儿童颞叶蛛网膜囊肿。第一部分:颞叶囊肿患儿的认知概况及囊肿对日常生活的影响。对 100 名连续患儿进行的前瞻性研究。

IF 3 4区 生物学 Q3 BIOCHEMISTRY & MOLECULAR BIOLOGY
FEBS Letters Pub Date : 2022-05-20 Print Date: 2022-08-01 DOI:10.3171/2021.11.PEDS21203
Marie-Laure Cuny, Laurence Vaivre-Douret, Hélène Piana, Thomas Blauwblomme, Kévin Beccaria, Giovanna Paternoster, Marie Bourgeois, Syril James, Michel Zerah, Julie Prodhomme, Eglantine Esnault, Mathilde Cozzo, Clémence Trousson, Béatrice Navarro, Sarah Stricker, Nathalie Boddaert, Christian Sainte-Rose, Pascale Piolino, Stephanie Puget
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引用次数: 0

摘要

研究目的本研究旨在确定颞叶蛛网膜囊肿(TAC)患儿的认知状况及其对日常生活的影响:作者对连续100名儿童的认知和心理状况进行了前瞻性分析,分析结果与年龄、囊肿特征(一侧、囊肿大小、囊肿形状:凸形或非凸形)以及4年后的结果有关:平均智商正常,但全量表智商(FSIQ;范围59-150)差异很大;29%的儿童至少有一项韦氏指数低于正常水平,尤其是处理速度和工作记忆指数。31%的儿童在语言、言语记忆(28%)、视觉记忆(23%)、执行功能(21%)和视觉注意力(24%)方面存在障碍。半数儿童(50%)因学习困难需要康复治疗,26%的儿童有学业困难。家长问卷 BRIEF(执行功能行为评定量表)显示,22% 的儿童在日常生活中存在严重的执行功能障碍。三分之一的患者(34%)因焦虑或社交障碍而需要接受心理治疗,其中右侧囊肿患者和年龄较大的儿童接受心理治疗的比例更高。囊肿大小对神经心理学的影响很小。与非凸面囊肿相比,凸面囊肿患者在所有韦氏指数和FSIQ以及语言、言语记忆、注意力和视觉空间技能方面的表现明显较差。与其他儿童相比,患有凸面囊肿的儿童在日常生活中遇到的执行和行为困难明显更多,接受心理治疗的次数也更多。囊肿形状的影响与加拉西类型和囊肿侧无关。囊肿破裂或偶然发现囊肿的儿童通常具有良好的认知水平。四年后,没有出现初期障碍的儿童仍然保持稳定,而有困难但没有接受手术的儿童则需要更多的康复治疗和学校适应训练:这项大型队列研究揭示了TAC患儿的不同特征:在初步评估时,50%的患儿有神经心理障碍,需要进行康复治疗和/或心理治疗以缓解学习或行为障碍,50%的患儿没有任何障碍,这或许可以解释为什么人们对这种病理现象争论不休。有神经心理障碍的患者具有不同的特征,智力正常,但存在选择性认知和/或行为障碍,这可能会对他们的生活质量产生长期影响,尤其是那些患有右侧囊肿的患者。对于偶然发现的囊肿,并不一定需要进行神经心理学评估,但对于有学业、学习或心理障碍的患者,早期评估至关重要。当评估结果显示选择性障碍可能与囊肿位置有关时,可以考虑手术治疗,尤其是凸面囊肿,因为本研究发现与囊肿形状相关的影响比与囊肿大小相关的影响更大,凸面囊肿患者的学习成绩明显较差。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Temporosylvian arachnoid cysts in children. Part 1: Cognitive profile of children with a temporal cyst and impact of the cyst in daily life. A prospective study in 100 consecutive children.

Objective: The aim of this study was to determine the cognitive profile of children with a temporal arachnoid cyst (TAC) and its impact on daily life.

Methods: The authors prospectively analyzed the cognitive and psychological profiles of 100 consecutive children relative to age and cyst characteristics (side, cyst size, and cyst shape: convex or nonconvex) and their outcome 4 years later.

Results: Mean IQs were normal but with high heterogeneity on Full Scale IQ (FSIQ; range 59-150); 29% of children had at least one Wechsler index below the norm, in particular, Processing Speed and Working Memory Indexes. Impairments were observed in language for 31% of children, as well as in verbal memory (28%), visual memory (23%), executive function (21%), and visual attention (24%). Half of the children (50%) needed rehabilitation for learning difficulties, and 26% had academic difficulties. The parental questionnaire BRIEF (Behavior Rating Inventory of Executive Function) revealed significant executive dysfunctions in daily life for 22% of the children. One-third of the patients (34%) required psychotherapy for anxiety or social disorders, with higher rates in patients with a right-sided cyst and older children. Cyst size had very little neuropsychological impact. Convex cysts were significantly associated with worse performance than nonconvex cysts on all Wechsler indexes and FSIQ, and in language, verbal memory, attention, and visuospatial skills. Children with a convex cyst had significantly more executive and behavior difficulties in daily life and more psychotherapy than other children. The effect of cyst shape was independent of Galassi type and cyst side. Children with a ruptured cyst or an incidentally discovered cyst usually had a good cognitive level. Four years later, children without initial disorders remained stable, whereas those with difficulties who did not undergo surgery needed more rehabilitation and school adaptations.

Conclusions: This large cohort study revealed a varied profile of children with a TAC: at initial assessment, 50% had neuropsychological difficulties and needed rehabilitation and/or psychotherapy for learning or behavior difficulties, and 50% had no difficulties, which may explain the debate about this pathology. Patients with neuropsychological difficulties had a heterogeneous profile with normal intelligence but selective cognitive and/or behavior disorders that may have a long-term impact on their quality of life, particularly those with a right-sided cyst. A neuropsychological evaluation is not always necessary for a cyst discovered incidentally, but early evaluation is essential in patients with academic, learning, or psychological disorders. When assessment shows selective disorders presumably linked to cyst location, surgery may be considered, particularly for convex cysts, as this study revealed more effects in association with cyst shape than with cyst size and significantly poorer performance with a convex cyst.

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来源期刊
FEBS Letters
FEBS Letters 生物-生化与分子生物学
CiteScore
6.60
自引率
2.90%
发文量
303
审稿时长
1 months
期刊介绍: FEBS Letters is one of the world''s leading journals in molecular biology and is renowned both for its quality of content and speed of production. Bringing together the most important developments in the molecular biosciences, FEBS Letters provides an international forum for Minireviews, Research Letters and Hypotheses that merit urgent publication.
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