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Leukemia is the most common form of pediatric cancer, accounting for 25% of all cancers occurring before 20 years of age . Acute lymphoblastic leukemia (ALL) accounts for roughly 75% of all leukemia diagnoses, with roughly 3000 new cases diagnosed annually . Lymphomas are the third most common form of childhood cancer, occurring in roughly 1700 new cases annually . Improvements in the treatment of leukemia and lymphoma have led to a remarkable increase in the survival rate, which currently exceeds 80% . At these incidence and survival rates, it is estimated that 1 out of every 640 young adults will be a pediatric cancer survivor . As many as two-thirds of all pediatric cancer survivors experience one or more permanent side effects of their treatment, often referred to as “late effects” (i.e. persisting or developing 5 or more years following cancer diagnosis) . The late effects that commonly occur in patients with leukemia include neurocognitive impairment, obesity, short stature, osteoporosis, osteonecrosis, and cardiac dysfunction . Neurocognitive late effects are often associated with treatment for leukemia, given that central nervous system (CNS) prophylaxis is a standard of care. As pediatric cancer survivors constitute a significant proportion of young adults, and as neurocognitive late effects appear relatively common, the public health consequences are substantial. This chapter will provide a review of the basic pathophysiology of acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL) as well as a review of treatment factors, mediators and moderators that may influence neurocognitive and psychosocial outcomes, and evaluation, management, and prevention of these outcomes.
Quantitative electroencephalography (qEEG) and neurofeedback have received substantial attention in recent years, as potential tools for the evaluation and treatment of neurodevelopmental disorders. Each technique relies on the premise that electroencephalographic (EEG) specificity can serve as a marker for a particular neurodevelopmental disorder or syndrome, or as a marker of specific cognitive deficits associated with neurological and neuropsychological disorders. This chapter presents a critical review of the relevant literature that applies qEEG and neurofeedback to pediatric disorders. Prior to a review of this literature, a brief discussion of the technology is in order.
Quantitative EEG (qEEG) is a method of analyzing electrical activity of the brain and drawing comparisons between an individual and representative population. It involves the application of mathematical formulas and algorithms to traditional EEG, in order to derive quantitative patterns that correspond to diagnostic information and/or cognitive deficits. Patterns can be based on topographical organization (i.e. the location of specific patterns plotted on the surface of the scalp), amplitude, or spectral analysis (i.e. the presence of specific frequencies of EEG, either in isolation or in ratio to other frequencies). As these factors are influenced by the recording techniques utilized, some attention must be paid to basic electrophysiology and methods for acquiring information about cortical activity, in order to appreciate the issues inherent in qEEG research.
Information about the behavior of neural pathways can provide valuable insight into the functioning of an organism. Cortical activity has been identified as one means for gaining such insight.