Most children with cerebral sinovenous thrombosis (CSVT)
performed poorly on a least one domain in neuropsychological testing, according
to findings presented here at the annual meeting of the Child Neurology
Society.
"There is a clear problem in the neuropsychological
function in these kids. However, further investigation should be done using a
larger sample size to better understand the impact of these abnormalities in
real-life function," said Mahmoud Slim, PhD, a research fellow at the
Hospital for Sick Children in Toronto, who presented the data.
The retrospective study aimed to better understand the
long-term prospects for children with CSVT, an increasingly recognized cause of
childhood stroke with an incidence of 0.4 to 0.7 per 100,000 children per year.
Previous studies on neuropsychological outcomes have found that large
percentages of the children have developmental delays and cognitive deficits in
subsequent months. But, the study authors pointed out, most previous studies
did not use as wide an array of instruments as the current study and had
shorter follow-up times.
Researchers assessed 50 children on intellectual ability,
executive function, adaptive behavior, attention, verbal learning and memory,
and visual-motor integration. Not all of the children were assessed in all
domains. They averaged about 2.5 years old at the time of their CSVT and were
followed from about four to seven years, depending on the domain. A score that
was at least one standard deviation below the mean was considered to be
abnormally poor.
Eighty percent of children scored below normal in at least
one domain, and 6 percent scored below normal in all domains that were tested,
researchers found. Twenty percent scored normally.
To gauge how the testing results related to real-life
function, researchers looked at the prevalence of individualized education
plans; they found that 40 percent of the cohort had such a plan, compared with
a community prevalence of just 9 percent.
Researchers did not find predictors of poor testing
performance that rose to the level of significance, but that was likely limited
by the study size, Dr. Slim said.
"We need larger studies to better tackle the question
of predictors [of neuropsychological outcomes]," he said. "We mainly
believe that close surveillance of the cognitive and behavioral functioning
should be adapted by practicing clinicians and that children should be sent to
the most adequate rehabilitation programs based on their specific needs."
Commenting on the study, Rebecca N. Ichord, MD, director of
the pediatric stroke program at the Children's Hospital of Philadelphia, said
that the high prevalence of neurocognitive impairments isn't surprising.
"Any population of children that experiences acquired
brain injury can be expected to have long-term adverse neuropsychological
morbidity—similar to what has been found in all other types of acquired brain
injury such as arterial ischemic stroke, intracranial hemorrhage, and traumatic
brain injury. The good news from these data is that the severity of the
impairments appears generally to be in the mild range."
The bad news, she said, is that interventions to address
these problems are limited and vary greatly according to geography and socioeconomic
status.
"Good research such as this study should be helpful in
understanding predictors and mechanisms," she said. "I would
anticipate that interventions to address these problems will be applicable to
multiple types of diseases—arterial ischemic stroke, neonatal hypoxia-ischemia,
and traumatic brain injury."
The findings point to the need for strong partnerships
between medical providers, families, and educators, she said.
"The solution to these problems must be recognized to
be the responsibility of society at large, and not just the medical community.
Economic disparities and social inequities will interfere with the educational
and rehabilitation solutions that these children and their families will
need," Dr. Ichord said. "Treatment for these problems necessarily
extends to the community— education, social and mental health systems."
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