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Birch P, Beauchesne R, Bansback N, Boelman C, Connolly M, Demos M, Friedman JM, Race S, Stockler S, Elliott AM, Adam S. Where there is no genetic counselor: An online decision-aid supports the majority of parents' diagnostic genomic testing choices for their children. Genet Med 2024; 26:101173. [PMID: 38828700 DOI: 10.1016/j.gim.2024.101173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024] Open
Abstract
PURPOSE We evaluated DECIDE, an online pretest decision-support tool for diagnostic genomic testing, in nongenetics specialty clinics where there are no genetic counselors (GCs). METHODS Families of children offered genomic testing were eligible to participate. Fifty-six parents/guardians completed DECIDE at home, at their convenience. DECIDE includes an integrated knowledge quiz and decisional conflict screen. Six months later, parents were offered follow-up questionnaires and interviews about their experiences. RESULTS Forty parents (71%) had sufficient knowledge and no decisional conflict surrounding their testing decision, but 6 of this group had residual questions. These 6, plus 16 with decisional conflict or insufficient knowledge, saw a GC. At follow-up, little-to-no decisional regret and few negative emotions were identified in any parents. Most chose testing and described their decision as easy, yet stressful, and described many motivations for sequencing. Parents appreciated the simple comprehensive information DECIDE provided and the ability to view it in a low-stress environment. CONCLUSION DECIDE provides adequate decision-support to enable most parents to make value-consistent choices about genetic testing for their child. Parents reported that DECIDE helped to clarify motivations for pursuing (or declining) testing. DECIDE is a timely, well-tested, and accessible tool in clinical settings without GCs.
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Affiliation(s)
- Patricia Birch
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Rhea Beauchesne
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Cyrus Boelman
- BC Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Mary Connolly
- BC Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Demos
- BC Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Simone Race
- BC Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Biochemical Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sylvia Stockler
- BC Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Biochemical Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Alison M Elliott
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada; British Columbia Women's Hospital Research Institute, Vancouver, BC, Canada
| | - Shelin Adam
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada.
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Ayar D, Bektas M, Ünalp A, Yılmaz Ü, Kos FM, Okur TD, Kırkgöz HH, Yanar S. The effect of illness-related fears of parents of children with epilepsy during the COVID-19 period on their children's seizure self-efficacy. Arch Pediatr 2024; 31:326-332. [PMID: 38853083 DOI: 10.1016/j.arcped.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/08/2024] [Accepted: 02/03/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Seizure-related self-efficacy is the belief individuals have that they can perform the necessary actions to cope effectively with their seizures. Determining, developing, strengthening, and maintaining the perception of self-efficacy in children with epilepsy facilitates the child's disease management and their ability to cope with it. This study aimed to assess the impact of epilepsy-related parental fears during the COVID-19 period on the seizure self-efficacy of their children. METHODS A total of 321 children with epilepsy and their parents participated in this descriptive, correlational, and cross-sectional study. Data were collected through the Descriptive Information Form, the Seizure Self-Efficacy Scale for Children (SSES-C), and the Epilepsy-Related Fears in Parents Questionnaire (EFPQ). Descriptive statistics, including frequency, percentage, and mean scores, were used to analyze the characteristics of the children and their parents. The Shapiro-Wilk test was utilized to assess the normality of the scale data. Pearson correlation analysis examined the relationship between parents' epilepsy-related fears and their children's seizure self-efficacy, while multiple regression analysis determined the effect of parental fears on children's seizure self-efficacy. RESULTS The mean age of children included in the study was 12.65±2.37 years. Analysis revealed a strong and significant negative correlation between parents' epilepsy-related fears during the COVID-19 period and the seizure self-efficacy of their children. In the model created with regression analysis, The mean scores of parents on the short-term fears of parents about epilepsy of the EFPQ explained 85 % of children's seizure self-efficacy. The mean scores of parents on the long-term fears of parents about epilepsy of the EFPQ explained 85 % of children's seizure self-efficacy. It was determined that all of these variables together explained 85 % of the seizure self-efficacy of children with epilepsy. CONCLUSION The findings of the study underscore the importance of addressing parents' fears regarding epilepsy, emphasizing the need for healthcare professionals to be aware of and provide support for these concerns. Future studies should focus on interventions to enhance the seizure self-efficacy of children with epilepsy.
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Affiliation(s)
- Dijle Ayar
- Alanya Alaaddin Keykubat University Faculty of Health Science, Pediatric Nursing Department, Alanya, Turkey.
| | - Murat Bektas
- Dokuz Eylul University Faculty of Nursing, Pediatric Nursing Department, Izmir, Turkey
| | - Aycan Ünalp
- University of Health Sciences Turkey, Izmir Faculty of Medicine, Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Ünsal Yılmaz
- University of Health Sciences Turkey, Izmir Faculty of Medicine, Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Fulya Merve Kos
- Bilecik Şeyh Edebali University Faculty of Health Science, Bilecik, Turkey
| | - Tuncay Derya Okur
- University of Health Sciences Turkey, Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Hatice Hilal Kırkgöz
- University of Health Sciences Turkey, Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Saliha Yanar
- University of Health Sciences Turkey, Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
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Di Carlo C, Mighton C, Clausen M, Joshi E, Casalino S, Kim THM, Kowal C, Birken C, Maguire J, Bombard Y. Parents' attitudes towards research involving genome sequencing of their healthy children: a qualitative study. Eur J Hum Genet 2024; 32:171-175. [PMID: 37864046 PMCID: PMC10853502 DOI: 10.1038/s41431-023-01476-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/28/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023] Open
Abstract
With widespread genomic sequencing research efforts, there is increasing impetus to return results to participants. Parents of healthy children are increasingly asked to participate in genomic research, yet there are limited studies of parental expectations for the return of results amongst healthy children. We explored parental attitudes towards their healthy children's participation in genomic research and expectations for return of results. Data collection involved semi-structured telephone interviews with parents of healthy children participating in a primary care research network. Transcripts were analyzed thematically using constant comparison. A total of 26 parents were interviewed: 22 were female, 19 self-reported as White/European, and 20 were aged 30-39. Three themes emerged: (1) Reciprocity; Parents preferred to receive medically actionable, childhood-onset results and expected recontact overtime in exchange for their research participation. (2) Downstream impacts of testing; Parents expected future clinical benefits but were concerned about the risk of genetic discrimination. (3) Power and empowerment; Some parents felt empowered to take preventative action for their child and relatives, while others did not want to limit their child's autonomy. Considering these tensions may help to inform participant-centered approaches to optimize parental decision-making and participation, as well as maximize the utility of results.
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Affiliation(s)
- Christina Di Carlo
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
| | - Chloe Mighton
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Marc Clausen
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Esha Joshi
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Selina Casalino
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Theresa H M Kim
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Catherine Birken
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Jonathon Maguire
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Yvonne Bombard
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
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Addona C, Hurlimann T, Jaitovich-Groisman I, Godard B. Experiences of adults living with refractory epilepsy and their views and expectations on receiving results from whole genome sequencing. Epilepsy Res 2023; 196:107221. [PMID: 37696194 DOI: 10.1016/j.eplepsyres.2023.107221] [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: 03/21/2023] [Revised: 08/15/2023] [Accepted: 09/07/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Researchers, clinicians and patients are turning to new innovations in research and clinical practice to further their knowledge in the genetic domain and improve diagnostics or treatment. However, with increased knowledge in genetics, societal issues may arise. Being conscious of these issues is crucial in order to implement standardized and efficient testing on a wider scale that is accessible to a greater number of individuals while simultaneously returning test results, including incidental findings, in a timely manner. METHODS Within the framework of a genomics research project, we invited 20 participants who suffer from refractory epilepsy to provide insight on their personal experiences with epilepsy, as well as their thoughts on receiving Whole Genome Sequencing (WGS) results and with whom they would feel comfortable sharing these results with. RESULTS All participants had their own unique experience with epilepsy, such as how they handled their diagnosis, their struggles following the diagnosis, the healthcare services they received, how they shared their diagnosis with others, and how they managed stigmatization from others. Most participants would be eager to know their WGS results, whether the results be related to epilepsy (n = 19), response to pharmaceutical drugs including AEDs (n = 16), comorbidities (n = 19) and incidental findings (n = 15). CONCLUSION Our findings reinforce the need to improve access to genetic testing for epilepsy patients in clinical settings. Furthermore, while acquiring more genetic knowledge (i.e. WGS) about epilepsy can provide answers for the affected population, it also requires the simultaneous involvement of several medical disciplines, with greater emphasis on genetic and psychological counseling.
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Affiliation(s)
- Cynthia Addona
- Université de Montréal, PO Box 6128, Station Centre-ville, Montréal, QC H3C 3J7, Canada
| | - Thierry Hurlimann
- Université de Montréal, PO Box 6128, Station Centre-ville, Montréal, QC H3C 3J7, Canada
| | | | - Beatrice Godard
- Université de Montréal, PO Box 6128, Station Centre-ville, Montréal, QC H3C 3J7, Canada.
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5
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Tian AC, Graesser EA, Tarkunde Y, Frantz L, Wall LB. Caregiver Versus Surgeon Concerns in New Diagnosis of Congenital Hand and Upper Extremity Anomalies. J Hand Surg Am 2023; 48:896-903. [PMID: 37516940 DOI: 10.1016/j.jhsa.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/23/2023] [Accepted: 05/22/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE The initial office visit can be a stressful time for families with children with congenital upper extremity differences. These families may have concerns that differ from the information that pediatric hand surgeons believe is important to discuss. The purpose of this study was to compare topics that families and surgeons believe are most important to address at the initial office visits to better inform and guide that visit. METHODS Qualitative interviews were conducted with 15 pediatric hand surgeons and 17 caregivers of children with congenital upper extremity differences. Interviews were conducted using semi-structured guides. Interviews were recorded, transcribed, and analyzed using thematic analysis to identify recurring themes from both study groups. RESULTS Overarching themes were similar between the groups and included diagnosis/cause, treatment, psychosocial considerations, future outcomes, and further resources. However, emphasis among these themes differed, with surgeons emphasizing the cause and events leading up to the diagnosis and caregivers preferring to discuss next steps and treatment options. Surgeons also discussed feelings of grief or guilt more commonly than the caregivers. CONCLUSIONS Although surgeons emphasize the cause and psychosocial impact of a newly diagnosed congenital upper extremity difference at the initial office visit, caregivers mostly focused on the future and next steps that can be taken. CLINICAL RELEVANCE Surgeons should ensure to address these issues so that families are comfortable with the treating surgeon and believe that their concerns are being adequately addressed.
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Affiliation(s)
- Andrea C Tian
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO.
| | - Elizabeth A Graesser
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Yash Tarkunde
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Lisa Frantz
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
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6
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Gereis J, Hetherington K, Ha L, Robertson EG, Ziegler DS, Barlow-Stewart K, Tucker KM, Marron JM, Wakefield CE. Parents' understanding of genome and exome sequencing for pediatric health conditions: a systematic review. Eur J Hum Genet 2022; 30:1216-1225. [PMID: 35999452 PMCID: PMC9626631 DOI: 10.1038/s41431-022-01170-2] [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] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Genome and exome sequencing (GS/ES) are increasingly being used in pediatric contexts. We summarize evidence regarding the actual and perceived understanding of GS/ES of parents of a child offered testing for diagnosis and/or management of a symptomatic health condition. We searched four databases (2008-2021) and identified 1264 unique articles, of which 16 met inclusion criteria. We synthesized data from qualitative and quantitative studies and organized results using Ayuso et al. (2013)'s framework of key elements of information for informed consent to GS/ES. Many of the parents represented had prior experience with genetic testing and accessed a form of genetic counseling. Parents' understanding was varied across the domains evaluated. Parents demonstrated understanding of the various potential direct clinical benefits to their child undergoing GS/ES, including in relation to other genetic tests. We found parents had mixed understanding of the nature of potential secondary findings, and of issues related to data privacy, confidentiality, and usage of sequencing results beyond their child's clinical care. Genetic counseling consultations improved understanding. Our synthesis indicates that ES/GS can be challenging for families to understand and underscores the importance of equipping healthcare professionals to explore parents' understanding of ES/GS and the implications of testing for their child.
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Affiliation(s)
- Jessica Gereis
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
| | - Kate Hetherington
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
| | - Lauren Ha
- grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432School of Health Sciences, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - Eden G. Robertson
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - David S. Ziegler
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, UNSW Sydney, Sydney, NSW Australia
| | - Kristine Barlow-Stewart
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, UNSW Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XNorthern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Katherine M. Tucker
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - Jonathan M. Marron
- grid.65499.370000 0001 2106 9910Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA USA ,grid.2515.30000 0004 0378 8438Division of Hematology/Oncology, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XCenter for Bioethics, Harvard Medical School, Boston, MA USA
| | - Claire E. Wakefield
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
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Syrbe S. Developmental and epileptic encephalopathies - therapeutic consequences of genetic testing. MED GENET-BERLIN 2022; 34:215-224. [PMID: 38835873 PMCID: PMC11006352 DOI: 10.1515/medgen-2022-2145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Developmental and epileptic encephalopathies comprise a heterogeneous group of monogenic neurodevelopmental disorders characterized by early-onset seizures, marked epileptic activity and abnormal neurocognitive development. The identification of an increasing number of underlying genetic alterations and their pathophysiological roles in cellular signaling drives the way toward novel precision therapies. The implementation of novel treatments that target the underlying mechanisms gives hope for disease modification that will improve not only the seizure burden but also the neurodevelopmental outcome of affected children. So far, beneficial effects are mostly reported in individual trials and small numbers of patients. There is a need for international collaborative studies to define the natural history and relevant outcome measures and to test novel pharmacological approaches.
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Affiliation(s)
- Steffen Syrbe
- Division of Paediatric Epileptology, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
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Alam A, Parfyonov M, Huang CY, Gill I, Connolly MB, Illes J. Targeted Whole Exome Sequencing in Children With Early-Onset Epilepsy: Parent Experiences. J Child Neurol 2022; 37:840-850. [PMID: 35921196 PMCID: PMC9554160 DOI: 10.1177/08830738221113901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study investigated the experiences of 25 caregivers of children with early-onset, treatment-resistant epilepsy who pursued whole exome sequencing to determine the impact of the test results on their child's treatment. Caregivers who consented to be recontacted were recruited from a previous study investigating the diagnostic yield of whole exome sequencing. A semistructured interview addressed questions based on one of 2 study phases. The first phase discussed the decision-making process for genetic testing (15 interviews), which revealed 4 major themes: (1) prognosis, (2) engagement, (3) concerns, and (4) autonomy. The second phase discussed the impact of genetic testing on treatment (10 interviews), which revealed 3 major themes: (1) testing features, (2) emotional impact, and (3) treatment outcomes. Overall, parents pursued genetic testing to obtain a clear prognosis, inform treatment decisions, engage with other families, and exercise autonomy. Caregivers felt that early testing is warranted to inform their child's diagnostic odyssey.
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Affiliation(s)
- Armaghan Alam
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maksim Parfyonov
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Department of Pediatrics, Division of Neurology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Camille Y. Huang
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Inderpal Gill
- Department of Pediatrics, Division of Neurology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Mary B. Connolly
- Department of Pediatrics, Division of Neurology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Judy Illes, CM, PhD, Professor of Neurology, Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Koerner S124, Vancouver, BC V6T 2B5 Canada.
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9
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Syrbe S. Präzisionsmedizin für genetische Epilepsien – am Anfang des Weges? ZEITSCHRIFT FÜR EPILEPTOLOGIE 2021. [DOI: 10.1007/s10309-021-00409-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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10
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Cogsil T, Kim DJ, Morris M, Goldfarb CA, Wall LB. Congenital Upper-Extremity Differences: A Thematic Analysis of On-Line Discussion Boards. J Hand Surg Am 2021; 46:337.e1-337.e10. [PMID: 33023778 DOI: 10.1016/j.jhsa.2020.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/08/2020] [Accepted: 08/05/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE On-line discussion boards (DBs) are used by patients and family members to pose questions and share experiences with a broader community. Systematic analysis of the text posted to DBs about congenital upper-extremity (UE) differences may allow physicians to identify and address patients' questions and concerns better. METHODS We used Google and Yahoo! Internet search engines to identify on-line DBs pertaining to congenital UE differences. Posts written between January 1, 2009 and January 1, 2019 were collected and analyzed. Each on-line post was coded by 2 researchers using 3 rounds of grounded theory: open coding, axial coding, and selective coding. This allowed comprehensive, central themes of the DBs to emerge. RESULTS We collected 521 posts and analyzed 420 posts from 152 threads. A total of 163 unique users contributed to posts. Parents of a child with a congenital UE difference accounted for the majority of users (65%), most of which were postnatal (91%). Of posts written by patients, 48% expressed negative emotions pertaining to their difference, whereas 17% conveyed a positive experience. Five selective codes were identified from posts written by non-administrators: (1) Connecting With Others, (2) Emotional Aspects, (3) Treatment, (4) Diagnosis, and (5) Function. Connecting With Others was the most frequently assigned selective code; users were looking to establish a connection in 73% of posts. Posts seeking information (n = 106) were more often technical in nature than were posts providing information (54% vs 44%). Posts providing information (n = 206) were more often emotional (18% vs 13%). CONCLUSIONS Individuals accessing on-line DBs are commonly searching for technical and emotional support from others. Through analysis and identification of the themes from these posts, we believe physicians should be proactive in addressing technical concerns through education and counseling, but should also validate emotional concerns and assist families and patients via support groups or connections to others. CLINICAL RELEVANCE Treating surgeons can improve their care of patients with congenital UE differences by better understanding the needs of patients and their families that may not be elucidated in a traditional patient encounter.
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Affiliation(s)
- Taylor Cogsil
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Dongyeon J Kim
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Marie Morris
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO.
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Abstract
Because of next-generation sequencing and the discovery of many new causative genes, genetic testing in epilepsy patients has become widespread. Pathologic variants resulting in epilepsy cause a variety of changes that can be broadly classified into syndromic disorders (i.e., chromosomal abnormalities), metabolic disorders, brain malformations, and abnormal cellular signaling. Here, we review the available genetic testing, reasons to pursue genetic testing, common genetic causes of epilepsy, the data behind what patients are found to have genetic epilepsies based on current testing, and discussing these results with patients. We propose an algorithm for testing patients with epilepsy to maximize yield and limit costs based on their phenotype (including electroencephalography and magnetic resonance imaging findings), age of seizure onset, and presence of other neurologic comorbidities. Being able to discern which type of genetic testing to order, using that information to give targeted and cost-effective patient care, and interpreting results accurately will be a crucial skill for the modern neurologist.
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Affiliation(s)
- David M Ritter
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Katherine Holland
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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12
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Symonds JD, McTague A. Epilepsy and developmental disorders: Next generation sequencing in the clinic. Eur J Paediatr Neurol 2020; 24:15-23. [PMID: 31882278 DOI: 10.1016/j.ejpn.2019.12.008] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/06/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND The advent of Next Generation Sequencing (NGS) has led to a redefining of the genetic landscape of the epilepsies. Hundreds of single gene epilepsies have been described. Genes associated with epilepsy involve diverse processes. Now a substantial proportion of individuals with epilepsy can receive a high definition molecular genetic diagnosis. METHODS In this review we update the current genetic landscape of the epilepsies and categorise the major functional groupings of epilepsy-associated genes. We describe currently available genetic testing approaches. We perform a literature review of NGS studies and review the factors which determine yield in cohorts undergoing testing. We identify factors associated with positive genetic diagnosis and consider the utility of genetic testing in terms of treatment selection as well as more qualitative aspects of care. FINDINGS Epilepsy-associated genes can be grouped into five broad functional categories: ion transport; cell growth and differentiation; regulation of synaptic processes; transport and metabolism of small molecules within and between cells; and regulation of gene transcription and translation. Early onset of seizures, drug-resistance, and developmental comorbidity are associated with higher diagnostic yield. The most commonly implicated genes in NGS studies to date, in order, are SCN1A, KCNQ2, CDKL5, SCN2A, and STXBP1. In unselected infantile cohorts PRRT2, a gene associated with self-limited epilepsy, is frequently implicated. Genetic diagnosis provides utility in terms of treatment choice closing the diagnostic odyssey, avoiding unnecessary further testing, and informing future reproductive decisions. CONCLUSIONS Genetic testing has become a first line test in epilepsy. As techniques improve and understanding advances, its utility is set to increase. Genetic diagnosis, particularly in early onset developmental and epileptic encephalopathies, influences treatment choice in a significant proportion of patients. The realistic prospect of gene therapy is a cause for optimism.
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Affiliation(s)
- Joseph D Symonds
- Paediatric Neuroscience Research Group, Royal Hospital for Children, Glasgow, G51 4TF, UK; Medical Veterinary and Life Sciences, University of Glasgow, G12 8QQ, UK.
| | - Amy McTague
- Institute of Child Health, University Collge London, 30 Guilford St, Holborn, London WC1N 1EH, UK
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O'Toole S, Gallagher P, Benson A, Shahwan A, Austin JK, Lambert V. Exploring the relationship between parent-child communication about epilepsy and psychosocial well-being. J Health Psychol 2019; 26:1207-1221. [PMID: 31448626 DOI: 10.1177/1359105319871642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This study examined the relationship between parent-child communication and psychosocial well-being of 47 children living with epilepsy and 72 parents of children living with epilepsy. Open communication was associated with positive illness attitude, positive self-perception and greater health-related quality of life for children living with epilepsy; positive response to illness for parents; and more perceived social support and less need for epilepsy-related support for children living with epilepsy and parents. By contrast, closed communication was associated with poorer psychosocial well-being in children living with epilepsy and parents. Healthcare professionals should provide guidance for families living with childhood epilepsy on the importance of open communication in promoting greater psychosocial well-being.
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Affiliation(s)
| | | | | | - Amre Shahwan
- Children's Health Ireland at Temple Street, Ireland
| | - Joan K Austin
- Indiana University-Purdue University Indianapolis, USA
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