The Natural History of Hydrocephalus: Detailed Analysis of 182 Unoperated Cases

Laurence, K. M.; Coates, Stephen

doi:10.1136/adc.37.194.345

Cited by 229 publications

(72 citation statements)

References 16 publications

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“…In a study from 1962 of children with untreated hydrocephalus, the survival to adult life was around 20% and only 38% of them had IQ scores in the average range (Laurence and Coates 1962). The intellectual performance is affected even if the hydrocephalus is treated and the overall IQ is in the low-average range or below (Heinsbergen et al 2002, Lindquist et al 2005, Lumenta and Scotarczak 1995 As a group, children with MMC have higher IQ scores than other subgroups with hydrocephalus (Hoppe-Hirsch et al 1998, Kao et al 2001.…”

Section: Cognitionmentioning

confidence: 99%

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Vision in children with hydrocephalus

Andersson¹,

Persson²,

Aring³

et al. 2006

Dev Med Child Neurol

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Aims: To analyse trends in the live-birth prevalence of infantile hydrocephalus and hydrocephalus associated with myelomeningocele (MMC) during the period [1989][1990][1991][1992][1993][1994][1995][1996][1997][1998][1999][2000][2001][2002] and to study the outcome in terms of learning disability, cerebral palsy, epilepsy and visual deficits. Another objective was to explore motor function and disability profiles in various aetiological and gestational-age subgroups and to see whether treatment complications and neuroradiological findings correlate with outcome. Material and methods: A population-based study of all 262 live-born children with infantile hydrocephalus and hydrocephalus associated with MMC born in 1989-2002 in western Sweden. Aetiological and clinical information was collected from medical records, neuroimaging and ophthalmological examinations. A subgroup of 114 children were clinically examined and interviewed. Results: The live-birth prevalence of hydrocephalus was 0.77 per 1,000 live births, 0.48 for infantile hydrocephalus and 0.29 for hydrocephalus associated with MMC. The prevalence of infantile hydrocephalus decreased from 0.55 in 1989 to 0.48 per 1,000 in 2002, while that of MMC decreased from 0.35 to 0.16 per 1,000 during the same period. The prevalence in children born extremely preterm increased dramatically, with a gestational-age-specific prevalence of 13 per 1,000 in 1989 compared with 45 per 1,000 live births in 2002. During the same period, the perinatal mortality in these children decreased from 40 to 15 per 1,000 live births. A ventriculoperitoneal shunt was the first surgical intervention in 230 children (88%), while an endoscopic ventriculostomy was performed in 31 (12%). At least one surgical revision was required in 64% of the children. Of children with infantile hydrocephalus, 63% had at least one associated impairment, compared with 33% in the MMC group, apart from the consequences of the spinal lesion. Visual and other ophthalmological impairments were identified in the majority of the children. Very preterm birth was associated with a high risk of visual impairment. No child with normal neuroimaging had any associated neurological or visual impairment, compared with eleven of twelve with impairments in children with generalised parenchymal lesions. Conclusions: A decrease in the prevalence of infantile hydrocephalus was noted during the period 1989-1998, but it did not continue in 1999-2002. The stagnation was mainly explained by the increased survival of children born extremely preterm with post-haemorrhagic hydrocephalus. The aetiology of the hydrocephalus and gestational age at birth were important for outcome. The majority of the children had some associated neuroimpairment, such as learning disability, cerebral palsy or epilepsy, and more than three-quarters had ophthalmological abnormalities. Neuroimaging was found to be useful for aetiological, treatment and outcome considerations.

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Section: Cognitionmentioning

confidence: 99%

“…The mortality rate was high and the developmental outcome poor. The results of treatment from the first half of the twentieth century were evaluated by Hagberg (Hagberg 1962) and Laurence and Coates (Laurence and Coates 1962). The mortality rate varied from 45% to 53% in the different studies.…”

Section: Treatmentmentioning

confidence: 99%

Vision in children with hydrocephalus

Andersson¹,

Persson²,

Aring³

et al. 2006

Dev Med Child Neurol

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“…At the time of follow-up, only 38% of the children achieved IQ scores in the average range (Laurence & Coates, 1962). Intellectual performance in children with hydrocephalus has since been investigated continuously and the overall IQ has been reported to be in the range of low average or below.…”

Section: Intelligencementioning

confidence: 99%

Behavioural problems and autism in children with hydrocephalus

Lindquist

Carlsson

Persson

et al. 2006

Eur Child Adolesc Psychiatry

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Aims: The main objective of this thesis was to explore the cognitive and behavioural consequences of hydrocephalus in children born at term and preterm, with or without myelomeningocele (MMC) and with or without concomitant neurological impairments, such as cerebral palsy (CP), epilepsy or learning disabilities. Material and methods:From a population-based cohort of all 107 children with hydrocephalus born in [1989][1990][1991][1992][1993] 73 of the surviving children were assessed with intelligence tests and most of them also using behavioural and autism rating scales. Thirty-six of 47 (77%) children with an IQ of ≥ 70 and eight children with MMC but no hydrocephalus were assessed with a neuropsychological test battery (NIMES) and compared with age-and gender-matched controls. Results:One-third of the children were normally gifted (IQ > 85), another 30% had a low-average IQ of 70-84 and 37% had learning disabilities (IQ < 70). An IQ of < 70 was found in 42% of children without MMC and in 29% of those with MMC. Children born preterm had a lower IQ than those born at term. Children with CP and/or epilepsy had significantly lower IQ scores than those without these impairments. Parents rated 67% and teachers 39% of the children as having behavioural problems. Learning disabilities increased the risk significantly. Almost all the children with CP and/or epilepsy had behavioural problems. Learning disabilities, CP and epilepsy significantly increased the risk of autistic symptoms, which were present in 13 %, in 4 % of those with MMC and in 20 % of those without MMC. Children with hydrocephalus both with and without MMC and with an IQ of > 70 performed significantly less well than controls on learning, memory and executive functions but not on registration skills. There were no differences between children with hydrocephalus in combination with MMC and those without MMC, whereas children with MMC but no hydrocephalus and normal intelligence performed as well as controls on all the neuropsychological functions. Conclusions:The majority of children with hydrocephalus had learning disabilities or a low-average IQ, as well as behavioural problems, and some had autistic symptoms. Despite average or slightly below average intelligence, children with hydrocephalus had major difficulties with learning and memory and with executive functions, regardless of the aetiology of the hydrocephalus. Only MMC did not appear to influence cognitive and neuropsychological outcome as much as the brain lesion causing or caused by the hydrocephalus.

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“…2 Laurence reported in 1962, a 20% survival rate into adulthood and the surviving patients having severe sequelae. 3 Ventriculoperitoneal (VP) shunts are the gold standard in treatment of symptomatic hydrocephalus. With the advent of VP shunt surgeries, these children and adolescents can be assured of a near normal neurological development.…”

Section: Introductionmentioning

confidence: 99%