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Simon nadel for website
- 1. The Psychological Consequences of Meningitis and Septicaemia
- 35. Results ABOUT THE PARTICIPANTS
- 36. Participants PICU 125 Healthy Controls 100 PICU 88 SI 22 ME 21 Healthy Controls 100 PC 45 ME = Meningo-Encephalitis SI = Sepsis PC = Patient Controls
- 37. Disease Type
- 43. Results TEACHER RATED ACADEMIC PERFORMANCE
- 51. Results ONE YEAR FOLLOW-UP
- 57. Acknowledgements - Particularly Lorraine Als/Elena Garralda
- 58. Thank-you
Notas del editor
- Since the emergence of paediatric intensive care units the fatality rates associated with severe acute illness have declined dramatically. Most children admitted to PICU are now expected to make a complete medical recovery. However, considering the severity and life threat of medical illness necessitating PICU admission, the neuropsychological outcome of survivors has been an increasingly important area of research.
- For example, a review conducted by Carter et al., (2001) assessed neurological impairment following CNS infections such as meningitis, encephalitis, tetanus or malaria in children. Most common impairments seen were in cognition or motor functions. Increased levels of impairment were seen after encephalitis and BM.
- Whilst research suggests that neuropsychological sequelae are commonly evident following meningitis and encephalitis, most of this research has focused on illness onset in infants and young children and little is known about outcome in other age groups or in children with other types of critical illness.
- A pilot study conducted by Imperial College at St Mary’s hospital sought to investigate the effect of acute severe illness on neuropsychological function in children aged 5-16 years old and explore associations between any identified impairments and psychological outcome measures.
- However, need to be cautious when drawing conclusions from this study. Only a small sample. There were no patient controls and therefore it is difficult to attribute the source of this effect (i.e., Illness itself or the PICU admission more generally). Although some impairments were observed, the implications for a child’s future academic performance are as yet unknown. The persistence of the impairment is also unknown as there was no follow- up. A possible explanation for the association between emotional and memory impairment may lie in the marked biological stress associated with severe illness. Increased levels of cortisol have been associated with hippocampal damage. The hippocampus is implicated in learning and memory and is also connected to other regions in the limbic system, such as the amygdala, which is related to expression, recognition, and memory of emotions. Anomalous HPA axis reactivity and increased cortisol levels have been connected with stress disorders and memory impairment. SDQ Emotion and hyperactivity correlated with PRM. SDQ hyperactivity correlated with SWM & RVIP.
- The present study aimed to replicate and extend the findings of the pilot study.
- Neuropsychological Tests CANTAB The CANTAB is a computerised battery that utilises touch screen technology. The CANTAB is a well-standardised measure, which has been validated in adults and children and is differentially sensitive to dysfunction in brain regions . It was used to measure visual memory, learning, and attention. Specifically, PRM Test of visual pattern recognition memory. SWM Test of spatial working memory. SSP Test of spatial working memory capacity. RVIP Test of visual sustained attention PAL Test of visual memory and new learning. CMS Pen and paper based tasks. This scale is standardized for administration in children aged 5-16 yrs. Was used to assess Verbal learning and memory. Specifically. Stories Test of verbal learning and memory of semantically related material presented in a sequential format. Word Pairs Test of verbal learning and memory of a list of word pairs over three learning trials. IQ IQ was estimated using the WASI. This provides a brief measure of IQ, covering aspects of verbal and performance IQ.
- Psychiatric outcome questionnaires The SDQ was employed to provide measures on emotional symptoms, conduct problems, hyperactivity, peer relationship problems, and pro-social behaviour. The impact of Events Scale was employed in order to provide an indication of PTSD symptoms associated with PICU admission. Psychological well-being The Chalder Fatigue Scale, provides a measurement of both physical fatigue and mental fatigue. The sleep scales provides a measurement of sleep disturbance. Academic Measures Dr Hawley and colleagues originally created a questionnaire to assess academic performance in children after traumatic brain injury. We have adapted the questionnaire slightly to make it more appropriate for our needs. Our questionnaire explores teachers knowledge of PICU admission, the child’s educational performance and special educational needs before and after admission. Teachers will also be asked to rate the child against the ability of his/her classroom peers on a number of cognitive domains e.g., executive function, memory, and attention.
- The time-span was chosen to avoid short-term effects of PICU admission.
- We assessed neuropsychological sequelae in each of the illness groups in comparison to the healthy controls and compared the number of children performing at least 1SD below standard norms on each sub-test. I used crosstabs to perform analysis, with subsequent planned comparisons to see which groups differed significantly from controls (or patient controls in case of recognition memory as we had a specific prediction that the SI group would perform worse than non-septic PICU children). RESULTS: Significantly higher proportion of ME group performing below average on visual recall, working memory and working memory capacity than healthy controls Significantly higher proportion of SI group performing badly on working memory and recognition than healthy controls (and patient controls on recognition measure)
- Proportions not as high in the PC group (but still significantly different from controls). E.g., Performing worse than usual = 16% Difficulties with school work = 25%
- Sub-groups – HD – ME (10%) Vs. HC (0%) – P=0.028 - PC (7%) Vs. HC (0%) – P=0.029
- CHECK PC VS. HC COMPARISON (CREATE CROSS TABS)
- ADD FATIGUE CASENESS DATA
- Impairment was classed as either performing at least 1sd below norm standard scores on at least 3 tests, or performing 2sd below norms on 2 tests. When working this out, we did not include performance in IQ as indicator (we just used performance on verbal and visual memory and attention sub-tests), so maybe this is why SI do not appear to be sig. more impaired than healthy controls.
- All families that took part in the study Miss Sau-Ming Hau, Miss Seray Vezir, Miss Serenia Yip, Mr Russell Pryce, Dr Lola Picouto, Miss Natasha Khalife, Mr Kieran O’Donnell Dr Simon Nadel (C.I. SMH), Dr Mehrengise Cooper, Dr Christine Pierce (C.I. GOSH), Dr Tami Kramer, Dr Julia Gledhill, Prof. Vivette Glover, Prof. Barbara Sahakian, Prof. Elena Garralda (P.I) Miss Sarah Elison, Dr Dan Shears