Pediatric hydrocephalus is described as excess cerebrospinal fluid in the lateral ventricles. This is due to a failure of the fluid reabsorption mechanism, implying an exaggerated skull circumference, headache, dizziness, irritability and other disabling symptoms that require immediate surgical intervention.
In high- and middle-income countries, such as Europe, this diagnosis and its consequences have little impact because they are resolved with a simple surgical procedure that involves activating a valve or shunt in the patient to drain this excess fluid. .
In these more affluent geographic areas, the most common causes are postnatal cerebral hemorrhage and comorbidity with other neurodevelopmental disorders such as spina bifida. In both cases, there is a standardized intervention protocol that offers stability to the child patient. Also, the incidence is low and the mortality rate of this disease is almost nonexistent.
The problem has tripled in Africa
Nothing to do with prospects in low-income countries in Africa (Uganda, Tanzania and Sudan stand out). There the data on this disorder are much more alarming, even reaching 200,000 cases of live births per year.
More specifically, in 2009, just one hospital in Uganda, a country with more than 30 million people under the age of 15, treated 500 cases of hydrocephalus and 300 cases of spina bifida per year. That number has now tripled.
The moment of hydrocephalus diagnosis and perceptions of quality of life have been associated with delays in the onset of language, social, and behavioral problems.
In these areas, the main causes of hydrocephalus (congenital or acquired) are poor prenatal care (nutrition and intake of folic acid and ultrasound monitoring of the mother during pregnancy) and postnatal brain infections due to the lack of standardized treatment protocols in these areas. Consequently, most cases have a high potential for seriousness, including a high mortality rate before the age of two.
Significant neuropsychological deficits
Despite the paucity of experimental studies involving patients living in low-income countries, some have concluded that the neuropsychological deficits associated with this disorder are notable. Most of the data show a general index of developmental deficit compared to the control group. In addition, it is related to other variables associated with the disorder such as: B. a decrease in brain volume.
Memory, attention or executive function have not been studied so far due to several factors: heterogeneity of the methodology, lack of resources for neuropsychological assessment, preference for other indicators more related to neurology and neurosurgery, in addition to the fact that the severity of the Cases complicate this type of evaluation.
In contrast, the neuropsychological profile associated with pediatric hydrocephalus in patients residing in middle- and high-income countries has been further studied. The results are not meaningful because it is a heterogeneous profile with deficits in memory, attention and motor skills. In most cases, patients retain communication and language functions.
It is not enough to survive: it is important to study the quality of life
Likewise, most of these studies include quality of life parameters in the neuropsychological evaluation. To what extent does the illness affect everyday life? In this case, some studies have shown that the diagnosis of pediatric hydrocephalus in childhood affects the perception of the quality of life of patients and especially their guardians.
In particular, the fathers and mothers of patients with this diagnosis report that their quality of life in the school context is restricted due to hydrocephalus. The timing of hydrocephalus diagnosis and perceived quality of life have also been associated with delayed language onset, social and behavioral problems, intellectual disability, and other cognitive problems. However, when patients self-report this variable, they assume that they have similar scores to their peer group.
If they survive, the quality of life of these patients has added value. Mainly because if it is satisfactory it can make a difference in terms of their postoperative recovery, in addition to promoting cognitive improvement and greater involvement of this type of patient in society.
In studies in low-income countries like Africa, it is not common to assess the quality of life of these patients. Rather, they focus on exploring the neurosurgical evolution of the disease, including at most an assessment of cognitive development using scales rarely used in Europe, such as the Bayley Scale of Development-III. The difference is understandable if we consider that the African patient with pediatric hydrocephalus is younger than the European patient. In addition, the severity of hydrocephalus in these countries places neurosurgery as a top priority for the survival of the pediatric patient.
The paradox is that the quality of life of these patients has added value if they survive. Mainly because if it is satisfactory it can make a difference in terms of their postoperative recovery, in addition to promoting cognitive improvement and greater involvement of this type of patient in society. In short, a functional adaptation of the patient with hydrocephalus to his environment.
For this reason, several pioneering research groups have launched lines of research specifically aimed at studying the neuropsychological profile of patients with pediatric hydrocephalus living in these low-income areas, including Neuropsychology and Acquired Brain Injury at the International University of Valencia and the work group , which is associated with the VIU-NED Chair in Global Neuroscience and Social Change.
Research in the field of neuropsychology and health psychology will make it possible to achieve the much-needed improvement in patients’ quality of life.
Follow PLANETA FUTURO on TwitterFacebook and Instagram and subscribe to our “Newsletter” here.