Reye syndrome. Test measures included standard indices of intelligence, school achievement, visual-motor coordination and social maturity, plus the Halstead-Reitan Neuropsychological Batteries. There was a strong correlation between the degree of impaired neuropsychologic function and clinical grade at admission, the duration of impaired consciousness, and the number of exchange transfusions required. Patients with milder disease had normal brain function and fewer school problems. Language and perceptual-motor performance significantly improved with increasing years in recovery, suggesting that some of the disturbances of brain functioning are transient. The statistical analysis indicated that there are lasting, often subtle disturbances of higher cognitive function as a result of Reye syndrome. These deficits, not always apparent on clinical examination, are clearly correlated with the extent of neurologic involvement. This quantitative assessment of neuropsychologic function is a basis for determining the "quality of survival" in Reye syndrome, and such measurements should be included in the comparative evaluation of Reye syndrome treatment programs.

Neurological and intellectual sequelae of Reye's syndrome

Eleven survivors of Reye's syndrome ranging in age from 9 months to 12 years were evaluated for neurological and psychoeducational sequelae. Seven children showed significant neuropsychological sequelae, ranging from severe global psychomotor retardation to mild specific perceptual and/or language impairments and from spastic quadriplegia and decorticate posturing to mild dysarthria. The severity of sequelae was inversely related to age of the child at onset of the disease. Whereas those children developing the syndrome when they were less than 1 year of age were seriously impaired, 3 children developing it in late childhood sustained no sequelae. Biochemical and neurological status at disease onset did not predict neuropsychological outcome. The results parallel the pattern of sequelae for other encephalopathies and suggest the importance for both child and family of early developmental evaluation following recovery from the disease.