Zeynep GÖKER, Özden Şükran ÜNERİ, Gülser DİNÇ, Sabide Duygu TUNAS

Özgül Öğrenme Güçlüğü Etiyolojisinde Akut Dissemine Ensefalomiyelit (ADEM) Etken Olabilir mi?

Akut dissemine ensefalomiyelit (ADEM) santral sinir sisteminin immün aracılı demiyelinizan bir hastalığıdır. Literatürde ADEM geçiren çocukların yaşam boyu bilişsel süreçleri ile ilgili bilinen çok azdır. Bugüne kadar, yalnızca birkaç çalışma ve olgu sunumunda ADEM sonrası dikkat, sözel bellek, kısa süreli bellek, bilginin işlenmesi ve işlemleme hızı, dürtü kontrolü, yürütücü işlevler ve görsel-uzaysal beceriler gibi bilişsel işlev alanlarında hafif bozulmalar olduğu, öğrenme güçlükleri ve okul başarısızlığı gözlendiği bildirilmiştir. Özgül öğrenme güçlüğü (ÖÖG) bireyin yaş, zeka düzeyi ve aldığı eğitim ile açıklanamayan okuma, yazma, matematik alanlarından biri veya birkaçında, bireyin günlük işlevselliğini bozacak kadar, beklenen düzeyin altında kalması durumudur. Genel olarak ÖÖG etiyolojisinde kalıtımsal etkenlerin önemine vurgu yapılsa da, kesin etiyolojik faktörler henüz tam olarak ortaya konulamamıştır. Özellikle erken çocukluk döneminde geçirilen ADEM nedeniyle öğrenmeyle ilişkili becerilerin görece immatür kalabileceği, bu çocukların özellikle bilgi işlemleme bozukluklarına eğilimli olabileceği, sosyal gelişim ve öğrenmenin engellenebileceği bazı olgu sunumlarında ifade edilmiştir. Bu olgu sunumumuzda okuma-yazma sorunları nedeniyle çocuk psikiyatrisi polikliniği başvurusu olan, erken çocukluk döneminde geçirilmiş ADEM öyküsü olduğu saptanan ve ÖÖG tanısı alan olgumuz aracılığı ile ADEM'in ÖÖG etiyolojisindeki olası rolünün tartışılması amaçlanmıştır. Literatür gözden geçirildiğinde ADEM ve ÖÖG arasında henüz net olmayan bir nedensellik ilişkisi olabileceği, gelecekte geniş örneklemlere sahip prospektif olarak planlanmış kohort çalışmaları ile bu olası ilişkinin değerlendirilmesinin ÖÖG etiyolojisini aydınlatma açısından yararlı olacağı düşünülmüştür.

Specific Learning Disorder (SLD)? Could Acute Disseminated Encephalomyelitis (ADEM) be a Cause of Specific Learning Disorder (Sld)?

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating central nervous system disorder. There are few reports in the literature regarding the lifelong cognitive process in children who are affected by ADEM. A few studies and case reports have reported mild deterioration in some cognitive functions such as attention, verbal memory, short-term memory, information processing, processing speed, impulse control, executive functions, and spatial-visual skills after ADEM. Children who experienced ADEM have also been reported to display difficulties in learning and deterioration in academic skills. Specific learning disorder (SLD) is a condition of inadequate reading and/or writing levels and/or mathematics skills that cannot be explained with the child's age, intelligent quotient (IQ), or education. Although genetic factors have been implicated in the etiology of SLD, The exact etiological factors are still unknown. ADEM, especially in the very early childhood period, has been accused of immaturity of learning skills in the affected children and these patients have been reported to tend to suffer from deteriorating information processing, leading to a blockage in their social development and their learning skills. We report a child who presented to our clinic for difficulties in learning and was detected in his medical history to have suffered from ADEM when he was two years of age. The child was diagnosed with SLD after the examination. We discuss the possible effect of ADEM on the etiology of SLD. A correlation has been found between ADEM and SLD in the recent literature though it is not clear and further prospective cohort studies designed with larger samples are recommended to explore this reported correlation between ADEM and SLD.

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