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Routier L, Querné L, Fontaine C, Berquin P, Le Moing AG. Distinct attentional and executive profiles in neurofibromatosis type 1: Is there difference with primary attention deficit-hyperactivity disorder? Eur J Paediatr Neurol 2024; 51:93-99. [PMID: 38905883 DOI: 10.1016/j.ejpn.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/03/2024] [Accepted: 05/31/2024] [Indexed: 06/23/2024]
Abstract
PURPOSE Attentional and executive dysfunctions are the most frequent cognitive disorders in neurofibromatosis type 1 (NF1), with a high prevalence of attention deficit-hyperactivity disorder (ADHD). We (i) compared attentional profiles between NF1 children with and without ADHD and children with primary ADHD criteria and (ii) investigated the possible relationship between attentional disorders and "unidentified bright objects" (UBOs) in NF1. METHODS This retrospective study included 47 NF1 children, 25 with ADHD criteria (NF1+adhd group), matched for age, sex, and cognitive level with 47 children with primary ADHD (ADHD group). We collected computer task (sustained-attention, visuomotor-decision, inhibition, and cognitive-flexibility tasks) scores normalized for age and sex, and brain magnetic resonance imaging data. RESULTS (i) Working memory was impaired in all groups. (ii) Omissions (p < 0.002) and response-time variability (p < 0.05) in sustained-attention and visuomotor-decision tasks and errors (p < 0.02) in the cognitive-flexibility task were lower for the NFI+adhd and ADHD groups than for the NF1-no-adhd group. (iii) The NF1+adhd group had slower response times (p ≤ 0.02) for inhibition and visuomotor-decision tasks than the other groups. (iv) We found no relevant association between cognitive performance and UBOs. CONCLUSIONS NF1 children with ADHD have an attentional and executive functions deficit profile similar to that of children with primary ADHD, but with a slower response-time, increasing learning difficulties. The atypical connectivity of fronto-striatal pathways, poorer dopamine homeostasis, and increased GABA inhibition observed in NF1 renders vulnerable the development of the widely distributed neural networks that support attentional, working-memory, and executive functions.
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Affiliation(s)
- Laura Routier
- Pediatric Neurology Department, Amiens-Picardie University Hospital, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France; INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, rue René Laennec, 80054, Amiens, Cedex, France; Pediatric Neurophysiology Unit, Amiens-Picardie University Hospital, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France.
| | - Laurent Querné
- Pediatric Neurology Department, Amiens-Picardie University Hospital, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France; INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, rue René Laennec, 80054, Amiens, Cedex, France
| | - Cécile Fontaine
- Pediatric Neurology Department, Amiens-Picardie University Hospital, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France
| | - Patrick Berquin
- Pediatric Neurology Department, Amiens-Picardie University Hospital, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France; INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, rue René Laennec, 80054, Amiens, Cedex, France
| | - Anne-Gaëlle Le Moing
- Pediatric Neurology Department, Amiens-Picardie University Hospital, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France; INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, rue René Laennec, 80054, Amiens, Cedex, France
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Santos S, Martins B, Sereno J, Martins J, Castelo-Branco M, Gonçalves J. Neurobehavioral sex-related differences in Nf1 +/- mice: female show a "camouflaging"-type behavior. Biol Sex Differ 2023; 14:24. [PMID: 37101298 PMCID: PMC10131355 DOI: 10.1186/s13293-023-00509-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is an inherited neurocutaneous disorder associated with neurodevelopmental disorders including autism spectrum disorder (ASD). This condition has been associated with an increase of gamma-aminobutyric acid (GABA) neurotransmission and, consequently, an excitation/inhibition imbalance associated with autistic-like behavior in both human and animal models. Here, we explored the influence of biological sex in the GABAergic system and behavioral alterations induced by the Nf1+/- mutation in a murine model. METHODS Juvenile male and female Nf1+/- mice and their wild-type (WT) littermates were used. Hippocampus size was assessed by conventional toluidine blue staining and structural magnetic resonance imaging (MRI). Hippocampal GABA and glutamate levels were determined by magnetic resonance spectroscopy (MRS), which was complemented by western blot for the GABA(A) receptor. Behavioral evaluation of on anxiety, memory, social communication, and repetitive behavior was performed. RESULTS We found that juvenile female Nf1+/- mice exhibited increased hippocampal GABA levels. Moreover, mutant female displays a more prominent anxious-like behavior together with better memory performance and social behavior. On the other hand, juvenile Nf1+/- male mice showed increased hippocampal volume and thickness, with a decrease in GABA(A) receptor levels. We observed that mutant males had higher tendency for repetitive behavior. CONCLUSIONS Our results suggested a sexually dimorphic impact of Nf1+/- mutation in hippocampal neurochemistry, and autistic-like behaviors. For the first time, we identified a "camouflaging"-type behavior in females of an animal model of ASD, which masked their autistic traits. Accordingly, like observed in human disorder, in this animal model of ASD, females show larger anxiety levels but better executive functions and production of normative social patterns, together with an imbalance of inhibition/excitation ratio. Contrary, males have more externalizing disorders, such as hyperactivity and repetitive behaviors, with memory deficits. The ability of females to camouflage their autistic traits creates a phenotypic evaluation challenge that mimics the diagnosis difficulty observed in humans. Thus, we propose the study of the Nf1+/- mouse model to better understand the sexual dimorphisms of ASD phenotypes and to create better diagnostic tools.
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Affiliation(s)
- Sofia Santos
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
- Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Beatriz Martins
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
- Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - José Sereno
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
- Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - João Martins
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
- Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal.
- Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Joana Gonçalves
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal.
- Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal.
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Maziero S, Jucla M, Blais M, Albaret JM, Tallet J, Chaix Y. A preliminary study of the different memory systems in neurofibromatosis type 1: What is impaired and what is spared? Brain Dev 2023; 45:220-230. [PMID: 36609051 DOI: 10.1016/j.braindev.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Since 1990's, the cognitive profile of children with a neurofibromatosis type 1 (NF1) has been refined by many different studies. Children with NF1 may exhibit a variety of cognitive dysfunctions. Memory difficulties have been reported, but the results are contradictory and, compared to other cognitive functions, memory has been less evaluated. OBJECTIVE The aim of this study was to investigate the memory profile in NF1 with a particular population, children with NF1 without attention deficit hyperactivity disorder (ADHD). METHODS Eighteen children with NF1 without ADHD and eighteen typically developing aged from 8 to 12.6 years were compared in terms of both their verbal and visual working memory, anterograde memory, and procedural perceptual-motor memory. We also assessed semantic and autobiographical memory. RESULTS Our results indicate the existence of memory difficulties in children with NF1 without ADHD in verbal working and anterograde memory but not in terms of the visual domain. They also experienced difficulties recalling personal memories but these were improved by cueing. However, semantic memory and procedural perceptual-motor memory was preserved. CONCLUSIONS These results highlight a difference between memory systems in children with NF1 without ADHD and the importance to assess the different memory systems, the nature of information and the processes in long-term memory in NF1 population. However, our results raise questions about the possible links between these difficulties and the executive functions. The specifics of memory profile in children with NF1 must be taken into consideration in these children's clinical follow-up, in order to understand their learning difficulties and to make adaptations to their care.
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Affiliation(s)
- Stéphanie Maziero
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Laboratory of NeuroPsychoLinguistics, University of Toulouse, France.
| | - Mélanie Jucla
- Laboratory of NeuroPsychoLinguistics, University of Toulouse, France
| | - Mélody Blais
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Jean-Michel Albaret
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Jessica Tallet
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Yves Chaix
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Centre Hospitalier Universitaire de Toulouse, CHU Purpan, Toulouse, France
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Hellebrekers DMJ, van Abeelen SAM, Catsman CE, van Kuijk SMJ, Laridon AM, Klinkenberg S, Hendriksen JGM, Vles JSH. Cognitive and behavioral functioning in two neurogenetic disorders; how different are these aspects in Duchenne muscular dystrophy and Neurofibromatosis type 1? PLoS One 2022; 17:e0275803. [PMID: 36215287 PMCID: PMC9551631 DOI: 10.1371/journal.pone.0275803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
The presence of neurocognitive and behavioral problems are common features in various neurogenetic disorders. In Duchenne muscular dystrophy (DMD), these problems have been linked to mutations along the dystrophin gene affecting different brain dystrophin isoforms. However, comparable cognitive and behavioral problems have been found in Neurofibromatosis type 1 (NF1). This study aims to assess disorder specific differences in cognition and behavior between DMD and NF1. Retrospective data of 38 male patients with DMD were aged-matched with data of 38 male patients with NF1. Patients of both groups underwent neurocognitive assessment for regular clinical care. Intellectual abilities, sequential and simultaneous processing, verbal memory and sustained attention were evaluated. In addition, parents and teachers completed behavioral questionnaires. Males with DMD exhibited low intellectual abilities and sequential processing problems, but these outcomes not significantly differed from males with NF1. Simultaneous processing, verbal memory and sustained attention outcomes were equal for both groups. Outcomes of questionnaires displayed higher rates of aggressive behavior (13.2%) in DMD, whereas in NF1 higher rates of problems with thinking (15.8%), withdrawn (10.5%) and social behavior (10.5%) were noticed. In the neurogenetic disorders DMD and NF1, on average overlapping cognitive and behavioral problems are noticed, suggesting that these are not only caused by gene mutations resulting in a lack of one specific protein.
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Affiliation(s)
- Danique M. J. Hellebrekers
- Centre for Neurological Learning Disabilities, Kempenhaege, Heeze, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | | | - Coriene E. Catsman
- Department of Neurology, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - Sander M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Annick M. Laridon
- Centre for Neurological Learning Disabilities, Kempenhaege, Heeze, The Netherlands
| | - Sylvia Klinkenberg
- Centre for Neurological Learning Disabilities, Kempenhaege, Heeze, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos G. M. Hendriksen
- Centre for Neurological Learning Disabilities, Kempenhaege, Heeze, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Duchenne Centre Netherlands, Nijmegen and Leiden, The Netherlands
| | - Johan S. H. Vles
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Leppich K, Schneider J, Kaindl AM, Eismann C, Ryczek M, Potratz C. Psychosocial and Socioeconomic Factors in Children with Neurofibromatosis Type 1. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1731393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractThe aim of this study is to analyze whether children with familial and sporadic neurofibromatosis type 1 (NF1) differ in psychosocial and socioeconomic aspects such as developmental delay as well as in comorbidities. Medical records of 250 children with NF1 at a median age of 10.6 years (range = 2–20 years at time of data collection) were retrospectively reviewed. Specifically, psychosocial and socioeconomic factors from 88 children with a family history for NF1 and 162 sporadic cases were compared. Comparing IQ, familial cases scored significantly lower than sporadic cases (89.8 vs. 96.5; p = 0.015). IQ scores of children with familial and sporadic NF1 differ depending on level of parental education (mean IQ for high education 101.3 [familial] and 102.8 [sporadic] vs. low education 87.5 [familial] and 90.4 [sporadic]; p < 0.001). No significant differences were found regarding the presence of developmental delay, learning disorders, autism spectrum disorder, or attention deficit hyperactivity disease. Children with inherited NF1 had a significantly lower IQ than sporadic cases. Children with familial NF1 more often had parents with a lower level of education, highlighting a possible impact of NF1 through generations. Also, the present study confirmed previous results in literature regarding high frequencies of learning disabilities, autism spectrum disease, and attention deficits in children with NF1.
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Affiliation(s)
- Katalin Leppich
- Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children, Berlin, Germany
- Department of Pediatric Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Joanna Schneider
- Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children, Berlin, Germany
- Department of Pediatric Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Angela M. Kaindl
- Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children, Berlin, Germany
- Department of Pediatric Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Institute of Cell and Neurobiology, Berlin, Germany
| | - Caroline Eismann
- Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children, Berlin, Germany
- Department of Pediatric Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Monika Ryczek
- Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children, Berlin, Germany
- Department of Pediatric Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Cornelia Potratz
- Charité – Universitätsmedizin Berlin, Center for Chronically Sick Children, Berlin, Germany
- Department of Pediatric Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Biotteau M, Tournay E, Baudou E, Destarac S, Iannuzzi S, Faure-Marie N, Castelnau P, Schweitzer E, Rodriguez D, Kemlin I, Dorison N, Rivier F, Carneiro M, Preclaire E, Barbarot S, Lauwers-Cancès V, Chaix Y. Reading Comprehension Impairment in Children With Neurofibromatosis Type 1 (NF1): The Need of Multimodal Assessment of Attention. J Child Neurol 2021; 36:625-634. [PMID: 33507832 DOI: 10.1177/0883073820981270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Attention span, which has been shown to have an impact on reading quality in many other conditions, is one of the main cognitive disorders of neurofibromatosis type 1 (NF1). The aim of this work is to observe the impact of attention on reading comprehension, in NF1 and non-NF1 children. A multicenter, cross-sectional study was conducted on 150 children (8-12 years old) with or without NF1 (75 NF1 vs 75 non-NF1; 72 female, 78 male), matched for age, sex, handedness, and reading level, thus forming a continuum from good to poor readers in both NF1 and non-NF1 groups. Children with intellectual deficiency or neurologic or psychiatric disorder were excluded. Attentional skills were assessed by combining a parent questionnaire (Child Behavior CheckList) and a performance-based assessment (Conner's Continuous Performance Test-Second Edition). Reading comprehension was assessed through a standardized reading comprehension test (ORLEC Lobrot). The performance-based attention scores were associated with text and sentence comprehension ability (P = .0235 and P = .0164, respectively), while indirect questionnaire attention scores were only associated with sentence comprehension (P = .0263). For both groups, the correlations between questionnaire and performance-based measures were low. We have shown that reading comprehension is greatly influenced by attention in NF1 and non-NF1, even if predictors of good reading comprehension also include IQ score and reading accuracy. Indirect observer-rated questionnaires and direct performance-based measures of attention do not assess the same variables, are linked to different components of reading skills, and are not interchangeable assessments of attention difficulties. Both assessments are complementary and must be used simultaneously, leading to recommendations that support multimodal assessment of attention.
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Affiliation(s)
- Maëlle Biotteau
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, 27102Inserm, UPS, France.,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Elodie Tournay
- Epidemiology Department, Toulouse University Hospital, Toulouse, France
| | - Eloise Baudou
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, 27102Inserm, UPS, France.,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Sandrine Destarac
- Pediatric Clinical Research Unit, Toulouse Clinical Investigation Center, Children's Hospital, Purpan University Hospital, Inserm U1436, Toulouse, France
| | - Stéphanie Iannuzzi
- Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | | | - Pierre Castelnau
- Pediatric Neurology, Clocheville Children's Hospital, Tours University Hospital, Tours, France.,UMR 1253, iBrain, University fo Tours, 27102Inserm, Tours, France.,School of Medicine, University of Tours Francois Rabelais, Tours, France
| | - Elisabeth Schweitzer
- Pediatric Neurology, Clocheville Children's Hospital, Tours University Hospital, Tours, France
| | - Diana Rodriguez
- Sorbonne University, APHP.SU, Department of Neuropediatry & Reference Center for Neurogenetics Disabilities, Armand Trousseau University Hospital, Paris, France.,Inserm U1141, FHU I2-D2, Paris, France
| | - Isabelle Kemlin
- Sorbonne University, APHP.SU, Department of Neuropediatry & Reference Center for Neurogenetics Disabilities, Armand Trousseau University Hospital, Paris, France
| | - Nathalie Dorison
- Sorbonne University, APHP.SU, Department of Neuropediatry & Reference Center for Neurogenetics Disabilities, Armand Trousseau University Hospital, Paris, France
| | - François Rivier
- Department of Pediatric Neurology, Montpellier University Hospital, PhyMedExp, University of Montpellier, Inserm, CNRS, Montpellier, France
| | - Maryline Carneiro
- Department of Pediatric Neurology & Reference Center for Language Disabilities, Montpellier University Hospital, France
| | - Elodie Preclaire
- Department of Pediatric Neurology & Reference Center for Language Disabilities, Montpellier University Hospital, France
| | | | | | - Yves Chaix
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, 27102Inserm, UPS, France.,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
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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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Biotteau M, Déjean S, Lelong S, Iannuzzi S, Faure-Marie N, Castelnau P, Rivier F, Lauwers-Cancès V, Baudou E, Chaix Y. Sporadic and Familial Variants in NF1: An Explanation of the Wide Variability in Neurocognitive Phenotype? Front Neurol 2020; 11:368. [PMID: 32431664 PMCID: PMC7214842 DOI: 10.3389/fneur.2020.00368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Cognitive impairment is the most common neurological manifestation in NF1 and occurs in 30–70% of NF1 cases. The onset and severity of each specific cognitive deficit varies greatly from child to child, with no apparent external causes. The wide variability of phenotype is the most complex aspect in terms of management and care. Despite multiple research, the mechanism underlying the high heterogeneity in NF1 has not yet been elucidated. While many studies have focused on the effects of specific and precise genetic mutations on the NF1 phenotype, little has been done on the impact of NF1 transmission (sporadic vs. familial cases). We used a complete neuropsychological evaluation designed to assess five large cognitive areas: general cognitive functions (WISC-IV and EVIP); reading skills (“L'Alouette,” ODEDYS-2 and Lobrot French reading tests); phonological process (ODEDYS-2 test); visual perceptual skills (JLO, Thurstone and Corsi block tests) and attention (CPT-II), as well as psychosocial adjustments (CBCL) to explore the impact of NF1 transmission on cognitive disease manifestation in 96 children affected by NF1 [55 sporadic cases (29♀, 26♂); 41 familial cases (24♀, 17♂)]. Results: Familial and Sporadic form of NF1 only differ in IQ expression. The families' socioeconomic status (SES) impacts IQ performance but not differently between sporadic and familial variants. However, SES is lower in familial variants than in the sporadic variant of NF1. No other cognitive differences emerge between sporadic and familial NF1. Conclusions: Inheritance in NF1 failed to explain the phenotype variability in its entirety. IQ differences between groups seems in part linked to the environment where the child grows up. Children with NF1, and especially those that have early diagnoses (most often in inherited cases), must obtain careful monitoring from their early childhood, at home to strengthen investment in education and in school to early detect emerging academic problems and to quickly place them into care. Trial Registration: IDRCB, IDRCB2008-A01444-51. Registered 19 January 2009.
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Affiliation(s)
- Maëlle Biotteau
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Sébastien Déjean
- Institut de Mathématiques de Toulouse, UMR5219 Université de Toulouse, CNRS UPS, Toulouse, France
| | - Sandrine Lelong
- Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Stéphanie Iannuzzi
- Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | | | - Pierre Castelnau
- UMR 1253, iBrain, University of Tours, INSERM, Tours, France.,Department of Medicine, University of Tours Francois Rabelais, Tours, France.,Pediatric Neurology, Clocheville Children's Hospital, Tours University Hospital, Tours, France
| | - François Rivier
- Department of Pediatric Neurology and Reference Center for Language Disabilities, CHU Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | | | - Eloïse Baudou
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Yves Chaix
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
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10
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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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11
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Kehrer-Sawatzki H, Kluwe L, Salamon J, Well L, Farschtschi S, Rosenbaum T, Mautner VF. Clinical characterization of children and adolescents with NF1 microdeletions. Childs Nerv Syst 2020; 36:2297-2310. [PMID: 32533297 PMCID: PMC7575500 DOI: 10.1007/s00381-020-04717-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE An estimated 5-11% of patients with neurofibromatosis type 1 (NF1) harbour NF1 microdeletions encompassing the NF1 gene and its flanking regions. The purpose of this study was to evaluate the clinical phenotype in children and adolescents with NF1 microdeletions. METHODS We retrospectively analysed 30 children and adolescents with NF1 microdeletions pertaining to externally visible neurofibromas. The internal tumour load was determined by volumetry of whole-body magnetic resonance imaging (MRI) in 20 children and adolescents with NF1 microdeletions. Furthermore, the prevalence of global developmental delay, autism spectrum disorder and attention deficit hyperactivity disorder (ADHD) were evaluated. RESULTS Children and adolescents with NF1 microdeletions had significantly more often cutaneous, subcutaneous and externally visible plexiform neurofibromas than age-matched patients with intragenic NF1 mutations. Internal neurofibromas were detected in all 20 children and adolescents with NF1 microdeletions analysed by whole-body MRI. By contrast, only 17 (61%) of 28 age-matched NF1 patients without microdeletions had internal tumours. The total internal tumour load was significantly higher in NF1 microdeletion patients than in NF1 patients without microdeletions. Global developmental delay was observed in 28 (93%) of 30 children with NF1 microdeletions investigated. The mean full-scale intelligence quotient in our patient group was 77.7 which is significantly lower than that of patients with intragenic NF1 mutations. ADHD was diagnosed in 15 (88%) of 17 children and adolescents with NF1 microdeletion. Furthermore, 17 (71%) of the 24 patients investigated had T-scores ≥ 60 up to 75, indicative of mild to moderate autistic symptoms, which are consequently significantly more frequent in patients with NF1 microdeletions than in the general NF1 population. Also, the mean total T-score was significantly higher in patients with NF1 microdeletions than in the general NF1 population. CONCLUSION Our findings indicate that already at a very young age, NF1 microdeletions patients frequently exhibit a severe disease manifestation which requires specialized long-term clinical care.
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Affiliation(s)
- Hildegard Kehrer-Sawatzki
- Institute of Human Genetics, University of Ulm and University of Ulm Medical Center, Albert-Einstein-Allee 11, 89081, Ulm, Germany.
| | - Lan Kluwe
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Peterson RK, Tabori U, Bouffet E, Laughlin S, Liu F, Scantlebury N, Mabbott D. Predictors of neuropsychological late effects and white matter correlates in children treated for a brain tumor without radiation therapy. Pediatr Blood Cancer 2019; 66:e27924. [PMID: 31309694 DOI: 10.1002/pbc.27924] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Little is known about cognition and predictors of neuropsychological outcomes in pediatric low-grade glioma (PLGG) survivors treated without radiation therapy. This research expands upon our previous work by further identifying the cognitive profile of PLGG patients treated without radiation therapy, investigating the specific medical and demographic variables that predict functioning, and examining white matter structure and its relationship to neuropsychological performance. PROCEDURE Nineteen PLGG patients (11-19 years) were administered the Wechsler Intelligence Scale for Children/Wechsler Adult Intelligence Scale, and subtests from the Woodcock-Johnson Tests of Cognition (visual matching, rapid picture naming, and pair cancellation) and Cambridge Neuropsychological Test Automated Battery (pattern recognition memory, delayed matching to sample, intra-extra dimensional set shift, motor screening task, rapid visual information processing, and spatial span). RESULTS The sample had normative weaknesses in verbal working memory, brief attention/vigilance, psychomotor speeded output, visual perception and matching, overall cognition, working memory, and processing speed. Increased surgeries or subtotal resections, hydrocephalus, shunting procedures, chemotherapy, NF1, and supratentorial location were predictive of cognitive deficits. Broad white matter involvement of the frontal, temporal, parietal, and occipital lobes as well as the cerebellum, as inferred from diffusion tensor imaging indices of decreased fiber orientation and increased water diffusion, was related to many cognitive difficulties. CONCLUSIONS This study comprehensively examines cognitive functioning in PLGG patients treated without radiation therapy, predictors of cognition, and its relation to white matter structure. Our findings indicate that medical and demographic variables other than radiation therapy can lead to cognitive late effects with diffuse white matter involvement.
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Affiliation(s)
- Rachel K Peterson
- Department of Psychology, Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Uri Tabori
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Suzanne Laughlin
- Centre for Brain and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fang Liu
- Centre for Brain and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nadia Scantlebury
- Centre for Brain and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donald Mabbott
- Department of Psychology, Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
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13
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Eijk S, Mous SE, Dieleman GC, Dierckx B, Rietman AB, de Nijs PFA, Ten Hoopen LW, van Minkelen R, Elgersma Y, Catsman-Berrevoets CE, Oostenbrink R, Legerstee JS. Autism Spectrum Disorder in an Unselected Cohort of Children with Neurofibromatosis Type 1 (NF1). J Autism Dev Disord 2019; 48:2278-2285. [PMID: 29423604 PMCID: PMC5995999 DOI: 10.1007/s10803-018-3478-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In a non-selected sample of children with Neurofibromatosis type 1 (NF1) the prevalence rate of autism spectrum disorder (ASD) and predictive value of an observational (ADOS)—and questionnaire-based screening instrument were assessed. Complete data was available for 128 children. The prevalence rate for clinical ASD was 10.9%, which is clearly higher than in the general population. This prevalence rate is presumably more accurate than in previous studies that examined children with NF1 with an ASD presumption or solely based on screening instruments. The combined observational- and screening based classifications demonstrated the highest positive predictive value for DSM-IV diagnosis, highlighting the importance of using both instruments in children with NF1.
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Affiliation(s)
- S Eijk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - S E Mous
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - G C Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - B Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - A B Rietman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - P F A de Nijs
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - L W Ten Hoopen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - R van Minkelen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Y Elgersma
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus Medical Centre Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - C E Catsman-Berrevoets
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,Department of Pediatric Neurology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - R Oostenbrink
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,Department of General Paediatrics, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - J S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. .,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. .,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Room Sp-2509, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
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14
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Visuoperceptual Impairment in Children with NF1: From Early Visual Processing to Procedural Strategies. Behav Neurol 2019; 2019:7146168. [PMID: 30733835 PMCID: PMC6348799 DOI: 10.1155/2019/7146168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/30/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022] Open
Abstract
Visual-spatial impairment has long been considered a hallmark feature of neurofibromatosis type 1 (NF1). No study investigating the cognitive and neuropsychological profile of NF1 used the Rey Complex Figure Test (RCFT) task as the primary measure of visual-perceptual abilities taking into consideration all functions involved including the strategic processing style. We compared 18 children with NF1, 17 siblings (S), and 18 typically developing children (TD) at intelligence scale and RCFT copy, recall, and recognition trials; we also evaluated the copy strategy as a measure of a visual-processing style. Children with NF1 had normal total IQ, with cognitive weaknesses in the perceptual organization and working memory in line with the existing literature. At the RCFT copy, immediate and delay recall scores are significantly lower in NF1 than S and TD, while recognition is in the normal range in all groups. Copy style was poor and less efficient in children with NF1 and correlated to copy and recall ability, but the effect of the group in the RCFT copy and recall remained significantly controlling for strategic approach. The present study confirms visuospatial impairment in children with NF1, due to a deficit in perceptual analysis of shape and their spatial features, in visuomotor integration efficiency and strategies, in recall memory, while recognition memory is preserved. A more configural/holistic style may facilitate both the visual-perceptual and visuomotor ability and the recall process. Visuoperceptual impairment in NF1 seems to be a unified process from early visual processing to higher order functions (planning, strategy, and executive functioning).
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15
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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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16
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Domon-Archambault V, Gagnon L, Benoît A, Perreault S. Psychosocial Features of Neurofibromatosis Type 1 in Children and Adolescents. J Child Neurol 2018; 33:225-232. [PMID: 29318935 DOI: 10.1177/0883073817749367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Neurofibromatosis type 1 (NF1) is a common neurologic condition associated with a wide variety of developmental deficits that have an important impact on children and adolescents. OBJECTIVE This article aims to document the psychosocial features of NF1 and to report the interventions described to address the needs of pediatric patients with NF1. METHODS A literature review was conducted concerning the social life, mental health, and quality of life (QOL) of children and adolescents with NF1 as well as the psychosocial interventions addressed to this population. RESULTS Compared to unaffected children and adolescents of the general population, pediatric patients with NF1 have an increased risk of having social difficulties, mental health disorders, behavioral and emotional problems, as well as diminished QOL. Only 3 articles describe interventions within the NF1 population to address these difficulties. CONCLUSION There is a need to develop and assess psychosocial interventions for patients with NF1.
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Affiliation(s)
| | - Louise Gagnon
- 2 Department of Pediatric, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Amélie Benoît
- 2 Department of Pediatric, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Sébastien Perreault
- 2 Department of Pediatric, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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17
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Chaix Y, Lauwers-Cancès V, Faure-Marie N, Gentil C, Lelong S, Schweitzer E, Rodriguez D, Iannuzzi S, Kemlin I, Dorison N, Rivier F, Carniero M, Preclaire E, Barbarot S, Lion-François L, Castelnau P. Deficit in phonological processes: a characteristic of the neuropsychological profile of children with NF1. Child Neuropsychol 2017; 24:558-574. [DOI: 10.1080/09297049.2017.1313970] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Yves Chaix
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
- Children’s Hospital, Purpan University Hospital, Toulouse, France
| | | | | | - Catherine Gentil
- Epidemiology Department, Toulouse University Hospital, Toulouse, France
| | - Sandrine Lelong
- Children’s Hospital, Purpan University Hospital, Toulouse, France
- Pediatric Clinical Research Unit, Toulouse Clinical Investigation Center, Children’s Hospital, Purpan University Hospital, Toulouse, France
| | - Elisabeth Schweitzer
- Neuropediatrics & Disabilities Unit, Gatien de Clocheville Children’s Hospital, Tours University Hospital, Tours, France
| | - Diana Rodriguez
- Pediatric Neurology Department & Neurofibromatosis Referral Center, Armand Trousseau Hospital, East Paris University Hospital, Paris, France
- University of Paris VI Pierre & Marie Curie, Sorbonne Universities, Paris, France
- “Neuroprotection of the Developing Brain” Joint Research Unit (U1141), INSERM, Paris, France
| | | | - Isabelle Kemlin
- Pediatric Neurology Department & Neurofibromatosis Referral Center, Armand Trousseau Hospital, East Paris University Hospital, Paris, France
| | - Nathalie Dorison
- Pediatric Neurology Department & Neurofibromatosis Referral Center, Armand Trousseau Hospital, East Paris University Hospital, Paris, France
| | - François Rivier
- Neuropediatric Department & Language Disorders Referral Center, Montpellier Regional University Hospital, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
- “Physiology & Experimental Medicine” Research Unit (U1046 INSERM & UMR 9214 CNRS), University of Montpellier, Montpellier, France
| | - Maryline Carniero
- Neuropediatric Department & Language Disorders Referral Center, Montpellier Regional University Hospital, Montpellier, France
| | - Elodie Preclaire
- Neuropediatric Department & Language Disorders Referral Center, Montpellier Regional University Hospital, Montpellier, France
| | | | | | - Pierre Castelnau
- “Brain & Imaging” Joint Research Unit (UMR 930), Bretonneau Hospital, Tours Regional University Hospital, Tours, France
- University of Tours François Rabelais, Tours, France
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18
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Stafstrom CE, Staedtke V, Comi AM. Epilepsy Mechanisms in Neurocutaneous Disorders: Tuberous Sclerosis Complex, Neurofibromatosis Type 1, and Sturge-Weber Syndrome. Front Neurol 2017; 8:87. [PMID: 28367137 PMCID: PMC5355446 DOI: 10.3389/fneur.2017.00087] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/24/2017] [Indexed: 01/27/2023] Open
Abstract
Neurocutaneous disorders are multisystem diseases affecting skin, brain, and other organs. Epilepsy is very common in the neurocutaneous disorders, affecting up to 90% of patients with tuberous sclerosis complex (TSC) and Sturge–Weber syndrome (SWS), for example. The mechanisms underlying the increased predisposition to brain hyperexcitability differ between disorders, yet some molecular pathways overlap. For instance, the mechanistic target of rapamycin (mTOR) signaling cascade plays a central role in seizures and epileptogenesis in numerous acquired and genetic disorders, including several neurocutaneous disorders. Potential routes for target-specific treatments are emerging as the genetic and molecular pathways involved in neurocutaneous disorders become increasingly understood. This review explores the clinical features and mechanisms of epilepsy in three common neurocutaneous disorders—TSC, neurofibromatosis type 1, and SWS.
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Affiliation(s)
- Carl E Stafstrom
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Verena Staedtke
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Anne M Comi
- Department of Neurology, Kennedy Krieger Institute, Johns Hopkins University School of Medicine , Baltimore, MD , USA
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Costa DDS, de Paula JJ, Alvim-Soares AM, Pereira PA, Malloy-Diniz LF, Rodrigues LOC, Romano-Silva MA, de Miranda DM. COMT Val(158)Met Polymorphism Is Associated with Verbal Working Memory in Neurofibromatosis Type 1. Front Hum Neurosci 2016; 10:334. [PMID: 27458360 PMCID: PMC4932101 DOI: 10.3389/fnhum.2016.00334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 06/16/2016] [Indexed: 12/26/2022] Open
Abstract
Neurofibromatosis type I (NF1) is a neurogenetic disease marked by multiple cognitive and learning problems. Genetic variants may account for phenotypic variance in NF1. Here, we investigated the association between the catechol-O-methyltransferase (COMT) Val(158)Met polymorphism and working memory and arithmetic performance in 50 NF1 individuals. A significant association of the COMT polymorphism was observed only with verbal working memory, as measured by the backward digit-span task with an advantageous performance for Met/Met carriers. To study how genetic modifiers influence NF1 cognitive performance might be of importance to decrease the unpredictability of the cognitive profile among NF1 patients.
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Affiliation(s)
- Danielle de Souza Costa
- Postgraduate Program in Molecular Medicine, School of Medicine, Federal University of Minas GeraisBelo Horizonte, Brazil
| | - Jonas J. de Paula
- Postgraduate Program in Molecular Medicine, School of Medicine, Federal University of Minas GeraisBelo Horizonte, Brazil
- Department of Psychology, Faculty of Medical Sciences of Minas GeraisBelo Horizonte, Brazil
| | - Antonio M. Alvim-Soares
- Postgraduate Program in Molecular Medicine, School of Medicine, Federal University of Minas GeraisBelo Horizonte, Brazil
| | - Patrícia A. Pereira
- Postgraduate Program in Molecular Medicine, School of Medicine, Federal University of Minas GeraisBelo Horizonte, Brazil
| | - Leandro F. Malloy-Diniz
- Department of Psychiatry, School of Medicine, Federal University of Minas GeraisBelo Horizonte, Brazil
- National Institute of Science and Technology of Molecular MedicineBelo Horizonte, Brazil
| | - Luiz O. C. Rodrigues
- Neurofibromatosis Outpatient Reference Center, School of Medicine, Federal University of Minas GeraisBelo Horizonte, Brazil
| | - Marco A. Romano-Silva
- Department of Psychiatry, School of Medicine, Federal University of Minas GeraisBelo Horizonte, Brazil
- National Institute of Science and Technology of Molecular MedicineBelo Horizonte, Brazil
| | - Débora M. de Miranda
- National Institute of Science and Technology of Molecular MedicineBelo Horizonte, Brazil
- Department of Pediatrics, School of Medicine, Federal University of Minas GeraisBelo Horizonte, Brazil
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Iannuzzi S, Albaret JM, Chignac C, Faure-Marie N, Barry I, Karsenty C, Chaix Y. Motor impairment in children with Neurofibromatosis type 1: Effect of the comorbidity with language disorders. Brain Dev 2016; 38:181-7. [PMID: 26321374 DOI: 10.1016/j.braindev.2015.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/27/2015] [Accepted: 08/03/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a body of evidence demonstrating comorbidity of motor and cognitive deficit in «idiopathic» developmental disorders. These associations are also found in developmental disorders secondary to monogenic disorders as in Neurofibromatosis type 1 for which the principal complication during childhood is learning disabilities. The comparison of motor impairment between developmental disorders either idiopathic or secondary as in NF1 could help us to better understand the cause of the combined language/motor deficit in these populations. AIM The aim of this current study was to investigate motor impairment in children with NF1 for which oral language had been specified and then to compare the motors skills of the NF1 group to motor performance of children with Specific Language Disorder (SLD). METHOD Two groups of 49 children between 5 and 12years old were included and compared, the NF1 group and the SLD (Specific Language Disorder) group. Each child completed evaluation involving cognitive, language and motor assessment. RESULTS In NF1 group, motor impairment was more frequent and more severe and concerned specifically balance rather than manual dexterity or ball skills, compared to a group of children with SLD. This motor impairment was independent of language status in the NF1 group. CONCLUSIONS These results as well as other studies on the same topic could suggest that in NF1 children, fine motor skills impairment would be dependent on the existence of comorbidity with language disorders. Also, that gross motor skills impairment, and more precisely the balance deficit would be characteristic of NF1. This issue encourages studies of procedural learning that can involve the fronto-striatal or the fronto-cerebellar loops according to the type of motor tasks and the stage of learning.
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Affiliation(s)
- Stéphanie Iannuzzi
- Unité de Neurologie Pédiatrique, Hôpital des Enfants, Toulouse, France; Inserm, Imagerie Cérébrale et Handicaps Neurologiques UMR 825, CHU Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France.
| | | | - Céline Chignac
- Unité de Neurologie Pédiatrique, Hôpital des Enfants, Toulouse, France
| | | | - Isabelle Barry
- Unité de Neurologie Pédiatrique, Hôpital des Enfants, Toulouse, France
| | - Caroline Karsenty
- Unité de Neurologie Pédiatrique, Hôpital des Enfants, Toulouse, France
| | - Yves Chaix
- Unité de Neurologie Pédiatrique, Hôpital des Enfants, Toulouse, France; Inserm, Imagerie Cérébrale et Handicaps Neurologiques UMR 825, CHU Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France; Université de Toulouse, UPS, Imagerie Cérébrale et Handicaps Neurologiques UMR 825, CHU Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
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21
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Apostolova I, Niedzielska D, Derlin T, Koziolek EJ, Amthauer H, Salmen B, Pahnke J, Brenner W, Mautner VF, Buchert R. Perfusion single photon emission computed tomography in a mouse model of neurofibromatosis type 1: towards a biomarker of neurologic deficits. J Cereb Blood Flow Metab 2015; 35:1304-12. [PMID: 25785829 PMCID: PMC4528004 DOI: 10.1038/jcbfm.2015.43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/21/2015] [Accepted: 02/16/2015] [Indexed: 12/16/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a single-gene disorder affecting neurologic function in humans. The NF1+/- mouse model with germline mutation of the NF1 gene presents with deficits in learning, attention, and motor coordination, very similar to NF1 patients. The present study performed brain perfusion single-photon emission computed tomography (SPECT) in NF1+/- mice to identify possible perfusion differences as surrogate marker for altered cerebral activity in NF1. Cerebral perfusion was measured with hexamethyl-propyleneamine oxime (HMPAO) SPECT in NF1+/- mice and their wild-type littermates longitudinally at juvenile age and at young adulthood. Histology and immunohistochemistry were performed to test for structural changes. There was increased HMPAO uptake in NF1 mice in the amygdala at juvenile age, which reduced to normal levels at young adulthood. There was no genotype effect on thalamic HMPAO uptake, which was confirmed by ex vivo measurements of F-18-fluorodeoxyglucose uptake in the thalamus. Morphologic analyses showed no major structural abnormalities. However, there was some evidence of increased density of microglial somata in the amygdala of NF1-deficient mice. In conclusion, there is evidence of increased perfusion and increased density of microglia in juvenile NF1 mice specifically in the amygdala, both of which might be associated with altered synaptic plasticity and, therefore, with cognitive deficits in NF1.
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Affiliation(s)
- Ivayla Apostolova
- 1] Department of Nuclear Medicine, University Medicine Charité Berlin, Berlin, Germany [2] Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Dagmara Niedzielska
- Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Eva J Koziolek
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Amthauer
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Benedikt Salmen
- Neuroscience Research Center, University Medicine Charité Berlin, Berlin, Germany
| | - Jens Pahnke
- 1] Department of Neuropathology, Oslo University Hospital (OUS), University of Oslo (UiO), Oslo, Norway [2] LIED, University of Lübeck, Lübeck, Germany [3] Leibniz Institute of Plant Biochemistry, Halle, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, University Medicine Charité Berlin, Berlin, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Buchert
- Department of Nuclear Medicine, University Medicine Charité Berlin, Berlin, Germany
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22
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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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Casnar CL, Janke KM, van der Fluit F, Brei NG, Klein-Tasman BP. Relations between fine motor skill and parental report of attention in young children with neurofibromatosis type 1. J Clin Exp Neuropsychol 2014; 36:930-43. [PMID: 25284746 DOI: 10.1080/13803395.2014.957166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Neurofibromatosis type 1 (NF1) is one of the most common genetic disorders presenting in approximately 1 in 3,500 live births. NF1 is a highly variable condition with a large number of complications. A common complication is neuropsychological problems, including developmental delays and learning difficulties that affect as many as 60% of patients. Research has suggested that school-aged children with NF1 often have poorer fine motor skills and are at greater risk for attention difficulties than the general population. Thirty-eight children with NF1 and 23 unaffected children between the ages of 4 and 6 years, who are enrolled in a study of early development in NF1, were included in the present study. Varying levels of fine motor functioning were examined (simple to complex fine motor tasks). For children with NF1, significant difficulties were demonstrated on lab-based mid-level and complex fine motor tasks, even after controlling for nonverbal reasoning abilities, but not on simple fine motor tasks. Parental report also indicated difficulties in everyday adaptive fine motor functioning. No significant correlations were found between complex fine motor ability and attention difficulties. This study provides much needed descriptive data on the early emergence of fine motor difficulties and attention difficulties in young children with NF1.
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Affiliation(s)
- Christy L Casnar
- a Department of Psychology , University of Wisconsin-Milwaukee , Milwaukee , WI , USA
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24
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Galasso C, Lo-Castro A, Di Carlo L, Pitzianti MB, D'Agati E, Curatolo P, Pasini A. Planning deficit in children with neurofibromatosis type 1: a neurocognitive trait independent from attention-deficit hyperactivity disorder (ADHD)? J Child Neurol 2014; 29:1320-6. [PMID: 24532810 DOI: 10.1177/0883073813517001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neurofibromatosis type 1 is associated with executive dysfunctions and comorbidity with attention-deficit hyperactivity disorder (ADHD) in 30% to 50% of children. This study was designed to clarify the neurocognitive phenotype observed in neurofibromatosis type 1 by testing the hypothesis that children with neurofibromatosis type 1 have specific planning deficits independently from intellectual level and ADHD comorbidity. Eighteen children with neurofibromatosis type 1 were pair-matched to 18 children with ADHD and 18 healthy controls. All groups were assessed on the presence of ADHD symptoms (Conners Scales) and planning deficits (Tower of London). Compared with control group, groups with neurofibromatosis type 1 and ADHD demonstrated significant impairment of planning and problem solving. The lack of correlation between Tower of London results and Conners subscale scores in neurofibromatosis type 1 group confirmed that the planning and problem-solving deficit is not directly related to inattention level. These findings suggested that the executive impairment probably represents a peculiar trait of neurofibromatosis type 1 neurocognitive phenotype.
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Affiliation(s)
- Cinzia Galasso
- Pediatric Neurology and Psychiatry Unit, Neuroscience Department, Tor Vergata University of Rome, Rome, Italy
| | - Adriana Lo-Castro
- Pediatric Neurology and Psychiatry Unit, Neuroscience Department, Tor Vergata University of Rome, Rome, Italy
| | - Loredana Di Carlo
- Pediatric Neurology and Psychiatry Unit, Neuroscience Department, Tor Vergata University of Rome, Rome, Italy
| | - Maria Bernarda Pitzianti
- Pediatric Neurology and Psychiatry Unit, Neuroscience Department, Tor Vergata University of Rome, Rome, Italy
| | - Elisa D'Agati
- Pediatric Neurology and Psychiatry Unit, Neuroscience Department, Tor Vergata University of Rome, Rome, Italy
| | - Paolo Curatolo
- Pediatric Neurology and Psychiatry Unit, Neuroscience Department, Tor Vergata University of Rome, Rome, Italy
| | - Augusto Pasini
- Pediatric Neurology and Psychiatry Unit, Neuroscience Department, Tor Vergata University of Rome, Rome, Italy
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25
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Schwetye KE, Gutmann DH. Cognitive and behavioral problems in children with neurofibromatosis type 1: challenges and future directions. Expert Rev Neurother 2014; 14:1139-52. [PMID: 25161109 DOI: 10.1586/14737175.2014.953931] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cognitive and behavioral disorders affect nearly 80% of all children with the neurofibromatosis type 1 inherited cancer syndrome, and are among the most significant clinical manifestations for patients and their families. One of the barriers to successful therapeutic intervention is the wide spectrum of clinical phenotypic expression, ranging from visuospatial learning problems to social perceptual deficits (autism). Leveraging numerous small-animal models of neurofibromatosis type 1, several promising targets have been identified to treat the learning, attention, and autism spectrum phenotypes in this at-risk population. In this review, we provide an up-to-date summary of our current understanding of these disorders in NF1, and propose future research directions aimed at designing more effective therapeutic approaches and clinical trials.
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Affiliation(s)
- Katherine E Schwetye
- Department of Pathology, Division of Neuropathology, Washington University School of Medicine, Box 8111, 660 S. Euclid Avenue, St. Louis MO 63110, USA
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26
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Costa DDS, de Paula JJ, de Rezende NA, Rodrigues LOC, Malloy-Diniz LF, Romano-Silva MA, Miranda DMD. Neuropsychological impairments in elderly Neurofibromatosis type 1 patients. Eur J Med Genet 2014; 57:216-9. [DOI: 10.1016/j.ejmg.2014.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
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Esposito M, Marotta R, Roccella M, Gallai B, Parisi L, Lavano SM, Carotenuto M. Pediatric neurofibromatosis 1 and parental stress: a multicenter study. Neuropsychiatr Dis Treat 2014; 10:141-6. [PMID: 24489471 PMCID: PMC3904813 DOI: 10.2147/ndt.s55518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neurofibromatosis 1 (NF1) is a complex and multifaceted neurocutaneous syndrome with many and varied comorbidities. The literature about the prevalence and degree of maternal stress and the impact of NF1 in the parent-child interaction is still scant. The aim of this study was to evaluate the prevalence of maternal stress in a large pediatric sample of individuals affected by NF1. METHODS Thirty-seven children (19 boys, 18 girls) of mean age 7.86±2.94 (range 5-11) years affected by typical NF1 and a control group comprising 405 typically developing children (207 boys, 198 girls; mean age 8.54±2.47 years) were included in this study. To assess parental stress, the mothers of all individuals (NF1 and comparisons) filled out the Parenting Stress Index-Short Form test. RESULTS The two study groups were comparable for age (P=0.116), gender (P=0.886), and body mass index adjusted for age (P=0.305). Mothers of children affected by NF1 reported higher mean Parenting Stress Index-Short Form scores on the Parental Distress domain (P<0.001), Difficult Child domain (P<0.001), and Total Stress domain than the mothers of typically developing children (controls) (P<0.001). No significant differences between the two groups were found for the Parent-Child Dysfunctional Interaction domain (P=0.566) or Defensive Responding domain scores (P=0.160). CONCLUSION NF1 is considered a multisystemic and complex disease, with many still unrecognized features in pediatric patients and in their families. In this light, our findings about the higher levels of maternal stress highlight the importance of considering the environmental aspects of NF1 management in developmental age.
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Affiliation(s)
- Maria Esposito
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Rosa Marotta
- Department of Psychiatry, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Michele Roccella
- Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy
| | - Beatrice Gallai
- Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, Italy
| | - Lucia Parisi
- Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy
| | | | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
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28
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Garg S, Green J, Leadbitter K, Emsley R, Lehtonen A, Evans DG, Huson SM. Neurofibromatosis type 1 and autism spectrum disorder. Pediatrics 2013; 132:e1642-8. [PMID: 24190681 DOI: 10.1542/peds.2013-1868] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the prevalence of autism spectrum disorder (ASD) in Neurofibromatosis Type 1 (NF1). METHODS Second-phase population-based epidemiologic study using an allcase NF1 registry in a defined UK 4.1 million population area. A total of 109 (52.7%) of 207 responders from the initial screening phase were grouped by using the parent-rated Social Responsiveness Scale (SRS) as significant ASD (SRS≥76; n = 32), moderate ASD (SRS ≥ 60<76; n = 29), or non-ASD (SRS <60, n = 48). Twenty-three cases from the significant ASD group, 16 from moderate ASD, and 8 from non-ASD (total n = 47), invited proportionately by random selection, were seen for detailed confirmatory ascertainment. Assessments on Autism Diagnostic Interview-Revised, Autism Diagnostic Observation Scale-Generic, and verbal IQ were combined by using standard Collaborative Program for Excellence in Autism criteria into an ASD categorization for each case (ASD, broad ASD with partial features, non-ASD). A preplanned weighted analysis was used to derive prevalence estimates for the whole population. RESULTS Fourteen (29.5%) of 47 showed ASD, 13 (27.7%) broad ASD, and 20 (42.5%) non-ASD. The ASD/broad ASD group showed male predominance (1.7:1.0), but did not differ significantly from the non-ASD group on IQ, age, socioeconomic status, inheritance, physical severity, or education. The population prevalence estimate is 24.9% ASD (95% confidence interval 13.1%-42.1%) and 20.8% broad ASD (95% confidence interval 10.0%-38.1%); a total of 45.7% showing some ASD spectrum phenotype. CONCLUSIONS Findings indicate high prevalence of ASD in NF1, with implications for clinical practice and further research into NF1 as a single-gene model for autism.
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Affiliation(s)
- Shruti Garg
- FRCPsych, Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre, Royal Manchester Children's Hospital, Room 4.308, Jean McFarlane Building, Oxford Rd, Manchester M13 9PL, UK.
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29
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van Minkelen R, van Bever Y, Kromosoeto J, Withagen-Hermans C, Nieuwlaat A, Halley D, van den Ouweland A. A clinical and genetic overview of 18 years neurofibromatosis type 1 molecular diagnostics in the Netherlands. Clin Genet 2013; 85:318-27. [DOI: 10.1111/cge.12187] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 05/03/2013] [Accepted: 05/03/2013] [Indexed: 11/26/2022]
Affiliation(s)
- R. van Minkelen
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - Y. van Bever
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - J.N.R. Kromosoeto
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - A. Nieuwlaat
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - D.J.J. Halley
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
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30
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Carotenuto M, Esposito M. Nutraceuticals safety and efficacy in migraine without aura in a population of children affected by neurofibromatosis type I. Neurol Sci 2013; 34:1905-9. [PMID: 23532548 DOI: 10.1007/s10072-013-1403-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/13/2013] [Indexed: 02/06/2023]
Abstract
Neurofibromatosis type 1 (NF1) is one of the most common autosomal dominant disorders with a prevalence of one in 4,000 people worldwide, associated with many neurological comorbidities, such as headache. Despite the high prevalence of headache in this population, little data exist regarding the classification of headaches experienced by patients with NF1. Aim of this study is to verify the efficacy and safety of a nutraceutical complex containing Ginkgolide B/Coenzyme Q10/Riboflavin/Magnesium for prophylaxis in a sample of children affected by NF1 presenting migraine without aura. Ginkgolide B/Coenzyme Q10/Riboflavin/Magnesium complex was orally administered twice a day for 6 months, to 18 school-aged patients with NF1 and presenting symptoms of migraine without aura (10 M, mean age 8.4 ± 1.65). Each patient kept a journal to record: number, intensity (according VAS scale), duration of attacks and concomitant symptoms. In addition, the PedMIDAS scale was administered to assess migraine-related disability. To verify the efficacy of the association, we tested the starting frequency (T0) of headache after 6 months (T1) and then we calculated the migraine frequency delta percentage to express the decrease in monthly frequency. After treatment, a reduction was reported (p < 0.001) in all migraine outcomes (frequency, duration, intensity, and grade of disability). In conclusion, the present study should be considered as the first report on the efficacy and safety of nutraceutical complex containing Ginkgolide B/Coenzyme Q10/Riboflavin/Magnesium for the prophylaxis of migraine in children affected by NF1. Our findings suggest that headache symptoms should be considered a therapeutic target independent of primary disorder.
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Affiliation(s)
- Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Center for Childhood Headache, Second University of Naples, Via Sergio Pansini 5 PAD XI, 80131, Naples, Italy,
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31
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Lehtonen A, Howie E, Trump D, Huson SM. Behaviour in children with neurofibromatosis type 1: cognition, executive function, attention, emotion, and social competence. Dev Med Child Neurol 2013; 55:111-125. [PMID: 22934576 DOI: 10.1111/j.1469-8749.2012.04399.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This systematic review aimed to pull together the findings from research into behavioural systems and attention in children with neurofibromatosis type 1 (NF1) and to identify areas that need further study. METHOD Relevant papers were identified through searches of electronic databases (MEDLINE, PsycINFO, EMBASE) and manual searches through reference lists. In total, 5746 articles were identified and 57 met the inclusion criteria. The data were synthesized using the narrative approach, as the studies varied considerably in terms of participants and measures. RESULTS The results of the review showed that intelligence, academic skills, visuospatial skills, social competence, and attention are impaired in children with NF1. Evidence of deficits in memory, motor functioning, language, and executive functions was less clear. INTERPRETATION Research has made marked progress in outlining the behavioural phenotype of NF1. However, although the general areas of impairment are becoming better known, the exact nature of the impairment is still not understood in many areas of behaviour. Care needs to be taken with the way in which behavioural constructs are defined and measured, and the variability of problems in NF1 is a particular challenge. Nevertheless, research is steadily moving towards comprehensive understanding of behaviour in children with NF1.
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Affiliation(s)
- Annukka Lehtonen
- Genetic Medicine, St Mary's Hospital, Manchester Academic Health Science Centre, University of Manchester
| | - Emma Howie
- Paediatric Psychosocial Department, Royal Manchester Children's Hospital, Manchester Academic Health Science Centre, Manchester, UK
| | - Dorothy Trump
- Genetic Medicine, St Mary's Hospital, Manchester Academic Health Science Centre, University of Manchester
| | - Susan M Huson
- Genetic Medicine, St Mary's Hospital, Manchester Academic Health Science Centre, University of Manchester
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32
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Pasini A, Lo-Castro A, Di Carlo L, Pitzianti M, Siracusano M, Rosa C, Galasso C. Detecting anxiety symptoms in children and youths with neurofibromatosis type I. Am J Med Genet B Neuropsychiatr Genet 2012; 159B:869-73. [PMID: 22911924 DOI: 10.1002/ajmg.b.32095] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/31/2012] [Indexed: 11/07/2022]
Abstract
Children with Neurofibromatosis type 1 (NF1) are known to have cognitive, social, and behavioral deficits. Fifteen NF1-subjects (5 boys, 10 girls, mean age = 13.4), and 15 healthy controls matched for age and sex were assessed on the presence of anxiety symptoms, using the Multidimensional Anxiety Scale for Children (MASC), self-report questionnaire. Significant group differences emerged with regard to MASC total (Z = -2.058, P = 0.041) and anxiety disorder index (ADI; Z = -2.202, P = 0.026), but not with regard to single scales. When the severity and visibility of NF1 were considered, correlation between severity and social anxiety, and severity and MASC total was found. This is the first study assessing anxiety symptoms in NF1 children and youths. A precocious psychological survey and intervention in NF1 subjects, may contribute to reduce the risk of psychiatric disorders in adulthood.
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Affiliation(s)
- Augusto Pasini
- Department of Neuroscience, Child Neurology and Psychiatry Unit, "Tor Vergata" University of Rome, Italy
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Williams TS, Westmacott R, Dlamini N, Granite L, Dirks P, Askalan R, Macgregor D, Moharir M, Deveber G. Intellectual ability and executive function in pediatric moyamoya vasculopathy. Dev Med Child Neurol 2012; 54:30-7. [PMID: 22117564 DOI: 10.1111/j.1469-8749.2011.04144.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Moyamoya vasculopathy is characterized by progressive stenosis of the major arteries of the Circle of Willis, resulting in compromised cerebral blood flow and increased risk of stroke. The objectives of the current study were to examine intellectual and executive functioning of children with moyamoya and to evaluate the impact of moyamoya type, stroke (clinical or silent), vasculopathy laterality, and disease duration on neurocognitive abilities. METHOD Thirty pediatric participants (mean age 10 y 10 mo, SD 4 y; 18 females, 12 males) completed age-appropriate Wechsler Intelligence Scales before any therapeutic revascularization procedures. Reports of executive function were obtained from parents and teachers using the Behavior Rating Index of Executive Function. RESULTS Children with moyamoya scored significantly lower than the test standardization samples on all indices of intelligence and ratings of executive functioning (p<0.001). Patients did not differ by type of moyamoya or history of stroke. Patients with bilateral disease and stroke scored significantly lower than those with unilateral disease on measures of overall intellectual function (p=0.035) and verbal comprehension (p=0.04). Deficits in metacognitive executive functions were also more pronounced in bilateral patients according to teacher ratings. INTERPRETATION Children with moyamoya are at risk for intellectual and executive problems, exacerbated by bilateral disease and clinical stroke history.
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Affiliation(s)
- Tricia S Williams
- Department of Psychology, The Hospital for Sick Children, University of Toronto, ON, Canada
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Quintáns B, Pardo J, Campos B, Barros F, Volpini V, Carracedo A, Sobrido MJ. Neurofibromatosis without Neurofibromas: Confirmation of a Genotype-Phenotype Correlation and Implications for Genetic Testing. Case Rep Neurol 2011; 3:86-90. [PMID: 21532985 PMCID: PMC3084038 DOI: 10.1159/000327557] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is a multisystem disease with autosomal dominant inheritance and complete penetrance diagnosed by clinical findings. Cutaneous neurofibromas are present in almost all adult patients in the dermis, epidermis or along the peripheral nerves. Plexiform neurofibromas are subcutaneous or deep lesions involving nerve plexuses or roots. Neurofibromas can degenerate into malignant tumors, with important prognostic implications. NF1 shows a broad clinic variability even within a single family. Exceptions are cases reporting the in-frame microdeletion c.2970_2972delAAT, presenting with the typical pigmentary features of NF1, but no cutaneous or plexiform neurofibromas. We report a patient with a de novo c.2970_2972delAAT mutation who had few café-au-lait spots, only 2 of which measured >15 mm, axillary and submammary freckling, a flat angioma extending over the neck, arm and trunk, a high arched palate, micrognathia, macrocephaly, pes cavus and scoliosis. There was complete absence of observable cutaneous neurofibromas as well as external plexiform neurofibromas. She had had epileptic seizures since childhood; however, a diagnosis of NF1 had not been confirmed until she was 38, partly due to the paucity of characteristic cutaneous stigmata. We confirm the association of the c.2970_2972delAAT mutation in NF1 with a particular clinical phenotype, especially with lack of detectable neurofibromas. For an appropriate management of patients and family counseling, molecular study of the NF1 gene should be considered in patients not fulfilling NIH criteria when other features suggestive of NF1 are present. In the absence of neurofibromas, starting NF1 testing with the screening of exon 17 may be worthwhile.
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Affiliation(s)
- B Quintáns
- University Clinical Hospital of Santiago de Compostela-SERGAS, Spain
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