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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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2
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Vernet M, Ducrot S, Chaix Y. A Systematic Review on Visual-Processing Deficits in Neurofibromatosis Type 1: What Possible Impact on Learning to Read? Dev Neuropsychol 2024; 49:111-137. [PMID: 38469855 DOI: 10.1080/87565641.2024.2326151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
This systematic review aimed to examine the possible implication of visual-perceptual, visuo-attentional and oculomotor processing in the reading deficits frequently experienced by children with Neurofibromatosis type 1 (NF1), as previously shown in dyslexia. Using PRISMA methodological guidelines, we examined 49 studies; most of these reported visual-processing deficits in this population, raising the importance of directly studying the visuo-perceptual and visuo-attentional processes and eye-movement control involved in the learning-to-read process in NF1. The discussion provides a reflection for a better understanding of how visual-processing skills interact with reading deficits in NF1, as well as new avenues for their screening and care.
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Affiliation(s)
- Marie Vernet
- Aix Marseille Univ, CNRS, LPL, Aix-en-Provence, France
- Centre de jour enfants, Centre hospitalier de Digne-les-Bains, Digne-les-Bains, France
- TONIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | | | - Yves Chaix
- TONIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
- Neuropediatric Department, Toulouse-Purpan University Hospital, Toulouse, France
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3
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Di Stasi M, Cocozza S, Buccino S, Paolella C, Di Napoli L, D'Amico A, Melis D, Ugga L, Villano G, Ruocco M, Scala I, Brunetti A, Elefante A. The role of unidentified bright objects in the neurocognitive profile of neurofibromatosis type 1 children: a volumetric MRI analysis. Acta Neurol Belg 2024; 124:223-230. [PMID: 37733157 PMCID: PMC10874314 DOI: 10.1007/s13760-023-02381-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Cognitive impairment is described in 80% of Neurofibromatosis type 1 (NF1) patients. Brain focal areas of T2w increased signal intensity on MRI, the so-called Unidentified Bright Objects (UBOs) have been hypothesized to be related to cognitive dysfunction, although conflicting results are available in literature. Here, we investigated the possible relation between UBOs' volume, cognitive impairment, and language disability in NF1 patients. MATERIAL AND METHODS In this retrospective study, clinical and MRI data of 21 NF1 patients (M/F = 12/9; mean age 10.1 ± 4.5) were evaluated. Brain intellectual functioning and language abilities were assessed with specific scales, while the analyzed MRI sequences included axial 2D-T2-weighted and FLAIR sequences. These images were used independently for UBOs segmentation with a semiautomatic approach and obtained volumes were normalized for biparietal diameters to take into account for brain volume. Possible differences in terms of normalized UBOs volumes were probed between cognitively affected and preserved patients, as well as between subjects with or without language impairment. RESULTS Patients cognitively affected were not different in terms of UBOs volume compared to those preserved (p = 0.35 and p = 0.30, for T2-weighted and FLAIR images, respectively). Similarly, no differences were found between patients with and without language impairment (p = 0.47 and p = 0.40, for the two sequences). CONCLUSIONS The relation between UBOs and cognition in children with NF1 has been already investigated in literature, although leading to conflicting results. Our study expands the current knowledge, showing a lack of correlation between UBOs volume and both cognitive impairment and language disability in NF1 patients.
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Affiliation(s)
- Martina Di Stasi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
- Department of Diagnostic and Interventional Neuroradiology, University Hospital "San Giovanni di Dio e Ruggi di Aragona", Salerno, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy.
| | - Sara Buccino
- Department of Maternal and Child Health, Federico II University Hospital, Naples, Italy
| | - Chiara Paolella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Linda Di Napoli
- Department of Maternal and Child Health, Federico II University Hospital, Naples, Italy
| | | | - Daniela Melis
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Gianmichele Villano
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Manuel Ruocco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Iris Scala
- Department of Maternal and Child Health, Federico II University Hospital, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
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4
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Özden C, Mautner VF, Farschtschi S, Molwitz I, Ristow I, Bannas P, Well L, Klutmann S, Adam G, Apostolova I, Buchert R. Asymmetry of thalamic hypometabolism on FDG-PET/CT in neurofibromatosis type 1: Association with peripheral tumor burden. J Neuroimaging 2024; 34:138-144. [PMID: 37942683 DOI: 10.1111/jon.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/15/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Thalamic hypometabolism is a consistent finding in brain PET with F-18 fluorodeoxyglucose (FDG) in patients with neurofibromatosis type 1 (NF1). However, the pathophysiology of this metabolic alteration is unknown. We hypothesized that it might be secondary to disturbance of peripheral input to the thalamus by NF1-characteristic peripheral nerve sheath tumors (PNSTs). To test this hypothesis, we investigated the relationship between thalamic FDG uptake and the number, volume, and localization of PNSTs. METHODS This retrospective study included 22 adult NF1 patients (41% women, 36.2 ± 13.0 years) referred to whole-body FDG-PET/contrast-enhanced CT for suspected malignant transformation of PNSTs and 22 sex- and age-matched controls. Brain FDG uptake was scaled voxelwise to the individual median uptake in cerebellar gray matter. Bilateral mean and left-right asymmetry of thalamic FDG uptake were determined using a left-right symmetric anatomical thalamus mask. PNSTs were manually segmented in contrast-enhanced CT. RESULTS Thalamic FDG uptake was reduced in NF1 patients by 2.0 standard deviations (p < .0005) compared to controls. Left-right asymmetry was increased by 1.3 standard deviations (p = .013). Thalamic hypometabolism was higher in NF1 patients with ≥3 PNSTs than in patients with ≤2 PNSTs (2.6 vs. 1.6 standard deviations, p = .032). The impact of the occurrence of paraspinal/paravertebral PNSTs and of the mean PNST volume on thalamic FDG uptake did not reach statistical significance (p = .098 and p = .189). Left-right asymmetry of thalamic FDG uptake was not associated with left-right asymmetry of PNST burden (p = .658). CONCLUSIONS This study provides first evidence of left-right asymmetry of thalamic hypometabolism in NF1 and that it might be mediated by NF1-associated peripheral tumors.
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Affiliation(s)
- Cansu Özden
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- 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
| | - Susanne Klutmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivayla Apostolova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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5
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Harriott EM, Nguyen TQ, Landman BA, Barquero LA, Cutting LE. Using a semi-automated approach to quantify Unidentified Bright Objects in Neurofibromatosis type 1 and linkages to cognitive and academic outcomes. Magn Reson Imaging 2023; 98:17-25. [PMID: 36608909 PMCID: PMC9908856 DOI: 10.1016/j.mri.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous syndrome that affects multiple organ systems resulting in widespread symptoms, including cognitive deficits. In addition to the criteria required for an NF1 diagnosis, approximately 70% of children with NF1 present with Unidentified Bright Objects (UBOs) or Focal Areas of Signal Intensity, which are hyperintense bright spots seen on T2-weighted magnetic resonance images and seen more prominently on FLAIR magnetic resonance images (Sabol et al., 2011). Current findings relating the presence/absence, quantities, sizes, and locations of these bright spots to cognitive abilities are mixed. To contribute to and hopefully disentangle some of these mixed findings, we explored potential relationships between metrics related to UBOs and cognitive abilities in a sample of 28 children and adolescents with NF1 (M=12.52 years; SD=3.18 years; 16 male). We used the Lesion Segmentation Tool (LST) to automatically detect and segment the UBOs. The LST was able to qualitatively and quantitatively reliably detect UBOs in images of children with NF1. Using these automatically detected and segmented lesions, we found that while controlling for age, biological sex, perceptual IQ, study, and scanner, "total UBO volume", defined as the sum of all the voxels representing all of the UBOs for each participant, helped explain differences in word reading, phonological awareness, and visuospatial skills. These findings contribute to the emerging NF1 literature and help parse the specific deficits that children with NF1 have, to then help improve the efficacy of reading interventions for children with NF1.
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Affiliation(s)
- Emily M Harriott
- Vanderbilt Brain Institute, 465 21(st) Avenue South, Nashville, TN 37212, USA.
| | - Tin Q Nguyen
- Vanderbilt Brain Institute, 465 21(st) Avenue South, Nashville, TN 37212, USA.
| | - Bennett A Landman
- Department of Electrical Engineering and Computer Science, Vanderbilt University, 2301Vanderbilt Place, Nashville, TN 37235, USA; Vanderbilt Kennedy Center, 110 Magnolia Circle, Nashville, TN 37203, USA.
| | - Laura A Barquero
- Department of Special Education, Peabody College of Education and Human Development, Vanderbilt University, 110 Magnolia Circle, Nashville, TN 37203, USA.
| | - Laurie E Cutting
- Vanderbilt Brain Institute, 465 21(st) Avenue South, Nashville, TN 37212, USA; Department of Special Education, Peabody College of Education and Human Development, Vanderbilt University, 110 Magnolia Circle, Nashville, TN 37203, USA; Vanderbilt Kennedy Center, 110 Magnolia Circle, Nashville, TN 37203, USA.
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6
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Pillay-Smiley N, Leach J, Lane A, Hummel T, Fangusaro J, de Blank P. Evaluating Focal Areas of Signal Intensity (FASI) in Children with Neurofibromatosis Type-1 (NF1) Treated with Selumetinib on Pediatric Brain Tumor Consortium (PBTC)-029B. Cancers (Basel) 2023; 15:cancers15072109. [PMID: 37046770 PMCID: PMC10092996 DOI: 10.3390/cancers15072109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Understanding the effect of selumetinib on FASI may help elucidate the biology, proliferative potential, and role in neurocognitive changes for these NF1-associated lesions. Methods: Patients with NF1-associated LGG and FASI treated with selumetinib on PBTC-029B were age-matched to untreated patients with NF1-associated FASI at Cincinnati Children’s Hospital Medical Center. Paired bidirectional measurements were compared over time using nonparametric tests. Results: Sixteen age-matched pairs were assessed (age range: 2.8–16.9 years, 60% male). Initial FASI burden was not different between groups (median range 138.7 cm2 [88.4–182.0] for the treated subjects vs. 121.6 cm2 [79.6—181.9] for the untreated subjects; p = 0.98). Over a mean follow-up of 18.9 (±5.9) months, the LGG size consistently decreased with treatment while no consistent change among the treated or untreated FASI size was seen. At the paired time points, the median treated LGG decreased significantly more than the treated FASI (−41.3% (LGG) versus −10.7% (FASI), p = 0.006). However, there was no difference in the median size change in the treated versus untreated FASI (−10.7% (treated FASI) versus −17.9% (untreated FASI), p = 0.08). Among the treated subjects, there was no correlation between the change in LGG and FASI (r = −0.04, p = 0.88). Conclusions: Treatment with selumetinib did not affect the overall FASI size in children with NF1 treated for progressive low-grade glioma.
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Affiliation(s)
- Natasha Pillay-Smiley
- Cancer and Blood Diseases Institute, The Cure Starts Now Foundation Brain Tumor Center, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
| | - James Leach
- Cancer and Blood Diseases Institute, The Cure Starts Now Foundation Brain Tumor Center, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Adam Lane
- Cancer and Blood Diseases Institute, The Cure Starts Now Foundation Brain Tumor Center, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Trent Hummel
- Cancer and Blood Diseases Institute, The Cure Starts Now Foundation Brain Tumor Center, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Jason Fangusaro
- Children’s Healthcare of Atlanta and Aflac Cancer Center, Atlanta, GA 30322, USA
- Children’s Healthcare of Atlanta and Emory, University School of Medicine, Atlanta GA 30322, USA
| | - Peter de Blank
- Cancer and Blood Diseases Institute, The Cure Starts Now Foundation Brain Tumor Center, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
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7
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Basto DL, de Souza Vieira G, Andrade-Losso RM, Almeida PN, Riccardi VM, Rozza-de-Menezes RE, Cunha KS. Head circumference and anthropometric changes and their relation to plexiform and skin neurofibromas in sporadic and familial neurofibromatosis 1 Brazilian adults: a cross-sectional study. Orphanet J Rare Dis 2022; 17:341. [PMID: 36064430 PMCID: PMC9446792 DOI: 10.1186/s13023-022-02482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neurofibromatosis 1 (NF1) is a common autosomal dominant syndrome with complete penetrance and highly variable expressivity. The cutaneous neurofibroma (Cnf) and plexiform neurofibroma (Pnf), café-au-lait spots, and freckle-like lesions are common in NF1, but many other manifestations can occur. We aimed to evaluate head circumference, height, weight, body mass index (BMI), head circumference-to-height ratio (HCHR) and waist–hip ratio (WHR) in adult NF1 Brazilian individuals versus a paired control group and investigate their correlation with the presence of clinically visible Pnfs, and number of “skin neurofibromas” (Snf), which include both cutaneous and subcutaneous neurofibromas. Methods A case–control study was conducted with 168 individuals, 84 with NF1 and 84 without NF1, paired by sex and age. Head circumference and anthropometric measurements, Snf quantification, evaluation of clinically visible Pnf and familial inheritance were accessed. Results Prevalence of macrocephaly was significantly higher in NF1 women. Height and weight were significantly lower in both males and females with NF1. HCHR was higher in the NF1 group than in the control group for both sexes. BMI was significantly lower in men with NF1. Waist and hip circumferences were significantly reduced in NF compared with the controls, but the mean WHR was significantly lower only in NF1 women. No correlation was found between the Snf and head circumference and anthropometric measurements, sex or family history. The presence and larger size of clinically visible plexiform neurofibromas were associated with normal stature (p = 0.037 and p = 0.003, respectively). Conclusions NF1 individuals have increased prevalence of macrocephaly, short stature, low BMI, and reduced abdominal fat. There is no relation between head circumference and anthropometric data with family history, or neurofibromas.
Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02482-8.
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Affiliation(s)
- Diogo Lisbôa Basto
- Graduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil.,Neurofibromatosis National Center, Rio de Janeiro, RJ, Brazil
| | - Gustavo de Souza Vieira
- Graduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil.,Neurofibromatosis National Center, Rio de Janeiro, RJ, Brazil
| | - Raquel M Andrade-Losso
- Graduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil.,Neurofibromatosis National Center, Rio de Janeiro, RJ, Brazil
| | - Paula Nascimento Almeida
- Graduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil.,Neurofibromatosis National Center, Rio de Janeiro, RJ, Brazil
| | | | - Rafaela Elvira Rozza-de-Menezes
- Graduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil.,Neurofibromatosis National Center, Rio de Janeiro, RJ, Brazil.,Department of Pathology, School of Medicine, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Av. Marquês Do Paraná, 303, 4oandar, sala 01. Centro, Niterói, RJ, 24033-900, Brazil
| | - Karin Soares Cunha
- Graduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil. .,Neurofibromatosis National Center, Rio de Janeiro, RJ, Brazil. .,Department of Pathology, School of Medicine, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Av. Marquês Do Paraná, 303, 4oandar, sala 01. Centro, Niterói, RJ, 24033-900, Brazil.
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8
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Crow AJD, Janssen JM, Marshall C, Moffit A, Brennan L, Kohler CG, Roalf DR, Moberg PJ. A systematic review and meta-analysis of intellectual, neuropsychological, and psychoeducational functioning in neurofibromatosis type 1. Am J Med Genet A 2022; 188:2277-2292. [PMID: 35546306 PMCID: PMC9302478 DOI: 10.1002/ajmg.a.62773] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/27/2022] [Accepted: 04/06/2022] [Indexed: 01/07/2023]
Abstract
Neurofibromatosis Type 1 (NF1) is a common genetic disorder frequently associated with cognitive deficits. Despite cognitive deficits being a key feature of NF1, the profile of such impairments in NF1 has been shown to be heterogeneous. Thus, we sought to quantitatively synthesize the extant literature on cognitive functioning in NF1. A random-effects meta-analysis of cross-sectional studies was carried out comparing cognitive functioning of patients with NF1 to typically developing or unaffected sibling comparison subjects of all ages. Analyses included 50 articles (Total NNF1 = 1,522; MAge = 15.70 years, range = 0.52-69.60), yielding 460 effect sizes. Overall moderate deficits were observed [g = -0.64, 95% CI = (-0.69, -0.60)] wherein impairments differed at the level of cognitive domain. Deficits ranged from large [general intelligence: g = -0.95, 95% CI = (-1.12, -0.79)] to small [emotion: g = -0.37, 95% CI = (-0.63, -0.11)]. Moderation analyses revealed nonsignificant contributions of age, sex, educational attainment, and parental level of education to outcomes. These results illustrate that cognitive impairments are diffuse and salient across the lifespan in NF1. Taken together, these results further demonstrate efforts should be made to evaluate and address cognitive morbidity in patients with NF1 in conjunction with existing best practices.
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Affiliation(s)
- Andrew J D Crow
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennica M Janssen
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Carolina Marshall
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Psychology, Hope College, Holland, Michigan, USA
| | - Anne Moffit
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Biology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Christian G Kohler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David R Roalf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Paul J Moberg
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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9
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Vernet M, Jover M, Bellocchi S, Maziero S, Jucla M, Tallet J, Danna J, Chaix Y, Ducrot S. Visual-processing deficits in children with neurofibromatosis type 1: A clinical marker of reading difficulties. Eur J Paediatr Neurol 2022; 38:25-32. [PMID: 35381410 DOI: 10.1016/j.ejpn.2022.03.009] [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: 07/30/2021] [Revised: 03/07/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022]
Abstract
Today's estimates indicate that nearly 50% of children with Neurofibromatosis type 1 (NF1) suffer from reading disabilities, with a high impact on their academic achievement. In addition to the well-documented importance of phonological skills in reading acquisition and neurodevelopmental disorders, visual-attention processes also appear as important factors in learning to read. The present study aimed at assessing the role of visual-processing dysfunction in the high prevalence of reading disabilities in NF1 children and providing a useful tool for clinician in the early detection of reading impairment in this neurogenetic disorder. Forty-two children with NF1 and 42 typically developing children (TD) participated in the study. All were right-handed and did not present intellectual disability or attention deficit hyperactivity disorder. Visual-attention processes were assessed with the Developmental Eye Movement (DEM) test, together with the NF1 children's reading level. NF1 children with and without reading disabilities were then compared. The results showed that visual-processing deficits were highly present among the NF1 children included in our study. Furthermore, poor readers with NF1 presented an increased risk of visual-processing deficits compared to peers. This finding supports the role of visual-processing deficits in the reading difficulties encountered in nearly half of children with NF1. Finally, in NF1 children without intellectual or attention disability, visual-processing deficits emerge as one of the clinical markers of reading disabilities. The study holds important clinical implications both for the identification, by providing a useful screening tool, and the management of reading disabilities in NF1 children.
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Affiliation(s)
- Marie Vernet
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France; Aix Marseille Univ, CNRS, LPL, Aix-en-Provence, France.
| | | | - Stéphanie Bellocchi
- Univ. Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA, 4556, Montpellier, France
| | - Stéphanie Maziero
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France; Octogone-Lordat, University of Toulouse, Toulouse, France
| | - Mélanie Jucla
- Octogone-Lordat, University of Toulouse, Toulouse, France
| | - Jessica Tallet
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
| | - Jérémy Danna
- Aix Marseille Univ, CNRS, LNC, Marseille, France
| | - Yves Chaix
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France; Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
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10
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Wang S, Friedman JM, Suppa P, Buchert R, Mautner VF. White matter is increased in the brains of adults with neurofibromatosis 1. Orphanet J Rare Dis 2022; 17:115. [PMID: 35248131 PMCID: PMC8898512 DOI: 10.1186/s13023-022-02273-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neurofibromatosis 1 (NF1) is a rare autosomal dominant disease characterized by increased Schwann cell proliferation in peripheral nerves. Several small studies of brain morphology in children with NF1 have found increased total brain volume, total white matter volume and/or corpus callosum area. Some studies (mostly in children with NF1) also attempted to correlate changes in brain morphology and volume with cognitive or behavioural abnormalities, although the findings were inconsistent. We aimed to characterize alterations in brain volumes by three-dimensional (3D) MRI in adults with NF1 in major intracranial sub-regions. We also aimed to assess the effect of age on these volumes and correlated brain white matter and grey matter volumes with neuropsychometric findings in adults with NF1. Methods We obtained brain volume measurements using 3D magnetic resonance imaging for 351 adults with NF1 and, as a comparison group, 43 adults with neurofibromatosis 2 (NF2) or Schwannomatosis. We assessed a subset of 19 adults with NF1 for clinical severity of NF1 features and neurological problems and conducted psychometric testing for attention deficiencies and intelligence quotient. We compared brain volumes between NF1 patients and controls and correlated volumetric measurements to clinical and psychometric features in the NF1 patients. Results Total brain volume and total and regional white matter volumes were all significantly increased in adults with NF1. Grey matter volume decreased faster with age in adults with NF1 than in controls. Greater total brain volume and white matter volume were correlated with lower attention deficits and higher intelligence quotients in adults with NF1. Conclusion Our findings are consistent with the hypothesis that dysregulation of brain myelin production is a cardinal manifestation of NF1 and that these white matter changes may be functionally important in affected adults. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02273-1.
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11
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Baudou E, Nemmi F, Peran P, Cignetti F, Blais M, Maziero S, Tallet J, Chaix Y. Atypical connectivity in the cortico-striatal network in NF1 children and its relationship with procedural perceptual-motor learning and motor skills. J Neurodev Disord 2022; 14:15. [PMID: 35232382 PMCID: PMC8903485 DOI: 10.1186/s11689-022-09428-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Neurofibromatosis type 1 (NF1) is considered a model of neurodevelopmental disorder because of the high frequency of learning deficits, especially developmental coordination disorder. In neurodevelopmental disorder, Nicolson and Fawcett formulated the hypothesis of an impaired procedural learning system that has its origins in cortico-subcortical circuits. Our aim was to investigate the relationship between cortico-striatal connectivity and procedural perceptual-motor learning performance and motor skills in NF1 children. Methods Seventeen NF1 and 18 typically developing children aged between 8 and 12 years old participated in the study. All were right-handed and did not present intellectual or attention deficits. In all children, procedural perceptual-motor learning was assessed using a bimanual visuo-spatial serial reaction time task (SRTT) and motor skills using the Movement Assessment Battery for Children (M-ABC). All participants underwent a resting-state functional MRI session. We used a seed-based approach to explore cortico-striatal connectivity in somatomotor and frontoparietal networks. A comparison between the groups’ striato-cortical connectivity and correlations between connectivity and learning (SRTT) and motor skills (M-ABC) were performed. Results At the behavioral level, SRTT scores are not significantly different in NF1 children compared to controls. However, M-ABC scores are significantly impaired within 9 patients (scores below the 15th percentile). At the cerebral level, NF1 children present a higher connectivity in the cortico-striatal regions mapping onto the right angular gyrus compared to controls. We found that the higher the connectivity values between these regions, differentiating NF1 and controls, the lower the M-ABC scores in the whole sample. No correlation was found for the SRTT scores. Conclusion NF1 children present atypical hyperconnectivity in cortico-striatal connections. The relationship with motor skills could suggest a sensorimotor dysfunction already found in children with developmental coordination disorder. These abnormalities are not linked to procedural perceptual-motor learning assessed by SRTT. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-022-09428-y.
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Affiliation(s)
- Eloïse Baudou
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France. .,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France. .,Pediatric Neurology Unit, Hôpital des Enfants, CHU Toulouse, 330 av de Grande Bretagne-TSA, 31059, Toulouse, France.
| | - Federico Nemmi
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Patrice Peran
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Fabien Cignetti
- CNRS, TIMC-IMAG, Université Grenoble Alpes, Grenoble, France
| | - Melody Blais
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.,EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Ales, Montpellier, France
| | - Stéphanie Maziero
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Jessica Tallet
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, 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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12
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Castricum J, Tulen JHM, Taal W, Rietman AB, Elgersma Y. Attention and Motor Learning in Adult Patients with Neurofibromatosis Type 1. J Atten Disord 2022; 26:563-572. [PMID: 33978520 PMCID: PMC8987013 DOI: 10.1177/10870547211012035] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder that is associated with cognitive disabilities, including attention and motor learning problems. These disabilities have been extensively studied in children with NF1 but limited studies have been performed in adults. METHOD Attention, motor learning and intellectual performance were studied with neuropsychological tasks in 32 adults with NF1 and 32 controls. RESULTS The NF1 and control group performed similarly on attention and motor learning tasks, although controls had shorter reaction times than adults with NF1 during the motor learning task (t[60] = -2.20, p = .03). Measures of attention or motor learning were not significantly associated with reduced intellectual performance in NF1. CONCLUSION In contrast to many studies in children with NF1, our findings did not provide evidence for presence of attention or motor learning problems in adults with NF1 in neuropsychological tasks. Our observations may be of clinical importance to determine treatment focus in adults with NF1.
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Affiliation(s)
- Jesminne Castricum
- Erasmus University Medical Center, Rotterdam, The Netherlands,The ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, the Netherlands
| | - Joke H. M. Tulen
- Erasmus University Medical Center, Rotterdam, The Netherlands,The ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, the Netherlands
| | - Walter Taal
- Erasmus University Medical Center, Rotterdam, The Netherlands,The ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, the Netherlands
| | - André B. Rietman
- The ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, the Netherlands,Erasmus University Medical Center Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Ype Elgersma
- Erasmus University Medical Center, Rotterdam, The Netherlands,The ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, the Netherlands,Ype Elgersma, Department of Clinical Genetics, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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13
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Kallionpää RA, Valtanen M, Auranen K, Uusitalo E, Rinne JO, Peltonen S, Peltonen J. Increased risk for dementia in neurofibromatosis type 1. Genet Med 2021; 23:2219-2222. [PMID: 34257422 PMCID: PMC8553610 DOI: 10.1038/s41436-021-01261-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine the risk for dementia in neurofibromatosis type 1 (NF1) using a Finnish nationwide cohort of individuals with NF1, and data from national registries. METHODS A Finnish cohort of 1,349 individuals with confirmed NF1 according to the US National Institutes of Health (NIH) diagnostic criteria was compared with a control cohort of 13,870 individuals matched for age, sex, and area of residence. Dementia-related hospital visits were retrieved from the Finnish Care Register for Health Care using International Classification of Diseases, 10th revision (ICD-10) diagnosis codes G30 and F00-F03. Purchases of antidementia drugs were queried with Anatomical Therapeutic Chemical (ATC) classification code N06D from the drug reimbursement register maintained by the Social Insurance Institution of Finland. The follow-up spanned 1998-2014. RESULTS Totals of 16 and 165 individuals with at least two dementia-related diagnoses or drug purchases were identified in the NF1 and control cohorts, respectively. The hazard ratio for dementia in NF1 was 1.67 (95% confidence interval [CI] 1.00-2.80, P = 0.050). In an analysis stratified by the type of dementia, the risk for Alzheimer disease was increased in NF1 compared to controls with a hazard ratio of 2.88 (95% CI 1.47-5.66, P = 0.002). CONCLUSION Dementia and especially Alzheimer disease are previously unrecognized neurological complications of NF1.
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Affiliation(s)
| | - Mikko Valtanen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Department of Dermatology and Venereology, University of Turku, Turku, Finland.,Department of Dermatology, Turku University Hospital, Turku, Finland.,Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Kari Auranen
- Department of Mathematics and Statistics, University of Turku, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Elina Uusitalo
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Juha O Rinne
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Turku PET Centre, University of Turku, Turku, Finland
| | - Sirkku Peltonen
- Department of Dermatology and Venereology, University of Turku, Turku, Finland.,Department of Dermatology, Turku University Hospital, Turku, Finland.,Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Juha Peltonen
- Institute of Biomedicine, University of Turku, Turku, Finland.
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14
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Pacot L, Vidaud D, Sabbagh A, Laurendeau I, Briand-Suleau A, Coustier A, Maillard T, Barbance C, Morice-Picard F, Sigaudy S, Glazunova OO, Damaj L, Layet V, Quelin C, Gilbert-Dussardier B, Audic F, Dollfus H, Guerrot AM, Lespinasse J, Julia S, Vantyghem MC, Drouard M, Lackmy M, Leheup B, Alembik Y, Lemaire A, Nitschké P, Petit F, Dieux Coeslier A, Mutez E, Taieb A, Fradin M, Capri Y, Nasser H, Ruaud L, Dauriat B, Bourthoumieu S, Geneviève D, Audebert-Bellanger S, Nizon M, Stoeva R, Hickman G, Nicolas G, Mazereeuw-Hautier J, Jannic A, Ferkal S, Parfait B, Vidaud M, Wolkenstein P, Pasmant E. Severe Phenotype in Patients with Large Deletions of NF1. Cancers (Basel) 2021; 13:cancers13122963. [PMID: 34199217 PMCID: PMC8231977 DOI: 10.3390/cancers13122963] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 12/18/2022] Open
Abstract
Complete deletion of the NF1 gene is identified in 5-10% of patients with neurofibromatosis type 1 (NF1). Several studies have previously described particularly severe forms of the disease in NF1 patients with deletion of the NF1 locus, but comprehensive descriptions of large cohorts are still missing to fully characterize this contiguous gene syndrome. NF1-deleted patients were enrolled and phenotypically characterized with a standardized questionnaire between 2005 and 2020 from a large French NF1 cohort. Statistical analyses for main NF1-associated symptoms were performed versus an NF1 reference population. A deletion of the NF1 gene was detected in 4% (139/3479) of molecularly confirmed NF1 index cases. The median age of the group at clinical investigations was 21 years old. A comprehensive clinical assessment showed that 93% (116/126) of NF1-deleted patients fulfilled the NIH criteria for NF1. More than half had café-au-lait spots, skinfold freckling, Lisch nodules, neurofibromas, neurological abnormalities, and cognitive impairment or learning disabilities. Comparison with previously described "classic" NF1 cohorts showed a significantly higher proportion of symptomatic spinal neurofibromas, dysmorphism, learning disabilities, malignancies, and skeletal and cardiovascular abnormalities in the NF1-deleted group. We described the largest NF1-deleted cohort to date and clarified the more severe phenotype observed in these patients.
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Affiliation(s)
- Laurence Pacot
- Service de Génétique et Biologie Moléculaires, Hôpital Cochin, DMU BioPhyGen, Assistance Publique-Hôpitaux de Paris, AP-HP, Centre-Université de Paris, F-75014 Paris, France; (L.P.); (D.V.); (A.B.-S.); (A.C.); (T.M.); (C.B.); (B.P.); (M.V.)
- Inserm U1016—CNRS UMR8104, Institut Cochin, Université de Paris, CARPEM, F-75014 Paris, France;
| | - Dominique Vidaud
- Service de Génétique et Biologie Moléculaires, Hôpital Cochin, DMU BioPhyGen, Assistance Publique-Hôpitaux de Paris, AP-HP, Centre-Université de Paris, F-75014 Paris, France; (L.P.); (D.V.); (A.B.-S.); (A.C.); (T.M.); (C.B.); (B.P.); (M.V.)
- Inserm U1016—CNRS UMR8104, Institut Cochin, Université de Paris, CARPEM, F-75014 Paris, France;
| | - Audrey Sabbagh
- UMR 261, Laboratoire MERIT, IRD, Faculté de Pharmacie de Paris, Université de Paris, F-75006 Paris, France;
| | - Ingrid Laurendeau
- Inserm U1016—CNRS UMR8104, Institut Cochin, Université de Paris, CARPEM, F-75014 Paris, France;
| | - Audrey Briand-Suleau
- Service de Génétique et Biologie Moléculaires, Hôpital Cochin, DMU BioPhyGen, Assistance Publique-Hôpitaux de Paris, AP-HP, Centre-Université de Paris, F-75014 Paris, France; (L.P.); (D.V.); (A.B.-S.); (A.C.); (T.M.); (C.B.); (B.P.); (M.V.)
- Inserm U1016—CNRS UMR8104, Institut Cochin, Université de Paris, CARPEM, F-75014 Paris, France;
| | - Audrey Coustier
- Service de Génétique et Biologie Moléculaires, Hôpital Cochin, DMU BioPhyGen, Assistance Publique-Hôpitaux de Paris, AP-HP, Centre-Université de Paris, F-75014 Paris, France; (L.P.); (D.V.); (A.B.-S.); (A.C.); (T.M.); (C.B.); (B.P.); (M.V.)
| | - Théodora Maillard
- Service de Génétique et Biologie Moléculaires, Hôpital Cochin, DMU BioPhyGen, Assistance Publique-Hôpitaux de Paris, AP-HP, Centre-Université de Paris, F-75014 Paris, France; (L.P.); (D.V.); (A.B.-S.); (A.C.); (T.M.); (C.B.); (B.P.); (M.V.)
| | - Cécile Barbance
- Service de Génétique et Biologie Moléculaires, Hôpital Cochin, DMU BioPhyGen, Assistance Publique-Hôpitaux de Paris, AP-HP, Centre-Université de Paris, F-75014 Paris, France; (L.P.); (D.V.); (A.B.-S.); (A.C.); (T.M.); (C.B.); (B.P.); (M.V.)
| | - Fanny Morice-Picard
- Inserm U1211, Service de Génétique Médicale, CHU de Bordeaux, F-33000 Bordeaux, France;
| | - Sabine Sigaudy
- Department of Medical Genetics, Children’s Hospital La Timone, Assistance Publique des Hôpitaux de Marseille, F-13000 Marseille, France;
| | - Olga O. Glazunova
- Centre de Référence des Anomalies du Développement et Syndromes Malformatifs (UF 2970), CHU Timone, Assistance Publique des Hôpitaux de Marseille, F-13000 Marseille, France;
| | - Lena Damaj
- Department of Pediatrics, Competence Center of Inherited Metabolic Disorders, Rennes Hospital, F-35000 Rennes, France;
| | - Valérie Layet
- Consultations de Génétique, Groupe Hospitalier du Havre, F-76600 Le Havre, France;
| | - Chloé Quelin
- Service de Génétique Clinique, CLAD Ouest, CHU Rennes, Hôpital Sud, F-35000 Rennes, France; (C.Q.); (M.F.)
| | | | - Frédérique Audic
- Service de Neurologie Pédiatrique, CHU Timone Enfants, F-13000 Marseille, France;
| | - Hélène Dollfus
- Centre de Référence Pour les Affections Rares en Génétique Ophtalmologique, CARGO, Filière SENSGENE, Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France;
- Medical Genetics Laboratory, INSERM U1112, Institute of Medical Genetics of Alsace, Strasbourg Medical School, University of Strasbourg, F-67000 Strasbourg, France
| | | | - James Lespinasse
- Service de Génétique Clinique, CH de Chambéry, F-73000 Chambéry, France;
| | - Sophie Julia
- Service de Génétique Médicale, CHU de Toulouse, Hôpital Purpan, F-31000 Toulouse, France;
| | - Marie-Christine Vantyghem
- Endocrinology, Diabetology, Metabolism and Nutrition Department, Inserm 1190, Lille University Hospital EGID, F-59000 Lille, France;
| | - Magali Drouard
- Dermatology Department, CHU Lille, University of Lille, F-59000 Lille, France;
| | - Marilyn Lackmy
- Unité de Génétique Clinique, Centre de Compétences Maladies Rares Anomalies du Développement, CHRU de Pointe à Pitre, F-97110 Guadeloupe, France;
| | - Bruno Leheup
- Service de Génétique Médicale, Hôpitaux de Brabois, CHRU de Nancy, F-54500 Vandoeuvre-lès-Nancy, France;
| | - Yves Alembik
- Department of Medical Genetics, Strasbourg-Hautepierre Hospital, F-67000 Strasbourg, France; (Y.A.); (A.L.)
| | - Alexia Lemaire
- Department of Medical Genetics, Strasbourg-Hautepierre Hospital, F-67000 Strasbourg, France; (Y.A.); (A.L.)
| | - Patrick Nitschké
- Bioinformatics Platform, Imagine Institute, INSERM UMR 1163, Université de Paris, F-75015 Paris, France;
| | - Florence Petit
- CHU Lille, Clinique de Génétique, Centre de Référence Anomalies du Développement, F-59000 Lille, France; (F.P.); (A.D.C.)
| | - Anne Dieux Coeslier
- CHU Lille, Clinique de Génétique, Centre de Référence Anomalies du Développement, F-59000 Lille, France; (F.P.); (A.D.C.)
| | - Eugénie Mutez
- Lille University, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France;
| | - Alain Taieb
- Department of Dermatology and Pediatric Dermatology, Bordeaux University Hospital, F-33000 Bordeaux, France;
| | - Mélanie Fradin
- Service de Génétique Clinique, CLAD Ouest, CHU Rennes, Hôpital Sud, F-35000 Rennes, France; (C.Q.); (M.F.)
| | - Yline Capri
- Département de Génétique, APHP Nord, Hôpital Robert Debré, F-75019 Paris, France; (Y.C.); (H.N.); (L.R.)
| | - Hala Nasser
- Département de Génétique, APHP Nord, Hôpital Robert Debré, F-75019 Paris, France; (Y.C.); (H.N.); (L.R.)
| | - Lyse Ruaud
- Département de Génétique, APHP Nord, Hôpital Robert Debré, F-75019 Paris, France; (Y.C.); (H.N.); (L.R.)
- UMR 1141, NEURODIDEROT, INSERM, Université de Paris, F-75019 Paris, France
| | - Benjamin Dauriat
- Department of Cytogenetics and Clinical Genetics, Limoges University Hospital, F-87000 Limoges, France;
| | - Sylvie Bourthoumieu
- Service de Cytogénétique et Génétique Médicale, CHU Limoges, F-87000 Limoges, France;
| | - David Geneviève
- Department of Genetics, Arnaud de Villeneuve University Hospital, F-34000 Montpellier, France;
| | - Séverine Audebert-Bellanger
- Département de Génétique Médicale et Biologie de la Reproduction, CHU Brest, Hôpital Morvan, F-29200 Brest, France;
| | - Mathilde Nizon
- Genetic Medical Department, CHU Nantes, F-44000 Nantes, France;
| | - Radka Stoeva
- Service de Cytogénétique, Centre Hospitalier Universitaire du Mans, F-72000 Le Mans, France;
| | - Geoffroy Hickman
- Department of Dermatology, Reference Center for Rare Skin Diseases MAGEC, Saint Louis Hospital AP-HP, F-75010 Paris, France;
| | - Gaël Nicolas
- Department of Genetics, FHU G4 Génomique, Normandie University, UNIROUEN, CHU Rouen, Inserm U1245, F-76000 Rouen, France;
| | - Juliette Mazereeuw-Hautier
- Département de Dermatologie, Centre de Référence des Maladies Rares de la Peau, CHU de Toulouse, F-31000 Toulouse, France;
| | - Arnaud Jannic
- Département de Dermatologie, AP-HP and UPEC, Hôpital Henri-Mondor, F-94000 Créteil, France; (A.J.); (S.F.); (P.W.)
| | - Salah Ferkal
- Département de Dermatologie, AP-HP and UPEC, Hôpital Henri-Mondor, F-94000 Créteil, France; (A.J.); (S.F.); (P.W.)
- INSERM, Centre d’Investigation Clinique 1430, F-94000 Créteil, France
| | - Béatrice Parfait
- Service de Génétique et Biologie Moléculaires, Hôpital Cochin, DMU BioPhyGen, Assistance Publique-Hôpitaux de Paris, AP-HP, Centre-Université de Paris, F-75014 Paris, France; (L.P.); (D.V.); (A.B.-S.); (A.C.); (T.M.); (C.B.); (B.P.); (M.V.)
- Inserm U1016—CNRS UMR8104, Institut Cochin, Université de Paris, CARPEM, F-75014 Paris, France;
| | - Michel Vidaud
- Service de Génétique et Biologie Moléculaires, Hôpital Cochin, DMU BioPhyGen, Assistance Publique-Hôpitaux de Paris, AP-HP, Centre-Université de Paris, F-75014 Paris, France; (L.P.); (D.V.); (A.B.-S.); (A.C.); (T.M.); (C.B.); (B.P.); (M.V.)
- Inserm U1016—CNRS UMR8104, Institut Cochin, Université de Paris, CARPEM, F-75014 Paris, France;
| | | | - Pierre Wolkenstein
- Département de Dermatologie, AP-HP and UPEC, Hôpital Henri-Mondor, F-94000 Créteil, France; (A.J.); (S.F.); (P.W.)
| | - Eric Pasmant
- Service de Génétique et Biologie Moléculaires, Hôpital Cochin, DMU BioPhyGen, Assistance Publique-Hôpitaux de Paris, AP-HP, Centre-Université de Paris, F-75014 Paris, France; (L.P.); (D.V.); (A.B.-S.); (A.C.); (T.M.); (C.B.); (B.P.); (M.V.)
- Inserm U1016—CNRS UMR8104, Institut Cochin, Université de Paris, CARPEM, F-75014 Paris, France;
- Correspondence:
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15
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Scala M, Schiavetti I, Madia F, Chelleri C, Piccolo G, Accogli A, Riva A, Salpietro V, Bocciardi R, Morcaldi G, Di Duca M, Caroli F, Verrico A, Milanaccio C, Viglizzo G, Traverso M, Baldassari S, Scudieri P, Iacomino M, Piatelli G, Minetti C, Striano P, Garrè ML, De Marco P, Diana MC, Capra V, Pavanello M, Zara F. Genotype-Phenotype Correlations in Neurofibromatosis Type 1: A Single-Center Cohort Study. Cancers (Basel) 2021; 13:cancers13081879. [PMID: 33919865 PMCID: PMC8070780 DOI: 10.3390/cancers13081879] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Neurofibromatosis type 1 (NF1) is a complex disorder characterized by a multisystem involvement and cancer predisposition. It is caused by genetic variants in NF1, a large tumor suppressor gene encoding a cytoplasmatic protein (neurofibromin) with a regulatory role in essential cellular processes. Genotype–phenotype correlations in NF1 patients are so far elusive. We retrospectively reviewed clinical, radiological, and genetic data of 583 individuals with at least 1 National Institutes of Health (NIH) criterion for NF1 diagnosis, including 365 subjects fulfilling criteria for the diagnosis. Novel genotype–phenotype correlations were identified through uni- and multivariate statistical analysis. Missense variants negatively correlated with neurofibromas. Skeletal abnormalities were associated with frameshift variants and whole gene deletions. The c.3721C>T; p.(R1241*) variant positively correlated with structural brain alterations, whereas the c.6855C>A; p.(Y2285*) variant was associated with a higher prevalence of Lisch nodules and endocrinological disorders. These novel NF1 genotype–phenotype correlations may have a relevant role in the implementation of patients’ care. Abstract Neurofibromatosis type 1 (NF1) is a proteiform genetic condition caused by pathogenic variants in NF1 and characterized by a heterogeneous phenotypic presentation. Relevant genotype–phenotype correlations have recently emerged, but only few pertinent studies are available. We retrospectively reviewed clinical, instrumental, and genetic data from a cohort of 583 individuals meeting at least 1 diagnostic National Institutes of Health (NIH) criterion for NF1. Of these, 365 subjects fulfilled ≥2 NIH criteria, including 235 pediatric patients. Genetic testing was performed through cDNA-based sequencing, Next Generation Sequencing (NGS), and Multiplex Ligation-dependent Probe Amplification (MLPA). Uni- and multivariate statistical analysis was used to investigate genotype–phenotype correlations. Among patients fulfilling ≥ 2 NIH criteria, causative single nucleotide variants (SNVs) and copy number variations (CNVs) were detected in 267/365 (73.2%) and 20/365 (5.5%) cases. Missense variants negatively correlated with neurofibromas (p = 0.005). Skeletal abnormalities were associated with whole gene deletions (p = 0.05) and frameshift variants (p = 0.006). The c.3721C>T; p.(R1241*) variant positively correlated with structural brain alterations (p = 0.031), whereas Lisch nodules (p = 0.05) and endocrinological disorders (p = 0.043) were associated with the c.6855C>A; p.(Y2285*) variant. We identified novel NF1 genotype–phenotype correlations and provided an overview of known associations, supporting their potential relevance in the implementation of patient management.
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Affiliation(s)
- Marcello Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, 16132 Genoa, Italy;
| | - Francesca Madia
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Cristina Chelleri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Gianluca Piccolo
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Andrea Accogli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
| | - Antonella Riva
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Vincenzo Salpietro
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Renata Bocciardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Guido Morcaldi
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Marco Di Duca
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Francesco Caroli
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Antonio Verrico
- Neuro-Oncology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.V.); (C.M.); (M.L.G.)
| | - Claudia Milanaccio
- Neuro-Oncology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.V.); (C.M.); (M.L.G.)
| | | | - Monica Traverso
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Simona Baldassari
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Paolo Scudieri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Michele Iacomino
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Gianluca Piatelli
- Neurosurgery Department, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy;
| | - Carlo Minetti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Maria Luisa Garrè
- Neuro-Oncology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.V.); (C.M.); (M.L.G.)
| | - Patrizia De Marco
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Maria Cristina Diana
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Valeria Capra
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Marco Pavanello
- Neurosurgery Department, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy;
- Correspondence:
| | - Federico Zara
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
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16
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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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