1
|
Hagan AJ, Verity SJ. Translating methylphenidate's efficacy on selective and sustained attentional deficits to those reported in childhood cancer survivors: A qualitative review. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:74-87. [PMID: 35108133 DOI: 10.1080/21622965.2022.2025538] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Whilst an increasing number of children survive previously incurable cancers of the central nervous system (CNS), associated treatments often result in significant neurocognitive late effects. Methylphenidate provides some signs of alleviating cognitive difficulties in different pediatric groups; however, a minimal amount of systematic work has explored its effectiveness isolated to vulnerable attentional domains. The current review aimed to explore the effectiveness of methylphenidate isolated to two attentional domains (sustained and selective attention)-with an aim to substantiate its utility in childhood cancer survivors. Five databases were comprehensively searched for relevant articles. A purpose-developed tool was used to assess each study's robustness and research quality. Eleven out of 1,865 identified articles were included within the review. Studies drew upon five clinical populations. Individual attentional domains demonstrate variation in their response to methylphenidate. Sustained attention demonstrated the most consistent benefit of methylphenidate, reported largely in attention-deficit/hyperactivity disorder (ADHD) groups. Gains in selective attention and higher-order cognitive functions appeared to follow initial gains in sustained attention. Childhood cancer survivors report greater gains in selective attention compared to sustained attention. Higher doses may yield greater benefit for children with more diffuse attentional deficits. There is a need to improve the validity of current attentional measures before further methylphenidate trials are conducted.
Collapse
Affiliation(s)
- Alexander J Hagan
- Department of Paediatric Health Psychology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Sarah J Verity
- Department of Paediatric Health Psychology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK.,Newcastle University Centre for Cancer, Newcastle University, Newcastle Upon Tyne, UK
| |
Collapse
|
2
|
Desjardins L, Lai MC, Vorstman J, Bartels U, Barrera M. A Novel Approach to Understanding Social Behaviors in Pediatric Brain Tumor Survivors: A Pilot Study. J Pediatr Psychol 2021; 46:80-90. [PMID: 33377489 DOI: 10.1093/jpepsy/jsaa090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES Pediatric brain tumor survivors (PBTS) are at risk of experiencing challenges in social adjustment. However, the specific social behaviors of PBTS have rarely been directly assessed. This pilot study explores the first novel use of the Autism Diagnostic Observation Schedule, second edition (ADOS-2), to evaluate the social behaviors of PBTS. METHODS Twenty-six PBTS (ages 9-17 years; M = 7.8 years from diagnosis; 52% male; 41% received radiation treatment) completed the ADOS-2. The proportion of the sample experiencing impairment was examined descriptively across all items of the ADOS-2, as well as by a summary "overall score" created for this study, and using the ADOS-2 "diagnostic algorithm" scores for autism. Social adjustment, cognitive, medical, and demographic variables were explored as correlates of the ADOS-2 "overall score". RESULTS Study recruitment was 34%, impeded by distance from the tertiary-care center. The percentage of PBTS experiencing detectable impairments ranged from 0% to 50% across ADOS-2 items. Cranial radiation treatment, lower IQ, and slower cognitive processing were associated with higher impairment on the ADOS-2 "overall score". CONCLUSION The ADOS-2 can be used to assess the discrete social behaviors of PBTS. This study provides a foundation for future investigations using the ADOS-2 to assess social behaviors in this population. Identifying specific social behavior difficulties in PBTS is key to refining much needed targeted social skills interventions for this population.
Collapse
Affiliation(s)
- Leandra Desjardins
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Charles-Bruneau Cancer Care Centre, Sainte-Justine University Health Centre, Montreal, Canada
| | - Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Azrieli Adult Neurodevelopmental Centre, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry and Autism Research Unit, The Hospital for Sick Children, Toronto, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jacob Vorstman
- Department of Psychiatry and Autism Research Unit, The Hospital for Sick Children, Toronto, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Maru Barrera
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Ontario Institute of Studies in Education and Institute of Medical Sciences, University of Toronto, Toronto, Canada
| |
Collapse
|
3
|
Are we friends? Best friend nominations in pediatric brain tumor survivors and associated factors. Support Care Cancer 2019; 27:4237-4244. [PMID: 30847703 DOI: 10.1007/s00520-019-04706-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pediatric brain tumor survivors (PBTSs) are at risk of impairments in social competence. Limited information is available regarding nominations and reciprocated nominations of PBTSs as best friends and factors which may predict these. PROCEDURE Caregivers of children (n = 32) aged 8-16 (38% low-grade glioma, 34% medulloblastoma, 28% other) completed ratings of child adjustment at baseline (T1) and PBTSs and classmates completed the Three Best Friends measure approximately 12 months later (T2). Sociometric data yielded ratings of best friend nominations and reciprocated best friend nominations. RESULTS Nominations of PBTSs as best friends were not significantly different than controls, but PBTSs had fewer reciprocated best friend nominations than controls. Approximately half of PBTSs in this study did not have any reciprocated best friend nominations and 25% were not nominated by any peer as a best friend. Greater symptoms of depression and lower social skills in PBTSs were associated with fewer nominations as a best friend by peers and a greater likelihood of no reciprocal best friend nominations. Greater difficulties in emotional control were associated with fewer nominations as a best friend by peers. CONCLUSIONS The discrepancy between reciprocated best friend nominations and best friend nominations highlights a need to attend to reciprocal friendships in PBTSs and further understand social information processes in this population. Longitudinal analyses illustrate the impact of emotional adjustment on PBTS friendships.
Collapse
|
4
|
Sahnoune I, Inoue T, Kesler SR, Rodgers SP, Sabek OM, Pedersen SE, Zawaski JA, Nelson KH, Ris MD, Leasure JL, Gaber MW. Exercise ameliorates neurocognitive impairments in a translational model of pediatric radiotherapy. Neuro Oncol 2019; 20:695-704. [PMID: 29121259 DOI: 10.1093/neuonc/nox197] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background While cranial radiation therapy (CRT) is an effective treatment, healthy areas surrounding irradiation sites are negatively affected. Frontal lobe functions involving attention, processing speed, and inhibition control are impaired. These deficits appear months to years after CRT and impair quality of life. Exercise has been shown to rejuvenate the brain and aid in recovery post-injury through its effects on neurogenesis and cognition. Methods We developed a juvenile rodent CRT model that reproduces neurocognitive deficits. Next, we utilized the model to test whether exercise ameliorates these deficits. Fischer rats (31 days old) were irradiated with a fractionated dose of 4 Gy × 5 days, trained and tested at 6, 9, and 12 months post-CRT using 5-choice serial reaction time task. After testing, fixed rat brains were imaged using diffusion tensor imaging and immunohistochemistry. Results CRT caused early and lasting impairments in task acquisition, accuracy, and latency to correct response, as well as causing stunting of growth and changes in brain volume and diffusion. Exercising after irradiation improved acquisition, behavioral control, and processing speed, mitigated the stunting of brain size, and increased brain fiber numbers compared with sedentary CRT values. Further, exercise partially restored global connectome organization, including assortativity and characteristic path length, and while it did not improve the specific regional connections that were lowered by CRT, it appeared to remodel these connections by increasing connectivity between alternate regional pairs. Conclusions Our data strongly suggest that exercise may be useful in combination with interventions aimed at improving cognitive outcome following pediatric CRT.
Collapse
Affiliation(s)
- Iman Sahnoune
- Department of Psychology, University of Houston, Houston, Texas
| | - Taeko Inoue
- Department of Pediatrics, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Shelli R Kesler
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Omaima M Sabek
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Steen E Pedersen
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, Texas
| | - Janice A Zawaski
- Department of Pediatrics, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Katharine H Nelson
- Department of Pediatrics, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - M Douglas Ris
- Department of Pediatrics, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.,Psychology Service, Texas Children's Hospital, Houston, Texas
| | - J Leigh Leasure
- Department of Psychology, University of Houston, Houston, Texas
| | - M Waleed Gaber
- Department of Pediatrics, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
5
|
Annett RD, Patel SK, Phipps S. Monitoring and Assessment of Neuropsychological Outcomes as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S460-513. [PMID: 26700917 DOI: 10.1002/pbc.25749] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/13/2015] [Indexed: 11/07/2022]
Abstract
Central nervous system cancers or exposure to CNS-directed therapies increase risk for neuropsychological deficits. There are no accepted guidelines for assessment of neuropsychological functioning in this population. A multifaceted literature search was conducted and relevant literature reviewed to inform the guidelines. Studies of neuropsychological outcomes are widely documented in the pediatric oncology literature. There is strong evidence of need for neuropsychological assessment, but insufficient evidence to guide the timing of assessment, nor to recommend specific interventions. Children with brain tumors and others at high risk for neuropsychological deficits should be monitored and assessed for neuropsychological deficits.
Collapse
Affiliation(s)
- Robert D Annett
- Universityof Mississippi Medical Center, Jackson, Mississippi
| | - Sunita K Patel
- City of Hope Medical Center and Beckman Research Institute, Duarte, California
| | - Sean Phipps
- St. Jude Children's Hospital, Memphis, Tennessee
| |
Collapse
|
6
|
Drimtzias E, Falzon K, Picton S, Jeeva I, Guy D, Nelson O, Simmons I. The ophthalmic natural history of paediatric craniopharyngioma: a long-term review. J Neurooncol 2014; 120:651-6. [DOI: 10.1007/s11060-014-1600-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/23/2014] [Indexed: 11/30/2022]
|
7
|
Foster RH, Russell CC, Dillon R, Bitsko MJ, Godder K, Stern M. Relations Among Optimism, Perceived Health Vulnerability, and Academic, Self-Regulatory, and Social Self-Efficacy in Adolescent Survivors of Childhood Cancer. J Psychosoc Oncol 2014; 32:207-23. [DOI: 10.1080/07347332.2013.874000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
8
|
Neurogenesis, exercise, and cognitive late effects of pediatric radiotherapy. Neural Plast 2013; 2013:698528. [PMID: 23691370 PMCID: PMC3649702 DOI: 10.1155/2013/698528] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/20/2013] [Indexed: 11/17/2022] Open
Abstract
Brain cancer is a common type of childhood malignancy, and radiotherapy (RT) is a mainstay of treatment. RT is effective for tumor eradication, and survival rates are high. However, RT damages the brain and disrupts ongoing developmental processes, resulting in debilitating cognitive “late” effects that may take years to fully manifest. These late effects likely derive from a long-term decrement in cell proliferation, combined with a neural environment that is hostile to plasticity, both of which are induced by RT. Long-term suppression of cell proliferation deprives the brain of the raw materials needed for optimum cognitive performance (such as new neurons in the hippocampus and new glia in frontal cortex), while chronic inflammation and dearth of trophic substances (such as growth hormone) limit neuroplastic potential in existing circuitry. Potential treatments for cognitive late effects should address both of these conditions. Exercise represents one such potential treatment, since it has the capacity to enhance cell proliferation, as well as to promote a neural milieu permissive for plasticity. Here, we review the evidence that cognitive late effects can be traced to RT-induced suppression of cell proliferation and hostile environmental conditions, as well as emerging evidence that exercise may be effective as an independent or adjuvant therapy.
Collapse
|
9
|
Lewis FM, Perry ML, Murdoch BE. Longitudinal language outcomes following intrathecal chemotherapy for acute lymphoblastic leukaemia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2013; 15:156-164. [PMID: 22663017 DOI: 10.3109/17549507.2012.684888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Intrathecal chemotherapy (ITC) is the treatment option for acute lymphoblastic leukaemia (ALL). Neurocognitive deficits have been described following ITC, but language status post-treatment is yet to be clarified. This study examined the language skills of nine children following ITC for ALL (mean age 7;8 years and 3;2 years post-diagnosis at baseline measurement) and nine age- and sex-matched controls, at baseline then 2 years later, using a battery of tests assessing general language skills. An assessment of cognitively-demanding high level language skills was undertaken on a sub-group of the children (n =12). Statistical analysis revealed no significant difference between children treated with ITC and controls when comparing change in performance scores from baseline measurement to 2 years post-baseline measurement. Descriptive analysis of three of the ALL participants in the Intermediate Stage survivorship at language re-assessment indicated no clinically-significant change in performance over 2 years for all measures except receptive language skills, which improved over the time for two of the children. As language skills continue to develop into late adolescence, the need for the monitoring of language abilities of children treated at a young age with ITC as they enter the Intermediate and Late Stages of survivorship is discussed.
Collapse
Affiliation(s)
- Fiona M Lewis
- Centre for Neurogenic Communication Disorders Research, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane 4072, Australia.
| | | | | |
Collapse
|
10
|
Abstract
BACKGROUND The increasing survival rate of children with cancer because of more refined treatments makes necessary the investigation of psychological burden for the young patients. OBJECTIVE The aim of the study was to evaluate the development of psychological problems in children with cancer during the initial 6-month period of intensive treatment. METHODS This prospective, comparative study was conducted at one of the largest Greek pediatric oncology units in Athens. The sample comprised 132 children with cancer treated during a 30-month period and 100 children with no cancer as control group. Data were collected using the Rutter instruments for parents and teachers. For patients, it was completed by their parents at 1 (T1), 3 (T2), and 6 months (T3) from diagnosis and by teachers at T3. In the control group, the questionnaire was completed by teachers and parents once. RESULTS The comparison of total Rutter scores for patients at T1, T2, and T3, according to parents' responses, showed statistically significant difference (P < .001). The difference in scores for patients (at T3) and control subjects was also significant according to both parents' (P < .00001) and teachers' (P < .001) responses. Children with leukemia had higher score reduction during treatment (P = .009) compared with the rest. Only age had a marginal impact on score of patients at T1 (R = 0.04). CONCLUSIONS Based on parental reports, children treated for cancer develop psychological problems during the period of intensive treatment. The development and evolution of these problems depend on their age and type of cancer. IMPLICATIONS FOR PRACTICE This information can be used for relevant interventions in specific groups.
Collapse
|
11
|
Hardy KK, Willard VW, Bonner MJ. Computerized cognitive training in survivors of childhood cancer: a pilot study. J Pediatr Oncol Nurs 2011; 28:27-33. [PMID: 20966158 DOI: 10.1177/1043454210377178] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of the current study was to pilot a computerized cognitive training program, Captain's Log, in a small sample of survivors of childhood cancer. A total of 9 survivors of acute lymphoblastic leukemia and brain tumors with attention and working memory deficits were enrolled in a home-based 12-week cognitive training program. Survivors returned for follow-up assessments postintervention and 3 months later. The intervention was associated with good feasibility and acceptability. Participants exhibited significant increases in working memory and decreases in parent-rated attention problems following the intervention. Findings indicate that home-based, computerized cognitive intervention is a promising intervention for survivors with cognitive late effects; however, further study is warranted with a larger sample.
Collapse
Affiliation(s)
- Kristina K Hardy
- Duke University Medical Center and Duke University, Durham, NC, USA.
| | | | | |
Collapse
|
12
|
Elliott RE, Sands SA, Strom RG, Wisoff JH. Craniopharyngioma Clinical Status Scale: a standardized metric of preoperative function and posttreatment outcome. Neurosurg Focus 2010; 28:E2. [PMID: 20367359 DOI: 10.3171/2010.2.focus09304] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Controversy persists concerning the optimal treatment of craniopharyngiomas in children, and no standard outcome metric exists for comparison across treatment modalities, nor is there one that adequately reflects the multisystem dysfunction that may arise. METHODS The authors retrospectively analyzed the records of 86 consecutive children who underwent a uniform treatment paradigm of attempted radical resection performed by a single surgeon. Excluding 3 perioperative deaths and 3 patients with inadequate follow-up, 80 children (34 girls and 46 boys; mean age 9.56 years; mean follow-up 9.6 years) composed the study group (53 primary and 27 previously treated/recurrent tumors). Building on existing classification schemes proposed by De Vile for hypothalamic dysfunction and Wen for overall functional outcome, the authors devised a more nuanced classification system (Craniopharyngioma Clinical Status Scale [CCSS]) that assesses outcome across 5 axes, including neurological examination, visual status, pituitary function, hypothalamic dysfunction, and educational/occupational status at last follow-up (there is a 4-tiered grading scale in each domain, with increasing values reflecting greater dysfunction). RESULTS There was a significant increase in pituitary dysfunction following treatment-consistent with the high rates of diabetes insipidus and hypopituitarism common to the surgical management of craniopharyngiomas-and less dramatic deterioration in hypothalamic function or cognitive domains. Significant improvement in vision was also demonstrated, with no significant overall change in neurological status. Preoperative CCSS scores predicted postoperative outcome better than clinical characteristics like patient age, sex, tumor size, and the location or presence of hydrocephalus. CONCLUSIONS Preoperative CCSS scores predicted outcome with higher accuracy than clinical or imaging characteristics. In lieu of randomized trials, the CCSS may provide a useful outcome assessment tool for comparison across treatment paradigms and surgical approaches. Long-term follow-up is critical to the analysis of outcomes of craniopharyngioma treatment, given the often-delayed sequelae of all therapies and the high recurrence rates of these tumors.
Collapse
Affiliation(s)
- Robert E Elliott
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | | | | | | |
Collapse
|
13
|
Elliott RE, Hsieh K, Hochm T, Belitskaya-Levy I, Wisoff J, Wisoff JH. Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children. J Neurosurg Pediatr 2010; 5:30-48. [PMID: 20043735 DOI: 10.3171/2009.7.peds09215] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Optimal treatment of primary and recurrent craniopharyngiomas remains controversial. Radical resection and limited resection plus radiation therapy yield similar rates of disease control and overall survival. The data are much less clear for recurrent tumors. The authors report their experience with radical resection of both primary and recurrent craniopharyngiomas in children and compare the outcomes between the 2 groups. METHODS A retrospective analysis was performed in 86 children younger than 21 years of age who underwent a total of 103 operations for craniopharyngioma between 1986 and 2008; these were performed by the senior author. The goal was resection with curative intent in all patients. Two patients were lost to follow-up and were excluded from analysis. The mean age at the time of surgery was 9.6 years, and the mean follow-up was 9.0 years. RESULTS All 57 children with primary tumors underwent gross-total resection (GTR). A GTR was achieved in significantly fewer children with recurrent tumors (18 [62%] of 29). There were 3 perioperative deaths (3%). Tumor recurred after GTR in 14 (20%) of 71 patients. Overall survival and progression-free survival were significantly better in patients with primary tumors at time of presentation to the authors' institution. There were no significant differences in the neurological, endocrinological, visual, or functional outcomes between patients with primary and those with recurrent tumors. Factors negatively affecting overall survival and progression-free survival include subtotal resection (recurrent tumors only), tumor size >or= 5 cm, or presence of hydrocephalus or a ventriculoperitoneal shunt. Prior radiation therapy and increasing tumor size were both risk factors for incomplete resection at reoperation. CONCLUSIONS In the hands of surgeons with experience with craniopharyngiomas, the authors believe that radical resection at presentation offers the best chance of disease control and potential cure with acceptable morbidity. While GTR does not preclude recurrence and is more difficult to achieve in recurrent tumors, especially large and previously irradiated tumors, radical resection is still possible in patients with recurrent craniopharyngiomas with morbidity similar to that of primary tumors.
Collapse
Affiliation(s)
- Robert E Elliott
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA
| | | | | | | | | | | |
Collapse
|
14
|
Elliott RE, Wisoff JH. Successful surgical treatment of craniopharyngioma in very young children. J Neurosurg Pediatr 2009; 3:397-406. [PMID: 19409019 DOI: 10.3171/2009.1.peds08401] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Given the potential morbidity of cranial irradiation in young children, the risk-benefit analysis of limited surgery plus irradiation versus radical resection may favor the latter strategy. The purpose of this study was to assess the oncological, endocrinological, and functional outcomes of patients 5 years of age and younger who underwent radical resection of craniopharyngiomas. METHODS Between 1991 and 2008, 19 children age < or = 5 years were diagnosed with a craniopharyngioma and underwent radical resection by the senior author (J.H.W.). Data were retrospectively collected on these 19 patients (11 males, 8 females; mean age 3.2 years) to assess the efficacy and impact of surgical treatment. RESULTS Eighteen (95%) of 19 patients underwent gross-total resection (GTR) confirmed by intraoperative inspection and postoperative imaging. There was no operative death and 18 of (95%) 19 patients were alive at a mean follow-up of 9.4 years (median 8.3 years). Six patients (31%) had a total of 7 tumor recurrences treated by repeat GTR in 5 patients and Gamma knife surgery in 1 patient. No patient required conventional, fractionated radiation therapy. Disease control was achieved surgically in 17 (89.5%) patients and with surgery and Gamma knife surgery in 1 patient, yielding an overall rate of disease control of 95% without the use of conventional radiotherapy. New-onset diabetes insipidus occurred in 50% of patients. Vision worsened in 1 patient, and there was no long-term neurological morbidity. CONCLUSIONS In this retrospective series, children aged < or = 5 years with craniopharyngiomas can have excellent outcomes with minimal morbidity after radical resection by an experienced surgeon. Disease control in this population can be successfully achieved with GTR alone in the majority of cases, avoiding the detrimental effects of radiotherapy in this vulnerable population.
Collapse
Affiliation(s)
- Robert E Elliott
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA.
| | | |
Collapse
|
15
|
Elliott RE, Moshel YA, Wisoff JH. Minimal residual calcification and recurrence after gross-total resection of craniopharyngioma in children. J Neurosurg Pediatr 2009; 3:276-83. [PMID: 19338405 DOI: 10.3171/2009.1.peds08335] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The purpose of this study was to assess the impact of minimal residual calcification without enhancing tumor on the rate of recurrence after gross-total resection (GTR) of craniopharyngioma in children. METHODS Data were retrospectively collected in 86 patients younger than 21 years of age in whom 103 craniopharyngioma resections were performed by the senior author between 1986 and 2008. Forty-nine patients (27 boys and 22 girls, with a mean age of 8.6 years) fulfilled the criteria for inclusion in this study by having tumor calcification on the preoperative CT scan, undergoing GTR, and having complete postoperative CT and MR imaging and clinical follow-up. RESULTS Thirteen patients (27%) had residual calcification (< or = 2 mm in 12 patients; 3.5 mm in 1 patient) on their postoperative CT scan. At a mean follow-up of 9.4 years (median 10 years), 2 (15%) of 13 patients with and 10 (28%) of 36 patients without residual calcification experienced tumor recurrence. There were no significant differences between these groups in terms of the duration of follow-up, time to recurrence, rate of recurrence, or recurrence-free survival. CONCLUSIONS The absence or presence of minimal residual calcification does not have an impact on the risk of recurrence after GTR in pediatric craniopharyngiomas. The authors recommend withholding irradiation or other adjuvant therapy in the setting of minimal residual calcification without enhancing tumor. Close follow-up with frequent serial imaging in all patients after GTR is imperative to identify and treat early recurrence.
Collapse
|
16
|
Vakil E, Blachstein H, Sheinman M, Greenstein Y. Developmental changes in attention tests norms: implications for the structure of attention. Child Neuropsychol 2009; 15:21-39. [PMID: 18608225 DOI: 10.1080/09297040801947069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Assessment of attention is a key issue in the study of neuropsychological development. In this study we collected Hebrew norms for four frequently used attention tests (Trail Making, Digit-Symbol, Digit Span, and Digit Cancellation), analyzed the developmental sensitivity of each test and traced changes in attention across ages. The tests were administered to 809 boys and girls ranging in age from 8 to 17, divided into 10 age cohorts. The results indicate that, although all tests showed age effects, Digit-Symbol and Digit Cancellation tests were most developmentally sensitive. Another interesting finding was that younger age groups (8-11) are more dissociable by attention tests than older age groups (12-17), indicating that changes in attention are more pronounced in the early years and stabilize in later years.
Collapse
Affiliation(s)
- Eli Vakil
- Department of Psychology, Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel.
| | | | | | | |
Collapse
|
17
|
Lofstad GE, Reinfjell T, Hestad K, Diseth TH. Cognitive outcome in children and adolescents treated for acute lymphoblastic leukaemia with chemotherapy only. Acta Paediatr 2009; 98:180-6. [PMID: 18826490 PMCID: PMC2659382 DOI: 10.1111/j.1651-2227.2008.01055.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective: To examine cognitive outcome in children and adolescents with acute lymphoblastic leukaemia (ALL) in remission, treated with central nervous system prophylactic chemotherapy only. Method: Thirty-five children and adolescents, age 8.4–15.3 years in long-term remission from ALL, 4.2–12.4 years post diagnosis, without relapse and no prediagnosis history of neurodevelopmental disorder were compared with 35 healthy controls matched for gender and age, on measures of intellectual functioning Wechsler Intelligence Scale for Children-Third Edition (WISC-III). Results: All but two of the ALL survivors treated by chemotherapy only obtained WISC-III Total Intelligence Quotient (IQ) scores in the normal range (M = 95.3), but their scores were significantly below levels for their matched controls and below normative standards for WISC-III. The difference between patients and controls was significant at the p < 0.001 level for the following measures: Total IQ, Verbal IQ, Verbal Comprehension Index, Freedom from Distraction Index and three verbal subtest scores. Conclusion: The results indicate long-term sequelae in global cognitive functions, and indicate that verbal function, processing speed, attention and complex visual-spatial problem solving may be affected in the chemotherapy only group.
Collapse
Affiliation(s)
- G Elisabeth Lofstad
- Neuropsychological Clinic, Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | | | | |
Collapse
|
18
|
Rey-Casserly C, Meadows ME. Developmental perspectives on optimizing educational and vocational outcomes in child and adult survivors of cancer. ACTA ACUST UNITED AC 2008; 14:243-50. [DOI: 10.1002/ddrr.31] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
19
|
Abstract
Military, occupational, and environmental events can cause toxic injuries that require psychiatric diagnosis and treatment. This article reviews the psychiatric effects of neurotoxins, including nerve gases, ionizing radiation, insecticides, heavy metals, solvents, and other toxic agents. Diagnostic considerations and clinical tests for further evaluation of the numerous psychiatric conditions and symptoms caused by toxic exposures are discussed.
Collapse
|
20
|
Armstrong GT, Sklar CA, Hudson MM, Robison LL. Long-Term Health Status Among Survivors of Childhood Cancer: Does Sex Matter? J Clin Oncol 2007; 25:4477-89. [PMID: 17906209 DOI: 10.1200/jco.2007.11.2003] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Increasing numbers of children diagnosed with cancer will survive their primary malignancy. Within this growing population of long-term survivors, considerable effort has been put forth to identify treatment-related risks for adverse health-related outcomes, such as exposure to alkylating agents, anthracyclines, radiotherapy, and surgery. Patient sex has been identified as a risk factor for numerous long-term adverse outcomes, with female sex more commonly associated with higher risks. In this article, we review the literature, which generally supports associations between female sex and cognitive dysfunction after cranial irradiation, cardiovascular outcomes, obesity, radiation-associated differences in pubertal timing, development of primary hypothyroidism, breast cancer as a second malignant neoplasm and suggests an increased prevalence for the development of osteonecrosis among females. Results of this review support future investigations to further define sex as a risk factor for other common treatment-specific exposures and outcomes. Additionally, research should focus on understanding the underlying biologic and physiological basis of these sex-specific risks. Historically, evidence from both basic science and clinical research has been used to develop risk-stratified therapy, allowing reduction of toxic therapies to low-risk patients without compromising overall survival. With greater knowledge of sex-specific risks, the potential application of sex-specific therapy designed to avoid poor long-term adverse outcomes may become a viable strategy.
Collapse
Affiliation(s)
- Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
| | | | | | | |
Collapse
|
21
|
Benjamin C, Anderson V, Pinczower R, Leventer R, Richardson M, Nash M. Pre- and post-encephalitic neuropsychological profile of a 7-year-old girl. Neuropsychol Rehabil 2007; 17:528-50. [PMID: 17676533 DOI: 10.1080/09602010601130927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Our understanding of the neuropsychological effects of encephalitis has largely come from studies in which the level of premorbid functioning is estimated. Moreover, data on the neuropsychological effects of encephalitogenic pathogens other than the herpes simplex virus (HSV) are scant. We present the case of a 7-year-old girl who had intellectual and language assessment seven months prior to the onset of non-HSV encephalitis (possible aetiology: Mycoplasma pneumoniae), and again post-encephalitis. MRI post-illness demonstrated basal frontal, temporal and (limited) parietal damage. Details of speech, psychological and neuropsychological assessments were also documented. Pervasive changes were apparent in the domains of personality, behaviour, emotionality, attention, executive function, speech, language and memory. The patient's profile appears to differ most from that seen following typical HSV encephalitis with respect to marked executive and attentional difficulties. Her deficits appear to reflect both her acute basal brain injury and more diffuse insult, probably caused by postinfectious encephalitis.
Collapse
Affiliation(s)
- C Benjamin
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | | | | | | | | |
Collapse
|
22
|
Qiu D, Kwong DLW, Chan GCF, Leung LHT, Khong PL. Diffusion tensor magnetic resonance imaging finding of discrepant fractional anisotropy between the frontal and parietal lobes after whole-brain irradiation in childhood medulloblastoma survivors: reflection of regional white matter radiosensitivity? Int J Radiat Oncol Biol Phys 2007; 69:846-51. [PMID: 17544593 DOI: 10.1016/j.ijrobp.2007.04.041] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 04/13/2007] [Accepted: 04/13/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE To test the hypothesis that fractional anisotropy (FA) is more severely reduced in white matter of the frontal lobe compared with the parietal lobe after receiving the same whole-brain irradiation dose in a cohort of childhood medulloblastoma survivors. METHODS AND MATERIALS Twenty-two medulloblastoma survivors (15 male, mean [+/- SD] age = 12.1 +/- 4.6 years) and the same number of control subjects (15 male, aged 12.0 +/- 4.2 years) were recruited for diffusion tensor magnetic resonance imaging scans. Using an automated tissue classification method and the Talairach Daemon atlas, FA values of frontal and parietal lobes receiving the same radiation dose, and the ratio between them were quantified and denoted as FFA, PFA, and FA(f/p), respectively. The Mann-Whitney U test was used to test for significant differences of FFA, PFA, and FA(f/p) between medulloblastoma survivors and control subjects. RESULTS Frontal lobe and parietal lobe white matter FA were found to be significantly less in medulloblastoma survivors compared with control subjects (frontal p = 0.001, parietal p = 0.026). Moreover, these differences were found to be discrepant, with the frontal lobe having a significantly larger difference in FA compared with the parietal lobe. The FA(f/p) of control and medulloblastoma survivors was 1.110 and 1.082, respectively (p = 0.029). CONCLUSION Discrepant FA changes after the same irradiation dose suggest radiosensitivity of the frontal lobe white matter compared with the parietal lobe. Special efforts to address the potentially vulnerable frontal lobe after treatment with whole-brain radiation may be needed so as to balance disease control and treatment-related morbidity.
Collapse
Affiliation(s)
- Deqiang Qiu
- Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | | | | | | | | |
Collapse
|
23
|
Bauld C, Toumbourou JW, Anderson V, Coffey C, Olsson CA. Health-risk behaviours among adolescent survivors of childhood cancer. Pediatr Blood Cancer 2005; 45:706-15. [PMID: 16007604 DOI: 10.1002/pbc.20421] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The purpose of the study was to investigate smoking, alcohol use, illicit drug use and sexual risk taking among adolescent survivors of childhood cancer treated in Australia. PROCEDURE A comparison study selecting on exposure (cancer vs. healthy) and administering a branched computerised questionnaire assessing health-risk behaviour, predominately by telephone interview. One hundred fifty-three adolescent survivors of childhood cancer were compared with age matched healthy adolescents drawn from one of two Australian population based surveys of adolescent health. Behaviours assessed were tobacco use, alcohol use, binge drinking, cannabis use, pain reliever use, other illicit drug use and unprotected sex. RESULTS Compared to their healthy peers, younger survivors (13- to 17-years) were at an increased risk of reporting pain reliever use (OR = 2.1) for non-medical purposes, but lower risk of binge drinking (OR = 0.20), cannabis use (OR = 0.25), other illicit drug use (OR = 0.31), tobacco use (OR = 0.38) and alcohol use (OR = 0.44). Older survivors (18- to 24-years) were at an increased risk of reporting alcohol use (OR 1.5), but at lower risk of reporting cannabis use (OR = 0.27), other illicit drug use (OR = 0.44) and tobacco use (OR = 0.47). Survival analysis using the full adolescent survivor cohort (13- to 24-years) showed that the age of onset of tobacco use was later for cancer survivors (hazard ratio HR = 0.65). CONCLUSION Adolescent cancer survivors show reduced involvement in most health-risk behaviours, with the exception of pain reliever use among younger survivors and alcohol use among the older survivors. Although risks were reduced a substantial proportion of survivors engage in these behaviours.
Collapse
Affiliation(s)
- Catherine Bauld
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Children's Hospital, University of Melbourne, Victoria, Australia.
| | | | | | | | | |
Collapse
|
24
|
Yeates KO, Armstrong K, Janusz J, Taylor HG, Wade S, Stancin T, Drotar D. Long-term attention problems in children with traumatic brain injury. J Am Acad Child Adolesc Psychiatry 2005; 44:574-84. [PMID: 15908840 DOI: 10.1097/01.chi.0000159947.50523.64] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine long-term attention problems and their cognitive correlates after childhood traumatic brain injury (TBI). METHOD Data were drawn from a prospective, longitudinal study conducted between 1992 and 2002. Participants included 41 children with severe TBI, 41 with moderate TBI, and 50 with orthopedic injury (OI), who were all between 6 and 12 years of age at the time of injury. Parent ratings of attention problems were obtained at a long-term follow-up on average 4 years post-injury and compared with ratings of premorbid attention problems obtained shortly after injury. At the long-term follow-up, children also completed several cognitive tests of attention and executive functions. RESULTS Hierarchical linear and logistic regression analyses indicated that the severe TBI group displayed significantly more attention problems than the OI group at 4 years post-injury, both behaviorally and cognitively, after controlling for race, socioeconomic status, and premorbid attention problems. At long-term follow-up, 46% of the severe TBI group displayed significant attention problems on the Child Behavior Checklist, as opposed to 26% of the OI group (odds ratio=3.38; 95% confidence interval, 1.15-9.94). On the Attention-Deficit/Hyperactivity Disorder Rating Scale, 20% of the severe TBI group displayed clinically significant attention problems compared with 4% in the OI group (odds ratio=9.59; 95% confidence interval, 1.24-73.99). However, group differences in behavioral symptoms were significantly larger for children with more premorbid symptoms than for children with fewer premorbid problems. Measures of executive functions were significantly related to behavioral attention problems, after controlling for group membership, race, and socioeconomic status. CONCLUSIONS Childhood TBI exacerbates premorbid attention problems. Long-term behavioral symptoms of attention problems are related to the cognitive deficits in attention and executive functions that often occur in association with childhood TBI.
Collapse
Affiliation(s)
- Keith Owen Yeates
- Department of Pediatrics, The Ohio State University and Columbus Children's Research Institute, Columbus, OH, USA.
| | | | | | | | | | | | | |
Collapse
|