الفهرس 
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Abstract
Patients treated with contemporary risk-based therapy, had an over all 5-year survival rates exceeded 85%. (Brenner., 2001). As more survivors are progressing through school and into adulthood, understanding the long-term intellectual and academic sequelae of CNS chemotherapy becomes more urgent. Understanding what these deficits are can help the child and her or his parents and teachers to prepare for the future through remediation. Unequivocal conclusions about neuro cognitive dysfunction in children with ALL who received CNS- directed therapy in the ALL literature are non existent. This is partially due to the unavoidable methodological difficulties inherent in such research. Varying protocols across institutions renders generalization difficult. Suitable control groups are lacking in many studies. Longitudinal studies are rare and contain confounds such as practice effects and the use of different measures as the subjects mature. Over reliance on IQ scores may obscure the intellectual and educational difficulties experienced by ALL survivors. Despite these barriers, conclusions about the effects of CNS prophylaxis on ALL survivors can be tentatively drawn. Most of the studies measuring the global intellectual abilities, neuropsychological, and/or academic achievement performance of ALL survivors documented declines in cognitive functioning. It may be concluded that CNS prophylaxis for ALL is not a benign form of treatment. What remains to be seen is whether the late effects of CNS prophylaxis prove to be progressive in their course, or whether and when stabilization of cognitive functioning occurs. Conclusions about declines in specific abilities are harder to come by, as there has been more research conducted on IQ than on specific domains of cognitive functioning. The most robust findings are long-term deficits in attention and nonverbal memory, although more research is needed toconfirm these results as well as to scrutinize other domains of neuropsychological functioning. The acute effects of CNS prophlaxis on fine-motor and perceptual-motor skills are well documented, but more research on long-term effects is needed. Significant declines in academic achievement have been found in mathematics, reading, and spelling.