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Intrathecal methotrexate affects cognitive function in children with medulloblastoma
1Developmental Neurology Unit, Istituto Nazionale Neurologico C. Besta, Milano, Italy. driva@istituto-besta.it
Neurology
|July 10, 2002
Summary
Intrathecal methotrexate worsens cognitive deficits in children treated for medulloblastoma. This treatment, combined with radiotherapy and chemotherapy, negatively impacts intelligence, executive function, and memory, especially in younger children.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Pediatric Neuropsychology
Background:
- Children treated for malignant brain tumors often experience cognitive impairment.
- Treatment modalities include radiotherapy, systemic chemotherapy, and intrathecal chemotherapy.
Purpose of the Study:
- Compare cognitive functions (intelligence, executive function, attention, memory) in children with cerebellar medulloblastoma.
- Assess the impact of intrathecal methotrexate (MTX+) versus no MTX on cognitive outcomes.
- Correlate cognitive performance with MRI-detected leukomalacia.
Main Methods:
- Comparative neuropsychological testing of two patient groups and their healthy relatives.
- Standardized assessments of intelligence, executive function, attention, visual perception, and short-term memory.
- Magnetic Resonance Imaging (MRI) to evaluate leukomalacia.
Main Results:
- Both patient groups performed worse than controls across all tested cognitive domains.
- Children under 10 receiving MTX+ showed significant deficits in all areas, particularly executive functions.
- Older children (over 10) on MTX+ had impaired short-term memory; those without MTX showed fewer deficits.
- Leukomalacia correlated with poorer performance in the MTX+ group.
Conclusions:
- Intrathecal methotrexate exacerbates cognitive deficits in pediatric medulloblastoma patients.
- The findings suggest a need to re-evaluate the use of intrathecal methotrexate in medulloblastoma treatment protocols.