CORRELATION OF MEDICAL AND NEUROSURGICAL EVENTS WITH NEUROPSYCHOLOGICAL STATUS IN CHILDREN AT DIAGNOSIS OF ASTROCYTOMA - UTILIZATION OF A NEUROLOGICAL SEVERITY SCORE

Neuropsychological studies of children who have brain tumors have yiel ded diverse results with respect to identifying factors that contribut e to poor intellectual outcome. The purpose of this study was to evalu ate the relationship between pre- and perioperative events, tumor-rela ted factors, and the neuropsychological status of children diagnosed w ith astrocytoma. Events that could potentially be detrimental to neuro psychological outcome were quantified utilizing a new ''neurological s everity score.'' The Neurological Severity Score was developed as a re search tool to test our hypothesis that ultimate intellectual outcome is a result of cumulative, interactive insults on the central nervous system. This study constitutes a first step in examining the predictiv e value of the Neurological Severity Score by evaluating its correlati on with baseline neuropsychological status. Fifty-nine children who ha d astrocytoma (36 supratentorial and 23 infratentorial) received compl ete neurological and neuropsychological evaluations within 3 months of diagnosis. Each child's neurological history and examination results were scored by an independent observer using the Neurological Severity Score. Neuroimages obtained at diagnosis and at the time of neuropsyc hological testing were evaluated as well. For the group as a whole, me mory, attention, and motor abilities were significantly below age-appr opriate norms, whereas intelligence, language, and academic skills wer e preserved. Patterns of deficits were identified and related to tumor site. There were no significant differences in mean neuropsychologica l domain scores between groups based on gender, pre- versus post-opera tive status, ethnicity, tumor grade, or abnormalities on magnetic reso nance imaging (MRI). The Neurological Severity Score was significantly inversely correlated with visual-spatial skills, memory, attention, p erformance IQ, and global IQ. Ln conclusion, among all the medical and neurological factors present at diagnosis, the neurological severity score had the highest correlation with neuropsychological scores. This instrument has promise as a research tool in investigations of the ps ychological effects of cancer and its treatment on children.