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Child's Nervous System
Published in: Child's Nervous System 7/2016

01-07-2016 | Review Paper

Consensus paper on post-operative pediatric cerebellar mutism syndrome: the Iceland Delphi results

Authors: Thora Gudrunardottir, Angela T. Morgan, Andrew L. Lux, David A. Walker, Karin S. Walsh, Elizabeth M. Wells, Jeffrey H. Wisoff, Marianne Juhler, Jeremy D. Schmahmann, Robert F. Keating, Coriene Catsman-Berrevoets, For the Iceland Delphi Group

Published in: Child's Nervous System | Issue 7/2016

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Abstract

Introduction

Confusion has surrounded the description of post-operative mutism and associated morbidity in pediatric patients with cerebellar tumors for years. The heterogeneity of definitions and diagnostic features has hampered research progress within the field, and to date, no international guidelines exist on diagnosis, prevention, treatment, or follow-up of this debilitating condition. An international group of clinicians and researchers from multiple relevant disciplines recently formed a cohesive panel to formulate a new working definition and agree upon standardized methods for diagnosis and follow-up.

Methods

Consensus was obtained using the modified nominal group technique, involving four rounds of online Delphi questionnaires interspersed with a structured consensus conference with lectures, group work, and open discussion sessions.

Results

A new, proposed definition of “post-operative pediatric CMS” was formed, preliminary recommendations for diagnostic and follow-up procedures were created, two working groups on a new scoring scale and risk prediction and prevention were established, and areas were identified where further information is needed.

Discussion

The consensus process was motivated by desire to further research and improve quality of life for pediatric brain tumor patients. The Delphi rounds identified relevant topics and established basic agreement, while face-to-face engagement helped resolve matters of conflict and refine terminology. The new definition is intended to provide a more solid foundation for future clinical and research work. It is thought as a consensus for moving forward and hopefully paves the way to developing a standard approach to this challenging problem with the advent of better scoring methods and ultimate goal of reducing the risk of CMS.
Appendix
Available only for authorised users
Footnotes
1
International multi-disciplinary group of researchers and health care professionals including adult and pediatric neurosurgeons, adult and pediatric neurologists, (neuro)radiologists, (neuro)psychologists, speech pathologists, linguists and neuroscientists who are active within the field of posterior fossa research.
 
2
Speech production that is severely reduced and limited to single words or short sentences that can only be elicited after vigorous stimulation [49].
 
3
Impairment of gait (ataxia), extremity coordination (dysmetria), disordered eye movements, poor articulation (dysarthria), impaired swallowing (dysphagia) and tremor [90].
 
4
A pattern of behavioral abnormalities that includes impairments of executive function (planning, set-shifting, abstract reasoning, verbal fluency, working memory), often with perseveration, distractibility or inattention; visual-spatial disorganization and impaired visual-spatial memory; personality change with blunting of affect or disinhibited and inappropriate behavior; and difficulties with language production including dysprosodia, agrammatism and mild anomia [35].
 
5
Symptoms such as urinary retention/incontinence and hemiparesis, which are frequently observed in this patient population [40, 91].
 
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Metadata
Title
Consensus paper on post-operative pediatric cerebellar mutism syndrome: the Iceland Delphi results
Authors
Thora Gudrunardottir
Angela T. Morgan
Andrew L. Lux
David A. Walker
Karin S. Walsh
Elizabeth M. Wells
Jeffrey H. Wisoff
Marianne Juhler
Jeremy D. Schmahmann
Robert F. Keating
Coriene Catsman-Berrevoets
For the Iceland Delphi Group
Publication date
01-07-2016
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 7/2016
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-016-3093-3

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