Intellectual and Perceptual-Motor Characteristics of Treated Myelomeningocele Children

Abstract

\s=b\We studied 173 children with myelomeningocele, 133 of whom developed hydrocephalus (and had shunt procedures) and 40 of whom did not. Eighty siblings were tested as a control group. Sixty-three percent of children with hydrocephalus had IQs above 80; 87% of those without hydrocephalus had IQs above 80. Children who had associated hydrocephalus were significantly less intelligent than their siblings, whereas those without hydrocephalus were not. When patients and siblings were matched by age and IQ, the former scored significantly lower on a perceptual-motor functioning test. When patients with and without hydrocephalus were similarly matched, those with hydrocephalus scored lower. Inverse relationships between sac location and IQ, and sensory level and IQ, were found to be dependent on the association of higher sac levels and of sensory loss with hydrocephalus. Patient IQ was related to family income and education. (Am J Dis Child 131:199-204, 1977) With few exceptions,'-7 published reports of the intelligence of myelomeningocele children with (MM/H) and without (MM) hydro¬ cephalus have been limited to analyz¬ ing the natural history of nonoperatively treated hydrocephalus. By and large, these studies have been retro¬ spective, based on an accumulation of varying numbers of survivors. Simi¬ larly, the appraisals of survival, quali¬ ty of survival, and impact of the affected child on his home and enviFrom the Division of Neurological Surgery, IL 60614 (Dr Raimondi). ronment have been made from anal¬ yses of groups of children whose management has not been adequately described. METHODAs a first step in studying these children we established the criteria for diagnosing hydrocephalus in the child with myelomeningocele, determining precisely when a shunt was no longer functioning, compar¬ ing intellectual quotients with the presence or absence of hydrocephalus (treated, in the former event), using the siblings as the norm, and identifying (neuroradiologically) the nature and degree of brain dyspla¬ sia."'3 The two groups studied were myelomeningocele (MM) and shunted hy¬ drocéphalie myelomeningocele (MM/HS) children. The abbreviation MM/H refers to children who did not undergo a shunt procedure.There is, at the present time, consid¬ erable interest in the question of whether to treat such children at all, or whether treatment should be offered only to those children who may be expected to "live a meaningful life." Criteria on which such a decision may be based are lacking, though some arbitrary criteria (such as level of the myelomeningocele sac at birth, paraplegia, and hydrocephalus) have been suggested.In fact, one author has carried prediction to an extreme,' -reporting such a poor prog¬ nosis for myelomeningocele children with a thoracolumbar lesion, for example, irre¬ spective of the presence of hydrocephalus, that he recommends withholding all forms of treatment. This article presents the results of our study of the intellectual development of 173 children with myelomeningocele, 133 who had a shunt for...

Neurological abnormalities, major orthopaedic deformities and ambulation analysis in a myelomeningocele population in Catalonia (Spain)

“…The mean IQ in our study was similar to results reported by Tew and Laurence 30 and Anderson and Spain, 31 and lower than results from Soare and Raimondi 32 and McLone et al 33 Once again, these discrepancies can be attributed to di erences in criteria (in this case de®nition of IQ) and to the heterogeneity of the samples. Overall distribution of IQ in our series was not gaussian or normal: the distribution curve deviated toward the left.…”

Complications of Ventriculo-Peritoneal Shunting and a Critical Comparison of the Three-Piece and One-Piece Systems

“…In a previous study [57] we reported that shunting any time during the first trimester of life was compatible with the attainment of normal psychomo tor function, providing the shunting system was subsequently kept func tioning. We also reported the effects of hydrocephalus in myelomeningo cele children and compared them to their normal siblings and to myelo meningocele children without hydrocephalus, observing that hydrocephal ic myelomeningocele children have significantly lower IQ than nonhydro cephalic myelomeningocele children, but that they do fairly well if the shunts are kept functioning [67], Therefore, we are presently attempting to delay insertion of the initial shunt as much as possible, but never wait ing in newborn with advanced hydrocephalus [54].…”

Early Brain Injury in Children: Development and Reorganization of Cognitive Function

“…Several studies of hydrocephalus from different etiologies found lower PIQ than VIQ scores (Dennis et al, 1981;Soare & Raimondi, 1977). Although it is tempting to attribute the PIQ decrement to motor impairment, comparison of the performance of children with SBM on motorbased and motor-free tasks revealed impairment on visiospatial tasks irrespective of the motor requirements .…”