Neuropsychologic function in children with brain tumors: II. Serial studies of intellect and time after treatment

Serial neuropsychologic studies were performed in 18 children following surgery and irradiation for brain tumors. Initial evaluations (#1) 3-70 months post therapy (median 22 months) revealed subnormal full scale IQ (FSIQ less than 90) in nine. Time elapsed since treatment did not significantly correlate with IQ or memory scores. Second evaluations (#2) 10-23 months after #1 showed FSIQ stability in 12 (67%) and improvement (FSIQ greater than or equal to 10 points higher) in three. Deterioration (FSIQ greater than or equal to 10 points lower) was noted in three, in each case associated with clinically significant neurologic events. Serial memory scores improved in two, remained stable in 10, and declined in six. Third evaluations (#3), 6-23 months after #2, documented FSIQ stability in 8/9 studied and significant, late improvement in one. The effect of age is suggested primarily in memory-oriented functions. Selective attending is abnormal at #1 in 6/9 less than 6 years old at diagnosis, and 1/9 greater than or equal to 6 years. Interval decline in memory scores between #1 and #2 occurred in 5/9 less than 6 years old at diagnosis, and 1/9 greater than or equal to 6 years. The findings support earlier observations of relative declines in intellectual function in this population. Identification of intellectual delays requiring special educational assistance permits learning intervention early in the child's course. Substantial interval improvement apparent in 4/18 children indicates some degree of repair or adaptation with time, likely affected by directed educational programs.