Cognitive Development After Kawasaki Disease

tic meningitis, cranial nerve palsy,15 and prolonged partial seizures with bilateral subdural collections.16 Endothelial cell dysfunction in KD patients may not be restricted to coronary vessels, and previous studies have suggested that both migraines and Raynaud’s phenomenon may be consequences of KD.17 Furthermore, coma and white matter injuries on brain magnetic resonance imaging (MRI) have been observed in KD patients.12 Nevertheless, few studies have focused on whether KD is related to cognitive impairment sequelae.18,19 One study conducted in Ottawa, Canada, recruited 32 KD patients aged 4–18 years, with their siblings enrolled as control subjects. In that study, no differences were found with regard to cognitive or academic measures in KD patients compared with control subjects, but a KD deficit was found in relation to internalizing and attentional behavior.18 Another clinical study conducted in North India recruited 20 KD patients aged between 5 and 10 years and 20 patients with mild intermittent asthma as comparison subjects.19 The researchers found no significant differences between the 2 groups with regard to social adaptation, cognitive function, or behavioral function. In general, various case reports have suggested that KD is linked to CNS involvement and neurological dysfuncA disease that primarily affects children under the age of 5 years, Kawasaki disease (KD) involves multisystemic vasculitis of unknown etiology.1,2 Although KD occurs around the world, its incidence rates are especially high in East Asia, particularly Japan, Korea, and Taiwan.3,4 The major clinical characteristics of KD consist of prolonged fever, diffuse mucosal inflammation, bilateral non-purulent conjunctivitis, non-suppurative cervical lymphadenopathy, indurative angioedema of the hands and feet, and polymorphous skin rashes.5–7 Although its etiology remains unknown, both genetic and environmental factors have been associated with the occurrence of KD.8,9 Intravenous immunoglobulin (IVIG) infusion is the standard treatment for acute KD, but 10–20% of patients show resistance to IVIG therapy and are at risk of complications,10 the most serious of which are cardiovascular complications (e.g., coronary artery aneurysms).11 However, KD is also characterized by multisystemic vasculitis and may thus affect blood perfusion and cause inflammatory changes in the brain.12,13 One study indicated that central nervous system (CNS) symptoms occur in 1–30 % of KD patients.14 KD patients with CNS involvement may exhibit a variety of symptoms and signs, including irritability, lethargy, asep-