Hydrocephalus status in spina bifida: an evaluation of variations in neuropsychological outcomes

Clinical article

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Object

The effect of hydrocephalus status on neuropsychological outcomes in children with spina bifida (SB) has not been carefully evaluated. The authors hypothesized a stepwise progression of outcomes related to hydrocephalus status (shunt-treated, arrested, or no hydrocephalus) and that motor, spatial, and executive function tasks would be more sensitive to hydrocephalus status than vocabulary and reading tasks.

Methods

Two hundred eight children (mean age 11.2 years) with SB were grouped according to hydrocephalus status: shunt-treated hydrocephalus (166 children), arrested hydrocephalus (18 children), and no hydrocephalus (24 children). Sixty-one typically developing children were included as a control group (mean age 12.05 years). All children were tested across neuropsychological content domains, including verbal and nonverbal IQ, reading and mathematical achievement, explicit memory, visuospatial function, executive function, and motor skills.

Results

There was a stepwise progression of outcomes. Averaging across tasks, performance scores of children with SB and no hydrocephalus (mean standard score 92.60) were higher than those of children with SB and arrested hydrocephalus (mean standard score 86.86), and scores of children in the latter group were higher than those of children with SB and shunt-treated hydrocephalus (mean standard score 82.30). All 3 groups scored lower than the control group (mean standard score 105.94). Fine motor tasks best differentiated the arrested-hydrocephalus and shunt-treated groups. Verbal and executive function tasks, often associated with socioeconomic status, best differentiated the group of children with SB and no hydrocephalus from the control group.

Conclusions

With the exception of fine motor skills and small differences in memory and spatial domains, children with SB and arrested or shunt-treated hydrocephalus have similar neuropsychological profiles. Performance of all 3 groups of children with SB was below that of the control group, which also reflects the lower socioeconomic status of the children with SB.

Abbreviations used in this paper: CM-I = Chiari malformation Type I; CM-II = CM Type II; SB = spina bifida; WJR = Woodcock-Johnson psychoeducational battery, revised.

Article Information

Address correspondence to: Lyla E. Hampton, M.A., Department of Psychology, University of Houston Texas Medical Center Annex, 2151 West Holcombe Boulevard, Suite 222, Houston, Texas 77204-5053. email: lelmessi@gmail.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Mean performance across neuropsychological domains for children with SB grouped by hydrocephalus status and a control group of typically developing children. EF = Executive Function; HC = hydrocephalus.

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    Linear order of overall performance across tasks for children with SB grouped by hydrocephalus status and for the control group.

References

  • 1

    Badell-Ribera AShulman KPaddock N: The relationship of non-progressive hydrocephalus to intellectual functioning in children with spina bifida cystica. Pediatrics 37:7877931966

    • Search Google Scholar
    • Export Citation
  • 2

    Bowman RMMcLone DG: Neurosurgical management of spina bifida: research issues. Dev Disabil Res Rev 16:82872010

  • 3

    Burmeister RHannay HJCopeland KFletcher JMBoudousquie ADennis M: Attention problems and executive functions in children with spina bifida and hydrocephalus. Child Neuropsychol 11:2652832005

    • Search Google Scholar
    • Export Citation
  • 4

    Carr L: Neuropsychological Profiles of English- and Spanish-Speaking Children With Spina Bifida [doctoral dissertation] Houston, TXUniversity of Houston2009

    • Search Google Scholar
    • Export Citation
  • 5

    Charney FNeural tube defects: spina bifida and myelomeningocele. Batshaw MLPerret Y: Children With Disabilities: A Medical Primer ed 3BaltimoreBrookes1992. 471488

    • Search Google Scholar
    • Export Citation
  • 6

    Del Bigio MR: Neuropathology and structural changes in hydrocephalus. Dev Disabil Res Rev 16:16222010

  • 7

    Del Bigio MRWilson MJEnno T: Chronic hydrocephalus in rats and humans: white matter loss and behavior changes. Ann Neurol 53:3373462003

    • Search Google Scholar
    • Export Citation
  • 8

    Delis DKramer JHKaplan EOber BA: California Verbal Learning Test—Children's Version San Antonio, TXPsychological Corporation1994

    • Search Google Scholar
    • Export Citation
  • 9

    Dennis MBarnes MA: The cognitive phenotype of spina bifida meningomyelocele. Dev Disabil Res Rev 16:31392010

  • 10

    Dennis MFitz CRNetley CTSugar JHarwood-Nash DCHendrick EB: The intelligence of hydrocephalic children. Arch Neurol 38:6076151981

    • Search Google Scholar
    • Export Citation
  • 11

    Dennis MHetherington CRSpiegler BJBarnes MFunctional consequences of congenital cerebellar dysmorphologies and acquired cerebellar lesions of childhood. Broman SHFletcher JM: The Changing Nervous System: Neurobehavioral Consequences of Early Brain Disorders New YorkOxford University Press1999. 172198

    • Search Google Scholar
    • Export Citation
  • 12

    Dennis MJewell DEdelstein KBrandt MEHetherington RBlaser SE: Motor learning in children with spina bifida: intact learning and performance on a ballistic task. J Int Neuropsychol Soc 12:5986082006

    • Search Google Scholar
    • Export Citation
  • 13

    Dennis MLandry SHBarnes MFletcher JM: A model of neurocognitive function in spina bifida over the life span. J Int Neuropsychol Soc 12:2852962006

    • Search Google Scholar
    • Export Citation
  • 14

    Fletcher JMCopeland KFrederick JABlaser SEKramer LANorthrup H: Spinal lesion level in spina bifida: a source of neural and cognitive heterogeneity. J Neurosurg 102:3 Suppl2682792005

    • Search Google Scholar
    • Export Citation
  • 15

    Fletcher JMDennis MSpina bifida and hydrocephalus. Yeates KORis MDTaylor HG: Pediatric Neuropsychology: Research Theory and Practice ed 2New YorkGuilford Press2010. 325

    • Search Google Scholar
    • Export Citation
  • 16

    Fletcher JMFrancis DJThompson NMDavidson KCMiner ME: Verbal and nonverbal skill discrepancies in hydrocephalic children. J Clin Exp Neuropsychol 14:5936091992

    • Search Google Scholar
    • Export Citation
  • 17

    Hammock MKMilhorat THBaron IS: Normal pressure hydrocephalus in patients with myelomeningocele. Dev Med Child Neurol Suppl 37:55681976

    • Search Google Scholar
    • Export Citation
  • 18

    Hetherington RDennis MBarnes MDrake JMGentili F: Functional outcome in young adults with spina bifida and hydrocephalus. Childs Nerv Syst 22:1171242006

    • Search Google Scholar
    • Export Citation
  • 19

    Hirsch JF: Consensus: long-term outcome in hydrocephalus. Childs Nerv Syst 10:64691994

  • 20

    Iddon JLMorgan DJLoveday CSahakian BJPickard JD: Neuropsychological profile of young adults with spina bifida with or without hydrocephalus. J Neurol Neurosurg Psychiatry 75:111211182004

    • Search Google Scholar
    • Export Citation
  • 21

    Juranek JSalman MS: Anomalous development of brain structure and function in spina bifida myelomeningocele. Dev Disabil Res Rev 16:23302010

    • Search Google Scholar
    • Export Citation
  • 22

    Lindgren SDBenton AL: Developmental patterns of visuospatial judgment. J Pediatr Psychol 5:2172251980

  • 23

    Lorber J: Results of treatment of myelomeningocele. An analysis of 524 unselected cases, with special reference to possible selection for treatment. Dev Med Child Neurol 13:2793031971

    • Search Google Scholar
    • Export Citation
  • 24

    Mataró MPoca MASahuquillo JCuxart AIborra Jde la Calzada MD: Cognitive changes after cerebrospinal fluid shunting in young adults with spina bifida and assumed arrested hydrocephalus. J Neurol Neurosurg Psychiatry 68:6156212000

    • Search Google Scholar
    • Export Citation
  • 25

    Matson MAMahone EMZabel TA: Serial neuropsychological assessment and evidence of shunt malfunction in spina bifida: a longitudinal case study. Child Neuropsychol 11:3153322005

    • Search Google Scholar
    • Export Citation
  • 26

    Maxwell SEDelaney HD: Designing Experiments and Analyzing Data: A Model Comparison Perspective ed 2Mahwah, NJLawrence Erlbaum Associates2004

    • Search Google Scholar
    • Export Citation
  • 27

    Raimondi AJ: A unifying theory for the definition and classification of hydrocephalus. Childs Nerv Syst 10:2121994

  • 28

    Reigel DHRotenstein DSpina bifida. Cheek WRMarlin AEMcLone DG: Pediatric Neurosurgery: Surgery of the Developing Nervous System ed 3PhiladelphiaHarcourt Brace1994. 5176

    • Search Google Scholar
    • Export Citation
  • 29

    Shaffer JFriedrich WNShurtleff DBWolf L: Cognitive and achievement status of children with myelomeningocele. J Pediatr Psychol 10:3253361985

    • Search Google Scholar
    • Export Citation
  • 30

    Tew BLaurence KM: The effects of hydrocephalus on intelligence, visual perception, and school attainment. Dev Med Child Neurol Suppl 35:1291341975

    • Search Google Scholar
    • Export Citation
  • 31

    Thorndike RLHagen EPSattler JM: Stanford-Binet Intelligence Scale ed 4ChicagoRiverside Publishing1987

  • 32

    Tiffin J: Purdue Pegboard Examiner Manual Rosemount, ILLondon House1968

  • 33

    Wills KE: Neuropsychological functioning in children with spina bifida and/or hydrocephalus. J Clin Child Psychol 22:2472651993

  • 34

    Woodcock RWJohnson MB: Woodcock-Johnson Psycho-Educational Battery—Revised Itasca, ILRiverside Publishing1989

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