Long-Term Neuromotor Speech Deficits in Survivors of Childhood Posterior Fossa Tumors: Effects of Tumor Type, Radiation, Age at Diagnosis, and Survival Years

Abstract

The cerebellum is important for the coordination of fluent speech. The authors studied how childhood cerebellar tumors affect long-term neuromotor speech outcomes, including the relation between outcome and tumor type, radiation, age at diagnosis, and survival years. Videotaped speech samples of child and adult long-term survivors of childhood cerebellar astrocytoma (nonradiated) and medulloblastoma (radiated) tumors and healthy controls were analyzed by 2 speech pathologists for ataxic dysarthria, dysfluency, and speech rate. Ataxia varied with tumor type/radiation. Medulloblastoma survivors had significantly more ataxic dysarthric features than either survivors of astrocytomas or controls, who did not differ from each other. Dysfluency varied with a history of a posterior fossa tumor. Medulloblastoma and astrocytoma survivors were each significantly more dysfluent than controls but did not differ from each other. Speech rate varied with age and tumor type. Adult controls were significantly faster than child controls, although adult tumor survivors were comparable to their child counterparts. Adult controls had significantly faster speech rates than adult survivors of medulloblastoma tumors. Ataxic dysarthric speech characteristics are more frequent in radiated survivors of medulloblastoma tumors than nonradiated survivors of astrocytoma tumors. Dysfluent and slow speech occur in cerebellar tumor survivors, regardless of tumor type and radiation history. Cerebellar tumors in childhood limit speech rate in adulthood.

Hyponatremia and poor cognitive outcome following pediatric brain tumor surgery

“…Table 3 presents the multivariable analysis for measures of sodium derangement individually adjusted for patient factors previously associated with poor outcome (age, obstructive hydrocephalus, tumor location, and malignant histology). 1,8,9,11,12,14,15,[21][22][23]29 Rapid declines in serum sodium > 15 mEq/L within 24 hours, nadir sodium concentration, duration of hyponatremia, and number of episodes of hyponatremia all remained independently associated with increased odds of poor outcome.…”

“…21,27 We assessed cognitive function at initial hospital discharge with the PCPC score, which enabled assessment of all patients and limited the number of confounding factors, such as radiation, chemotherapy, and reoperations associated with worsened outcome with later followup. 1,9,14,16,21 Both tumor progression and additional therapies (i.e., cranial radiation) cause cognitive dysfunction 8 (6) 9 (9) 7 (11) 5 (38) 1 ( with later onset and progression over time. 1,9,16 Neurosurgical procedures themselves worsen neurological status in approximately one-third of patients, 13,27 and patients needing reoperations have worsened long-term outcomes.…”

“…Sodium concentration nadir, rates of sodium change, duration of hyponatremia, and episodes of hyponatremia were all individually adjusted for patient factors (age, tumor location, malignant histology, and hydrocephalus) previously associated with worsened neurocognitive outcomes. 1,8,9,11,12,14,15,[21][22][23]29 A multivariable model was also created containing the same patient factors and measures of sodium derangement (sodium concentration nadir, sodium value decrease > 15 mEq/L in 24 hours, duration of mild hyponatremia, episodes of mild hyponatremia) to determine which aspects of sodium disruption remained independently associated with poor outcome. Forward and backward stepwise selection using the Akaike Information Criteria was used to present a reduced, best-fit model.…”

“…1,8,9,11,12,[14][15][16][21][22][23]29 We previously reported that among patients with serum sodium concentrations ≤ 130 mEq/L following initial surgical care for pediatric brain tumors, 21% of patients had hyponatremic seizures and 41% had altered mental status documented by the care team. Furthermore, we found that any serum sodium concentration ≤ 130 mEq/L during the admission was independently and strongly associated with worse cognitive outcome.…”

Verb generation in children with spina bifida

“…They have speech deficits such as dysfluency, ataxic dysarthria, and slow speech rate (Huber-Okrainec et al, 2002) similar to those seen after acquired lesions of the cerebellum (Ackermann & Hertrich, 2000;Brown et al, 1970;Darley et al, 1969aDarley et al, , 1969bHuber et al, 2006Huber et al, , 2007Riva & Giorgi, 2000).…”