Pre-existing neuro-developmental difficulties in childhood brain tumours—implications for outcome

Abstract

Aims The incidence and significance of pre-existing neuro-developmental problems in children presenting with brain tumours is yet to be determined. It is often unclear whether these problems are secondary to the tumour itself or instead are due to primary disorders predisposing to tumour development. Coexistent neuro-developmental problems have a profound impact on patient management, as well as huge implications for studies on outcome post-treatment. Our aim was to establish the prevalence and highlight the range of pre-existing neuro-developmental difficulties in children at diagnosis of brain tumour. Methods In our busy tertiary neurosurgical unit all children are seen at presentation by a multidisciplinary team encompassing a neurologist, oncologist, neurosurgeon, nurse specialist and when appropriate neuro-psychiatrist. Clinical experience has highlighted high numbers of children diagnosed with brain tumours who also have particular neuro-developmental difficulties detectable at the time of presentation. The authors reviewed case notes of all children (n=131) admitted to our neurosurgical unit between July 2006 and November 2009 with a new diagnosis of brain tumour. Results 12/131 (9.2%) patients had documented neuro-developmental problems prior to diagnosis or treatment. These included anxiety disorders such as school refusal and specific phobias, tic disorder, social communication difficulties, language disorder, cognitive and neuro-psychiatric difficulties. These problems could not be attributed either directly to the tumour or to a primary syndromic diagnosis (eg, tuberous sclerosis or neurofibromatosis) in every patient. Some children were receiving management for these disorders and in some there were family members with similar difficulties without brain tumour. Conclusion Long-term outcome studies in paediatric brain tumours are limited to date. Where available they have considered the effect of different treatment modalities on cognitive outcome and survival. To our knowledge, the importance of premorbid factors when considering long-term outcome has not been studied. This important area must be addressed if intervention is to be targeted appropriately. The authors recommend prospective collection of data on all children diagnosed with brain tumours, enquiring specifically about the neurodevelopmental features and neuropsychiatric comorbidity so these important issues can be managed appropriately.