PSYCH  Vol.5 No.9 , July 2014
Neuropsychological Profile of Treated Children with Congenital Toxoplasmosis
ABSTRACT

Background: Very little is known about the long-term neuropsychological outcomes of infants who were treated with pyrimethamine and sulfadiazine for congenital Toxoplasma infection. This study investigated the neurocognitive functioning and behavior of a cohort of treated infants exposed to Toxoplasma gondii in the 1994-1995 outbreak in Victoria, British Columbia. Methods: Ten infants from the original cohort, treated with pyrimethamine and sulfadiazine starting during first year of life and continuing for 12 months, were evaluated at 7 to 8.5 years of age. Neuropsychological evaluations focused on the cognitive, academic, adaptive, and behavioral functioning of these children. Results: The cohort demonstrated generally average neurocognitive abilities and academic achievement. According to parental ratings, the children’s executive functions, behavior and adaptive functioning did not differ significantly from the normative population. However, subtle difficulties were seen on more demanding sustained attention and impulse control tasks. Conclusions: These results suggest favorable outcomes in infants who were treated for one year with pyrimethamine and sulfadiazine. Nonetheless, congenital toxoplasmosis might contribute to some difficulties with higher-order cognitive abilities or tasks demanding greater self-monitoring. These difficulties could become more pronounced as higher demands for these abilities and brain areas come online during late childhood and adolescence. These findings highlight the importance of effective treatment and longitudinal follow-up of children with congenital toxoplasmosis.


Cite this paper
Kerns, K. , Mish, S. , Roberts, J. & Jagdis, F. (2014). Neuropsychological Profile of Treated Children with Congenital Toxoplasmosis. Psychology, 5, 1079-1089. doi: 10.4236/psych.2014.59120.
References
[1]   Bowie, W. R., King, A. S., Werker, D. H., Isaac-Renton, J. L., Bell, A., Eng, S. B., & Marian, S. A. (1997). Outbreak of Toxoplasmosis Associated with Municipal Drinking Water. Lancet, 350, 173-177.
http://dx.doi.org/10.1016/S0140-6736(96)11105-3

[2]   Brezin, A. P., Thulliez, P., Couvreur, J., Nobre, R., McLeod, R., & Mets, M. B. (2003). Ophthalmic Outcomes after Prenatal and Postnatal Treatment of Congenital Toxoplasmosis. American Journal of Ophthalmology, 135, 779-784.
http://dx.doi.org/10.1016/S0002-9394(02)01704-X

[3]   Bruininks, R. H., Woodcock, R. W., Weatherman, R. F., & Hill, B. K. (1996). Scales of Independent Behavior—Revised Comprehensive Manual. Itasca, IL: Riverside Publishing.

[4]   Canadian Paediatric Society (1999). Common Questions about the Diagnosis and Management of Congenital Toxoplasmosis. Paediatrics & Child Health, 4, 137-141.

[5]   Conners, C. K. (1994). Conners’ Continuous Performance Test Computer Program 3.0 User’s Guide. Toronto, ON: Multi-Health Systems Inc.

[6]   Conners, C. K. (1997). Conner’s Rating Scales—Revised Technical Manual. Toronto, ON: Multi-Health Systems Inc.

[7]   Couvreur, J., & Desmonts, G. (1962). Congenital and Maternal Toxoplasmosis: A Review of 300 Congenital Cases. Developmental Medical Child Neurology, 4, 519-530.
http://dx.doi.org/10.1111/j.1469-8749.1962.tb03221.x

[8]   Daffos, F., Forestier, F., Capella-Pavlovsky, M., Thulliez, P., Aufrant, C., Valenti, D., Cox, W. L. et al. (1988). Prenatal Management of 746 Pregnancies at Risk for Congenital Toxoplasmosis. New England Journal of Medicine, 318, 271-275.
http://dx.doi.org/10.1056/NEJM198802043180502

[9]   Derouin, F. (2001). Anti-Toxoplasmosis Drugs. Current Opinion: Investigative Drugs, 2, 1368-1374.

[10]   Desmonts, G., & Couvreur, J. (1974). Congenital Toxoplasmosis—A Prospective Study of 378 Pregnancies. New England Journal of Medicine, 290, 1110-1116.
http://dx.doi.org/10.1056/NEJM197405162902003

[11]   Dodgson, J. E., Garwick, A., Blozia, S. A., Patterson, J. M., Bennett, F. C., & Blum, R. W. (2000). Uncertainty in Childhood Chronic Conditions and Family Distress in Families of Young Children. Journal of Family Nursing, 6, 252-266.
http://dx.doi.org/10.1177/107484070000600304

[12]   Dunn, D., Wallon, M., Peyron, F., Peterson, E., Peckham, C., & Gilbert, R. (1999). Mother-to-Child Transmission of Toxoplasmosis: Risk Estimates for Clinical Counselling. Lancet, 353, 1829-1833.
http://dx.doi.org/10.1016/s0140-6736(98)08220-8

[13]   Eichenwald, H. F. (1960). A Study of Congenital Toxoplasmosis with Particular Emphasis on Clinical Manifestations, Sequellae and Therapy. In J. C. Siim (Ed.), Human Toxoplasmosis (pp. 41-49). Copenhagen: Munksgaard.

[14]   Foulon, W., Villena, I., Stray-Pedersen, B., Decaster, A., Lappalainen, M., Pinon, J. M. et al. (1999). Treatment of Toxoplasmosis during Pregnancy: A Multicenter Study of Impact on Fetal Transmission and Children’s Sequelae at Age 1 Year. American Journal of Obstetrics and Gynecology, 180, 410-415.
http://dx.doi.org/10.1016/S0002-9378(99)70224-3

[15]   Freeman, K., Salt, A., Prusa, A., Malm, G., Ferret, N., Buffolano, W. et al. (2005). Association between Congenital Toxoplasmosis and Parent-Reported Developmental Outcomes, Concerns, and Impairments, in 3 Year Old Children. BMC Pediatrics, 5, 23.
http://dx.doi.org/10.1186/1471-2431-5-23

[16]   Gilbert, R. E., Gras, L., Wallon, M., Peyron, F., Ades, A. E., & Dunn, D. T. (2001). Effect of Prenatal Treatment on Mother to Child Transmission of Toxoplasma gondii: Retrospective Cohort Study of 554 Mother-Child Pairs in Lyon, France. International Journal of Epidemiology, 30, 1303-1308.
http://dx.doi.org/10.1093/ije/30.6.1303

[17]   Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Behavior Rating Inventory of Executive Function Professional Manual. Lutz, FL: Psychological Assessment Resources.

[18]   Guerina, N. G., Hsu, H.-W., Meissner, H. C., Maguire, J. H., Lynfield, R., Stechenberg, B. et al. (1994). Neonatal Serologic Screening and Early Treatment for Congenital Toxoplasma gondii Infection. New England Journal of Medicine, 330, 1858-1863.
http://dx.doi.org/10.1056/NEJM199406303302604

[19]   Hohlfeld, P., Daffos, F., Thulliez, P., Aufrant, C., Couvreur, J., MacAlees, J. et al. (1989). Fetal Toxoplasmosis: Outcome of Pregnancy and Infant Follow-Up after in Utero Treatment. Journal of Pediatrics, 115, 765-769.
http://dx.doi.org/10.1016/S0022-3476(89)80660-2

[20]   Jeremy, R. J., Kim, S., Nozyce, M., Nachman, S., McIntosh, K., Pelton, S. I. et al. (2005). Neuropsychological Functioning and Viral Load in Stable Antiretroviral Therapy-Experienced HIV-Infected Children. Pediatrics, 115, 380-387.
http://dx.doi.org/10.1542/peds.2004-1108

[21]   Katz, S. (2002). When the Child’s Illness Is Life Threatening: Impact on the Parents. Pediatric Nursing, 28, 453-463.

[22]   Koppe, J. G., Loewer-Sieger, D. H., & de Roever-Bonnet, H. (1986). Results of 20-Year Follow-Up of Congenital Toxoplasmosis. Lancet, 1, 254-256.
http://dx.doi.org/10.1016/S0140-6736(86)90785-3

[23]   Korkman, M., Kirk, U., & Kemp, S. (1998). NEPSY: A Developmental Neuropsychological Assessment Manual. San Antonio, TX: The Psychological Corporation.

[24]   Manly, T., Robertson, I. H., Anderson, V., & Nimmo-Smith, I. (1999). The Test of Everyday Attention for Children Manual. Bury St. Edmunds: Thames Valley Test Co Ltd.

[25]   Mather, N., & Woodcock, R. W. (2001). Woodcock-Johnson III Tests of Achievement Examiner’s Manual. Itasca, IL: Riverside Publishing.

[26]   McAuley, J., Boyer, K. M., Patel, D., Mets, M., Swisher, C., Roizen, N. et al. (1994). Early and Longitudinal Evaluations of Treated Infants and Children and Untreated Historical Patients with Congenital Toxoplasmosis: The Chicago Collaborative Treatment Trial. Clinical Infectious Disease, 18, 38-72.
http://dx.doi.org/10.1093/clinids/18.1.38

[27]   McGee, T., Wolters, C., Stein, L., Kraus, N., Johnson, D., Boyer, K. et al. (1992). Absence of Sensorineural Hearing Loss in Treated Infants and Children with Congenital Toxoplasmosis. Otolaryngology, Head and Neck Surgery, 106, 75-80.

[28]   McInerney, R. J., Hrabok, M., & Kerns, K. A. (2005). The Children’s Size-Ordering Task: A New Measure of Nonverbal Working Memory. Journal of Clinical and Experimental Neuropsychology, 27, 735-745.
http://dx.doi.org/10.1081/13803390490918633

[29]   McLeod, R., Boyer, K., Karrison, T., Kasza, K., Swisher, C., Roizen, N. et al. (2006). Outcome of Treatment for Congenital Toxoplasmosis, 1981-2004: The National Collaborative Chicago-Based, Congenital Toxoplasmosis Study. Clinical Infectious Disease, 42, 1383-1394.
http://dx.doi.org/10.1086/501360

[30]   Mets, M. B., Holfels, E., Boyer, K. M., Swisher, C. N., Roizen, N., Stein, L. et al. (1996). Eye Manifestations of Congenital Toxoplasmosis. American Journal of Ophthalmology, 122, 309-324.

[31]   Meyers, J. E., & Meyers, K. R. (1995). Rey Complex Figure Test and Recognition Trial: Professional Manual. Odessa, FL: Psychological Assessment Resources.

[32]   Michel, J. A., Kerns, K. A., & Mateer, C. A. (2005). The Effect of Reinforcement Variables on Inhibition in Children with ADHD. Child Neuropsychology, 11, 295-302.
http://dx.doi.org/10.1080/092970490911270

[33]   Patel, D. V., Holfels, E. M., Vogel, N. P., Boyer, K. M., Mets, M. B., Swisher, C. N. et al. (1996). Resolution of Intracranial Calcifications in Infants with Treated Congenital Toxoplasmosis. Radiology, 199, 433-440.

[34]   Peyron, F., Wallon, M., & Bernardoux, C. (1996). Long-Term Follow-Up of Patients with Congenital Ocular Toxoplasmosis. New England Journal of Medicine, 334, 993-994.
http://dx.doi.org/10.1056/NEJM199604113341517

[35]   Remington, J. S., McLeod, R., Thulliez, P., & Desmonts, G. (2006). Toxoplasmosis. In J. S. Remington, J. O. Klein, C. B. Baker, & C. J. Wilson (Eds.), Infectious Diseases of the Fetus and Newborn Infant (6th ed., pp. 947-1091). Philadelphia, PA: Elsevier Saunders.
http://dx.doi.org/10.1016/B0-72-160537-0/50033-5

[36]   Roberts, J., Mortimer, T., Mish, S., Kerns, K., Jagdis, F., & MacMath, S. (2005). The Experiences and Recommendations of Families with Children Who Have Congenital Toxoplasmosis. Physical Disabilities: Education and Related Services, 24, 23-39.

[37]   Roizen, N., Swisher, C. N., Stein, M. A., Hopkins, J., Boyer, K., Holfels, E. et al. (1995). Neurologic and Developmental Outcome in Treated Congenital Toxoplasmosis. Pediatrics, 95, 11-20.

[38]   Sheslow, D., & Adams, W. (1990). Wide Range Assessment of Memory and Learning Administration Manual. Wilmington, DE: Jastak Associates.

[39]   Wallon, M., Kodjikian, L., Binquet, C., Gerweg, J., Fleury, J., Quantin, C., & Peyron, F. (2004). Long-Term Ocular Prognosis in 327 Children with Congenital Toxoplasmosis. Pediatrics, 113, 1567-1572.
http://dx.doi.org/10.1542/peds.113.6.1567

[40]   Wechsler, D. (1991). Wechsler Intelligence Scale for Children—Third Edition Manual. San Antonio, TX: The Psychological Corporation.

[41]   Wilson, C. B., Remington, J. S., Stagno, S., & Reynolds, D. W. (1980). Development of Adverse Sequelae in Children Born with Subclinical Congenital Toxoplasma Infection. Pediatrics, 66, 767-774.

 
 
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