An evaluation of Intelligence Quotient in children with myelomeningocele aged 5-12 years

Background: Myelomeningocele is the most common central nervous system birth defect compatible with life. The various impairments occurring in these children are skeletal, genitourinary, psychological defect and infections. The learning disabilities are usually overlooked. We conducted this study to evaluate the intelligence quotient (IQ) in these children using Ravens test.
Methods: A case-control study was conducted in the Children's Medical Center in Tehran from February 2005 to 2006. The case group included children of 5-12 years old, with myelomeningocele that were admitted or referred due to complications or follow-up. The control group was selected from children that were referred to the hospital for reasons other than myelomeningocele and diseases affecting brain development or neurological status and were matched for age and sex. An IQ test (Ravens progressive matrices test) was taken and the rest of the data was collected by filling a questionnaire. The test was performed by the same person in the same circumstances for both groups.
Findings: There were 47 cases for which 47 controls were randomly selected. The two groups were similar according to the socioeconomic status and the education level of the parents (p=0.59). The age of the patients at the time of surgery varied from 21 days to 8 years (mean=3.3 months). Only 21.3% of meningomylocele patients were ambulant with a normal gait. 46.8% of total patients had a ventriculoperitoneal shunt inserted and half of them had experienced shunt complications in the form of obstruction or infection. 72.3% of patients had incontinece (both for urine and feces). The IQ in the case group varied from 73 to 134 with a mean of 96.4, whereas it varied from 70 to 128 with a mean of 104.9% in the control group. A statistically significant correlation was found in comparing the IQ of both groups (p=0.000). In the case group none of the factors such as age at the time of meningomylocele repair, history of meningitis before repair, placement of shunt and/or its complications, urine and fecal incontinence, presence of urinary problems, usage of CIC, inability to have a normal ambulatory status, recurrent hospital admissions, orthopedic problems, had an effect on the IQ of the patients.
Conclusions: Inspite that, the IQ of the case group was significantly lower than the control group, still 90% of the patients in the case group had an average IQ.

Keywords
IQ , meningomylocele , hydrocephauls , shunt , central nervous system defect