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‘Chemobrain’ in Children

Methotrexate chemotherapy, intravenous or intrathecal, induced measurable cognitive deficits in 24 to 72 hours after exposure, in a study reported at the AACR Annual Meeting of eight children with leukemia who were given standard tests of memory before and after chemotherapy.

The first author, Ava Dorfman, MA, a PhD candidate in pediatric neuropsychology at Fordham University, said the study was sparked by reports of early cognitive deficits due to methotrexate treatment in adults with rheumatoid arthritis, and by the fact that pediatric hematology patients receive much higher doses than adults with rheumatoid arthritis. Most of the eight children (mean age of 11.8 years, range of 6 to 17) were being treated for acute lymphoblastic leukemia. Each received a different methotrexate-based regimen, with each child serving as his or her own control.

The tests were administered two hours before and 24 to 48 hours after chemotherapy. They focused on verbal and non-verbal memory, attention, visual memory, and fine motor functioning—the last being one of the most common side effects seen in children after chemotherapy, Ms. Dorfman noted. The verbal memory test of auditory delayed recall dropped by two words (out of 15) after 30 minutes, versus one word out of 15 before treatment; and recognition of target words presented orally to measure auditory recognition decreased by 1.9 words. Both changes were statistically significant, she said.

No statistically significant differences were seen in any of the other tests. “These children were all back in school within two days, so if they are having trouble with verbal memory this will affect their ability to function adequately in school,” she said.

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