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Educational Late Effects

Originally published on November 11, 2009
Most recently updated on April 10, 2013

Unfortunately, survivors of childhood brain tumors frequently develop problems in the areas of intellectual ability, academic achievement, memory, and attention. Although many different factors are probably responsible for these changes, including tumor location and surgery, age (younger than 7 years) at diagnosis and treatment with radiation therapy are the major risk factors for neurocognitive impairments.

Learning disabilities are particularly common among brain tumor survivors, and many children with learning disabilities require special education services at school. Moreover, one can observe deterioration in function over time, particularly in children who were treated with radiation to the brain at a young age. Thus, it is extremely important to reassess cognitive functioning periodically in all survivors who are at high risk, as well as in survivors who are experiencing academic difficulties. This is done by administering a battery of tests known as psychometric or neuropsychological tests.

Assessment is best accomplished by working closely with a pediatric neuropsychologist who has experience working with children with brain tumors. Most major medical centers will have trained neuropsychologists on staff, as will many schools. If problems are identified, then the school must provide your child with appropriate services. Although this is now mandated by federal law, you and the members of the medical team may need to advocate for your child to get all the services to which he or she is entitled.

“When I thought my child was having learning difficulties, I went right to the school for help. I needed to educate the school about her diagnosis and treatment, but once they understood more about the long-term effects of having a brain tumor, the school worked with me on the concerns I had.”

Learning problems are clearly among the most difficult and frustrating problems facing young brain tumor survivors, but new areas of research such as cognitive rehabilitation offer hope for the future.

Neurological and Neurosensory Problems

Neurological problems such as seizures and muscle coordination problems are relatively common among childhood brain tumor survivors. These sorts of disabilities often develop around the time of diagnosis or after initial surgery, but sometimes they may first appear months to years after diagnosis. Radiation injury to the brain can, on rare occasions, cause delayed neurological problems that may become apparent 10 or more years after treatment.

Neurosensory problems such as impaired vision and hearing may also develop, both early in the course of diagnosis and treatment and years after treatments are finished. Radiation can cause delayed visual problems through several different mechanisms. Direct damage to the eye nerves (optic nerves) can infrequently result in visual changes years after treatment. In rare instances, previous radiation can produce cataracts in the eyes that can interfere with normal vision. If your child has had surgery near the eye or eye nerves or has had radiation to the head, regular visits to an eye specialist (ophthalmologist) are highly recommended.

Hearing difficulties are common after treatment for brain tumors and, in general, remain stable or even decrease in severity over time. Under certain circumstances, though, hearing problems have been shown to get worse or appear for the first time months to years after treatment ends. Children who receive treatment with the combination of the drug cisplatin and radiation to the brain appear to be at the greatest risk for developing delayed hearing problems. Periodic hearing tests should be performed for all children at risk for hearing problems as well as for any child who is experiencing academic or learning difficulties.

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