IQ in Patients with Myelomeningocele – A Review
Info: 6425 words (26 pages) Dissertation
Published: 9th Dec 2019
Tagged: Mental HealthMedicineNeurology
IQ IN PATIENTS WITH MYELOMENINGOCELE – A REVIEW
It has been proposed that the presence of hydrocephalus in children with myelomeningocele (MMC) can be an indication of a decreased intelligence quotient (IQ). Others have argued that it is not the mere presence of hydrocephalus but the superimposition of CSF infections, multiple shunt procedures, and other CNS complications that lead to the decreased IQ observed in these patients. In this paper, we review different studies to better discern the IQ in patients with MMC and if it changes after infections and shunt procedures. We also have a glance at other factors that might play a role in IQ development in these patients and the differences observed in brain imaging of individuals with MMC.
Keywords; Myelomeningocele, spina bifida, hydrocephalus, intelligence quotient, venticuloperitoneal shunt
Myelomeningocele (MMC) is the most serious form of spina bifida with a prevalence of about 1 per 1,000 births globally [6, 23]. The pathogenesis of MMC has been proposed to be multi-factorial, although its association with maternal folate deficiency is well known [6, 24, 33]. While compatible with life, children with MMC tend to have a lower quality of life compared to normal individuals mostly due to the central nervous system impairment associated with this disorder. Spinal cord defect in children born with MMC can present as either sensory or motor deficits with extreme cases causing an impairment of mobility .
Cranial abnormalities can also present in individuals with MMC. This might be attributed to the similar embryological structure, the neural tube, from which both the brain and the spinal cord develop during embryogenesis. Some well-known abnormalities associated with the brain in individuals with MMC include hydrocephalus, corpus callosum dysgenesis and Chiari II malformation, which itself is a cause of hydrocephalus [6, 18, 19, 24, 28, 37]. These abnormalities have been linked to a variety of learning disabilities as well as decreased executive functioning in these individuals [18, 21, 24]. The presence of hydrocephalus has been proposed to be a significant predictor of intellectual capacity in MMC patients and most studies on IQ and executive functioning in these individuals have been focused on hydrocephalus with or without ventricular shunting [3, 9, 17, 26, 30]. Complications secondary to ventricular shunting have also been postulated to worsen intellectual function .
Intelligence Quotient and Myelomeningocele
Intellectual capacity is an important factor by which an individual’s survival quality may be evaluated. Therefore, it is of great importance we know how the intelligence quotient (IQ) of children with MMC is being affected by the subsequent death of neuron in-utero [19, 30]. Several studies have been performed to see how IQ is affected in children with MMC [3, 9, 10, 11, 17, 19, 21, 24, 27]. Many of these studies demonstrate how hydrocephalus in children with MMC can be a negative predictor of intellectual capacity, which in tandem, is detrimental to the quality of life in these patients . In one of the earlier studies performed by Mapstone et al., a significant difference in intellectual function was observed when comparing the IQ of MMC children with and without hydrocephalus . Children with hydrocephalus were noted to have a low-normal IQ whereas those without were in the normal range. Similar conclusions were drawn from an identical study performed by Soare and Raimondi, where they observed 173 children with 133 having developed hydrocephalus and the remaining 40 presented swelling-free . Their results showed about 63% of children with hydrocephalus had an IQ greater than 80, which in this study was considered normal. However, 87% of children without hydrocephalus had similar results albeit with a smaller sample size. When compared with their siblings, children with hydrocephalus scored notably lower on a test for accessing perceptual-motor function.
Soare and Raimondi also observed that individuals with a higher level of spinal cord lesion tended to have a lower IQ when compared to their counterparts with a lower level lesion . This was again almost identical to that observed by Mapstone et al. in that they did see an inverse relationship between IQ and lesion levels, but deemed the results statistically insignificant . However, results from Nejat et al., contradicted the above findings with their study showing no significant correlation between the level of the lesion and IQ . Could this be attributed to a much smaller sample size of 50 children in this study compared to the former with 173 or were Mapstone et al. right when they considered the relationship to be insignificant? More studies would be needed to provide a definite answer to this hypothesis.
Several other studies have demonstrated the relationship between decreased cognitive function and hydrocephalus in individuals with MMC [9, 10, 17, 30]. One major inclusion from the study by Hampton et al was that although children with spina bifida do perform poorer in tasks involving spatial and executive function, their performance in vocabulary related task was relatively higher . This might not mean much as children without MMC used as control also performed much better in verbal related tasks compared to spatial tasks and might just suggest a general trend.
It is worthy of note that although executive functioning, learning and memory-related tasks might be impaired in patients with MMC, emotion recognition is also deemed to be negatively affected and some studies have argued that performance in visual tasks involving object based visual processing might be intact in these patients [31, 34]. Arnold Chiari-II malformation, which is mostly present in children with spina bifida, has been proposed to negatively affect both performance IQ, verbal IQ and visual related tasks in patients with MMC .
Is hydrocephalus alone, when present in individuals with MMC, the sole predictor of IQ? Probably not. A study by McLone showed that children with complicated hydrocephalus (i.e., hydrocephalus along with other CNS insults such as ventriculitis, meningitis, and an increase in revision of shunts) tended to have significantly lower IQ when compared to previously recorded intellectual functioning scores . However, children with hydrocephalus (+/- shunt) but without complications had scores similar to their previous record. Other studies have had similar results associating more frequent shunt revisions and complications with poorer functional outcomes [13, 20]. McLone also observed a slight correlation between lesion location and infection rate such that children with a higher lesion had a higher incidence of infection and therefore a lower IQ .
A lower socioeconomic status (SES) has been generally assumed to occur simultaneously with a lower IQ [11, 32]. It is therefore of no surprise to inquire about the IQ of children with MMC born into a low SES family. A study was performed by Swartwout et al. to discern the relationship between MMC children, IQ, and SES . Although this article does not compare the IQ difference between children with and without MMC with lower SES as the common variable, the results of their study demonstrated that a lower socioeconomic status in children with MMC is associated with a lower “verbal” IQ, which in turn tends to lead to a lower IQ. .
Cortical organization and imaging of the brain in MMC
IQ is a measure of cortical function and visualizing the differences in cortical organization and overall brain topography in patients with MMC can assist in further understanding this disorder. It has been postulated that the cerebral cortex in individuals with MMC has an atypical organization leading to a derangement in motor and cognitive function . Although heritability does play a prominent role in IQ development, research have shown that people with higher IQ tend to have a prolonged period of cortical thickening during childhood . But how does an atypical arrangement of the cerebral cortex lead to a perturbed cognitive function and what physical characteristics are seen in the cerebral cortex of these individuals and how do these relate to IQ? To investigate this conundrum, Treble et al. performed a study to show how cortical thickness relates to IQ and fine motor function in MMC . Their perspective was that since a significant amount of neuro-cognitive disorders have an association with atypical brain volume, how does the unusual organization of the cortex in individuals with MMC relate with the thickness of the cortex? The relationship between the thickness of the cerebral cortex and IQ in individuals with MMC was studied as well as whether an upper or lower limit to cortical thickness and gyrification exists for ideal motor and cognitive function in these individuals . High resolution magnetic resonance images (MRI) of the brain were taken 64 patients with MMC and compared with 24 normally developing controls with each individual undergoing IQ and fine motor dexterity tests and results match for their respective age groups. Temple et al. observed that there was a negative correlation between IQ and increased cerebral thickness in individuals with MMC, and stipulated that the more the increase in cerebral thickness, the lower the IQ observed, resulting in poorer fine motor and cognitive function. On the other end of the spectrum, there was a positive correlation between a reduced thickness of the cerebral cortex and IQ. They concluded that the more the deviation of the cortical thickness from the norm, the lower the IQ .
Another imaging study showed a remarkable decrease in white matter and a corresponding increase in cerebrospinal fluid (CSF) of the brain in children with MMC . Their result suggested a decreased myelination and disruption of white matter pathways secondary to hydrocephalus. This supports the consensus that hydrocephalus is associated with an increase in IQ deficit observed in patients with MMC plus hydrocephalus when compared to individuals with MMC but without hydrocephalus. The negative effect of hydrocephalus on development of the brain in both humans and animals, with impact such as neuronal disruption and cellular death, is well documented, hence it is of no surprise that IQ deficits are more pronounced in individuals with MMC + hydrocephalus . Another supporting evidence of the detrimental effect of hydrocephalus on learning and executive functioning was a study by Lindquist et al which showed that there was no significant different in these cortical processes when comparing children with MMC plus hydrocephalus and children with hydrocephalus secondary to other causes with both having similarly low scores on tests for executive function compared to normal children .
Treatment of Hydrocephalus in MMC and how it affects IQ
Since the consensus appears to be that children with MMC tend to have a sub-average IQ, and the presence of hydrocephalus in patients with MMC carries a negative IQ prognosis, it is important for us to know how or if these children improve after treatment. The MMC lesion can be repaired via a variety of surgical techniques . Surgical treatment for MMC has been on the decline in the past two decades due to public awareness about folate supplementation before and during pregnancy . The argument about prenatal versus postnatal repair of the lesion is an ongoing debate in the literature, and most clinicians favor the former since it reduces the need for VP shunt placement [1, 7, 29]. Hydrocephalus tends to be one of the ever-present complications of MMC and although fetal surgical repair of the MMC lesion is a mainstay of treatment, the presence of hydrocephalus might require the placement of a ventriculoperitoneal (VP) shunt. Hammock et al. were one of the first to conduct studies on what course the intellectual performance and IQ take after surgery . All their patients, eight of them ranging from 30 months to 13 years and 5 months of age, had ventriculomegaly along with the MMC lesion but no apparent symptoms or signs of an increased intracranial pressure. The patients underwent psychological testing along with cranial CT preoperatively as well as continuous monitoring of their intraventricular pressure. Each of the patients underwent ventricular shunting and then underwent psychological testing postoperatively. Hammock et al. observed that over a period of 1 to 3 months, there was a reversal and stabilization in the downward trend on intellectual performance in these children with a noticeable improvement in performance IQ in 1 of the patients within 6 months. In a 9-month period, all the children but one had a significant improvement in their IQ scores . A much more standardized test was performed by Mapstone et al. where the patients were divided into three groups . Group I included children that never required shunting, group II were children with shunting but without any CNS complications (such as ventriculitis and anoxia) and group III were children requiring shunting but with CNS complications. Mapstone et al. observed that there after CSF shunting, the average IQ for children who never required shunting (Group 1) was much higher compared to the other two groups. Children in group II also had a higher IQ average compared to those in group III, but the difference was much larger compared to group I vs group II . They concluded that the downward trend in IQ seen in patients in group III can be attributed to the shunting complications or infections. Does this mean that if shunting complication or infections are minimized, these children will have a similar IQ to their counterparts in group II? This was exactly what was observed in another study by Arrington et al., who showed that repeat in shunt revisions can be associated with reduced cognition .
The result from most studies has shown that the IQ loss in children with MMC is an inborn error that occurs early during embryogenesis, thereby no amount of treatment or correction performed can correct the IQ deficit to normal [4, 20]. However, hydrocephalus if corrected early on, can prevent further worsening of the patients IQ functioning and return IQ to baseline for MMC patients .
The debate remains about the causes of the low IQ observed in many patients with MMC. Some have proposed that prenatal repair of the MMC lesion reduces the need for ventricular shunting after birth, and thereby decreases the risk of shunt complication and CNS infection, which normally have a negative prognosis on IQ if present. The general idea remains that patients with MMC, with or without complications, tend to have a lower IQ when compared to those without the lesion. Hydrocephalus appears to further increase the IQ deficit in patient with MMC and some studies have shown that if quickly corrected, IQ can return to baseline but not normal levels. More studies are needed to evaluate what other risk factors, apart from folate deficiency, and genetic factors might play a role in the development of MMC and how these factors might impact on the patients IQ. This is necessary to be able to fully understand, prevent and better care for children born with this disorder.
- Adzick NS, Thom EA, Spong CY, Brock JW, Burrows PK, Johnson MP, Farmer DL (2011) A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364(11): 993-1004. doi:10.1056/nejmoa1014379
- Aoyama Y, Kinoshita Y, Yokota A, Hamada T (2006) Neuronal damage in hydrocephalus and its restoration by shunt insertion in experimental hydrocephalus: A study involving the neurofilament-immunostaining method. J Neurosurg: Pediatrics 104(5): 332-339. doi:10.3171/ped.2006.104.5.332
- Arrington CN, Ware AL, Ahmed Y, Kulesz PA, Dennis M, Fletcher JM (2016) Are shunt revisions associated with IQ in congenital hydrocephalus? a meta -analysis. Neuropsychol Rev 26(4): 329-339. doi:10.1007/s11065-016-9335-z
- Beeker TW, Scheers MM, Faber JA, Tulleken CA (2005) Prediction of independence and intelligence at birth in meningomyelocele. Childs Nerv Syst 22(1): 33-37. doi:10.1007/s00381-004-1128-7
- Brant AM, Munakata Y, Boomsma DI, Defries JC, Haworth CM, Keller MC, Hewitt JK (2013) The nature and nurture of high IQ. Psychol Sci 24(8): 1487-1495. doi:10.1177/0956797612473119
- Copp AJ, Adzick NS, Chitty LS, Fletcher JM, Holmbeck GN, Shaw GM (2015) Spina bifida. Nat Rev Dis Primers 15007. doi:10.1038/nrdp.2015.7
- Gupta N, Farrell JA, Rand L, Cauldwell CB, Farmer D (2012) Open fetal surgery for myelomeningocele. J Neurosurg: Pediatrics 9(3): 265-273. doi:10.3171/2011.12.peds11403
- Haddad FA, Qaisi I, Joudeh N, Dajani H, Jumah F, Elmashala A, Tubbs RS (2018) The newer classifications of the chiari malformations with clarifications: An anatomical review. Clin Anat 31(3): 314-322. doi:10.1002/ca.23051
- Hammock MK, Milhorat TH, Baron IS (2008) Normal pressure hydrocephalus in patients with myelomeningocele. Dev Med Child Neurol 18: 55-68. doi:10.1111/j.1469-8749.1976.tb04281.x
- Hampton LE, Fletcher JM, Cirino PT, Blaser S, Kramer LA, Drake J, Dennis M (2011) Hydrocephalus status in spina bifida: An evaluation of variations in neuropsychological outcomes. J Neurosurg: Pediatrics 8(3): 289-298. doi:10.3171/2011.6.peds10584
- Hanscombe KB, Trzaskowski M, Haworth CM, Davis OS, Dale PS, Plomin R (2012) Socioeconomic status (SES) and children’s intelligence (IQ): in a UK-representative sample SES moderates the environmental, not genetic effect on IQ. PLoS One,7(2). doi:10.1371/journal.pone.0030320
- Hasan KM, Sankar A, Halphen C, Kramer LA, Ewing-Cobbs L, Dennis M, Fletcher JM (2008) Quantitative diffusion tensor imaging and intellectual outcomes in spina bifida. J Neurosurg: Pediatrics 2(1): 75-82. doi:10.3171/ped/2008/2/7/075
- Hetherington R, Dennis M, Barnes M, Drake J, Gentili F (2005) Functional outcome in young adults with spina bifida and hydrocephalus. Childs Nerv Syst 22(2): 117-124. doi:10.1007/s00381-005-1231-4
- Kobraei EM, Ricci JA, Vasconez HC, Rinker BD (2014) A comparison of techniques for myelomeningocele defect closure in the neonatal period. Childs Nerv Syst 30(9): 1535-1541. doi:10.1007/s00381-014-2430-7
- Kshettry VR, Kelly ML, Rosenbaum BP, Seicean A, Hwang L, Weil RJ (2014) Myelomeningocele: surgical trends and predictors of outcome in the United States, 1988–2010. J Neurosurg: Pediatrics 13(6): 666-678. doi:10.3171/2014.3.peds13597
- Lindquist B, Persson E, Uvebrant P, Carlsson G (2008) Learning, memory and executive functions in children with hydrocephalus. Acta Paediatr 97(5): 596-601. doi:10.1111/j.1651-2227.2008.00747.x
- Lindquist B, Uvebrant P, Rehn E, Carlsson G (2009) Cognitive functions in children with myelomeningocele without hydrocephalus. Childs Nerv Syst,25(8): 969-975. doi:10.1007/s00381-009-0843-5
- Liptak GS, Garver K, Dosa, NP (2013) Spina bifida grown up. J Dev Behav Pediatr 34(3): 206-215. doi:10.1097/dbp.0b013e31828c5f88
- Mapstone TB, Rekate HL, Nulsen FE, Dixon JM, Glaser N, Jaffe M (1984) Relationship of CSF shunting and IQ in children with myelomeningocele: a retrospective analysis. Pediatr Neurosurg 11(2): 112-118. doi:10.1159/000120166
- Matson MA, Mahone EM, Zabel TA (2005) Serial neuropsychological assessment and evidence of shunt malfunction in spina bifida: A longitudinal case study. Child Neuropsychol 11(4): 315-332. doi:10.1080/09297040490916910
- McLone DG. (1979) The effect of complications on intellectual function in 173 children with myelomeningocele. Presented at The International Society for Paediatric Neurosurgery vii scientific meeting. September 16-19.
- Mechelen MC, Verhoef M, Asbeck FW, Post MW (2008) Work participation among young adults with spina bifida in the Netherlands. Dev Med Child Neurol 50(10): 772-777. doi:10.1111/j.1469-8749.2008.03020.x
- Mitchell LE, Adzick NS, Melchionne J, Pasquariello PS, Sutton LN, Whitehead AS (2004) Spina bifida. The Lancet 364(9448): 1885-1895. doi:10.1016/s0140-6736(04)17445-x
- Nejat F, Kazmi SS, Habibi Z, Tajik P, Shahrivar Z (2007) Intelligence quotient in children with meningomyeloceles: a case–control study. J Neurosurg: Pediatrics 106(2): 106-110. doi:10.3171/ped.2007.106.2.106
- Northrup H, Volcik KA (2000) Spina bifida and other neural tube defects. Curr Probl Pediatr 30(10): 317-332. doi:10.1067/mpp.2000.112052
- Rodrigues AB, Krebs VL, Matushita H, Carvalho WB (2016) Short-term prognostic factors in myelomeningocele patients. Childs Nerv Syst 32(4): 675-680. doi:10.1007/s00381-016-3012-7
- Schoenmakers MA, Uiterwaal CS, Gulmans VA, Gooskens RH, Helders PJ (2005) Determinants of functional independence and quality of life in children with spina bifida. Clin Rehab 19(6): 677-685. doi:10.1191/0269215505cr865oa
- Shoja MM, Johal J, Oakes WJ, Tubbs RS (2017) Embryology and pathophysiology of the Chiari I and II malformations: A comprehensive review. Clin Anat 31(2): 202-215. doi:10.1002/ca.22939
- Smith GM, Krynska B (2015) Myelomeningocele: How we can improve the assessment of the most severe form of spina bifida. Brain Res 1619: 84-90. doi:10.1016/j.brainres.2014.11.053
- Soare PL, Raimondi AJ (1977) Intellectual and perceptual-motor characteristics of treated myelomeningocele children. Arch Pediatr Adolesc Med 131(2): 199-204. doi:10.1001/archpedi.1977.02120150081017
- Stubberud, J (2017) Theory of mind in spina bifida: Relationship with intellectual and executive functioning. Scand J Psychol 58(5): 379-388. doi:10.1111/sjop.12390
- Stumm SV, Plomin R (2015) Socioeconomic status and the growth of intelligence from infancy through adolescence. Intelligence 48: 30-36. doi:10.1016/j.intell.2014.10.002
- Sutton M, Daly LE, Kirke PN (2008) Survival and disability in a cohort of neural tube defect births in Dublin, Ireland. Birth defects research part A: Clin Mol Teratol 82(10): 701-709. doi:10.1002/bdra.20498
- Swain MA, Joy P, Bakker K, Shores EA, West C (2009) Object-based visual processing in children with spina bifida and hydrocephalus: A cognitive neuropsychological analysis. J Neuropsychol 3(2): 229-244. doi:10.1348/174866408×399438
- Swartwout MD, Garnaat SL, Myszka KA, Fletcher JM, Dennis M (2010) Associations of ethnicity and SES with IQ and achievement in spina bifida meningomyelocele. J Pediatr Psychol 35(9): 927-936. doi:10.1093/jpepsy/jsq001
- Treble A, Juranek J, Stuebing KK, Dennis M, Fletcher JM (2012) Functional significance of atypical cortical organization in spina bifida myelomeningocele: relations of cortical thickness and gyrification with IQ and fine motor dexterity. Cereb Cortex 23(10): 2357-2369. doi:10.1093/cercor/bhs226
- Tubbs RS, Griessenauer CJ, Hendrix P, Oakes P, Loukas M, Chern JJ, Oakes WJ (2015) Relationship between pharyngitis and peri-odontoid pannus: A new etiology for some Chiari I malformations? Clin Anat 28(5): 602-607. doi:10.1002/ca.22563
- Vinck A (2006) Arnold-Chiari-II malformation and cognitive functioning in spina bifida. J Neurol Neurosurg Psychiatry 77(9): 1083-1086. doi:10.1136/jnnp.2005.075887
Also need to include the following in references and analysis/discussion:
Theory of mind in spina bifida: Relationship with intellectual and executive functioning.
Scand J Psychol. 2017 Oct;58(5):379-388. doi: 10.1111/sjop.12390.
Select item 2287585710.
Functional significance of atypical cortical organization in spina bifida myelomeningocele: relations of cortical thickness and gyrification with IQ and fine motor dexterity.
Treble A, Juranek J, Stuebing KK, Dennis M, Fletcher JM.
Cereb Cortex. 2013 Oct;23(10):2357-69. doi: 10.1093/cercor/bhs226. Epub 2012 Aug 8.
Select item 2188292111.
Hydrocephalus status in spina bifida: an evaluation of variations in neuropsychological outcomes.
Hampton LE, Fletcher JM, Cirino PT, Blaser S, Kramer LA, Drake J, Dennis M.
J Neurosurg Pediatr. 2011 Sep;8(3):289-98. doi: 10.3171/2011.6.PEDS10584.
Select item 1933872919.
Object-based visual processing in children with spina bifida and hydrocephalus: a cognitive neuropsychological analysis.
Swain MA, Joy P, Bakker K, Shores EA, West C.
J Neuropsychol. 2009 Sep;3(Pt 2):229-44. doi: 10.1348/174866408X399438. Epub 2009 Feb 27.
Motor profile and cognitive functioning in children with spina bifida.
Vinck A, Nijhuis-van der Sanden MW, Roeleveld NJ, Mullaart RA, Rotteveel JJ, Maassen BA.
Eur J Paediatr Neurol. 2010 Jan;14(1):86-92. doi: 10.1016/j.ejpn.2009.01.003. Epub 2009 Feb 23.
Survival and disability in a cohort of neural tube defect births in Dublin, Ireland.
Sutton M, Daly LE, Kirke PN.
Birth Defects Res A Clin Mol Teratol. 2008 Oct;82(10):701-9. doi: 10.1002/bdra.20498.
Select item 1869986125.
Work participation among young adults with spina bifida in the Netherlands.
van Mechelen MC, Verhoef M, van Asbeck FW, Post MW.
Dev Med Child Neurol. 2008 Oct;50(10):772-7. doi: 10.1111/j.1469-8749.2008.03020.x. Epub 2008 Aug 11.
Quantitative diffusion tensor imaging and intellectual outcomes in spina bifida: laboratory investigation.
Hasan KM, Sankar A, Halphen C, Kramer LA, Ewing-Cobbs L, Dennis M, Fletcher JM.
J Neurosurg Pediatr. 2008 Jul;2(1):75-82. doi: 10.3171/PED/2008/2/7/075.
Select item 1839410527.
Learning, memory and executive functions in children with hydrocephalus.
Lindquist B, Persson EK, Uvebrant P, Carlsson G.
Acta Paediatr. 2008 May;97(5):596-601. doi: 10.1111/j.1651-2227.2008.00747.x.
Arnold-Chiari-II malformation and cognitive functioning in spina bifida.
Vinck A, Maassen B, Mullaart R, Rotteveel J.
J Neurol Neurosurg Psychiatry. 2006 Sep;77(9):1083-6. Epub 2006 May 11.
Select item 1618880932.
Learning disabilities in a population-based group of children with hydrocephalus.
Lindquist B, Carlsson G, Persson EK, Uvebrant P.
Acta Paediatr. 2005 Jul;94(7):878-83.
Select item 1618788033.
Implicit and explicit memory in children with congenital and acquired brain disorder.
Yeates KO, Enrile BG.
Neuropsychology. 2005 Sep;19(5):618-28.
Select item 1618060534.
Determinants of functional independence and quality of life in children with spina bifida.
Schoenmakers MA, Uiterwaal CS, Gulmans VA, Gooskens RH, Helders PJ.
Clin Rehabil. 2005 Sep;19(6):677-85.
Select item 1617057435.
Functional outcome in young adults with spina bifida and hydrocephalus.
Hetherington R, Dennis M, Barnes M, Drake J, Gentili F.
Childs Nerv Syst. 2006 Feb;22(2):117-24. Epub 2005 Sep 17.
Select item 1613866836.
Medical, functional, and social determinants of health-related quality of life in individuals with myelomeningocele.
Bier JA, Prince A, Tremont M, Msall M.
Dev Med Child Neurol. 2005 Sep;47(9):609-12.
Select item 1605156138.
Serial neuropsychological assessment and evidence of shunt malfunction in spina bifida: a longitudinal case study.
Matson MA, Mahone EM, Zabel TA.
Child Neuropsychol. 2005 Aug;11(4):315-32.
Select item 1595203039.
Prediction of independence and intelligence at birth in meningomyelocele.
Beeker TW, Scheers MM, Faber JA, Tulleken CA.
Childs Nerv Syst. 2006 Jan;22(1):33-7. Epub 2005 Jun 11.
Select item 1588864340.
Constructing a prospective model of psychosocial adaptation in young adolescents with spina bifida: an application of optimal data analysis.
Coakley RM, Holmbeck GN, Bryant FB.
J Pediatr Psychol. 2006 Nov-Dec;31(10):1084-99. Epub 2005 May 11.
Select item 1051986350.
Link between the CSF shunt and achievement in adults with spina bifida.
Hunt GM, Oakeshott P, Kerry S.
J Neurol Neurosurg Psychiatry. 1999 Nov;67(5):591-5.
The relationship between intellectual skills and the computerised axial tomograms of children with spina bifida and hydrocephalus.
Z Kinderchir Grenzgeb. 1979 Dec;28(4):368-74.
Select item 31965483.
Intellectual and perceptual-motor characteristics of treated myelomeningocele children.
Soare PL, Raimondi AJ.
Am J Dis Child. 1977 Feb;131(2):199-204.
Select item 110711586.
Lacunar skull deformity related to intelligence in children with myelomeningocele and hydrocephalus.
Lonton AP, Barrington NA, Lorber J.
Dev Med Child Neurol Suppl. 1975;(35):58-64.
Select item 457958687.
The relationship of intelligence and cerebral mantle in treated infantile hydrocephalus. (IQ potential in hydrocephalic children).
Young HF, Nulsen FE, Weiss MH, Thomas P.
Pediatrics. 1973 Jul;52(1):38-44. No abstract available.
Arq Neuropsiquiatr. 1999 Mar;57(1):44-50.
[IQ in hydrocephalus and myelomeningocele. Implications of surgical treatment].
[Article in Portuguese]
Fobe JL1, Rizzo AM, Silva IM, Da Silva SP, Teixeira CE, De Souza AM, Fernandes A.
Myelomeningocele occurs in 0.4 for 1000 neonates and is associated with hydrocephalus in 85-90%, and reports on cognition are sparsely found in literature. Forty five children with treated hydrocephalus and myelomeningocele were studied in regard of IQ, and statistically correlated to functional motor level, age of the first shunt, number of revisions of shunt, infection of the shunt and circumference of the head. The medium age was of 7.5 years (3-15 years), 16 males and 29 females. Three (6.6%) had a IQ score > 110, 11 (24.4%) had a score between 100-110, 8 between 85-100 (17.7%), 16 (35.5%) between 85-100 (17.7%) and 7 (15.5%) between 50-70. IQ directly correlated with motor level, having better cognitive results the children with minor functional motor disabilities. Cognition was best in children operated until the seven day of life (t 0.0099), with progressive worse results in children operated after the first month of life, no significance was observed in children operated in the period 7 to 31 days (t 0.1013). Worse results were observed in the group of patients with infection of shunts (t 0.0146). Results were progressively worse with reoperations. The best results in relation of the circumference of the head were seen with children in the medium range (t 0.0115); intermediate results were seen in patients between the medium range and-1SD (t 0.00130) and medium range and +1SD. The worse results were seen in patients at the extremes of > 1SD (t 0.0269) and < ISD (t 0.0042). According to cognitive results the surgical treatment of hydrocephalus have to be done until the first month of life, avoiding reoperations and infections that have unfavorable impact in IQ.
Select item 1019026352.
Neuropsychologic and adaptive functioning in adolescents and young adults shunted for congenital hydrocephalus.
Hommet C, Billard C, Gillet P, Barthez MA, Lourmiere JM, Santini JJ, de Toffol B, Corcia P, Autret A.
J Child Neurol. 1999 Mar;14(3):144-50. Review.
Select item 992632753.
A longitudinal study of cognitive abilities and achievement status of children with myelomeningocele and their relationship with clinical types.
Casari EF, Fantino AG.
Eur J Pediatr Surg. 1998 Dec;8 Suppl 1:52-4.
Psychosocial adjustment of children with spina bifida.
Zurmöhle UM, Homann T, Schroeter C, Rothgerber H, Hommel G, Ermert JA.
J Child Neurol. 1998 Feb;13(2):64-70.
The use of neuropsychological data to detect altered neurological functioning in a child with myelomeningocele.
Williams J, Ashcraft EW.
J Dev Behav Pediatr. 1993 Dec;14(6):401-4.
Select item 237407367.
Intelligence and achievement in children with myelomeningocele.
Wills KE, Holmbeck GN, Dillon K, McLone DG.
J Pediatr Psychol. 1990 Apr;15(2):161-76.
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