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Jandhyala NR, Garcia MR, Kim M, Yohay K, Segal D. Identifying Lesions of the Corpus Callosum in Patients With Neurofibromatosis Type 1. Pediatr Neurol 2024; 156:66-71. [PMID: 38733856 DOI: 10.1016/j.pediatrneurol.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/04/2024] [Accepted: 04/12/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a multisystemic autosomal dominant disorder that includes intracranial lesions such as unidentified bright objects (UBOs)-areas of increased T2 signal on magnetic resonance imaging (MRI)-and tumors known as gliomas. The presence of these lesions in the corpus callosum (CC) has not been previously studied in a large cohort. METHODS We reviewed medical records of 681 patients (aged three months to 86 years) followed at our institution from 2000 to 2023 with NF1 and one or more brain MRI. Patients with lesions in the CC were identified, and RAPNO/RANO criteria were used to determine changes in size over time, where a change of 25% in the product of perpendicular measurements indicates growth or shrinkage. RESULTS Forty-seven patients had CC UBOs, most of which were in the splenium (66.0%). Seventeen patients had CC gliomas (10% of those with any glioma), two of whom had two gliomas. Seventeen of 19 gliomas were in the splenium. Over follow-up, eight of 19 remained stable, three shrunk, and eight grew. The mean percentage change in the product of the dimensions was 311.5% (ranging from -46.7% to 2566.6%). Of the eight lesions that grew, one required treatment. CONCLUSIONS There is a 6.9% and 2.5% prevalence of CC UBOs and gliomas, respectively, in our cohort of patients with NF1. Most lesions are present in the splenium, and although some gliomas demonstrate significant growth, they rarely require treatment. This work is the largest series of CC lesions in NF1 and adds to the growing data to inform appropriate follow-up.
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Affiliation(s)
- Nora R Jandhyala
- New York University Grossman School of Medicine, New York, New York
| | - Mekka R Garcia
- Department of Neurology, NYU Langone Health, New York, New York
| | - Monica Kim
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kaleb Yohay
- Department of Neurology, NYU Langone Health, New York, New York
| | - Devorah Segal
- Department of Neurology, NYU Langone Health, New York, New York.
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2
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Di Pietro S, Reali L, Tona E, Belfiore G, Praticò AD, Ruggieri M, David E, Foti PV, Santonocito OG, Basile A, Palmucci S. Magnetic Resonance Imaging of Central Nervous System Manifestations of Type 1 Neurofibromatosis: Pictorial Review and Retrospective Study of Their Frequency in a Cohort of Patients. J Clin Med 2024; 13:3311. [PMID: 38893021 PMCID: PMC11172829 DOI: 10.3390/jcm13113311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background: type 1 neurofibromatosis (NF1) is the most common neurocutaneous disorder, and it is an inherited condition that causes a tumour predisposition. Central nervous system (CNS) manifestations are a significant cause of morbidity and mortality in NF1. We provide a pictorial review of neuroradiological features of NF1, with emphasis on magnetic resonance imaging (MRI), and we assess the frequency of those features on a cohort of NF1 patients. Methods: we retrospectively evaluated all patients with a diagnosis of NF1 who underwent MRI of the spine and brain in our centre over a period of almost 5 years. A total of 74 patients were enrolled, 28 males and 46 females, with a mean age of 21 ± 12.67 years. The frequency of CNS manifestations encountered in our cohort of NF1 patients was assessed and compared with the data found in other studies published in the literature. Results: many of our findings were in line with the literature, and possible interpretations for those that turned out to be different were suggested in the discussion. Conclusion: imaging plays a central role in the diagnosis and management of NF1, and the knowledge of CNS manifestations could be critical for its early detection and identification, such as for treatment planning and prognostic implications.
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Affiliation(s)
- Stefano Di Pietro
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Linda Reali
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Emanuela Tona
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Giuseppe Belfiore
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | | | - Martino Ruggieri
- Unit of Clinical Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, A.O.U. “Policlinico”, P.O. “G. Rodolico”, via S. Sofia, 78, 95125 Catania, Italy
| | - Emanuele David
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Pietro Valerio Foti
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Orazio Giuseppe Santonocito
- UOSD “IPTRA”, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Stefano Palmucci
- UOSD “IPTRA”, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
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Di Stasi M, Cocozza S, Buccino S, Paolella C, Di Napoli L, D'Amico A, Melis D, Ugga L, Villano G, Ruocco M, Scala I, Brunetti A, Elefante A. The role of unidentified bright objects in the neurocognitive profile of neurofibromatosis type 1 children: a volumetric MRI analysis. Acta Neurol Belg 2024; 124:223-230. [PMID: 37733157 PMCID: PMC10874314 DOI: 10.1007/s13760-023-02381-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Cognitive impairment is described in 80% of Neurofibromatosis type 1 (NF1) patients. Brain focal areas of T2w increased signal intensity on MRI, the so-called Unidentified Bright Objects (UBOs) have been hypothesized to be related to cognitive dysfunction, although conflicting results are available in literature. Here, we investigated the possible relation between UBOs' volume, cognitive impairment, and language disability in NF1 patients. MATERIAL AND METHODS In this retrospective study, clinical and MRI data of 21 NF1 patients (M/F = 12/9; mean age 10.1 ± 4.5) were evaluated. Brain intellectual functioning and language abilities were assessed with specific scales, while the analyzed MRI sequences included axial 2D-T2-weighted and FLAIR sequences. These images were used independently for UBOs segmentation with a semiautomatic approach and obtained volumes were normalized for biparietal diameters to take into account for brain volume. Possible differences in terms of normalized UBOs volumes were probed between cognitively affected and preserved patients, as well as between subjects with or without language impairment. RESULTS Patients cognitively affected were not different in terms of UBOs volume compared to those preserved (p = 0.35 and p = 0.30, for T2-weighted and FLAIR images, respectively). Similarly, no differences were found between patients with and without language impairment (p = 0.47 and p = 0.40, for the two sequences). CONCLUSIONS The relation between UBOs and cognition in children with NF1 has been already investigated in literature, although leading to conflicting results. Our study expands the current knowledge, showing a lack of correlation between UBOs volume and both cognitive impairment and language disability in NF1 patients.
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Affiliation(s)
- Martina Di Stasi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
- Department of Diagnostic and Interventional Neuroradiology, University Hospital "San Giovanni di Dio e Ruggi di Aragona", Salerno, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy.
| | - Sara Buccino
- Department of Maternal and Child Health, Federico II University Hospital, Naples, Italy
| | - Chiara Paolella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Linda Di Napoli
- Department of Maternal and Child Health, Federico II University Hospital, Naples, Italy
| | | | - Daniela Melis
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Gianmichele Villano
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Manuel Ruocco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Iris Scala
- Department of Maternal and Child Health, Federico II University Hospital, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
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Srivastava P, Gupta S, Bamba C, Daniel R, Kaur P, Kaur A, Panigrahi I, Mandal K. Neurofibromatosis type 1: Clinical characteristics and mutation spectrum in a North Indian cohort. Heliyon 2024; 10:e23685. [PMID: 38226287 PMCID: PMC10788438 DOI: 10.1016/j.heliyon.2023.e23685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/28/2023] [Accepted: 12/09/2023] [Indexed: 01/17/2024] Open
Abstract
Background Neurofibromatosis type 1 (NF1) is a unique, highly penetrant neuro-cutaneous disorder with a wide range of manifestations. Though the clinical diagnosis of NF1 is straight forward, there can be other disorders which mimic NF1, especially its cutaneous features. Here we describe the clinical and mutation spectrum of a series of individuals whose primary diagnosis was NF1 or NF1 related disorders. Methods We have screened 29 unrelated individuals who fulfilled the clinical criteria of NF1. Whole exome sequencing (WES) was done in all individuals except one with suspected microdeletion syndrome with NF1 in whom Cytogenetic microarray (CMA) was done. Results Out of 29 suspected patients, 25 had germline pathogenic/likely pathogenic variants involving NF1 gene. Five novel and 20 known variants in coding and non-coding regions were identified, among them 7 variants were deletions (28%), 7 nonsense (28%), 3 splice-site (12%), 4 missense (16%), 2 duplications (8%) and 2 (8%) were contiguous deletions. In those where NF1 variants were not detected, 3 had neurofibromatosis type 2 (NF2) and 1 rare autosomal recessive form of Elher Danlos syndrome. Conclusion We hereby present the wide range of manifestations in different age groups and the mutation spectrum ranging from small scale variants to contiguous gene deletion syndromes involving NF1 gene. We highlight the usefulness of molecular testing and its importance in tumor surveillance and genetic counseling in this disorder.
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Affiliation(s)
- Priyanka Srivastava
- Genetic Metabolic Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
| | - Shifali Gupta
- Genetic Metabolic Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
| | - Chitra Bamba
- Genetic Metabolic Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
| | - Roshan Daniel
- Genetic Metabolic Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
| | - Parminder Kaur
- Genetic Metabolic Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
| | - Anupriya Kaur
- Genetic Metabolic Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
| | - Inusha Panigrahi
- Genetic Metabolic Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
| | - Kausik Mandal
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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5
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Harriott EM, Nguyen TQ, Landman BA, Barquero LA, Cutting LE. Using a semi-automated approach to quantify Unidentified Bright Objects in Neurofibromatosis type 1 and linkages to cognitive and academic outcomes. Magn Reson Imaging 2023; 98:17-25. [PMID: 36608909 PMCID: PMC9908856 DOI: 10.1016/j.mri.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous syndrome that affects multiple organ systems resulting in widespread symptoms, including cognitive deficits. In addition to the criteria required for an NF1 diagnosis, approximately 70% of children with NF1 present with Unidentified Bright Objects (UBOs) or Focal Areas of Signal Intensity, which are hyperintense bright spots seen on T2-weighted magnetic resonance images and seen more prominently on FLAIR magnetic resonance images (Sabol et al., 2011). Current findings relating the presence/absence, quantities, sizes, and locations of these bright spots to cognitive abilities are mixed. To contribute to and hopefully disentangle some of these mixed findings, we explored potential relationships between metrics related to UBOs and cognitive abilities in a sample of 28 children and adolescents with NF1 (M=12.52 years; SD=3.18 years; 16 male). We used the Lesion Segmentation Tool (LST) to automatically detect and segment the UBOs. The LST was able to qualitatively and quantitatively reliably detect UBOs in images of children with NF1. Using these automatically detected and segmented lesions, we found that while controlling for age, biological sex, perceptual IQ, study, and scanner, "total UBO volume", defined as the sum of all the voxels representing all of the UBOs for each participant, helped explain differences in word reading, phonological awareness, and visuospatial skills. These findings contribute to the emerging NF1 literature and help parse the specific deficits that children with NF1 have, to then help improve the efficacy of reading interventions for children with NF1.
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Affiliation(s)
- Emily M Harriott
- Vanderbilt Brain Institute, 465 21(st) Avenue South, Nashville, TN 37212, USA.
| | - Tin Q Nguyen
- Vanderbilt Brain Institute, 465 21(st) Avenue South, Nashville, TN 37212, USA.
| | - Bennett A Landman
- Department of Electrical Engineering and Computer Science, Vanderbilt University, 2301Vanderbilt Place, Nashville, TN 37235, USA; Vanderbilt Kennedy Center, 110 Magnolia Circle, Nashville, TN 37203, USA.
| | - Laura A Barquero
- Department of Special Education, Peabody College of Education and Human Development, Vanderbilt University, 110 Magnolia Circle, Nashville, TN 37203, USA.
| | - Laurie E Cutting
- Vanderbilt Brain Institute, 465 21(st) Avenue South, Nashville, TN 37212, USA; Department of Special Education, Peabody College of Education and Human Development, Vanderbilt University, 110 Magnolia Circle, Nashville, TN 37203, USA; Vanderbilt Kennedy Center, 110 Magnolia Circle, Nashville, TN 37203, USA.
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6
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Neurofibromatosis Type 1: Pediatric Aspects and Review of Genotype-Phenotype Correlations. Cancers (Basel) 2023; 15:cancers15041217. [PMID: 36831560 PMCID: PMC9954221 DOI: 10.3390/cancers15041217] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant condition, with a birth incidence of approximately 1:2000-3000, caused by germline pathogenic variants in NF1, a tumor suppressor gene encoding neurofibromin, a negative regulator of the RAS/MAPK pathway. This explains why NF1 is included in the group of RASopathies and shares several clinical features with Noonan syndrome. Here, we describe the main clinical characteristics and complications associated with NF1, particularly those occurring in pediatric age. NF1 has complete penetrance and shows wide inter- and intrafamilial phenotypic variability and age-dependent appearance of manifestations. Clinical presentation and history of NF1 are multisystemic and highly unpredictable, especially in the first years of life when penetrance is still incomplete. In this scenario of extreme phenotypic variability, some genotype-phenotype associations need to be taken into consideration, as they strongly impact on genetic counseling and prognostication of the disease. We provide a synthetic review, based on the most recent literature data, of all known genotype-phenotype correlations from a genetic and clinical perspective. Molecular diagnosis is fundamental for the confirmation of doubtful clinical diagnoses, especially in the light of recently revised diagnostic criteria, and for the early identification of genotypes, albeit few, that correlate with specific phenotypes.
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7
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Galasso C, Casarelli L, El Malhany N, Spiridigliozzi S, Pitzianti MB, Curatolo P, Pasini A. Presence of neurologic signs in children with neurofibromatosis type 1. Minerva Pediatr (Torino) 2023; 75:1-7. [PMID: 27471818 DOI: 10.23736/s2724-5276.16.04476-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Neurofibromatosis type 1 is a common neurogenetic disorder affecting nervous system, caused by germiline mutations of the NF1 gene. Although the clinical diagnosis of NF1 is defined by presence of cafe-au-laits spots, freckling and benign tumors (neurofibromatosis), neurocognitive impairment and neuropsychiatric disorders are reported in comorbidity. Children with NF1 show higher incidence of executive deficits, such attention, response inhibition, executive planning and problem solving, working memory, and learning impairment. In this study we examine the presence of neurological soft signs and planning function in subjects with NF1. The NSS are minor motor and sensory abnormalities without focal brain damage. METHODS Eleven drug naïve children between 7-15 years with clinical and molecular diagnosis of NF are matched to 11 healthy controls to ass the presence of neurological soft signs and planning executive functions. NSS were assessed using Physical and Neurological Examination for Subtle Signs and the Tower of London task is performance test to assess the capacity of planning, organization and execution of a work. RESULTS Our results revealed highest rate of NSS and planning deficit in children with NF1 compared to healthy controls. CONCLUSIONS The motor abnormalities and planning deficit are possible markers to confirm that NF1 could be considering a neurodevelopmental disorder.
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Affiliation(s)
- Cinzia Galasso
- Child Neurology and Psychiatry Unit, Department of System Medicine, Tor Vergata University, Rome, Italy
| | - Livia Casarelli
- Child Neurology and Psychiatry Unit, Department of System Medicine, Tor Vergata University, Rome, Italy
| | - Nadia El Malhany
- Child Neurology and Psychiatry Unit, Department of System Medicine, Tor Vergata University, Rome, Italy
| | - Simonetta Spiridigliozzi
- Child Neurology and Psychiatry Unit, Department of System Medicine, Tor Vergata University, Rome, Italy
| | - Maria B Pitzianti
- Child Neurology and Psychiatry Unit, Department of System Medicine, Tor Vergata University, Rome, Italy
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Department of System Medicine, Tor Vergata University, Rome, Italy
| | - Augusto Pasini
- Child Neurology and Psychiatry Unit, Department of System Medicine, Tor Vergata University, Rome, Italy -
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Anders R, Hirsch FW, Roth C. [Neurofibromatosis type 1 : From diagnosis to follow-up]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:1050-1057. [PMID: 36070094 DOI: 10.1007/s00117-022-01059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a tumor predisposition syndrome and is one of the most common genetic diseases. It is therefore a condition encountered by radiologists in clinical routine. Since the variability of the clinical expression is very high and several organ systems are affected, we present a standardized diagnostic approach in this article. METHODS Evaluation of the literature on neurofibromatosis type 1 in the context of radiological examination methods. RESULTS In addition to the frequently known changes in the central and peripheral nervous system such as optic gliomas and plexiform neurofibromas, lesions from the orthopedic spectrum and vascular changes must also be included in the radiological diagnosis. CONCLUSIONS Due to the diversity of the clinical picture of NF1, it is reasonable to define an examination strategy which takes into account the needs of radiological routine and also reliably detects the most frequent and prognostically significant pathologies accompanying this disease. In this article, the current recommendations for diagnosis of neurofibromatosis-associated tumors and skeletal changes are summarized, and examination protocols and time intervals are suggested.
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Affiliation(s)
- Rebecca Anders
- Institut für Kinderradiologie, Universitätsklinikum Leipzig, Liebigstr. 20a, 04103, Leipzig, Deutschland
| | - Franz Wolfgang Hirsch
- Institut für Kinderradiologie, Universitätsklinikum Leipzig, Liebigstr. 20a, 04103, Leipzig, Deutschland
| | - Christian Roth
- Institut für Kinderradiologie, Universitätsklinikum Leipzig, Liebigstr. 20a, 04103, Leipzig, Deutschland.
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Russo C, Russo C, Cascone D, Mazio F, Santoro C, Covelli EM, Cinalli G. Non-Oncological Neuroradiological Manifestations in NF1 and Their Clinical Implications. Cancers (Basel) 2021; 13:cancers13081831. [PMID: 33921292 PMCID: PMC8070534 DOI: 10.3390/cancers13081831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Central nervous system involvement (CNS) is a common finding in Neurofibromatosis type 1 (NF1). Beside tumor-related manifestations, NF1 is also characterized by a wide spectrum of CNS alterations with variable impacts on functioning and life quality. Here, we propose an overview of non-oncological neuroradiological findings in NF1, with an insight on pathophysiological and embryological clues for a better understanding of the development of these specific alterations. Abstract Neurofibromatosis type 1 (NF1), the most frequent phakomatosis and one of the most common inherited tumor predisposition syndromes, is characterized by several manifestations that pervasively involve central and peripheral nervous system structures. The disorder is due to mutations in the NF1 gene, which encodes for the ubiquitous tumor suppressor protein neurofibromin; neurofibromin is highly expressed in neural crest derived tissues, where it plays a crucial role in regulating cell proliferation, differentiation, and structural organization. This review article aims to provide an overview on NF1 non-neoplastic manifestations of neuroradiological interest, involving both the central nervous system and spine. We also briefly review the most recent MRI functional findings in NF1.
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Affiliation(s)
- Camilla Russo
- Department of Electrical Engineering and Information Technology (DIETI), University of Naples “Federico II”, 80125 Naples, Italy
- Correspondence: ; Tel.: +39-333-7050711
| | - Carmela Russo
- Pediatric Neuroradiology Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (C.R.); (D.C.); (F.M.); (E.M.C.)
| | - Daniele Cascone
- Pediatric Neuroradiology Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (C.R.); (D.C.); (F.M.); (E.M.C.)
| | - Federica Mazio
- Pediatric Neuroradiology Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (C.R.); (D.C.); (F.M.); (E.M.C.)
| | - Claudia Santoro
- Neurofibromatosis Referral Center, Department of Woman, Child, General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Eugenio Maria Covelli
- Pediatric Neuroradiology Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (C.R.); (D.C.); (F.M.); (E.M.C.)
| | - Giuseppe Cinalli
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy;
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Importance of Thalamostriatal Pathway Associated With Neurocognitive Dysfunctions in Children With Neurofibromatosis Type 1: Diffusion Tensor Imaging Findings. J Comput Assist Tomogr 2021; 45:294-299. [PMID: 33661154 DOI: 10.1097/rct.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether there is a difference between healthy control group and children with neurofibromatosis type 1 (NF1) in terms of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values in different regions of the brain associated with neurocognitive functions and to investigate the correlation between diffusion tensor imaging parameters and neurocognitive dysfunctions. METHODS The study included 28 children with NF1 and 21 controls. Nine distinct areas related to cognitive functions were selected for the analysis. The ADC and FA values were compared. RESULTS There was a significant difference between NF1 and healthy control in terms of ADC values obtained from all areas. The ADC values at obtained from thalamus and striatum were positively correlated with the full-scale intelligence quotient (IQ), verbal IQ, and performance IQ. CONCLUSIONS We are speculated that the development of microstructural damage in the thalamostriatal pathway may lead to neurocognitive dysfunction.
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Evaluation of clinical findings and neurofibromatosis type 1 bright objects on brain magnetic resonance images of 60 Turkish patients with NF1 gene variants. Neurol Sci 2021; 42:2045-2057. [PMID: 33443663 DOI: 10.1007/s10072-020-04988-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
Neurofibromatosis type 1 (NF1) is caused by mutations in the NF1 gene. This retrospective study aims to evaluate the clinical manifestations and brain magnetic resonance images (MRI) analysis in 60 genetically confirmed NF1 patients. The results of next-generation sequencing (NGS), Sanger sequencing, and MLPA of NF1 gene were evaluated. A total of 54 different variants were identified. Fourteen out of them were novel variants (25.9%). Patients who complied with NIH criteria had most frequently frameshift variants (11/32 patients), and those with only CALMs had missense variants (9/28 patients). Neurofibromatosis type 1 bright objects (NBOs) on T2-weighted MRI were detected in 42 patients (42/56; 75%). These brain lesions were detected mostly in basal ganglia and in cerebellar vermis. NBOs were detected more in the patients who complied with NIH criteria (80.6%) compared to those who were only CALMs (68%). While frameshift variants (33.3%) were the most common type variants in the patients who had NBOs, the most common variants were splicing (35.7%) and missense (35.7%) variants in the patients whose MRIs were normal. Frameshift variants (11/28 patients; 39.3%) were the most common in the patients with more than one brain locus involvement. Therefore, we consider that frameshift variants may be associated with increased incidence of NBOs and involvement of more than one brain locus. In addition, NBOs may occur less frequently in the patients with splicing variants. To our knowledge, this is the first study evaluated the relationship between NF1 gene variants and NBOs. Future studies may help us understand the etiology of NBOs.
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Attina G, Maurizi P, Triarico S, Capozza MA, Romano A, Mastrangelo S, Ruggiero A. Management of Children with Optic Gliomas and Neurofibromatosis Type 1. BIOMEDICAL AND PHARMACOLOGY JOURNAL 2020; 13:1601-1606. [DOI: 10.13005/bpj/2035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Optic pathway gliomas (OPG) are a common cancer in children with neurofibromatosis type 1. OPGs can cause clinical symptoms such as reduction of visual acuity, alterations of the visual field, pallor of the optical papilla, strabismus, endocrinological alterations up to diencephalic syndrome.The current guidelines provide for wait and see as the main approach if the tumor is not causing visual deterioration and adopting treatment only in the event of significant impairment of the visual function. Therefore, it is essential to early detect the visual deterioration changes as well as the identification of children eligible for treatment.
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Affiliation(s)
- Giorgio Attina
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Palma Maurizi
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Silvia Triarico
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Michele Antonio Capozza
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Alberto Romano
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
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13
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Baudou E, Chaix Y. The value of screening tests in children with neurofibromatosis type 1 (NF1). Childs Nerv Syst 2020; 36:2311-2319. [PMID: 32524181 DOI: 10.1007/s00381-020-04711-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/28/2020] [Indexed: 11/26/2022]
Abstract
Neurofibromatosis type 1 (NF1) is one of the most prevalent rare diseases. Whilst penetrance is complete by adulthood, its expressivity is extremely variable with potential multi-systemic complications. Although NF1 is diagnosed clinically, molecular analysis has a part to play in the screening of atypical forms and in genetic counselling. The screening of complications is primarily based on a full annual clinical examination and an ophthalmological examination. Targeted paraclinical examinations will be carried out when clinical signs appear (neurological, ophthalmological, cutaneous, endocrinological, orthopaedic and cardiovascular, etc.). The implementation of routine paraclinical examinations, which are stressful for families, expensive and sometimes invasive (MRI under general anaesthetic), is only of minor interest and does not lead to any change in treatment if the child is asymptomatic. Part of the consultation should focus on evaluation of psychomotor development and learning difficulties, which are common features of this condition (50%), and impact the child's quality of life.
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Affiliation(s)
- Eloïse Baudou
- Paediatric Neurology Unit, Children's Hospital, Toulouse University Hospital , 330 Avenue de Grande-Bretagne, 31069, Toulouse, France.
- ToNIC, Toulouse NeuroImaging Center, Toulouse University Center, Inserm, UPS, Toulouse, France.
| | - Yves Chaix
- Paediatric Neurology Unit, Children's Hospital, Toulouse University Hospital , 330 Avenue de Grande-Bretagne, 31069, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University Center, Inserm, UPS, Toulouse, France
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14
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Farschtschi S, Mautner VF, McLean ACL, Schulz A, Friedrich RE, Rosahl SK. The Neurofibromatoses. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:354-360. [PMID: 32657748 DOI: 10.3238/arztebl.2020.0354] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 04/18/2019] [Accepted: 03/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Neurofibromatosis of types 1 and 2 (NF1, NF2) and schwannomatosis are the diseases that make up the neurofibromatosis spectrum. With respective incidences of 1 in 3000, 1 in 33 000, and 1 in 60 000 births, they form part of the group of rare tumor-suppressor syndromes. They give rise to a greater tumor burden for the nervous system than any other type of neoplastic disease. New approaches to symptomatic treatment are emerging. METHODS This review is based on articles retrieved by a selective literature search on the pathogenesis, diagnosis, and treatment of the neurofibromatoses. RESULTS NF1 and NF2 are monogenic diseases, while the genetics of schwannomatosis is complex. The three entities are clinically and pathophysiologically distinct. An important aspect of their tumor biology is the alternation of growth phases and growth pauses. Correlations between genotypes and phenotypes are variable, while new mutations and genetic mosaics are common. Ninety-nine percent of patients with NF1 have six or more café-au-lait spots by the age of 12 months; 90-95% of patients with NF2 develop bilateral vestibular schwannomas. In schwannomatosis, pain is the most prominent symptom; two-thirds of those affected develop spinal schwannomas. The severity and prognosis of these disorders are not closely correlated with the radiological findings; rather, neurologic deficits, malignant transformation, and psychosocial stress are of greater clinical importance. Advances in knowledge of pathophysiology have led to the development of targeted treatment approaches. Examples include the off-label treatment of vestibular schwannomas with bevacizumab and of plexiform neurofibromas with MEK inhibitors. CONCLUSION Patients with neurofibromatoses need individualized care. They should be treated in centers of expertise where interdisciplinary consultation is available and new types of pharmacotherapy can be provided.
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Affiliation(s)
- Said Farschtschi
- International Center for Neurofibromatoses (ICNF), Department of Neurology, University MedicalCenter Hamburg-Eppendorf
| | - Victor-Felix Mautner
- International Center for Neurofibromatoses (ICNF), Department of Neurology, University MedicalCenter Hamburg-Eppendorf
| | | | | | - Reinhard E Friedrich
- Department of Oromaxillofacial Surgery, University Medical Center Hamburg-Eppendorf
| | - Steffen K Rosahl
- Neurofibromatosis Center, Department of Neurosurgery, Helios Hospital Erfurt
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15
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Calvez S, Levy R, Calvez R, Roux CJ, Grévent D, Purcell Y, Beccaria K, Blauwblomme T, Grill J, Dufour C, Bourdeaut F, Doz F, Robert MP, Boddaert N, Dangouloff-Ros V. Focal Areas of High Signal Intensity in Children with Neurofibromatosis Type 1: Expected Evolution on MRI. AJNR Am J Neuroradiol 2020; 41:1733-1739. [PMID: 32816766 DOI: 10.3174/ajnr.a6740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/07/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Focal areas of high signal intensity are T2WI/T2-FLAIR hyperintensities frequently found on MR imaging of children diagnosed with neurofibromatosis type 1, often thought to regress spontaneously during adolescence or puberty. Due to the risk of tumor in this population, some focal areas of high signal intensity may pose diagnostic problems. The objective of this study was to assess the characteristics and temporal evolution of focal areas of high signal intensity in children with neurofibromatosis type 1 using long-term follow-up with MR imaging. MATERIALS AND METHODS We retrospectively examined the MRIs of children diagnosed with neurofibromatosis type 1 using the National Institutes of Health Consensus Criteria (1987), with imaging follow-up of at least 4 years. We recorded the number, size, and surface area of focal areas of high signal intensity according to their anatomic distribution on T2WI/T2-FLAIR sequences. A generalized mixed model was used to analyze the evolution of focal areas of high signal intensity according to age, and separate analyses were performed for girls and boys. RESULTS Thirty-nine patients (ie, 285 MR images) with a median follow-up of 7 years were analyzed. Focal areas of high signal intensity were found in 100% of patients, preferentially in the infratentorial white matter (35% cerebellum, 30% brain stem) and in the capsular lenticular region (22%). They measured 15 mm in 95% of cases. They appeared from the age of 1 year; increased in number, size, and surface area to a peak at the age of 7; and then spontaneously regressed by 17 years of age, similarly in girls and boys. CONCLUSIONS Focal areas of high signal intensity are mostly small (<15 mm) abnormalities in the posterior fossa or capsular lenticular region. Our results suggest that the evolution of focal areas of high signal intensity is not related to puberty with a peak at the age of 7 years. Knowledge of the predictive evolution of focal areas of high signal intensity is essential in the follow-up of children with neurofibromatosis type 1.
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Affiliation(s)
- S Calvez
- From the Pediatric Radiology Department (S.C., R.L., C.-J.R., D.G., N.B., V.D.-R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R Levy
- From the Pediatric Radiology Department (S.C., R.L., C.-J.R., D.G., N.B., V.D.-R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1000, (R.L., C.-J.R., D.G., N.B., V.D.-R.), Paris, France
- Institut Imagine (R.L., C.-J.R., D.G., N.B., V.D.-.R.), Unite Mixte de Recherche 1163, Paris, France
| | - R Calvez
- Expert Biostatistician (R.C.), Gagny, France
| | - C-J Roux
- From the Pediatric Radiology Department (S.C., R.L., C.-J.R., D.G., N.B., V.D.-R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1000, (R.L., C.-J.R., D.G., N.B., V.D.-R.), Paris, France
- Institut Imagine (R.L., C.-J.R., D.G., N.B., V.D.-.R.), Unite Mixte de Recherche 1163, Paris, France
| | - D Grévent
- From the Pediatric Radiology Department (S.C., R.L., C.-J.R., D.G., N.B., V.D.-R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1000, (R.L., C.-J.R., D.G., N.B., V.D.-R.), Paris, France
- Institut Imagine (R.L., C.-J.R., D.G., N.B., V.D.-.R.), Unite Mixte de Recherche 1163, Paris, France
| | - Y Purcell
- Radiology Department (Y.P.), Fondation Rothschild, Paris, France
| | - K Beccaria
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Pediatric Neurosurgery Department (K.B., T.B.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T Blauwblomme
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Pediatric Neurosurgery Department (K.B., T.B.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J Grill
- Department of Pediatric and Adolescent Oncology (J.G., C.D.), Gustave Roussy Institute, Villejuif, France
| | - C Dufour
- Department of Pediatric and Adolescent Oncology (J.G., C.D.), Gustave Roussy Institute, Villejuif, France
| | - F Bourdeaut
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Oncology Center SIREDO (Care Innovation and Research for Children, Adolescents and Young Adults with Cancer) (F.B., F.D.), Institute Curie, ???????, France
| | - F Doz
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
| | - M P Robert
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Ophthalmology Department (M.P.R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - N Boddaert
- From the Pediatric Radiology Department (S.C., R.L., C.-J.R., D.G., N.B., V.D.-R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1000, (R.L., C.-J.R., D.G., N.B., V.D.-R.), Paris, France
- Institut Imagine (R.L., C.-J.R., D.G., N.B., V.D.-.R.), Unite Mixte de Recherche 1163, Paris, France
| | - V Dangouloff-Ros
- From the Pediatric Radiology Department (S.C., R.L., C.-J.R., D.G., N.B., V.D.-R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1000, (R.L., C.-J.R., D.G., N.B., V.D.-R.), Paris, France
- Institut Imagine (R.L., C.-J.R., D.G., N.B., V.D.-.R.), Unite Mixte de Recherche 1163, Paris, France
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16
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Fangusaro J, Witt O, Hernáiz Driever P, Bag AK, de Blank P, Kadom N, Kilburn L, Lober RM, Robison NJ, Fisher MJ, Packer RJ, Young Poussaint T, Papusha L, Avula S, Brandes AA, Bouffet E, Bowers D, Artemov A, Chintagumpala M, Zurakowski D, van den Bent M, Bison B, Yeom KW, Taal W, Warren KE. Response assessment in paediatric low-grade glioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Lancet Oncol 2020; 21:e305-e316. [PMID: 32502457 DOI: 10.1016/s1470-2045(20)30064-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/23/2022]
Abstract
Paediatric low-grade gliomas (also known as pLGG) are the most common type of CNS tumours in children. In general, paediatric low-grade gliomas show clinical and biological features that are distinct from adult low-grade gliomas, and the developing paediatric brain is more susceptible to toxic late effects of the tumour and its treatment. Therefore, response assessment in children requires additional considerations compared with the adult Response Assessment in Neuro-Oncology criteria. There are no standardised response criteria in paediatric clinical trials, which makes it more difficult to compare responses across studies. The Response Assessment in Pediatric Neuro-Oncology working group, consisting of an international panel of paediatric and adult neuro-oncologists, clinicians, radiologists, radiation oncologists, and neurosurgeons, was established to address issues and unique challenges in assessing response in children with CNS tumours. We established a subcommittee to develop consensus recommendations for response assessment in paediatric low-grade gliomas. Final recommendations were based on literature review, current practice, and expert opinion of working group members. Consensus recommendations include imaging response assessments, with additional guidelines for visual functional outcomes in patients with optic pathway tumours. As with previous consensus recommendations, these recommendations will need to be validated in prospective clinical trials.
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Affiliation(s)
- Jason Fangusaro
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Aflac Cancer Center, Emory University and the Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Olaf Witt
- Department CCU Pediatric Oncology, Hopp Children's Cancer Center (KiTZ), University Hospital and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Asim K Bag
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Peter de Blank
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nadja Kadom
- Pediatric Neuroradiology, Emory University and the Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lindsay Kilburn
- Department of Hematology and Oncology, National Medical Center, Washington, DC, USA
| | - Robert M Lober
- Department of Neurosurgery, Dayton Children's Hospital and Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Nathan J Robison
- Division of Hematology and Oncology, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Michael J Fisher
- Division of Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, DC, USA
| | - Tina Young Poussaint
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ludmila Papusha
- Department of Neuro-Oncology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Alba A Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daniel Bowers
- Division of Pediatric Hematology and Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Anton Artemov
- Department of Neuro-Oncology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | | | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Brigitte Bison
- Diagnostic and Interventional Radiology, Universitatsklinikum Würzburg, Würzburg, Germany
| | - Kristen W Yeom
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Walter Taal
- Department of Neurology/Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Katherine E Warren
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Dana-Farber Cancer Institute, Boston, MA, USA
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17
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Bayat M, Bayat A. Neurological manifestations of neurofibromatosis: a review. Neurol Sci 2020; 41:2685-2690. [PMID: 32358705 DOI: 10.1007/s10072-020-04400-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/06/2020] [Indexed: 12/01/2022]
Abstract
Neurofibromatosis type 1(NF1) is a dominantly inherited genetic disorder caused by a mutation in the NF1 tumor-suppressor gene. Patients are prone to develop benign and malignant tumors not only in the central and peripheral nervous system but also in other parts of the body. Apart from tumors, neurofibromatosis may also be associated with neurological symptoms and disorders such as cerebrovascular disease, epilepsy, neuropathy, and headache. This article seeks to review the different neurological manifestations of neurofibromatosis.
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Affiliation(s)
- Michael Bayat
- Department of Neurology & Centre for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark.
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18
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Clinical Management of Children and Adolescents with Neurofibromatosis Type 1 Like Phenotypes and Complex Behavioural Manifestations: A Multidisciplinary and Dimensional Approach. Case Rep Psychiatry 2020; 2019:4764031. [PMID: 32089936 PMCID: PMC7011498 DOI: 10.1155/2019/4764031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 11/27/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction. Cognitive and behavioural problems associated with Neurofibromatosis type 1 (NF1) are common sources of distress and the reasons behind seeking help. Here we describe patients with NF1 or NF1-like phenotypes referred to a Tier 3 Child and Adolescent Psychiatry Department and highlight the benefits of a multidisciplinary assessment.
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19
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Bergqvist C, Servy A, Valeyrie-Allanore L, Ferkal S, Combemale P, Wolkenstein P. Neurofibromatosis 1 French national guidelines based on an extensive literature review since 1966. Orphanet J Rare Dis 2020; 15:37. [PMID: 32014052 PMCID: PMC6998847 DOI: 10.1186/s13023-020-1310-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/17/2020] [Indexed: 12/13/2022] Open
Abstract
Neurofibromatosis type 1 is a relatively common genetic disease, with a prevalence ranging between 1/3000 and 1/6000 people worldwide. The disease affects multiple systems with cutaneous, neurologic, and orthopedic as major manifestations which lead to significant morbidity or mortality. Indeed, NF1 patients are at an increased risk of malignancy and have a life expectancy about 10-15 years shorter than the general population. The mainstay of management of NF1 is a patient-centered longitudinal care with age-specific monitoring of clinical manifestations, aiming at the early recognition and symptomatic treatment of complications as they occur. Protocole national de diagnostic et de soins (PNDS) are mandatory French clinical practice guidelines for rare diseases required by the French national plan for rare diseases. Their purpose is to provide health care professionals with guidance regarding the optimal diagnostic and therapeutic management of patients affected with a rare disease; and thus, harmonizing their management nationwide. PNDS are usually developed through a critical literature review and a multidisciplinary expert consensus. The purpose of this article is to present the French guidelines on NF1, making them even more available to the international medical community. We further dwelled on the emerging new evidence that might have therapeutic potential or a strong impact on NF1 management in the coming feature. Given the complexity of the disease, the management of children and adults with NF1 entails the full complement healthcare providers and communication among the various specialties.
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Affiliation(s)
- Christina Bergqvist
- Faculty of medicine, Université Paris-Est Creteil (UPEC), F-94010 Créteil Cedex, France
- Assistance Publique-Hôpital Paris (AP-HP), Hôpital Henri-Mondor, Service de Dermatologie, F-94010 Créteil, France
| | - Amandine Servy
- Assistance Publique-Hôpital Paris (AP-HP), Hôpital Henri-Mondor, Service de Dermatologie, F-94010 Créteil, France
| | - Laurence Valeyrie-Allanore
- INSERM, Centre d’Investigation Clinique 006, Referral Center of Neurofibromatosis, Assistance Publique-Hôpital Paris (AP-HP), Hôpital Henri-Mondor, F-94010 Créteil, France
| | - Salah Ferkal
- INSERM, Centre d’Investigation Clinique 006, Referral Center of Neurofibromatosis, Assistance Publique-Hôpital Paris (AP-HP), Hôpital Henri-Mondor, F-94010 Créteil, France
| | - Patrick Combemale
- Rhône-Alpes Auvergne Competence Center for the treatment of Neurofibromatosis type 1, Léon Bérard Comprehensive Cancer Center, Hôpitaux Universitaires de Lyon, Université de Lyon, F-69008 Lyon, France
| | - Pierre Wolkenstein
- Faculty of medicine, Université Paris-Est Creteil (UPEC), F-94010 Créteil Cedex, France
- Assistance Publique-Hôpital Paris (AP-HP), Hôpital Henri-Mondor, Service de Dermatologie, F-94010 Créteil, France
- INSERM, Centre d’Investigation Clinique 006, Referral Center of Neurofibromatosis, Assistance Publique-Hôpital Paris (AP-HP), Hôpital Henri-Mondor, F-94010 Créteil, France
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20
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Baudou E, Nemmi F, Biotteau M, Maziero S, Peran P, Chaix Y. Can the Cognitive Phenotype in Neurofibromatosis Type 1 (NF1) Be Explained by Neuroimaging? A Review. Front Neurol 2020; 10:1373. [PMID: 31993017 PMCID: PMC6971173 DOI: 10.3389/fneur.2019.01373] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/11/2019] [Indexed: 12/29/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is one of the most frequent monogenetic disorders. It can be associated with cognitive dysfunctions in several domains such as executive functioning, language, visual perception, motor skills, social skills, memory and/or attention. Neuroimaging is becoming more and more important for a clearer understanding of the neural basis of these deficits. In recent years, several studies have used different imaging techniques to examine structural, morphological and functional alterations in NF1 disease. They have shown that NF1 patients have specific brain characteristics such as Unidentified Bright Objects (UBOs), macrocephaly, a higher volume of subcortical structures, microstructure integrity alterations, or connectivity alterations. In this review, which focuses on the studies published after the last 2 reviews of this topic (in 2010 and 2011), we report on recent structural, morphological and functional neuroimaging studies in NF1 subjects, with special focus on those that examine the neural basis of the NF1 cognitive phenotype. Although UBOs are one of the most obvious and visible elements in brain imaging, correlation studies have failed to establish a robust and reproducible link between major cognitive deficits in NF1 and their presence, number or localization. In the same vein, the results among structural studies are not consistent. Functional magnetic resonance imaging (fMRI) studies appear to be more sensitive, especially for understanding the executive function deficit that seems to be associated with a dysfunction in the right inferior frontal areas and the middle frontal areas. Similarly, fMRI studies have found that visuospatial deficits could be associated with a dysfunction in the visual cortex and especially in the magnocellular pathway involved in the processing of low spatial frequency and high temporal frequency. Connectivity studies have shown a reduction in anterior-posterior “long-range” connectivity and a deficit in deactivation in default mode network (DMN) during cognitive tasks. In conclusion, despite the contribution of new imaging techniques and despite relative advancement, the cognitive phenotype of NF1 patients is not totally understood.
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Affiliation(s)
- Eloïse Baudou
- Children's Hospital, Purpan University Hospital, Toulouse, France.,ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Federico Nemmi
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Maëlle Biotteau
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Stéphanie Maziero
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.,Octogone-Lordat, University of Toulouse, Toulouse, France
| | - Patrice Peran
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Yves Chaix
- Children's Hospital, Purpan University Hospital, Toulouse, France.,ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
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21
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Haebich KM, Pride NA, Walsh KS, Chisholm A, Rouel M, Maier A, Anderson V, Barton B, Silk T, Korgaonkar M, Seal M, Lami F, Lorenzo J, Williams K, Dabscheck G, Rae CD, Kean M, North KN, Payne JM. Understanding autism spectrum disorder and social functioning in children with neurofibromatosis type 1: protocol for a cross-sectional multimodal study. BMJ Open 2019; 9:e030601. [PMID: 31558455 PMCID: PMC6773330 DOI: 10.1136/bmjopen-2019-030601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Children with the single-gene disorder neurofibromatosis type 1 (NF1) appear to be at an increased risk for autism spectrum disorder (ASD) and exhibit a unique social-cognitive phenotype compared with children with idiopathic ASD. A complete framework is required to better understand autism in NF1, from neurobiological levels through to behavioural and functional outcomes. The primary aims of this study are to establish the frequency of ASD in children with NF1, examine the social cognitive phenotype, investigate the neuropsychological processes contributing to ASD symptoms and poor social functioning in children with NF1, and to investigate novel structural and functional neurobiological markers of ASD and social dysfunction in NF1. The secondary aim of this study is to compare the neuropsychological and neurobiological features of ASD in children with NF1 to a matched group of patients with idiopathic ASD. METHODS AND ANALYSIS This is an international, multisite, prospective, cross-sectional cohort study of children with NF1, idiopathic ASD and typically developing (TD) controls. Participants will be 200 children with NF1 (3-15 years of age), 70 TD participants (3-15 years) and 35 children with idiopathic ASD (7-15 years). Idiopathic ASD and NF1 cases will be matched on age, sex and intelligence. All participants will complete cognitive testing and parents will rate their child's behaviour on standardised questionnaires. Neuroimaging will be completed by a subset of participants aged 7 years and older. Children with NF1 that screen at risk for ASD on the parent-rated Social Responsiveness Scale 2nd Edition will be invited back to complete the Autism Diagnostic Observation Scale 2nd Edition and Autism Diagnostic Interview-Revised to determine whether they fulfil ASD diagnostic criteria. ETHICS AND DISSEMINATION This study has hospital ethics approval and the results will be disseminated through peer-reviewed publications and international conferences.
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Affiliation(s)
- Kristina M Haebich
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - Natalie A Pride
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Westmead, NSW, Australia
| | - Karin S Walsh
- Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, United States
- Departments of Pediatrics and Psychiatry, The George Washington University School of Medicine, Washington, DC, United States
| | - Anita Chisholm
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - Melissa Rouel
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Alice Maier
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Vicki Anderson
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - Belinda Barton
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Westmead, NSW, Australia
- Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Tim Silk
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Mayuresh Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
| | - Marc Seal
- Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Francesca Lami
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jennifer Lorenzo
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Gabriel Dabscheck
- Department of Neurology, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Caroline D Rae
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
| | - Michael Kean
- Imaging Department, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Kathryn N North
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jonathan M Payne
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
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Salman MS, Hossain S, Alqublan L, Bunge M, Rozovsky K. Cerebellar radiological abnormalities in children with neurofibromatosis type 1: part 1 - clinical and neuroimaging findings. CEREBELLUM & ATAXIAS 2018; 5:14. [PMID: 30410779 PMCID: PMC6211433 DOI: 10.1186/s40673-018-0093-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/03/2018] [Indexed: 02/01/2023]
Abstract
Background Many children with neurofibromatosis type 1 (NF1) have focal abnormal signal intensities (FASI) on brain MRI, whose full clinical impact and natural history have not been studied systematically. Our aims are to describe the clinical and neuroradiological features in children with NF1 and cerebellar FASI, and report on the natural history of FASI that display atypical features such as enhancement and mass effect. Method A retrospective review of the hospital charts and brain MRIs was performed on children from Manitoba diagnosed between 1999 and 2008 with NF1, who also had cerebellar FASI on MRI. Results Fifty patients (mean age: 16.1y, minimum-maximum: 6.4 - 30y, 27 M) were identified. Mean duration of follow up was 10.1y. Developmental delay, learning disabilities, tumors, and visual signs occurred commonly. Cerebellar signs were not reported. Mean age of the patients at baseline MRI was 7.8 (SD: 4.5) years. FASI occurred in several brain locations and were rarely confined to the cerebellum. FASI displayed mass effect and enhancement infrequently but were associated with malignancy only once. The number of FASI at baseline MRI was significantly less in patients with attention deficient hyperactivity disorder and more if a first degree relative had NF1 or if they had decreased visual acuity. Discussion Patients with NF1 and cerebellar FASI do not have motor or consistent non-motor (e.g. developmental delay or learning disabilities) cerebellar features. The number of FASI may correlate with some clinical features. FASI may display enhancement and mass effect but they rarely become malignant.
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Affiliation(s)
- Michael S Salman
- 1Section of Pediatric Neurology, Winnipeg Children's Hospital and Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, AE 308, 820 Sherbrook Street, Winnipeg, MB R3A 1R9 Canada
| | - Shakhawat Hossain
- 2Department of Mathematics and Statistics, University of Winnipeg, Winnipeg, MB Canada
| | - Lina Alqublan
- 3Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada.,4Present Address: Department of Radiology, King Fahad Armed Forces Hospital, Jeddah, Western region Saudi Arabia
| | - Martin Bunge
- 5Section of Pediatric Radiology, Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Katya Rozovsky
- 5Section of Pediatric Radiology, Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
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23
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Salman MS, Hossain S, Gorun S, Alqublan L, Bunge M, Rozovsky K. Cerebellar radiological abnormalities in children with neurofibromatosis type 1: part 2 - a neuroimaging natural history study with clinical correlations. CEREBELLUM & ATAXIAS 2018; 5:13. [PMID: 30410778 PMCID: PMC6208104 DOI: 10.1186/s40673-018-0092-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/03/2018] [Indexed: 01/12/2023]
Abstract
Background Focal abnormal signal intensities (FASI) on brain MRI occur commonly in patients with neurofibromatosis type 1 (NF1). The natural history of cerebellar FASI and their correlation with clinical features have not been studied comprehensively. Our aims are to describe the natural history of cerebellar FASI on repeat MRI scans and correlate the findings with the clinical features in children with NF1 and cerebellar FASI. Method A retrospective review of 226 brain MRI scans and hospital charts was performed in 50 patients with cerebellar FASI, who were diagnosed with NF1 during their childhood between 1999 and 2008. Results Mean age at the end of the study period was 16.1 years. There were 27 males. Mean duration of clinical follow up was 10.1 years. Mean duration between the first and the last MRI was 6.6 years (n = 36, SD: 2.8 years). FASI were rarely confined to the cerebellum. The number of FASI was highest in early childhood and decreased significantly on subsequent MRI scans in most brain regions with the exception of the cerebrum, where a fewer number of patients with a smaller number of FASI were seen. Four patterns of change in FASI size over time were determined, none correlated with the clinical features. Conclusions In patients with NF1, the natural history of FASI including their number, age at onset, rate of size changes, and resolution if any, varies by brain region. FASI patterns of change over time showed no clinical correlate.
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Affiliation(s)
- Michael S Salman
- 1Section of Pediatric Neurology, Winnipeg Children's Hospital and Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, AE 308, 820 Sherbrook Street, Winnipeg, MB R3A 1R9 Canada
| | - Shakhawat Hossain
- 2Department of Mathematics and Statistics, University of Winnipeg, Winnipeg, MB Canada
| | - Samantha Gorun
- 2Department of Mathematics and Statistics, University of Winnipeg, Winnipeg, MB Canada
| | - Lina Alqublan
- 3Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada.,4Present Address: Department of Radiology, King Fahad Armed Forces Hospital, Jeddah, Western region Saudi Arabia
| | - Martin Bunge
- 5Section of Pediatric Radiology, Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Katya Rozovsky
- 5Section of Pediatric Radiology, Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
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24
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Parmeggiani A, Boiani F, Capponi S, Duca M, Angotti M, Pignataro V, Sacrato L, Spinardi L, Vara G, Maltoni L, Cecconi I, Pastore Trossello M, Franzoni E. Neuropsychological profile in Italian children with neurofibromatosis type 1 (NF1) and their relationships with neuroradiological data: Preliminary results. Eur J Paediatr Neurol 2018; 22:822-830. [PMID: 29802023 DOI: 10.1016/j.ejpn.2018.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 04/04/2018] [Accepted: 04/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 is a genetic disorder associated with cognitive deficits, learning disabilities and behavioral problems. These domains appear to have a still controversial debated association with local areas of T2-hyperintensities on MRI images, called unidentified bright objects (UBOs). METHODS A cohort of 36 children (aged 7-11 years) included consecutively, underwent neuropsychological and behavioral assessment to determine their cognitive and neuropsychological profile, and the frequency of specific learning disabilities. MRI examination was used to determine the impact of UBOs' presence, number, and location on the cognitive, neuropsychological and behavioral profile, and also the presence of optic glioma. RESULTS The mean full intelligence quotient was 104.6; only one child had mild intellectual disability. Forty one percent of children had a diagnosis of specific learning disabilities and reading was mainly involved. Twenty per cent had attention problems. All children had normal scores in visuo-motor and visuo-perceptual tests. UBOs were present in 94.0% of the MRI examinations. Two children had optic glioma. Children with UBOs in a specific location and children with UBOs elsewhere were statistically compared, no one of the location seemed to have an impact on general cognition measured with full intelligence quotient. The thalamus was associated with problems in calculation and striatum with behavioral problems. An inverse relationship between the number of UBOs and the full intelligence quotient was present, but without a statistical significance. CONCLUSIONS In this study, the specific location of UBOs did not seem to influence the general cognitive profile and also the relationship between their number and the full intelligence quotient was not significant; these results are still controversial in literature. Finally, the presence of UBOs in the thalamus and striatum may represent a neuroradiological pattern that influences performances in calculation and behavior respectively in children with Neurofibromatosis type 1.
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Affiliation(s)
- A Parmeggiani
- Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
| | - F Boiani
- Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - S Capponi
- Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - M Duca
- Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - M Angotti
- Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - V Pignataro
- Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - L Sacrato
- Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - L Spinardi
- Neuroradiology Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - G Vara
- Neuroradiology Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - L Maltoni
- Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - I Cecconi
- Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - M Pastore Trossello
- Neuroradiology Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - E Franzoni
- Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy
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Griffith JL, Morris SM, Mahdi J, Goyal MS, Hershey T, Gutmann DH. Increased prevalence of brain tumors classified as T2 hyperintensities in neurofibromatosis 1. Neurol Clin Pract 2018; 8:283-291. [PMID: 30140579 DOI: 10.1212/cpj.0000000000000494] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/18/2018] [Indexed: 12/11/2022]
Abstract
Background We sought to define the radiologic features that differentiate neoplastic from non-neoplastic T2 hyperintensities (T2Hs) in neurofibromatosis type 1 (NF1) and identify those lesions most likely to require oncologic surveillance. Methods We conducted a single-center retrospective review of all available brain MRIs from 68 children with NF1 (n = 190) and 46 healthy pediatric controls (n = 104). All T2Hs identified on MRI were characterized based on location, border, shape, degree of T1 hypointensity, and presence of mass effect or contrast enhancement, and subsequently classified using newly established radiologic criteria as either unidentified bright objects (UBOs) or probable tumors. Lesion classification was pathologically confirmed in 10 NF1 cases. Results T2Hs were a highly sensitive (94.4%; 95% confidence interval [CI] 86.4%-98.5%) and specific (100.0%; 95% CI 92.3%-100.0%) marker for the diagnosis of NF1. UBOs constituted the majority of T2Hs (82%) and were most frequently located in cerebellar white matter, medial temporal lobe, and thalamus, where they were more likely than probable tumors to be bilateral (p < 0.001) and have nondiscrete borders (p < 0.001). Surprisingly, 57% of children with T2Hs harbored lesions classified as probable tumors, and 28% of children with probable tumors received treatment. In contrast to UBOs, probable tumors were most frequently located within the globus pallidus and medulla, and rarely occurred prior to 3 years of age. Conclusions With the implementation of standardized radiologic criteria, a high prevalence of brain tumors was identified in this at-risk population of children, of which nearly one-third required treatment, emphasizing the need for appropriate oncologic surveillance for patients with NF1 harboring nonoptic pathway brain tumors.
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Affiliation(s)
- Jennifer L Griffith
- Departments of Neurology (JLG, SMM, JM, DHG) and Radiology (MSG, TH), Washington University School of Medicine, St. Louis, MO
| | - Stephanie M Morris
- Departments of Neurology (JLG, SMM, JM, DHG) and Radiology (MSG, TH), Washington University School of Medicine, St. Louis, MO
| | - Jasia Mahdi
- Departments of Neurology (JLG, SMM, JM, DHG) and Radiology (MSG, TH), Washington University School of Medicine, St. Louis, MO
| | - Manu S Goyal
- Departments of Neurology (JLG, SMM, JM, DHG) and Radiology (MSG, TH), Washington University School of Medicine, St. Louis, MO
| | - Tamara Hershey
- Departments of Neurology (JLG, SMM, JM, DHG) and Radiology (MSG, TH), Washington University School of Medicine, St. Louis, MO
| | - David H Gutmann
- Departments of Neurology (JLG, SMM, JM, DHG) and Radiology (MSG, TH), Washington University School of Medicine, St. Louis, MO
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Khatua S, Gutmann DH, Packer RJ. Neurofibromatosis type 1 and optic pathway glioma: Molecular interplay and therapeutic insights. Pediatr Blood Cancer 2018; 65. [PMID: 29049847 DOI: 10.1002/pbc.26838] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/21/2017] [Accepted: 09/02/2017] [Indexed: 12/17/2022]
Abstract
Children with neurofibromatosis type 1 (NF1) are predisposed to develop central nervous system neoplasms, the most common of which are low-grade gliomas (LGGs). The absence of human NF1 associated LGG-derived cell lines, coupled with an inability to generate patient-derived xenograft models, represents barriers to profile molecularly targeted therapies for these tumors. Thus, genetically engineered mouse models have been identified to evaluate the interplay between Nf1-deficient tumor cells and nonneoplastic stromal cells to evaluate potential therapies for these neoplasms. Future treatments might also consider targeting the nonneoplastic cells in NF1-LGGs to reduce tumor growth and neurologic morbidity in affected children.
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Affiliation(s)
- Soumen Khatua
- Department of Pediatrics, MD Anderson Cancer Center, Houston, Texas
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington, District of Columbia
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Mahdi J, Shah AC, Sato A, Morris SM, McKinstry RC, Listernick R, Packer RJ, Fisher MJ, Gutmann DH. A multi-institutional study of brainstem gliomas in children with neurofibromatosis type 1. Neurology 2017; 88:1584-1589. [PMID: 28330960 DOI: 10.1212/wnl.0000000000003881] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 01/24/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To define the clinical and radiologic features of brainstem gliomas (BSGs) in children with neurofibromatosis type 1 (NF1). METHODS We performed a retrospective cross-sectional study of 133 children with NF1 and concurrent BSGs cared for at 4 NF1 referral centers. BSG was determined using radiographic criteria. Age at diagnosis, tumor location and appearance, clinical symptoms, treatment, and presence of a concurrent optic pathway glioma were assessed. RESULTS The average age at BSG diagnosis was 7.2 years, and tumors occurred most often in the midbrain and medulla (66%). The majority of children with NF1-BSGs were asymptomatic (54%) and were not treated (88%). Only 9 of the 72 asymptomatic children received treatment because of progressive tumor enlargement. In contrast, 61 children presented with clinical signs/symptoms attributable to their BSG; these individuals were older and more often had focal lesions. Thirty-one patients underwent treatment for their tumor, and 14 received CSF diversion only. Progression-free survival was ∼3 years shorter for children receiving tumor-directed therapy relative to those who had either no treatment or CSF diversion only. Overall survival was 85% for the tumor-directed therapy group, whereas no deaths were reported in the untreated or CSF diversion groups. CONCLUSIONS Unlike children with sporadically occurring BSGs, most children with NF1-BSGs were asymptomatic, and few individuals died from complications of their tumor. Those requiring tumor-directed treatment tended to be older children with focal lesions, and had clinically more aggressive disease relative to those who were not treated or underwent CSF diversion only.
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Affiliation(s)
- Jasia Mahdi
- From the Departments of Neurology (J.M., S.M.M., D.H.G.) and Radiology (R.C.M.), Washington University School of Medicine, St. Louis, MO; Division of Oncology (A.C.S., M.J.F.), Children's Hospital of Philadelphia, PA; Center for Neuroscience of Behavioral Medicine (A.S., R.J.P.), Children's National Medical Center, Washington, DC; Division of Academic General Pediatrics (R.L.), Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, IL; and Department of Pediatrics (M.J.F.), The Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Amish C Shah
- From the Departments of Neurology (J.M., S.M.M., D.H.G.) and Radiology (R.C.M.), Washington University School of Medicine, St. Louis, MO; Division of Oncology (A.C.S., M.J.F.), Children's Hospital of Philadelphia, PA; Center for Neuroscience of Behavioral Medicine (A.S., R.J.P.), Children's National Medical Center, Washington, DC; Division of Academic General Pediatrics (R.L.), Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, IL; and Department of Pediatrics (M.J.F.), The Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Aimee Sato
- From the Departments of Neurology (J.M., S.M.M., D.H.G.) and Radiology (R.C.M.), Washington University School of Medicine, St. Louis, MO; Division of Oncology (A.C.S., M.J.F.), Children's Hospital of Philadelphia, PA; Center for Neuroscience of Behavioral Medicine (A.S., R.J.P.), Children's National Medical Center, Washington, DC; Division of Academic General Pediatrics (R.L.), Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, IL; and Department of Pediatrics (M.J.F.), The Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Stephanie M Morris
- From the Departments of Neurology (J.M., S.M.M., D.H.G.) and Radiology (R.C.M.), Washington University School of Medicine, St. Louis, MO; Division of Oncology (A.C.S., M.J.F.), Children's Hospital of Philadelphia, PA; Center for Neuroscience of Behavioral Medicine (A.S., R.J.P.), Children's National Medical Center, Washington, DC; Division of Academic General Pediatrics (R.L.), Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, IL; and Department of Pediatrics (M.J.F.), The Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Robert C McKinstry
- From the Departments of Neurology (J.M., S.M.M., D.H.G.) and Radiology (R.C.M.), Washington University School of Medicine, St. Louis, MO; Division of Oncology (A.C.S., M.J.F.), Children's Hospital of Philadelphia, PA; Center for Neuroscience of Behavioral Medicine (A.S., R.J.P.), Children's National Medical Center, Washington, DC; Division of Academic General Pediatrics (R.L.), Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, IL; and Department of Pediatrics (M.J.F.), The Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Robert Listernick
- From the Departments of Neurology (J.M., S.M.M., D.H.G.) and Radiology (R.C.M.), Washington University School of Medicine, St. Louis, MO; Division of Oncology (A.C.S., M.J.F.), Children's Hospital of Philadelphia, PA; Center for Neuroscience of Behavioral Medicine (A.S., R.J.P.), Children's National Medical Center, Washington, DC; Division of Academic General Pediatrics (R.L.), Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, IL; and Department of Pediatrics (M.J.F.), The Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Roger J Packer
- From the Departments of Neurology (J.M., S.M.M., D.H.G.) and Radiology (R.C.M.), Washington University School of Medicine, St. Louis, MO; Division of Oncology (A.C.S., M.J.F.), Children's Hospital of Philadelphia, PA; Center for Neuroscience of Behavioral Medicine (A.S., R.J.P.), Children's National Medical Center, Washington, DC; Division of Academic General Pediatrics (R.L.), Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, IL; and Department of Pediatrics (M.J.F.), The Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Michael J Fisher
- From the Departments of Neurology (J.M., S.M.M., D.H.G.) and Radiology (R.C.M.), Washington University School of Medicine, St. Louis, MO; Division of Oncology (A.C.S., M.J.F.), Children's Hospital of Philadelphia, PA; Center for Neuroscience of Behavioral Medicine (A.S., R.J.P.), Children's National Medical Center, Washington, DC; Division of Academic General Pediatrics (R.L.), Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, IL; and Department of Pediatrics (M.J.F.), The Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - David H Gutmann
- From the Departments of Neurology (J.M., S.M.M., D.H.G.) and Radiology (R.C.M.), Washington University School of Medicine, St. Louis, MO; Division of Oncology (A.C.S., M.J.F.), Children's Hospital of Philadelphia, PA; Center for Neuroscience of Behavioral Medicine (A.S., R.J.P.), Children's National Medical Center, Washington, DC; Division of Academic General Pediatrics (R.L.), Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, IL; and Department of Pediatrics (M.J.F.), The Perelman School of Medicine at The University of Pennsylvania, Philadelphia.
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Aydin S, Kurtcan S, Alkan A, Guler S, Filiz M, Yilmaz TF, Sahin TU, Aralasmak A. Relationship between the corpus callosum and neurocognitive disabilities in children with NF-1: diffusion tensor imaging features. Clin Imaging 2016; 40:1092-1095. [DOI: 10.1016/j.clinimag.2016.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 05/31/2016] [Accepted: 06/29/2016] [Indexed: 11/30/2022]
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Figueiredo ACPCT, Mata-Machado N, McCoyd M, Biller J. Neurocutaneous Disorders for the Practicing Neurologist: a Focused Review. Curr Neurol Neurosci Rep 2016; 16:19. [DOI: 10.1007/s11910-015-0612-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Khadilkar S, Jaggi S, Patel B, Yadav R, Hanagandi P, Faria do Amaral LL. A practical approach to diseases affecting dentate nuclei. Clin Radiol 2015; 71:107-19. [PMID: 26577296 DOI: 10.1016/j.crad.2015.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/17/2015] [Accepted: 09/22/2015] [Indexed: 01/29/2023]
Abstract
A wide variety of diseases affect the dentate nuclei. When faced with the radiological demonstration of signal changes in the dentate nuclei, radiologists and clinical neurologists have to sieve through the many possibilities, which they do not encounter on a regular basis. This task can be challenging, and therefore, developing a clinical, radiological, and laboratory approach is important. Information on the topic is scattered and the subject has not yet been reviewed. In this review, a combined clinicoradiological approach is presented. The signal changes in T1, T2, fluid-attenuated inversion recovery (FLAIR), diffusion, susceptibility weighted, and gadolinium-enhanced images can give specific or highly suggestive patterns, which are illustrated. The role of computed tomography (CT) in the diagnostic process is discussed. Specific radiological patterns do not exist in a significant proportion of patients where the clinical and laboratory analysis becomes important. In this review, we group the clinical constellations to narrow down the differential diagnosis and highlight the diagnostic clinical signs, such as tendon xanthomas and Kayser-Fleischer rings. As will be seen, a number of these conditions are potentially reversible, and hence, their early diagnosis is desirable. Finally, key diagnostic tests and available therapies are outlined. The practical approach thus begins with the radiologist and winds its way through the clinician, towards carefully selected diagnostic tests defining the therapy options.
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Affiliation(s)
- S Khadilkar
- Department of Neurology, Grant Medical College and Sir J. J. Group of Hospitals, Mumbai, India.
| | - S Jaggi
- Department of Radiology, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - B Patel
- Neurology Department, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India
| | - R Yadav
- Neurology Department, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India
| | - P Hanagandi
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Canada
| | - L L Faria do Amaral
- Department of Neuroradiology - Medimagem, Hospital da Beneficencia Portuguesa de Sao Paulo, Brazil
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Batista PB, Bertollo EMG, Costa DDS, Eliam L, Cunha KSG, Cunha-Melo JR, Darrigo Junior LG, Geller M, Gianordoli-Nascimento IF, Madeira LG, Mendes HM, Miranda DMD, Mata-Machado NA, Morato EG, Pavarino ÉC, Pereira LB, Rezende NAD, Rodrigues LDO, Sette JBC, Silva CMD, Souza JFD, Souza MLRD, Martins AS, Valadares ER, Vidigal PVT, Waisberg V, Waisberg Y, Rodrigues LOC. Neurofibromatosis: part 2 – clinical management. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:531-43. [DOI: 10.1590/0004-282x20150042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/20/2015] [Indexed: 11/21/2022]
Abstract
Part 1 of this guideline addressed the differential diagnosis of the neurofibromatoses (NF): neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and schwannomatosis (SCH). NF shares some features such as the genetic origin of the neural tumors and cutaneous manifestations, and affects nearly 80 thousand Brazilians. Increasing scientific knowledge on NF has allowed better clinical management and reduced rate of complications and morbidity, resulting in higher quality of life for NF patients. Most medical doctors are able to perform NF diagnosis, but the wide range of clinical manifestations and the inability to predict the onset or severity of new features, consequences, or complications make NF management a real clinical challenge, requiring the support of different specialists for proper treatment and genetic counseling, especially in NF2 and SCH. The present text suggests guidelines for the clinical management of NF, with emphasis on NF1.
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Epstein JA, Ingram DA, Hirbe AC, Gutmann DH. A multidisciplinary approach in neurofibromatosis 1--authors' reply. Lancet Neurol 2015; 14:30-1. [PMID: 25496893 DOI: 10.1016/s1474-4422(14)70298-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jonathan A Epstein
- Department of Cell and Developmental Biology, The Institute for Regenerative Medicine and the Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David A Ingram
- Department of Pediatrics and Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Angela C Hirbe
- Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA.
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Rodrigues ACP, Ferraz-Filho JRL, Torres US, da Rocha AJ, Muniz MP, Souza AS, Goloni-Bertollo EM, Pavarino ÉC. Is magnetic resonance spectroscopy capable of detecting metabolic abnormalities in neurofibromatosis type 1 that are not revealed in brain parenchyma of normal appearance? Pediatr Neurol 2015; 52:314-9. [PMID: 25585912 DOI: 10.1016/j.pediatrneurol.2014.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Results of magnetic resonance spectroscopy studies in normal-appearing brain and in non-neoplastic brain lesions in individuals with neurofibromatosis type 1 (NF1) have been discrepant. OBJECTIVE We used magnetic resonance spectroscopy to analyze the metabolic patterns in the basal ganglia of patients with NF1 and examine their correlation with focal hyperintense lesions in T2-weighted images (T2-weighted hyperintensities). METHODS We used magnetic resonance spectroscopy data of 42 individuals with NF1 (18 with and 24 without T2- weighted hyperintensities) and 25 controls matched for gender and age. A single-voxel technique was employed by manually placing a region of interest with a uniform size over a predetermined anatomical region including the globus pallidum and putamen (capsulolenticular region). We further analyzed the ratios of choline/creatine, N-acetyl aspartate (NAA)/creatine, and myoinositol/creatine metabolites and the occurrence of T2-weighted hyperintensities in these regions in individuals with NF1. RESULTS There was a significant difference between the NF1 and control groups with regard to the mean values of myoinositol/creatine and choline/creatine, with higher metabolite values observed in the NF1 group (P < 0.001). Only the myoinositol/creatine ratio was able to discriminate between NF1 subgroups with and without T2-weighted hyperintensities. For the NAA/creatine ratio, there was no significant difference between the NF1 and the control groups. CONCLUSION Magnetic resonance spectroscopy allows the characterization of tissue abnormalities not demonstrable in the structural images of individuals with NF1 through choline and myoinositol metabolite analysis. Yet the preserved NAA values argue against demyelination and axonal degeneration occurring in the region, suggesting instead a functional neuronal stability. Taken in association with the findings of lack of clinical manifestations and the known transient nature of T2-weighted hyperintensities in NF1 as demonstrated by other studies, our results support the current histopathologically driven hypothesis that such T2-weighted hyperintensities may be related to intramyelinic edema.
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Affiliation(s)
| | | | - Ulysses S Torres
- Department of Radiology, Hospital São Luiz, Grupo Fleury, São Paulo Brazil
| | - Antônio José da Rocha
- Division of Neuroradiology, Santa Casa de Misericórdia São Paulo de, São Paulo, Brazil
| | - Marcos Pontes Muniz
- Department of Radiology, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, Brazil
| | - Antônio Soares Souza
- Department of Radiology, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, Brazil
| | - Eny Maria Goloni-Bertollo
- Center of Research and Attendance in Neurofibromatosis (CEPAN), São José do Rio Preto Medical School, São José do Rio Preto, Brazil
| | - Érika Cristina Pavarino
- Center of Research and Attendance in Neurofibromatosis (CEPAN), São José do Rio Preto Medical School, São José do Rio Preto, Brazil
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Ertan G, Zan E, Yousem DM, Ceritoglu C, Tekes A, Poretti A, Huisman TAGM. Diffusion tensor imaging of neurofibromatosis bright objects in children with neurofibromatosis type 1. Neuroradiol J 2014; 27:616-26. [PMID: 25260209 DOI: 10.15274/nrj-2014-10055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/06/2014] [Indexed: 11/12/2022] Open
Abstract
Neurofibromatosis bright objects (NBOs) are poorly understood. This article aimed to investigate: 1) differences in fractional anisotropy (FA) between NBOs based in gray matter (GM) and white matter (WM), and 2) the relationship between NBOs and the affected white matter tracts. Fourteen NF1 patients were included in this study. Apparent diffusion coefficient (ADC), FA, radial diffusivity (RD) and eigenvalues were used to compare NBOs and matching contralateral normal-appearing sites (NAS). Diffusion tensor imaging scalars were also compared with age-matched healthy controls. Fiber tractography was performed to assess NBO-induced changes in WM trajectories. ADC values were higher for GM and WM NBOs than for NAS and controls. FA values were lower in GM and WM NBOs compared with controls. In all regions, eigenvalues were higher in NBOs than in NAS and controls. Only three out of 18 NOBs appeared to disrupt WM tracts. ADC, λ2 and RD values of WM NBOs were higher in symptomatic compared to asymptomatic patients. Increased ADC, RD and eigenvalues and decreased FA values in NBOs can be explained by myelin and axonal damage. Increased ADC values and RD in WM NBOs correlated with the presence of symptoms. Tract integrity predominated in our study.
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Affiliation(s)
- Gulhan Ertan
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine; Baltimore, MD, USA -
| | - Elcin Zan
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - David M Yousem
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - Can Ceritoglu
- The Center for Imaging Science, The Johns Hopkins University; Baltimore, MD, USA
| | - Aylin Tekes
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - Andrea Poretti
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - Thierry A G M Huisman
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine; Baltimore, MD, USA
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Goktas S, Sakarya Y, Ozcimen M, Alpfidan I, Uzun M, Sakarya R, Yarbag A. Frequency of choroidal abnormalities in pediatric patients with neurofibromatosis type 1. J Pediatr Ophthalmol Strabismus 2014; 51:204-8. [PMID: 24844395 DOI: 10.3928/01913913-20140513-02] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/13/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the frequency of choroidal abnormalities in pediatric patients with neurofibromatosis type 1 detected by infrared reflectance imaging. METHODS The fundus of 38 eyes of 19 patients with neurofibromatosis type 1 was examined using infrared reflectance imaging with optical coherence tomography. Forty eyes of 20 age-matched controls were examined similarly. Each patient was evaluated for the presence and the number of choroidal abnormalities. The correlation between the total number of choroidal abnormalities and the patient's age was studied. RESULTS A total of 19 patients (11 females, 8 males) were included. The mean age of the neurofibromatosis group was 8.63 ± 3.15 years (range: 4 to 16 years) and that of the control group was 9.05 ± 3.27 years (range: 4 to 15 years). Choroidal nodules appearing as bright patchy nodules were detected in 15 (78.9%) of 19 patients with neurofibromatosis type 1 and 1 (5%) of 20 control subjects. In terms of the frequency of choroidal abnormalities, the difference was significant between the patients with neurofibromatosis type 1 and the controls (P < .001). There was a positive correlation between the number of choroidal abnormalities in both eyes and the patient's age (r = 0.701, P = .001). CONCLUSIONS Choroidal abnormalities are frequent in neurofibromatosis type 1. Choroidal abnormalities detected by infrared reflectance imaging with optical coherence tomography can be used to diagnose neurofibromatosis type 1.
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Batista PB, Lemos SMA, Rodrigues LOC, de Rezende NA. Auditory temporal processing deficits and language disorders in patients with neurofibromatosis type 1. JOURNAL OF COMMUNICATION DISORDERS 2014; 48:18-26. [PMID: 24447521 DOI: 10.1016/j.jcomdis.2013.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 06/03/2023]
Abstract
UNLABELLED Previous findings from a case report led to the argument of whether other patients with neurofibromatosis type 1 (NF1) may have abnormal central auditory function, particularly auditory temporal processing. We hypothesized that it is associated with language and learning disabilities in this population. The aim of this study was to measure central auditory temporal function in NF1 patients and correlate it with the results of language evaluation tests. A descriptive/comparative study including 25 NF1 individuals and 22 healthy controls compared their performances on audiometric evaluation and auditory behavioral testing (Sequential Verbal Memory, Sequential Non-Verbal Memory, Frequency Pattern, Duration Pattern, and Gaps in Noise Tests). To assess language performance, two tests (phonological and syntactic awareness) were also conducted. The study showed that all participants had normal peripheral acoustic hearing. Differences were found between the NF1 and control groups in the temporal auditory processing tests [Sequential Verbal Memory (P=0.009), Sequential Non-Verbal Memory (P=0.028), Frequency Patterns (P=0.001), Duration Patterns (P=0.000), and Gaps in Noise (P=0.000)] and in language tests. The results of Pearson correlation analysis demonstrated the presence of positive correlations between the phonological awareness test and Frequency Patterns humming (r=0.560, P=0.001), Frequency Patterns labeling (r=0.415, P=0.022) and Duration Pattern humming (r=0.569, P=0.001). These results suggest that the neurofibromin deficiency found in NF1 patients is associated with auditory temporal processing deficits, which may contribute to the cognitive impairment, learning disabilities, and attention deficits that are common in this disorder. LEARNING OUTCOMES The reader will be able to: (1) describe the auditory temporal processing in patients with neurofibromatosis type 1; and (2) describe the impact of the auditory temporal deficits in language in this population.
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Affiliation(s)
| | | | - Luiz Oswaldo Carneiro Rodrigues
- Clinical Coordinator at the Neurofibromatosis Outpatient Reference Center (NFRC), Dermatology Service, Clinics Hospital of the Federal University of Minas Gerais, Brazil
| | - Nilton Alves de Rezende
- Clinical Director of NFRC, Department of Internal Medicine, Federal University of Minas Gerais, Brazil.
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Familial syndromes associated with intracranial tumours: a review. Childs Nerv Syst 2014; 30:47-64. [PMID: 24193148 DOI: 10.1007/s00381-013-2309-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 10/15/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Most cancers of the central nervous system (CNS) occur sporadically in the absence of any known underlying familial disorder or multi-systemic syndrome. Several syndromes are associated with CNS malignancies, however, and their recognition has significant implications for patient management and prognosis. Patients with syndrome-associated CNS malignancies often have multiple tumours (either confined to one region or distributed throughout the body), with similar or different histology. OBJECTIVE This review examines syndromes that are strongly associated with CNS cancers: the phakomatosis syndromes, familial syndromes such as Li-Fraumeni and familial polyposis syndromes and dyschondroplasia.
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Pérez Villena A, Duat Rodríguez A, García Peñas J, López Pino M. Plexiform neurofibroma in an 8 year-old patient. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2012.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Khan A, Beri S, Baheerathan A, Balki A, Hussain N, Gosalakkal J. Globus pallidus high-signal lesions: A predominant MRI finding in children with neurofibromatosis type 1. Ann Indian Acad Neurol 2013; 16:53-6. [PMID: 23661963 PMCID: PMC3644782 DOI: 10.4103/0972-2327.107702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 04/15/2012] [Accepted: 04/16/2012] [Indexed: 11/16/2022] Open
Abstract
Introduction: Lesions of the brain, recognized as unidentified bright objects (UBOs), are commonly observed as areas of increased T2-weighted signal intensity on magnetic resonance imaging (MRI) in children with neurofibromatosis type 1 (NF1). Identification of these lesions is not currently encompassed in the National Institute of Health (NIH) diagnostic criteria for NF1. Objective: We aimed to determine the prevalence of UBOs in children with NF1 and identify areas of the brain that are commonly affected by these lesions, allowing us to evaluate whether UBOs should be included in the diagnostic criteria for the diagnosis of NF1. Materials and Methods: We reviewed the cranial MRI scans of 22 children who had been diagnosed with sporadic or familial NF1 in accordance with the criteria established by NIH. UBOs were present in 81% of the children with NF1. Results: These lesions have a predilection for specific areas of the brain, including the globus pallidus (72%), cerebellum (66%), brainstem (27%) and cerebral hemispheres (16%). The prevalence of UBOs identified varied significantly with age and sex; they were infrequent in children less than 4 years of age but were common in those aged between 4 and 12 years of age. UBOs were more commonly seen in males (66.6%) compared with females (33.3%). Repeat MRI scan on a subset of these patients with UBOs did not show any significant changes despite a worsening in clinical symptoms. Conclusion and Discussion: We have shown that UBOs are a common finding in children with NF1, and are most prevalent between the ages of 4 and 12 years. Many sites of the brain are affected by these lesions, most notably the globus pallidus and the cerebellum. Further research must be conducted to elucidate the significance of UBOs in patients with NF1 and whether these lesions have any utility in the clinical detection of NF1.
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Affiliation(s)
- Arif Khan
- Department of Pediatric Neurology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Sehgal VN, Oberai R, Venkatash P, Sharma S, Verma P, Chatterji K. Plexiform neurofibroma affecting the upper parietal scalp, with cerebellar hamartoma: role of histopathology, colour Doppler imaging and magnetic resonance imaging. Clin Exp Dermatol 2013; 38:285-8. [PMID: 23517359 DOI: 10.1111/ced.12027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2012] [Indexed: 11/28/2022]
Abstract
We report a patient with plexiform neurofibroma, which is pathognomonic for neurofibromatosis type 1 (NF1) affecting the upper parietal region of the scalp. Cerebellar hamartoma was present, a finding that, to our knowledge, has not been reported previously. We highlight the role of histopathology, ultrasonography, colour Doppler imaging and magnetic resonance imaging, in addition to the seven existing criteria, for the diagnosis of NF1.
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Affiliation(s)
- V N Sehgal
- Dermato-Venereology (Skin/VD) Centre, Sehgal Nursing Home, New Delhi, India
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Ferraz-Filho JRL, da Rocha AJ, Muniz MP, Souza AS, Goloni-Bertollo EM, Pavarino-Bertelli EC. Diffusion tensor MR imaging in neurofibromatosis type 1: expanding the knowledge of microstructural brain abnormalities. Pediatr Radiol 2012; 42:449-54. [PMID: 22033857 DOI: 10.1007/s00247-011-2274-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Revised: 08/25/2011] [Accepted: 08/30/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a hereditary disease with a dominant autosomal pattern. In children and adolescents, it is frequently associated with the appearance of T2-weighted hyperintensities in the brain's white matter. MRI with diffusion tensor imaging (DTI) is used to detect white matter abnormalities by measuring fractional anisotropy (FA). OBJECTIVE This study employed DTI to evaluate the relationship between FA patterns and the findings of T2 sequences, with the aim of improving our understanding of anatomical changes and microstructural brain abnormalities in individuals with NF1. MATERIALS AND METHODS Forty-four individuals with NF1 and 20 control subjects were evaluated. The comparative analysis of FA between NF1 and control groups was based on four predetermined anatomical regions of the brain hemispheres (basal ganglia, cerebellum, pons, thalamus) and related the presence or absence of T2-weighted hyperintensities in the brain, which are called unidentified bright objects (UBOs). RESULTS The FA values between the groups demonstrated statistically significant differences (P ≤ 0.05) for the cerebellum and thalamus in patients with NF1, independent of the occurrence of UBOs. CONCLUSIONS Diffusion tensor MR imaging confirms the influence of UBOs in the decrease of FA values in this series of patients with NF1. Additionally, this technique allows the characterization of microstructural abnormalities even in some brain regions that appear normal in conventional MR sequences.
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Affiliation(s)
- José R L Ferraz-Filho
- Radiology Department, Medical School in São José do Rio Preto, 5544 Brigadeiro Faria Lima, São Paulo, Brazil.
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Pérez Villena A, Duat Rodríguez A, García Peñas JJ, López Pino MA. Plexiform neurofibroma in an 8 year-old patient. Neurologia 2012; 28:319-20. [PMID: 22436367 DOI: 10.1016/j.nrl.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 12/21/2011] [Accepted: 01/08/2012] [Indexed: 11/19/2022] Open
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Sabol Z, Resić B, Gjergja Juraski R, Sabol F, Kovac Sizgorić M, Orsolić K, Ozretić D, Sepić-Grahovac D. Clinical sensitivity and specificity of multiple T2-hyperintensities on brain magnetic resonance imaging in diagnosis of neurofibromatosis type 1 in children: diagnostic accuracy study. Croat Med J 2012; 52:488-96. [PMID: 21853543 PMCID: PMC3160695 DOI: 10.3325/cmj.2011.52.488] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim To determine the prevalence, number, and location of multiple (≥2) T2-hyperintensities on brain magnetic resonance imaging (MRI) in children with neurofibromatosis type 1 (NF1) and their correlation with age, and to establish their sensitivity, specificity, and accuracy for the diagnosis of NF1 in children, especially in the early age (2-7 years). Methods We performed a cross-sectional study of 162 patients with NF1 from Croatian Neurofibromatosis Association Database and 163 control children between the ages of 2 and 18 years who underwent brain MRI between 1989 and 2009. Results Multiple T2-hyperintensities were present in 74% of NF1 patients and 1.8% of controls. They were mainly located in the basal ganglia, brainstem, and cerebellum and were significantly decreased in prevalence and number in the older age. T2-hyperintensities had excellent diagnostic accuracy with the area under the receiver operating characteristic (ROC) curve of 0.849 and 95% confidence interval (CI) of 0.805-0.886. The diagnostic sensitivity, specificity, and accuracy rate of T2-hyperintensities for NF1 were highest in the youngest age (2-7 years): 81% (95% CI 71%-89.1%), 99% (95% CI 92.3%-100%), and 85.8 (95% CI 83.3-93.8), respectively. Conclusion This study strongly suggests the inclusion of T2-hyperintensities on brain MRI on the list of diagnostic criteria for NF1, especially in children of early age, when the clinical penetration of the NF1 gene has not yet been completely finished.
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Affiliation(s)
- Zlatko Sabol
- Sabol Outpatient Clinic for Sick Children, Zagreb, Croatia.
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Ferraz-Filho JRL, José da Rocha A, Muniz MP, Souza AS, Goloni-Bertollo EM, Pavarino-Bertelli EC. Unidentified bright objects in neurofibromatosis type 1: conventional MRI in the follow-up and correlation of microstructural lesions on diffusion tensor images. Eur J Paediatr Neurol 2012; 16:42-7. [PMID: 22088602 DOI: 10.1016/j.ejpn.2011.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 06/23/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To evaluate the evolution of unidentified bright objects (UBOs) in individuals with neurofibromatosis type 1 (NF1) by serial magnetic resonance imaging (MRI), and to relate this to regional fractional anisotropy (FA). MATERIALS AND METHODS The signal pattern of the T2-weighted sequences in the basal ganglia, thalamus, brain stem, and cerebellum for 27 NF1 individuals and a control group were analyzed by diffusion tensor imaging (DTI). The presence or absence of UBOs in 2 consecutive MRI examinations was related to FA. RESULTS We demonstrated significant differences in FA for the basal ganglia, cerebellum, and thalamus between NF1 patients and controls (P ≤ 0.05), even with a reduction or disappearance of UBOs. CONCLUSIONS MRI allows for adequate monitoring of the temporal and spatial distribution of UBOs in patients with NF1. DTI confirmed changes in FA despite the disappearance or reduction of UBOs, thereby confirming the hypothesis that microstructural damage occurs in specific brain regions of NF1 patients.
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Graziadio C, Lorenzen MB, Moraes FND, Rosa RFM, Zen PRG, Raupp SF, Paskulin GA. Múltiplas hiperintensidades no sistema nervoso central em uma criança com neurofibromatose do tipo 1. REVISTA PAULISTA DE PEDIATRIA 2011. [DOI: 10.1590/s0103-05822011000400035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Relatar o caso de uma criança com neurofibromatose do tipo 1, apresentando o achado ocasional de múltiplas hiperintensidades e de lesão hamartomatosa pré-quiasmática no sistema nervoso central. DESCRIÇÃO DO CASO: Menino de tez escura de quatro anos, cujo pai apresentava manchas café-com-leite e história de cirurgia de tumor de ouvido. A criança evoluiu com um adequado desenvolvimento neuropsicomotor, sem crises convulsivas ou déficit de aprendizagem. Ao exame físico, possuía múltiplas manchas café-com-leite e efélides. A avaliação pela ressonância nuclear magnética de encéfalo evidenciou múltiplas imagens nodulares hiperintensas em T2 e Flair, com isossinal em T1, localizadas na substância branca dos hemisférios cerebrais, cerebelo e tronco cerebral. Apresentava ainda lesão hamartomatosa pré-quiasmática. A avaliação eletroencefalográfica e o exame neurológico eram normais. COMENTÁRIOS: As imagens hiperintensas verificadas na ressonância nuclear magnética correspondem aos chamados unidentified bright objects (UBOs), observados em de 60 a 70% das crianças com neurofibromatose do tipo 1, sendo raros em adultos. Sua etiologia e significado clínico ainda não são claros. Alguns estudos os têm associado à disfunção cognitiva, déficit neurológico e risco de malignização. Hamartomas localizados próximos ao quiasma óptico são incomuns, mas podem se relacionar à puberdade precoce. A avaliação do sistema nervoso central de crianças assintomáticas com neurofibromatose do tipo 1 é discutível. Contudo, nos casos em que UBOs sejam identificados, é importante considerar seu seguimento radiológico, especialmente diante de lesões múltiplas ou atípicas.
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Viola F, Villani E, Natacci F, Selicorni A, Melloni G, Vezzola D, Barteselli G, Mapelli C, Pirondini C, Ratiglia R. Choroidal abnormalities detected by near-infrared reflectance imaging as a new diagnostic criterion for neurofibromatosis 1. Ophthalmology 2011; 119:369-75. [PMID: 21963267 DOI: 10.1016/j.ophtha.2011.07.046] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 07/06/2011] [Accepted: 07/07/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate in a large sample of consecutive patients with neurofibromatosis type 1 (NF1) the possibility of including the presence of choroidal abnormalities detected by near-infrared reflectance (NIR) as a new diagnostic criterion for NF1. DESIGN Cross-sectional evaluation of a diagnostic test. PARTICIPANTS AND CONTROLS Ninety-five consecutive adult and pediatric patients (190 eyes) with NF1, diagnosed based on the National Institutes of Health (NIH) criteria. Controls included 100 healthy age- and gender-matched control subjects. METHODS Confocal scanning laser ophthalmoscopy was performed for each subject, investigating the presence and the number of choroidal abnormalities. MAIN OUTCOME MEASURES Sensitivity, specificity, and diagnostic accuracy for the different cutoff values of the criterion choroidal nodules detected by NIR compared with the NIH criteria. RESULTS Choroidal nodules detected by NIR imaging were present in 79 (82%) of 95 of the NF1 patients, including 15 (71%) of the 21 NF1 pediatric patients. Similar abnormalities were present in 7 (7%) of 100 healthy subjects, including 2 (8%) of the 25 healthy pediatric subjects. The highest accuracy was obtained at the cutoff value of 1.5 choroidal nodules detected by NIR imagery. Sensitivity and specificity of the examination at the optimal cutoff point were 83% and 96%, respectively. Diagnostic accuracy was 90% in the overall population and 83% in the pediatric population. Both of these values were in line with the most common NIH diagnostic criteria. CONCLUSIONS Choroidal abnormalities appearing as bright patchy nodules detected by NIR imaging frequently occurred in NF1 patients. The present study shows that NIR examination to detect choroidal involvement should be considered as a new diagnostic criterion for NF1.
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Affiliation(s)
- Francesco Viola
- Università degli Studi di Milano, UO Oculistica, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Lo-Castro A, D'Agati E, Curatolo P. ADHD and genetic syndromes. Brain Dev 2011; 33:456-61. [PMID: 20573461 DOI: 10.1016/j.braindev.2010.05.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 05/26/2010] [Accepted: 05/27/2010] [Indexed: 11/28/2022]
Abstract
A high rate of Attention Deficit/Hyperactivity Disorder (ADHD)-like characteristics has been reported in a wide variety of disorders including syndromes with known genetic causes. In this article, we review the genetic and the neurobiological links between ADHD symptoms and some genetic syndromes such as: Fragile X Syndrome, Neurofibromatosis 1, DiGeorge Syndrome, Tuberous Sclerosis Complex, Turner Syndrome, Williams Syndrome and Klinefelter Syndrome. Although each syndrome may arise from different genetic abnormalities with multiple molecular functions, the effects of these abnormalities may give rise to common effects downstream in the biological pathways or neural circuits, resulting in the presentation of ADHD symptoms. Early diagnosis of ADHD allows for earlier treatment, and has the potential for a better outcome in children with genetic syndromes.
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Affiliation(s)
- Adriana Lo-Castro
- Department of Neuroscience, Paediatric Neurology Unit, "Tor Vergata" University of Rome, Italy.
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Hachon C, Iannuzzi S, Chaix Y. Behavioural and cognitive phenotypes in children with neurofibromatosis type 1 (NF1): the link with the neurobiological level. Brain Dev 2011; 33:52-61. [PMID: 20106617 DOI: 10.1016/j.braindev.2009.12.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 12/27/2009] [Indexed: 11/19/2022]
Abstract
Neurofibromatosis type 1 (NF1) is one of the most frequent monogenetic disorder encountered in children. Approximately 50% of children with NF1 develop learning disabilities notably for reading. Understanding the reasons of reading impairment in this context may lead to improve therapeutic methods in NF1 and more generally in reading developmental disorders. An interesting challenge is to disentangle the connections between the different levels of description proposed in the etiological approach. This is the aim of this review based on recent advances in analysis of cognitive deficits observed in children with NF1 and on results of recent brain imaging (structural and functional) or animal model studies.
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Affiliation(s)
- Caroline Hachon
- Unité de Neurologie Pediatrique, Hôpital des Enfants, Toulouse, France
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