Cognitive functioning, behavior, and quality of life after stroke in childhood.
BACKGROUND
To provide a better understanding of cognitive functioning, motor outcome, behavior and quality of life after childhood stroke and to study the relationship between variables expected to influence rehabilitation and outcome (age at stroke, time elapsed since stroke, lateralization, location and size of lesion).


METHODS
Children who suffered from stroke between birth and their eighteenth year of life underwent an assessment consisting of cognitive tests (WISC-III, WAIS-R, K-ABC, TAP, Rey-Figure, German Version of the CVLT) and questionnaires (Conner's Scales, KIDSCREEN).


RESULTS
Twenty-one patients after stroke in childhood (15 males, mean 11;11 years, SD 4;3, range 6;10-21;2) participated in the study. Mean Intelligence Quotients (IQ) were situated within the normal range (mean Full Scale IQ 96.5, range IQ 79-129). However, significantly more patients showed deficits in various cognitive domains than expected from a healthy population (Performance IQ p = .000; Digit Span p = .000, Arithmetic's p = .007, Divided Attention p = .028, Alertness p = .002). Verbal IQ was significantly better than Performance IQ in 13 of 17 patients, independent of the hemispheric side of lesion. Symptoms of ADHD occurred more often in the patients' sample than in a healthy population (learning difficulties/inattention p = .000; impulsivity/hyperactivity p = .006; psychosomatics p = .006). Certain aspects of quality of life were reduced (autonomy p = .003; parents' relation p = .003; social acceptance p = .037). Three patients had a right-sided hemiparesis, mean values of motor functions of the other patients were slightly impaired (sequential finger movements p = .000, hand alternation p = .001, foot tapping p = .043). In patients without hemiparesis, there was no relation between the lateralization of lesion and motor outcome. Lesion that occurred in the midst of childhood (5-10 years) led to better cognitive outcome than lesion in the very early (0-5 years) or late childhood (10-18 years). Other variables such as presence of seizure, elapsed time since stroke and size of lesion had a small to no impact on prognosis.


CONCLUSIONS
Moderate cognitive and motor deficits, behavioral problems, and impairment in some aspects of quality of life frequently remain after stroke in childhood. Visuospatial functions are more often reduced than verbal functions, independent of the hemispheric side of lesion. This indicates a functional superiority of verbal skills compared to visuospatial skills in the process of recovery after brain injury. Compared to the cognitive outcome following stroke in adults, cognitive sequelae after childhood stroke do indicate neither the lateralization nor the location of the lesion focus. Age at stroke seems to be the only determining factor influencing cognitive outcome.
Division of Neuropediatrics, University Children's Hospital Inselspital, University of Bern, Switzerland.
Regula
R
Everts
Julia
J
Pavlovic
Franz
F
Kaufmann
Birgit
B
Uhlenberg
Ulrich
U
Seidel
Krassen
K
Nedeltchev
Walter
W
Perrig
Maja
M
Steinlin
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000209:etiology; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007360:Intelligence / Q000502:physiology; D008297:Male; D009069:Movement Disorders / Q000175:diagnosis / Q000209:etiology*; D009483:Neuropsychological Tests; D011788:Quality of Life; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D014888:Wechsler Scales; D055815:Young Adult