Psychological outcome in children treated for brain tumor.

The cognitive and psychosocial functions of 16 children with brain tumor, treated with wholebrain or local radiotherapy, were studied. Fifteen nonirradiated children with acute lymphatic leukemia (ALL) served as a comparison group. Mean Wechsler Intelligence Scale for Children--Revised Full Scale IQ score and mean Visual-Motor Integration Test (Beery VMI) standard score were significantly decreased in the brain tumor group. The Achenbach checklists were filled in by mothers (Child Behavior Checklist, CBCL) and teachers (Teacher's Report Form). Overall adjustment was rated lower in the children with brain tumor. Although most of the children in the ALL group were well adapted, one third of them had low CBCL Social Competence scores relative to nonclinical norms. On a visual analog scale a significantly decreased tempo was assessed by mothers and teachers in the children with brain tumor, and low speed and hypoactivity seemed to limit the majority of these children in school and daily life activities.

[Psychological functions in children treated for acute lymphatic leukemia. A 5-year follow-up of three different age groups of children]. / Psykologisk funksjonsevne hos barn behandlet for akutt lymfatisk leukemi. En fem års etterundersøkelse av tre årskull barn.

All the children, five girls and ten boys aged 8-16 years, mean 11 years, with acute lymphoblastic leukemia which had been diagnosed in 1980, 1981 or 1983 and was still in remission in 1990, were examined. The treatment included intratecal methotrexate, but no irradiation. Mean age at the time of diagnosis was 4.5 years. All the WISC-R IQ-scores were within the normal range (mean Full Scale IQ 109, range 93-142). Six children had a high negative Verbal/Performance split score (mean +/- 23, range -15 to -33). This indicated dysfunction in verbal compared with nonverbal problem solving ability. Only one child had a high positive WISC-R split score (+23). Except for one child, all the scores on the Visual-Motor Integration Test were within the normal range. The Achenbach checklists were completed by parents and teachers. A small increase was found in the total problem scores, but most of the children were evaluated as well adapted.

[Intellectual and psychosocial functions in children treated with radiation for brain tumor]. / Intellektuelle og psykososiale funksjoner hos barn strålebehandlet for hjernesvulst.

Modern treatment has increased the survival rate for children with brain tumour, but treatment with radiation may lead to late adverse neuropsychologic effects. Also, peer problems may follow long periods away from school, and painful treatment and anxiety about the disease may mobilize emotional stress reactions. 16 brain tumour children with a mean age of 11 years (range 6-16 years), all of them treated with radiation, were tested with WISC-R. The mean time between diagnosis and study was five years (range 2-11 years). Parents and teachers completed the Achenbach check lists CBCL and TRF. Children below age four years at diagnosis achieved the lowest WISC-R IQs, the highest problem scores and the lowest social adaptive scores on CBCL and TRF. More problems were reported among the youth group aged 12-16 years than among the child group aged 6-11 years. Hypoactivity and low psychomotor speed seemed to have an adverse effect on both intellectual and psychosocial functioning. An almost normal communicative and reasoning ability was a resource for most of the children.

Dystonia and dyskinesia in glutaric aciduria type I: clinical heterogeneity and therapeutic considerations.

Glutaric aciduria type I (GA-I) is an inborn error in the degradation of lysine, hydroxylysine, and tryptophan due to a deficiency of glutaryl-CoA dehydrogenase. Glutaric, 3-OH-glutaric, and glutaconic acids are excreted in the urine, particularly during intercurrent illness. The enzyme may be assayed in leukocytes, cultured fibroblasts and chorionic villi. Twelve new cases, 9 months-16 years of age, are reported, comprising all known cases of GA-I in Sweden and Norway. Ten had a severe dystonic-dyskinetic disorder, one had a mild hyperkinetic disorder, and one was asymptomatic. Two children died in a state of hyperthermia. Carnitine deficiency and malnutrition developed in patients with severe dystonia and dysphagia, which necessitated substitution and gastrostomy. A slowly progressive dyskinetic disorder developed in spite of adequate early dietary treatment in one subject. Macrocephaly was found in three. Computed tomography and magnetic resonance investigations in 10 showed deep bitemporal spaces in 7. Neuropsychological testing of 8 of 12 subjects demonstrated receptive language function to be superior to expressive language and motor function. Cognitive functions were obviously less affected than motor functions. A review of 57 pooled cases showed that a severe dystonic syndrome developed in 77%, a mild extrapyramidal syndrome in 10%, and 12% were asymptomatic. This disorder may pass undetected in the cerebral palsy and mentally retarded child and adult populations. Repeated urine examinations of organic acids in the urine and enzyme assay may be necessary to confirm GA-I.

Long-term cerebral effects of CNS chemotherapy in children with acute lymphoblastic leukemia.

Fifteen 7-16-year-old patients, treated in 1981-1984 for acute lymphoblastic leukemia (ALL) in first complete remission, were studied. As a central nervous system prophylaxis, all the children were treated with repeated methotrexate (MTX) instillations, but none were irradiated. The study protocol included magnetic resonance (MR) and a battery of neuropsychological tests. Small, punctate white-matter lesions were found by MR in eight children, probably minor vascular lesions. All the children were within normal intelligence range with a mean total WISC-R IQ of 109. Minor neuropsychologic problems were found in two patients, while one child showed a more extensive specific learning disorder in school.

[Glutaric aciduria type I]. / Glutarsyreuri type I.

Glutaric aciduria type I is a congenital metabolic disease caused by an enzymatic defect in the degradation of the amino acids lysine and tryptophane. This article presents five Norwegian patients with this condition. Early clinical features may be similar to those of encephalitis. The further clinical course is dominated by choreoathetosis, hyperkinesis and spasticity. The diagnosis is made by tracing enhanced glutaric acid in the urine. The treatment is a low protein diet containing only small quantities of lysine and tryptophane. Four of our patients underwent a neuropsychological examination. Despite the fact that such patients are difficult to test, our examination indicates that the condition has a greater effect on motor than on cognitive functions.

[Psychological and neurologic long-term consequences of brain tumors in children. A pilot study]. / Psykologiske og neurologiske langtidsvirkninger av hjernesvulst hos barn. En pilotstudie.

Brain tumor is one of the most common forms of cancer in children. The therapy includes surgical interventions, radiation of the central nervous system and chemotherapy. Combining these methods of treatment has remarkably improved the survival of children with certain brain tumours (e.g. medulloblastoma). However, long-term studies have revealed serious psychological and somatic consequences of the disease and the treatment. This paper presents the results of a pilot study of nine children with brain tumor. The patients were examined using a battery of neuropsychological methods (Luria's Neuropsychological Investigation, WISC-R), a semi-structured interview (Child Assessment Schedule), a parent report form (Achenbach Child Behaviour Checklist) and a clinical neurological examination. The most striking finding from this investigation was in the psychosocial field. Except for one child, all the patients showed an introvert reaction pattern with a tendency towards anxiety, depression and social withdrawal. All the children showed some neurological and neuropsychological deficits. Except in the case of two mentally retarded children, cognitive functions were within the lower normal range. Specific learning, memory and fine-motor disabilities were found in more than half of the patients. The investigation suggested that both fine-motor and mental performance was detrimentally affected by increased speed. This seems to be an area of special interest for further studies.

[Function and tasks of a psychiatric unit for children and adolescents at a regional hospital]. / Funksjon og oppgaver for en barne-og ungdomspsykiatrisk seksjon ved et regionsykehus.

We present a model for further development and application of a child psychiatric consultation and liaison service in pediatric wards, and describe areas of special importance in the collaboration between child psychiatry and somatic medicine (e.g. high technology medicine, cancer, perinatal care). We point out present trends and new challenges in the field.

Effects of hypnotics on memory.

The influence on memory of 7.5 mg zopiclone, given in single and repeated doses was compared with that of 2 mg flunitrazepam, 5 mg nitrazepam and placebo. Compared with placebo, all three drugs induced some impairment of memory especially after the first day of administration. Effects were more pronounced for the two benzodiazepines and more marked for flunitrazepam. There was one report of an anterograde amnestic episode after flunitrazepam.

Effects of hypnotics on memory.

The influence on memory of 7.5 mg zopiclone, given in single and repeated doses was compared with that of 2 mg flunitrazepam, 5 mg nitrazepam and placebo. Compared with placebo, all three drugs induced some impairment of memory especially after the first day of administration. Effects were more pronounced for the two benzodiazepines and more marked for flunitrazepam. There was one report of an anterograde amnestic episode after flunitrazepam.