This study investigated potential predictors of intellectual outcome in 417 children and 218 adults who had sustained a unilateral cortical lesion. Of these, 295 cases were collected from the scientific literature and 340 from medical records at seven hospitals in Canada. Different sets of predictors emerged for the Wechsler Verbal and Performance IQ values, accounting for differing variances (ie, 12.4% and 20.1%, respectively). The volume of the lesion was the factor that explained the most variance (ie, 4.95% and 11.7%, respectively). Age at lesion onset was significantly and positively correlated with verbal intelligence scores. This variable, considered independently or in interaction with other predictors, did not account for a large portion of the variance explained in intelligence. This refutes the commonly held notion that early onset of the insults results in a better prognosis. (J Child Neurol 2004; 19:935-943).
Get full access to this article
View all access options for this article.
References
1.
Ballantyne AO , Scarvie KM, Trauner DA: Verbal and Performance IQ patterns in children after perinatal stroke. Dev Neuropsychol1994 ;10:39—50.
2.
St. James-Roberts I.: A reinterpretation of hemispherectomy data without functional plasticity of the brain: I. Intellectual function. Brain Lang1981;13:31—53.
3.
Vargha-Khadem K., Isaacs E., Muter V.: A review of cognitive outcome after unilateral lesions sustained during childhood. Child Neurol1994;9(Suppl):2S67—2S73.
4.
Kennard MA: Reorganization of motor function in the cerebral cortex of monkeys deprived of motor and premotor areas in infancy. J Neuropsychol1938;1:477—496.
5.
Woods BT, Teuber HL: Early onset of complementary specalization of cerebral hemispheres in man . Trans Am Neurol Assoc1973;98:113—117.
6.
Banich MT, Cohen-Levine S., Kim H., Huttenlocher P.: The effects of developmental factors on IQ in hemiplegic children. Neuropsychologia1990;28:35—47.
7.
Aram DM, Ekelman BL: Scholastic aptitude and achievement among children with unilateral brain lesions . Neuropsychologia1988;26:903—916.
8.
Aram D.: Neuroplasticity: Evidence from unilateral brain lesions in children, in Broman S (ed): The Changing Nervous System: Neurobehavioral Consequences of Early Brain Disorders. New York, Oxford University Press, 254—273.
9.
Goodman R., Yude C.: IQ and its predictors in childhood hemiplegia. Dev Med Child Neurol1996;38:881—890.
10.
Riva D., Cazzaniga L.: Late effects of unilateral brain lesions sustained before and after age one . Neuropsychologia1986;24:423—428.
11.
Woods BT: The restricted effects of right-hemisphere lesions after age one; Wechsler test data. Neuropsychologia1980;18:65—70.
12.
Dennis M.: Intelligence after early brain injury I: Predicting IQ scores from medical variables. J Clin Exp Neuropsychol1985;7: 526—554.
13.
Aram DM, Eisele JA: Intellectual stability in children with unilateral brain lesions. Neuropsychologia1994;32:85—95.
14.
Muter V., Taylor S., Vargha-Khadem F: A longitudinal study of early intellectual development in hemiplegic children. Neuropsychologia1997 ;35:289—298.
15.
Jaffe KM, Polissar NL, Fay GC, Liao S.: Recovery trends over three years following pediatric traumatic brain injury . Arch Phys Med Rehabil1995; 76:17-26.
16.
Anderson V. , Moore C.: Age at injury as a predictor of outcome following pediatric head injury: A longitudinal perspective. Child Neuropsychol1995;1:187—202.
17.
Bornstein RA : Unilateral lesions and the Wechsler Adult Intelligence Scale-Revised: No sex differences. J Consult Clin Psychol1984;52:604—608.
18.
Milner B.: Psychological aspects of focal epilepsy and its neurosurgical managament, in Purpura DP, Penry JK, Walter RD (eds): Advances in Neurology, vol 8. New York, Raven Press, 299—321.
19.
Warrington EK, James M., Maciejewski C.: The WAIS as a lateralizing and localizing instrument: A study of 656 patients with unilateral cerebral lesions. Neuropsychologia1986;24:223—239.
20.
Teuber HL: Why two brains?, in Schmitt FO, Worden FG (eds): The Neurosciences: Third Study Program. Cambridge, MA, MIT Press, 71—74.
21.
Vargha-Khadem F., Isaacs E., Van Der Werf S., et al: Development of intelligence and memory in children with hemiplegic cerebral palsy. Brain1992;115:315—329.
22.
Satz P., Strauss E., Hunter M., Wada J.: Re-examination of the crowding hypothesis: Effects of age of onset. Neuropsychology1994;8: 255—262.
23.
Aram DM, Ekelman BL: Cognitive profiles of children with early onset unilateral lesions. Dev Neuropsychol1986;2:155—172.
24.
Lansdell H. : Verbal and nonverbal factors in right-hemisphere speech: Relation to early neurological history. J Physiol Comp Psychol1969;69:734—738.
25.
Nass R., Koch D., Janowsky J., Stiles-Davis J.: Differential effects on intelligence of early left versus right brain injury . Ann Neurol1985;18:394.
26.
Novelly RA, Naugle RI: Gender Specific Effects on VIQ vs PIQ in Acquired Right-Hemisphere Speech . Presented to the International Neuropsychological Society, Denver, CO, 1986.
27.
Ogden JA: Language and memory functions after long recovery periods in left-hemispherectomized subjects. Neuropsychologia1988;26:645—659.
28.
Orsini DL, Satz P.: A syndrome of pathological left-handedness. Arch Neurol1986;43:333—337.
29.
Satz P., Orsini DL, Saslow E., Henry D.: The pathological left-handedness syndrome. Brain Cogn1985;4:27—46.
30.
Strauss E., Satz P., Wada J.: An examination of the crowding hypothesis in epileptic patients who have undergone the carotid amytal test. Neuropsychologia1990;28:1221—1227.
31.
Nass R., Peterson Hdc, Koch D.: Differential effects of congenital left and right brain injury on intelligence . Brain Cogn1989;9: 258—266.
32.
Mariotti P. , Iuvone L., Torrioli MG, Silveri MC: Linguistic and non-linguistic abilities in a patient with early left hemispherectomy. Neuropsychologia1998;36:1303—1312.
33.
Vargha-Khadem F., Carr LJ, Isaacs E.: Onset of speech after left hemispherectomy in a nine-year-old boy. Brain1997;120:159—182.
34.
Gadian DG, Isaacs EB, Cross JH: Lateralization of brain function in childhood revealed by magnetic resonance spectroscopy. Neurology1996;46:974—977.
35.
Levine SC, Huttenlocher P., Banich MT, Duda E.: Factors affecting cognitive functioning of hemiplegic children. Dev Med Child Neurol1987;29:27—35.
36.
Goldenberg G. , Spatt J.: Influence of size and site of cerebral lesions on spontaneous recovery of aphasia and on success of language therapy. Brain Lang1994;47:684—698.
37.
Bates E.: Plasticity, localization, and language development, in Broman S (ed): The Changing Nervous System: Neurobehavioral Consequences of Early Brain Disorders. New York, Oxford University Press, 214—253.
38.
Filley CM, Young DA, Reardon MS, Wildening GN: Frontal lobe lesions and executive dysfunction in children. Neuropsychiatry Neuropsychol Behav Neurol1999;12:156—160.
39.
Milner B.: Some cognitive effects of frontal-lobe lesions in man. Philos Trans R Soc Lond B Biol Sci1982;298:211—226.
40.
Grattan LM, Eslinger PJ: Frontal lobe damage in children and adults: A comparative review. Dev Neuropsychol1991;7:283—326.
41.
We l s h M C, P e n n i n g t o n B F, G r o i s s e r D B: A normative-developmental study of executive function: A window on prefrontal function in children. Dev Neuropsychol1991 ;7:131—149.
42.
Segalowitz SJ, Unsal A., Dywan J.: Cleverness and wisdom in 12-year-olds: Electrophysiological evidence for late maturation of the frontal lobe. Dev Neuropsychol1992;8:279—298.
43.
McGlone J.: Sex differences in the cerebral organization of verbal functions in patients with unilateral brain lesions. Brain1977;100:775—793.
44.
Inglis J., Lawson JS: Sex differences in the effects of unilateral brain damage on intelligence . Science1981;212:693—695.
45.
Bornstein RA , Matarazzo JD: Relationship of sex and the effects of unilateral lesions on the Wechsler intelligence scales: Further considerations. J Nerv Ment Dis1984;172:707—710.
46.
Inglis J., Lawson JS: A meta-analysis of sex differences in the effects of unilateral brain damage on intelligence test results. Can J Psychol1982;36:670—683.
47.
Kimura D.: Sex differences in cerebral organization for speech and praxic functions. Can J Psychol1983;37:19—35.
48.
Levy, J., Heller W.: Gender differences in human neuropsychological functions, in Gerall AA, Moltz H, Ward IL (eds): Handbook of Behavioral Neurobiology. Sexual Differentiation, vol 11. New York, Plenum Press, 245—274.
49.
Breedlove SM : Sexual differentiation of the human nervous system. Annu Rev Psychol1994;45:389—418.
50.
Anderson V. , Catroppa C., Morse S., et al: Recovery of intellectual ability following traumatic brain injury in childhood: Impact of injury severity and age at injury. Pediatr Neurosurg2000;32: 282—290.
51.
Woods BT, Teuber HL: Changing patterns of childhood aphasia. Ann Neurol1978;3:273—280.
52.
Ris Douglas M, Noll RB: Long-term neurobehavioral outcome in pediatric brain-tumor patients: Review and methodological critique. J Clin Exp Neuropsychol1994;16:21—42.
53.
Klein B., Levin BE, Duchowny MS, Llabre MM: Cognitive outcome of children with epilepsy and malformation of cortical development . Neurology2000;55:230—235.
54.
Jones-Gotman M., Milner B.: Design fluency: The invention of nonsense drawings after focal cortical lesions. Neuropsychologia1977;15:653—674.
55.
Kuehn S., Keene DL, Richards P., Ventureyra EC: Are there changes in intelligence and memory functioning following surgery for treatment of refractory epilepsy in childhood? Childs Nerv Syst2002;18:306—310.
56.
Loonen CB, van Dongen HR: Acquired childhood aphasia. Outcome 1 year after onset. Arch Neurol1990;47:1324—1328.
57.
Riva D., Pantaleoni C., Devoti M.: Radiosurgery for cerebral AVMs in children and adolescents: The neurobehavioral outcome. J Neurosurg1997;86:207—210.
58.
McGlone J.: Sex differences in functional brain asymmetry. Cortex1978;14:122—128.
59.
Besag Fmc: Cognitive deterioration in children with epilepsy, in Trimble MR, Reynolds EH (eds): Epilepsy, Behaviour and Cognitive Function. New York, John Wiley & Sons, 113—127.
60.
Wechsler D.: Manual for the Wechsler Preschool and Primary Scale of Intelligence. New York, Psychological Corporation, 1967.
61.
Wechsler D.: Manual of the Wechsler Preschool and Primary Scale of Intelligence-Revised . New York, Psychological Corporation , 1989.
62.
Wechsler D.: Manual for the Wechsler Intelligence Scale for Children. New York, Psychological Corporation, 1949.
63.
Wechsler D.: Manual for the Wechsler Intelligence Scale for Children-Revised. New York, Psychological Corporation, 1974.
64.
Wechsler D.: Manual for the Wechsler Intelligence Scale for Children III. New York, Psychological Corporation, 1991.
65.
Wechsler D.: Manual for the Wechsler Adult Intelligence Scale. New York , Psychological Corporation, 1955 .
66.
Wechsler D.: Manual for the Wechsler Adult Intelligence Scale-Revised. New York, Psychological Corporation, 1981.
67.
Chagnon M.: Manuel et Normes de l'Échelle d'Intelligence Ottawa-Wechsler. Ottawa, ON, Editions Université d'Ottawa, 1953.
68.
Wechsler D.: Manual Canadian Supplement WISC-III. New York, Psychological Corporation, 1996.
69.
Schretlen D. , Benedict Rhb, Bobholz JH: Composite reliability and standard errors of measurement for a seven-subtest short form of the Wechsler Adult Intelligence Scale-Revised. Psychol Assess1994;6:188—190.
70.
Kleihues P, Cavenee WK (eds): Pathology & Genetics. Tumours of the Nervous System. Lyon, International Agency for Research on Cancer, 1997.
71.
Spaycar M, Randolph E (eds): Stedman's Medical Dictionary, 26th ed. Baltimore, Williams & Wilkins, 1995.
72.
Tabachnik BG, Fidell LS: Using Multivariate Statistics, 3rd ed. New York, Harper Collins College Publishers, 1996.
73.
Cohen J., Cohen P.: Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences . Hillsdale, NJ, Lawrence Erlbaum , 1983.
74.
Verger K., Junqué C., Jurado MA, et al: Age effects on long-term neuropsychological outcome in paediatric traumatic brain injury. Brain Injury2000; 14:495-503.
75.
Dennis M.: Language and the young damaged brain, in Boll T, Bryant B (eds): Clinical Neuropsychology and Brain Function: Research, Measurement and Practice . Washington, DC, American Psychological Association, 89—123.
76.
Eslinger PJ , Grattan LM: Perspectives on the developmental consequences of early frontal lobe damage: Introduction. Dev Neuropsychol1991;7:257—260.
77.
Lehr E.: A developmental perspective, in Lehr E (ed): Psychological Management of Traumatic Brain Injuries in Children and Adolescents. Chicago, Aspen Publications, 41—98.
78.
Braun Cmj, Montour-Proulx I., Daigneault S., et al: Prevalence and intellectual outcome of unilateral focal cortical brain damage as a function of age, sex and aetiology. Behav Neurol2001/2002; 13:105—116.
