Quality of life in children treated for brain tumors. Intellectual, emotional, and academic function

Thirty children with primary brain tumors were evaluated for alterations in intellectual, emotional, and academic functions. Nine were studied following surgery (prior to irradiation) and 21 after postoperative irradiation. Twenty-four patients (80%) showed no serious disabilities on routine medical and neurological examinations. Nineteen patients (63%) had normal intelligence quotient (IQ) levels. Qualitative disabilities on routine examinations were observed in six children: two of nine tested postoperatively, one of six tested after posterior fossa irradiation, and three of 15 tested after cranial irradiation. Subnormal IQ levels were also noted in two of nine children tested prior to irradiation and one of six after posterior fossa irradiation. Of the 15 studied after cranial irradiation, eight had subnormal IQ scores. Serial postirradiation testing in 10 patients revealed improvement in two, stability in five, and further deterioration in three. Ten children were placed in learning disability settings due to achievement delays or problems with selective attending. Social-emotional evaluations detected excessive tendencies toward psychotic symptomatology. Potential etiological factors, including primary tumor site, extent of irradiation, age, and increased intracranial pressure, are discussed. Preliminary findings suggest a greater than normal risk for late neuropsychological alterations among children with supratentorial tumors and/or cranial irradiation.