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Acute cognitive and behavioral effects of systemic corticosteroids in children treated for inflammatory bowel disease
Christine Mrakotsky1, Peter W Forbes, Jane Holmes Bernstein
1Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts 02115, USA. christine.mrakotsky@childrens.harvard.edu
Insights
Systemic corticosteroids can affect children with inflammatory bowel disease (IBD), impacting daily cognitive and emotional functioning. Further research is needed to understand the long-term effects of these steroid treatments.
Area of Science:
- Pediatric Neurology
- Child Psychology
- Gastroenterology
Background:
- Systemic corticosteroids are widely used for pediatric inflammatory bowel disease (IBD).
- Central nervous system effects of corticosteroids are well-documented in adults and animal models, but less understood in children.
- Pediatric IBD patients require careful monitoring for potential neurocognitive and behavioral side effects of corticosteroid therapy.
Purpose of the Study:
- To investigate the acute effects of high-dose systemic corticosteroids on memory, executive functions, emotion, and behavior in children and adolescents with IBD.
- To compare these effects between patients with Crohn's disease (CD) and ulcerative colitis (UC).
- To assess the influence of sleep disruption on observed outcomes.
Main Methods:
- A cohort of 66 pediatric IBD patients (ages 8-17) was studied.
- Thirty-three patients were on high-dose prednisone, and 33 were in remission without steroids.
- Standardized neuropsychological tests and behavior rating scales were administered to all participants.
Main Results:
- Few significant effects of corticosteroids were observed on laboratory cognitive measures.
- Steroid-treated patients were rated as having more daily-life emotional and cognitive difficulties.
- Corticosteroid effects were more pronounced in Crohn's disease patients than in ulcerative colitis patients.
- Sleep disruption was found to predict some outcomes, partially mitigating the observed steroid effects.
Conclusions:
- Corticosteroid therapy can acutely impact cognition, emotion, and behavior in chronically ill children with IBD.
- The clinical significance and long-term implications of these steroid-induced effects warrant further investigation.
- Differential effects may exist between Crohn's disease and ulcerative colitis patients undergoing corticosteroid treatment.
Abstract:
Systemic corticosteroids are a mainstay of treatment for many pediatric medical conditions. Although their impact on the central nervous system has been well-studied in animal models and adults, less is known about such effects in pediatric populations. The current study investigated acute effects of corticosteroids on memory, executive functions, emotion, and behavior in children and adolescents with inflammatory bowel disease (IBD). Patients 8-17 years with IBD (Crohn's disease, CD; ulcerative colitis, UC) on high-dose prednisone (n = 33) and IBD patients in remission off steroids (n = 33) completed standardized neuropsychological tests and behavior rating scales. In the IBD sample as a whole, few steroid effects were found for laboratory cognitive measures, but steroid-treated patients were rated as exhibiting more problems with emotional, and to a lesser extent with cognitive function in daily life. Steroid effects, assessed by laboratory measures and questionnaires, were more prevalent in CD than UC patients; UC patients on steroids sometimes performed better than controls. Sleep disruption also predicted some outcomes, diminishing somewhat the magnitude of the steroid effects. Corticosteroid therapy can have acute effects on cognition, emotion, and behavior in chronically ill children; the clinical and long-term significance of these effects require further investigation.
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