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Özgül Öğrenme Güçlüğü Etiyolojisinde Akut Dissemine Ensefalomiyelit (Adem ) Etken Olabilir mi?

Yıl 2017, Cilt: 11 Sayı: 4, 277 - 279, 01.12.2017

Öz

Akut dissemine ensefalomiyelit (ADEM) santral sinir sisteminin immün aracılı demiyelinizan bir hastalığıdır. Literatürde ADEM geçiren çocukların yaşam boyu bilişsel süreçleri ile ilgili bilinen çok azdır. Bugüne kadar, yalnızca birkaç çalışma ve olgu sunumunda ADEM sonrası dikkat, sözel bellek, kısa süreli bellek, bilginin işlenmesi ve işlemleme hızı, dürtü kontrolü, yürütücü işlevler ve görsel-uzaysal beceriler gibi bilişsel işlev alanlarında hafif bozulmalar olduğu, öğrenme güçlükleri ve okul başarısızlığı gözlendiği bildirilmiştir.Özgül öğrenme güçlüğü (ÖÖG) bireyin yaş, zeka düzeyi ve aldığı eğitim ile açıklanamayan okuma, yazma, matematik alanlarından biri veya birkaçında, bireyin günlük işlevselliğini bozacak kadar, beklenen düzeyin altında kalması durumudur. Genel olarak ÖÖG etiyolojisinde kalıtımsal etkenlerin önemine vurgu yapılsa da, kesin etiyolojik faktörler henüz tam olarak ortaya konulamamıştır. Özellikle erken çocukluk döneminde geçirilen ADEM nedeniyle öğrenmeyle ilişkili becerilerin görece immatür kalabileceği, bu çocukların özellikle bilgi işlemleme bozukluklarına eğilimli olabileceği, sosyal gelişim ve öğrenmenin engellenebileceği bazı olgu sunumlarında ifade edilmiştir.Bu olgu sunumumuzda okuma-yazma sorunları nedeniyle çocuk psikiyatrisi polikliniği başvurusu olan, erken çocukluk döneminde geçirilmiş ADEM öyküsü olduğu saptanan ve ÖÖG tanısı alan olgumuz aracılığı ile ADEM’in ÖÖG etiyolojisindeki olası rolünün tartışılması amaçlanmıştır. Literatür gözden geçirildiğinde ADEM ve ÖÖG arasında henüz net olmayan bir nedensellik ilişkisi olabileceği, gelecekte geniş örneklemlere sahip prospektif olarak planlanmış kohort çalışmaları ile bu olası ilişkinin değerlendirilmesinin ÖÖG etiyolojisini aydınlatma açısından yararlı olacağı düşünülmüştür.

Kaynakça

  • Krupp LB, Banwell B, Tenembaum S. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 2007:68:S7-S12.
  • Banwell B, Kennedy J, Sadovnick D, Arnold D, Magalhaes S, Wambera K, et al. Incidence of acquired demyelination of the CNS in Canadian children. Neurology 2009;72:232-9.
  • Pohl D, Waubant E, Banwell B, Chabas D, Chitnis T, Weinstock- Guttman B, et al. International Pediatric MS Study Group. Treatment of pediatric multiple sclerosis and variants. Neurology 2007;68:54-65.
  • Murthy KSN, Faden HS, Cohen ME, Bakshi R. Acute disseminated encephalomyelitis in children. Pediatrics 2002;110:21-8.
  • Tenembaum S, Chamoles N, Fejerman N. Acute disseminated encephalomyelitis: A long-term follow-up study of 84 pediatric patients. Neurology 2002;59:1224-31.
  • Hahn CD, Miles BS, MacGregor DL, Blaser SI, Banwell BL, Hetherington CR. Neurocognitive outcome after acute disseminated encephalomyelitis. Pediatric Neurology 2003;29:117-23.
  • Noorbakhsh F, Johnson RT, Emery D, Power C. Acute disseminated encephalomyelitis: Clinical and pathogenesis features. Neurol Clin 2008;26:759-80.
  • Callen DJA, Shroff MM, Branson HM, Li DK, Lotze T, Stephens D, et al. Role of MRI in the differentiation of ADEM from MS in children. Neurology 2009;72:968-73.
  • Deery B, Anderson V, Jacobs R, Neale J, Kornberg A. Childhood MS and ADEM: Investigation and comparison of neurocognitive features in children. Dev Neuropsychol 2010;35:506-21.
  • Idrissova ZR, Boldyreva MN, Dekonenko EP, Malishev NA, Leontyeva IY, Martinenko IN, et al. Acute disseminated encephalomyelitis in children: Clinical features and HLA-DR linkage. Eur J Neurol 2003;10:537-46.
  • Jacobs R, Northam E, Anderson V. Cognitive outcome in children with myelomeningocele and perinatal hydrocephalus: A longitudinal perspective. J Phys Devel Disabil 2001;13:389-404.
  • Jayakrishnan MP, Krishnakumar P. Clinical profile of acute disseminated encephalomyelitis in children J Pediatr Neurosci 2010;5:111-4.
  • Rostásy K, Nagl A, Lütjen S, Roll K, Zotter S, Blaschek A, et al. Clinical outcome of children presenting with a severe manifestation of acute disseminated encephalomyelitis. Neuropediatrics 2009;40:211-7.
  • Kuni BJ, Banwell BL, Till C. Cognitive and behavioral outcomes in individuals with a history of acute disseminated encephalomyelitis (ADEM). Dev Neuropsychol 2012;37:682-96.
  • Selikowitz M. Dyslexia and other learning difficulties. The facts. New York: Oxford University Press, 1993.
  • Anderson V, Catroppa C. Recovery of executive skills following paediatric traumatic brain injury (TBI): A 2 year follow-up. Brain Inj 2005;19:459-70.
  • Mulhern RK, Palmer SL, Reddick WE, Glass JO, Kun LE, Taylor J, et al. Risks of young age for selected neurocognitive deficits in medulloblastoma are associated with white matter loss. J Clin Oncol 2001;19:472-79.
  • Reddick WE, Shan ZY, Glass JO, Helton S, Xiong X, Wu S, et al. Smaller white-matter volumes are associated with larger deficits in attention and learning among long-term survivors of acute lymphoblastic leukemia. Cancer 2006;106:941-9.
  • Wozniak JR, Krach L, Ward E, Mueller BA, Muetzel R, Schnoebelen S, et al. Neurocognitive and neuroimaging correlates of pediatric traumatic brain injury: A diffusion tensor imaging study. Arch Clin Neuropsychol 2007;22:555-68.
  • Klinberg T, Vaidya CJ, Gabrieli JDE, Moseley M, Hedehus M. Myelination and organization of the frontal white matter in children: A diffusion tensor MRI study. Neuro Report 1999;10:2817-21.

Could Acute Disseminated Encephalomyelitis (Adem) be a Cause of Specific Learning Disorder (Sld)?

Yıl 2017, Cilt: 11 Sayı: 4, 277 - 279, 01.12.2017

Öz

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating central nervous system disorder. There are few reports in the literature regarding the lifelong cognitive process in children who are affected by ADEM. A few studies and case reports have reported mild deterioration in some cognitive functions such as attention, verbal memory, short-term memory, information processing, processing speed, impulse control, executive functions, and spatial-visual skills after ADEM. Children who experienced ADEM have also been reported to display difficulties in learning and deterioration in academic skills. Specific learning disorder (SLD) is a condition of inadequate reading and/or writing levels and/or mathematics skills that cannot be explained with the child’s age, intelligent quotient (IQ), or education. Although genetic factors have been implicated in the etiology of SLD, The exact etiological factors are still unknown. ADEM, especially in the very early childhood period, has been accused of immaturity of learning skills in the affected children and these patients have been reported to tend to suffer from deteriorating information processing, leading to a blockage in their social development and their learning skills. We report a child who presented to our clinic for difficulties in learning and was detected in his medical history to have suffered from ADEM when he was two years of age. The child was diagnosed with SLD after the examination. We discuss the possible effect of ADEM on the etiology of SLD. A correlation has been found between ADEM and SLD in the recent literature though it is not clear and further prospective cohort studies designed with larger samples are recommended to explore this reported correlation between ADEM and SLD

Kaynakça

  • Krupp LB, Banwell B, Tenembaum S. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 2007:68:S7-S12.
  • Banwell B, Kennedy J, Sadovnick D, Arnold D, Magalhaes S, Wambera K, et al. Incidence of acquired demyelination of the CNS in Canadian children. Neurology 2009;72:232-9.
  • Pohl D, Waubant E, Banwell B, Chabas D, Chitnis T, Weinstock- Guttman B, et al. International Pediatric MS Study Group. Treatment of pediatric multiple sclerosis and variants. Neurology 2007;68:54-65.
  • Murthy KSN, Faden HS, Cohen ME, Bakshi R. Acute disseminated encephalomyelitis in children. Pediatrics 2002;110:21-8.
  • Tenembaum S, Chamoles N, Fejerman N. Acute disseminated encephalomyelitis: A long-term follow-up study of 84 pediatric patients. Neurology 2002;59:1224-31.
  • Hahn CD, Miles BS, MacGregor DL, Blaser SI, Banwell BL, Hetherington CR. Neurocognitive outcome after acute disseminated encephalomyelitis. Pediatric Neurology 2003;29:117-23.
  • Noorbakhsh F, Johnson RT, Emery D, Power C. Acute disseminated encephalomyelitis: Clinical and pathogenesis features. Neurol Clin 2008;26:759-80.
  • Callen DJA, Shroff MM, Branson HM, Li DK, Lotze T, Stephens D, et al. Role of MRI in the differentiation of ADEM from MS in children. Neurology 2009;72:968-73.
  • Deery B, Anderson V, Jacobs R, Neale J, Kornberg A. Childhood MS and ADEM: Investigation and comparison of neurocognitive features in children. Dev Neuropsychol 2010;35:506-21.
  • Idrissova ZR, Boldyreva MN, Dekonenko EP, Malishev NA, Leontyeva IY, Martinenko IN, et al. Acute disseminated encephalomyelitis in children: Clinical features and HLA-DR linkage. Eur J Neurol 2003;10:537-46.
  • Jacobs R, Northam E, Anderson V. Cognitive outcome in children with myelomeningocele and perinatal hydrocephalus: A longitudinal perspective. J Phys Devel Disabil 2001;13:389-404.
  • Jayakrishnan MP, Krishnakumar P. Clinical profile of acute disseminated encephalomyelitis in children J Pediatr Neurosci 2010;5:111-4.
  • Rostásy K, Nagl A, Lütjen S, Roll K, Zotter S, Blaschek A, et al. Clinical outcome of children presenting with a severe manifestation of acute disseminated encephalomyelitis. Neuropediatrics 2009;40:211-7.
  • Kuni BJ, Banwell BL, Till C. Cognitive and behavioral outcomes in individuals with a history of acute disseminated encephalomyelitis (ADEM). Dev Neuropsychol 2012;37:682-96.
  • Selikowitz M. Dyslexia and other learning difficulties. The facts. New York: Oxford University Press, 1993.
  • Anderson V, Catroppa C. Recovery of executive skills following paediatric traumatic brain injury (TBI): A 2 year follow-up. Brain Inj 2005;19:459-70.
  • Mulhern RK, Palmer SL, Reddick WE, Glass JO, Kun LE, Taylor J, et al. Risks of young age for selected neurocognitive deficits in medulloblastoma are associated with white matter loss. J Clin Oncol 2001;19:472-79.
  • Reddick WE, Shan ZY, Glass JO, Helton S, Xiong X, Wu S, et al. Smaller white-matter volumes are associated with larger deficits in attention and learning among long-term survivors of acute lymphoblastic leukemia. Cancer 2006;106:941-9.
  • Wozniak JR, Krach L, Ward E, Mueller BA, Muetzel R, Schnoebelen S, et al. Neurocognitive and neuroimaging correlates of pediatric traumatic brain injury: A diffusion tensor imaging study. Arch Clin Neuropsychol 2007;22:555-68.
  • Klinberg T, Vaidya CJ, Gabrieli JDE, Moseley M, Hedehus M. Myelination and organization of the frontal white matter in children: A diffusion tensor MRI study. Neuro Report 1999;10:2817-21.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Diğer ID JA75FZ89AS
Bölüm Case Report
Yazarlar

Sabide Duygu Tunas Bu kişi benim

Gülser Dinç Bu kişi benim

Zeynep Göker Bu kişi benim

Özden Şükran Üneri Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2017
Gönderilme Tarihi 1 Aralık 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 11 Sayı: 4

Kaynak Göster

Vancouver Tunas SD, Dinç G, Göker Z, Üneri ÖŞ. Could Acute Disseminated Encephalomyelitis (Adem) be a Cause of Specific Learning Disorder (Sld)?. Türkiye Çocuk Hast Derg. 2017;11(4):277-9.

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