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Kallionpää RA, Johansson E, Böckerman P, Peltonen J, Peltonen S. The contribution of morbidity and unemployment for the reduced labor market participation of individuals with neurofibromatosis 1 in Finland. Eur J Hum Genet 2024; 32:83-90. [PMID: 37460655 PMCID: PMC10772102 DOI: 10.1038/s41431-023-01426-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 01/09/2024] Open
Abstract
Neurofibromatosis 1 (NF1) is a multisystem disorder associated with, for example, a high risk for cancer, a variety of behavioral and cognitive deficits, low educational attainment and decreased income. We now examined the labor market participation of individuals with NF1. We analyzed the numbers of days of work, unemployment, and sickness allowance among 742 Finnish individuals with NF1 aged 20-59 years using nationwide register data from Statistics Finland and the Social Insurance Institution of Finland. The individuals with NF1 were compared with a control cohort of 8716 individuals matched with age, sex, and the area of residence. Individuals with NF1 had a significantly lower number of working days per year than the controls (rate ratio [RR] 0.93, 95% CI 0.91-0.95). Unemployment (RR 1.79, 95% CI 1.58-2.02), and sickness absence (RR 1.44, 95% CI 1.25-1.67) were more frequent in the NF1 than in the control group. The causes of sickness allowances were highly concordant with the previously reported morbidity profile of NF1 including neoplasms, cardiovascular disease, mental and behavioral diseases, and neurological diseases. In conclusion, NF1 significantly interferes with labor market participation via both unemployment and morbidity. Unemployment seems to cause more days of not working than sickness absence.
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Affiliation(s)
- Roope A Kallionpää
- Cancer Research Unit and FICAN West Cancer Centre, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Edvard Johansson
- Faculty of Social Sciences, Business, and Economics, Åbo Akademi University, Turku, Finland
| | - Petri Böckerman
- Jyväskylä University School of Business and Economics, Jyväskylä, Finland
- Labour Institute for Economic Research LABORE, Helsinki, Finland
- IZA Institute of Labor Economics, Bonn, Germany
| | - Juha Peltonen
- Cancer Research Unit and FICAN West Cancer Centre, Institute of Biomedicine, 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
- Department of Dermatology and Allergology, University of Helsinki, Helsinki, Finland
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
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2
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Kenborg L, Frederiksen LE, Galanakis M, Doser K, Nielsen TT, Doherty MA, Hove H, Østergaard JR, Handrup MM, Ejerskov C, Mulvihill JJ, Winther JF. Employment, occupation, and income in adults with neurofibromatosis 1 in Denmark: a population- and register-based cohort study. Orphanet J Rare Dis 2023; 18:346. [PMID: 37932779 PMCID: PMC10629102 DOI: 10.1186/s13023-023-02965-2] [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: 09/21/2022] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Little is known about employment status, occupation, and disposable income in adults with NF1. METHODS From the Danish National Patient Registry and database of two national Centers for Rare Diseases, we identified 1469 adults with NF1, who were matched to 11,991 randomly selected population comparisons on sex and birth year and month. Annual information on employment, occupation and disposable income was ascertained from national registries in 1980-2019. RESULTS Adults with NF1 had a lower odds ratio (OR) for employment [OR 0.71, 95% confidence interval (CI) 0.61-0.83] and higher OR for health-related unemployment (OR 2.94, 95% CI 2.16-3.96) at age 30 years than population comparisons, which persisted at age 40 and 50 years. Somatic diagnoses were associated with a higher OR for health-related unemployment in adults with NF1 than in the population comparisons. Adults with NF1 had a slightly lower disposable income, with a 14% (0.82-0.89) reduction observed among the youngest birth cohort. Furthermore, adults with NF1 were less likely to be in a high skilled occupation at ages 30, 40 and 50 years. CONCLUSION Adults with NF1 have a lower employment rate, which was mainly due to health-related reasons and a slightly lower disposable income than adults without NF1. Thus, anticipation guidance for employment should be part of the management of NF1 families.
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Affiliation(s)
- Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Line E Frederiksen
- Childhood Cancer Research Group, Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Michael Galanakis
- Statistics and Data Analysis, Danish Cancer Institute, Copenhagen, Denmark
| | - Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Thomas T Nielsen
- Childhood Cancer Research Group, Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Mia Aagaard Doherty
- Childhood Cancer Research Group, Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Hanne Hove
- Department of Pediatrics, Center for Rare Diseases, University Hospital at Rigshospitalet, Copenhagen, Denmark
- The RAREDIS Database, Center for Rare Diseases, Copenhagen University Hospital and Aarhus University Hospital, Copenhagen, Denmark
| | - John R Østergaard
- Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Mette M Handrup
- Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Cecilie Ejerskov
- Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Oklahoma City, OK, USA
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
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3
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Kenborg L, Ebbehoj A, Ejerskov C, Handrup MM, Østergaard JR, Hove H, Doser K, Krøyer A, Mulvihill JJ, Winther JF, Stochholm K. Endocrine morbidity in neurofibromatosis 1: a nationwide, register-based cohort study. Eur J Endocrinol 2023; 189:190-198. [PMID: 37542520 DOI: 10.1093/ejendo/lvad101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/30/2023] [Accepted: 07/17/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Previous studies have found that neurofibromatosis 1 (NF1) is associated with an increased risk for endocrine disorders, but no comprehensive overview of the risk for specific endocrine disorders has been published. We assessed endocrine morbidity in individuals with NF1 from information on hospital admissions, surgery for endocrine disorders, and relevant medication. DESIGN A nationwide population registry-based cohort study. METHODS We identified 2467 individuals with NF1 diagnosed between 1977 and 2013 from the Danish National Patient Register and the RAREDIS database and 20 132 randomly sampled age- and sex-matched population comparisons. Information on endocrine diseases was identified using registrations of discharge diagnoses, surgery, and medication prescriptions. The rates of endocrine disorders in individuals with NF1 were compared with those in the comparison cohort in Cox proportional hazard models. RESULTS Individuals with NF1 had a higher rate than the comparison group of any endocrine discharge diagnosis (hazard ratio [HR] 1.72, 95% confidence interval [CI]: 1.58-1.87), endocrine-related surgery (2.03, 1.39-2.96), and prescribed medications (1.32, 1.23-1.42). Increased HRs were observed for diseases and surgical operations of several glands, including pheochromocytoma, and for osteoporosis, and osteoporotic fractures. Decreased rates were observed with drugs for type 2 diabetes. Women with NF1 had higher HRs for surgery of the ovaries, uterus, and sterilization, but lower rates of surgeries of cervix and prescriptions for birth control pills. CONCLUSIONS Neurofibromatosis 1 is associated with a variety of endocrine disorders, surgery, and medication related to endocrine disease. Awareness of endocrine morbidity is important in the clinical follow-up of individuals with NF1.
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Affiliation(s)
- Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen E, Denmark
| | - Andreas Ebbehoj
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Cecilie Ejerskov
- Centre for Rare Diseases, Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Mette Møller Handrup
- Centre for Rare Diseases, Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - John R Østergaard
- Centre for Rare Diseases, Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Hanne Hove
- The RAREDIS Database, Centre for Rare Diseases, Department of Paediatrics, Copenhagen University Hospital, 2100 Copenhagen E, Denmark
- Centre for Rare Diseases, Department of Paediatrics, Rigshospitalet, 2100 Copenhagen E, Denmark
| | - Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen E, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen E, Denmark
| | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Norman, OK 73019-3073, United States
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen E, Denmark
- Faculty of Health, Department of Clinical Medicine, Aarhus University and University Hospital, 8200 Aarhus N, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
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4
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Jahanshahi R, Yasaghi Z, Mirzaei F, Ghasemi S, Sanagoo A, Jouybari L, Foji S. Burden of adult neurofibromatosis 1 questionnaire: translation and psychometric properties of the Persian version. Orphanet J Rare Dis 2023; 18:161. [PMID: 37353850 DOI: 10.1186/s13023-023-02681-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/02/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The notion of "burden" has taken a key place in the evaluation of care, particularly in the case of rare diseases. The aim of this study was to evaluate the psychometric properties of the burden of neurofibromatosis 1 questionnaire (BoN) and to determine the perceived disease burden. RESULTS The 15-item BoN was translated into Persian, and no items were removed based on content validity. The adequacy of the sample was acceptable (KMO = 0.902), and Bartlett's test of sphericity revealed statistically significant results (P < 0.001). Exploratory factor analysis revealed three factors. The reliability of the scale was good (Cronbach's alpha: 0.90), and the intraclass coefficient was 0.85. The severity of the burden of neurofibromatosis was moderate, and the total mean burden score was 33.12 ± 16.12. CONCLUSIONS The Persian version of the BoN is an acceptable tool in terms of structure and content, and it specifically assesses the practical aspects of daily activities for patients with neurofibromatosis.
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Affiliation(s)
- Reza Jahanshahi
- BSN, Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zahra Yasaghi
- Master of critical care nursing, school of nursing and midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Mirzaei
- DDS, Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Shohreh Ghasemi
- DDS, MSc of Oral Surgery, Adjunct Clinical, Department of Augusta University, GA, Augusta, USA
| | - Akram Sanagoo
- School of nursing and midwifery, Golestan University of Medical Sciences, Gorgan, Iran.
| | - Leila Jouybari
- School of nursing and midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Samira Foji
- School of Nursing and Midwifery, Sabzevar university of medical scinces, Sabzevar, Iran
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5
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Ejerskov C, Farholt S, Nielsen FSK, Berg I, Thomasen SB, Udupi A, Ågesen T, de Fine Licht S, Handrup MM. Clinical Characteristics and Management of Children and Adults with Neurofibromatosis Type 1 and Plexiform Neurofibromas in Denmark: A Nationwide Study. Oncol Ther 2023; 11:97-110. [PMID: 36454436 PMCID: PMC9935791 DOI: 10.1007/s40487-022-00213-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Plexiform neurofibromas (PN) are benign nerve sheath tumours that are a frequent and potentially debilitating complication in patients with neurofibromatosis type 1 (NF1). The objective of this study was to describe the natural history of PN in children, adolescents and adults with NF1. METHODS This was a nationwide, longitudinal cohort study of patients with NF1 under observation at the two national centres of NF1 expertise in Denmark between 2000 and 2020. Patient and clinical characteristics were documented from individual medical records. RESULTS A total of 1099 patients with NF1 were included. Overall, 12% (35/296) of paediatric patients and 21% (172/803) of adult patients had ≥ 1 large PN (≥ 3 cm). Approximately half of patients with a large PN had ≥ 1 symptomatic PN. The most frequent symptoms were pain, neurological deficits, cosmetic issues, disfigurement, compression, increased psychosocial burden and vision loss. Clinical evaluations of PN size were available for 40 PN in 34 paediatric patients and 191 PN in 159 adult patients with large PN. Surgery (complete resection or debulking) was performed in 38% (15/40) of PN in paediatric patients and 45% (86/191) in adult patients. In addition, 35% of PN in paediatric patients and 33% in adult patients were inoperable. In a subgroup analysis, the overall PN size increased 1.06-fold per year. Malignant peripheral nerve sheath tumours (MPNST) were diagnosed in 21 patients (two paediatric and 19 adult patients). CONCLUSIONS This study shows that PN are common, their size and prevalence increase with age, many are often inoperable and pain and other symptoms are frequently associated. The results highlight the severe sequelae and unmet need for alternatives to analgesia and surgery in patients with PN.
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Affiliation(s)
- Cecilie Ejerskov
- Centre for Rare Diseases, Paediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Stense Farholt
- Centre for Rare Diseases, Paediatric and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | | | - Ingunn Berg
- Centre for Rare Diseases, Paediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Stine Bogetofte Thomasen
- Centre for Rare Diseases, Paediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Aparna Udupi
- Biostatistical Advisory Service (BIAS), Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | | | - Mette Møller Handrup
- Centre for Rare Diseases, Paediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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6
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Doser K, Belmonte F, Andersen KK, Østergaard JR, Hove H, Handrup MM, Ejerskov C, Mulvihill JJ, Winther JF, Kenborg L. School performance of children with neurofibromatosis 1: a nationwide population-based study. Eur J Hum Genet 2022; 30:1405-1412. [PMID: 35859011 PMCID: PMC9712673 DOI: 10.1038/s41431-022-01149-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/24/2022] [Accepted: 07/04/2022] [Indexed: 11/09/2022] Open
Abstract
Children with neurofibromatosis 1 (NF1) may have a high burden of somatic disease and cognitive impairments, which can lead to poor academic performance. We evaluated school grades from exams ending mandatory schooling (usually around age 15 or 16 years) of children with NF1 in a population-based registry study using a within-school matched design. The study included 285 children with NF1 and 12,000 NF1-free peers who graduated from the same school and year during 2002-2015. We estimated overall and gender-specific grades by subject and compared the grades of children with NF1 with those of NF1-free peers in linear regression models. We also examined the effect of social and socioeconomic factors (immigration status and parental education, income and civil status) on grades and age at finalizing ninth grade. School grades varied considerably by socioeconomic stratum for all children; however, children with NF1 had lower grades by an average of 11-12% points in all subjects. In the adjusted models, children with NF1 had significantly lower grades than their NF1-free peers, with largest negative differences in grades observed for girls with NF1. Finally, children with NF1 were 0.2 (CI 0.1-0.2) years older than their peers on graduating from ninth grade, but only maternal educational modified the age at graduating. In conclusion, students with NF1 perform more poorly than their peers in all major school subjects. Gender had a strong effect on the association between NF1 and school grades; however, socioeconomic factors had a similar effect on grades for children with NF1 and their peers.
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Affiliation(s)
- Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Federica Belmonte
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Klaus Kaae Andersen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - John R Østergaard
- Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Hove
- The RAREDIS Database, Center for Rare Diseases, Copenhagen University Hospital and Aarhus University Hospital, Aarhus, Denmark
| | - Mette M Handrup
- Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Cecilie Ejerskov
- Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.
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7
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Doser K, Hove H, Østergaard JR, Bidstrup PE, Dalton SO, Handrup MM, Ejerskov C, Krøyer A, Doherty MA, Møllegaard Jepsen JR, Mulvihill JJ, Winther JF, Kenborg L. Cohort profile: life with neurofibromatosis 1 - the Danish NF1 cohort. BMJ Open 2022; 12:e065340. [PMID: 36127120 PMCID: PMC9490603 DOI: 10.1136/bmjopen-2022-065340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The Danish neurofibromatosis 1 (NF1) cohort was initiated to study health-related, socioeconomic and psychological consequences of living with the monogenetic disorder NF1 using a nationwide and population-based approach. PARTICIPANTS The cohort includes all 2467 individuals in Denmark who were hospitalised with or due to NF1 from 1977 to 2013 or registered in the RAREDIS Database (1995-2013), a national clinical database for rare diseases, or both. A comparison cohort matched to individuals with NF1 on sex and date of birth was identified in the Civil Registration System (n=20 132). FINDINGS TO DATE All cohort members were linked to the unique Danish registries to obtain information on hospital contacts, birth outcomes, education and partnership. A questionnaire was completed by 244 of the 629 adult cohort members with NF1 registered in the RAREDIS Database to evaluate the psychosocial and emotional burden. Further, neuropsychological tests were performed on 103 adult cohort members with NF1 and 38 adult population comparisons. To date, six studies have been published. Individuals with NF1 had an increased risk for (1) hospitalisation for disorders affecting all organ systems of the body throughout all decades of life, (2) psychiatric disorders, (3) attaining a short or medium long education and (4) not forming a life partner. Women with NF1 had an increased risk for spontaneous abortions and stillbirths. Finally, adults with NF1 had an impaired quality of life and a high need for professional support for physical, psychological and work-related problems, which was partly associated with disease severity and visibility. FUTURE PLANS The cohort will regularly be updated with newly diagnosed patients in the RAREDIS Database as well as with outcome information in the Danish registries. New studies are in progress to assess other medical and socioeconomic dimensions of living with NF1.
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Affiliation(s)
- Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Hanne Hove
- Center for Rare Diseases, Department of Pediatrics and Adolescents, Rigshospitalet, Copenhagen, Denmark
- The RAREDIS Database, Section of Rare Diseases, Department of Pediatrics and Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - John R Østergaard
- Centre for Rare Diseases, Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne O Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital Naestved, Naestved, UK
| | - Mette Møller Handrup
- Centre for Rare Diseases, Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Cecilie Ejerskov
- Centre for Rare Diseases, Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mia Aagaard Doherty
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention, Mental Health Services, Copenhagen University Hospital Glostrup, Glostrup, Denmark
- Child and Adolescent Mental Health Center, Mental Health Services, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
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8
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Kenborg L, Boschini C, Bidstrup PE, Dalton SO, Doser K, Nielsen TT, Krøyer A, Johansen C, Frederiksen K, Sørensen SA, Hove H, Østergaard JR, Mulvihill JJ, Winther JF. Pregnancy outcomes in women with neurofibromatosis 1: a Danish population-based cohort study. J Med Genet 2022; 59:237-242. [PMID: 33495305 DOI: 10.1136/jmedgenet-2020-107201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/21/2020] [Accepted: 12/21/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The probability of a pregnancy, live birth, stillbirth and abortion has never been assessed in women with neurofibromatosis 1 (NF1) in a large population-based study. METHODS We included 1006 women (15-49 years) registered with NF1 in the Danish National Patient Registry or followed in two national Centers for Rare Diseases and 10 020 women from the Danish population. Information on pregnancy outcomes was ascertained from health registries. Cumulative incidence, mean cumulative count, hazard ratios (HRs) and proportion ratios (PRs) with 95% CIs were calculated. RESULTS The cumulative incidence of a first pregnancy at age 50 years was slightly lower in women with NF1 (74%; 95% CI 70 to 77) than in population comparisons (78%; 95% CI 77 to 79). When all pregnancies were included, two pregnancies were expected per woman at age of 50 years, irrespective of a NF1 diagnosis. The hazard of a pregnancy did not differ between women with NF1 (HR 1.03; 95% CI 0.95 to 1.11) and the comparisons after adjustment for somatic and psychiatric disease. The proportion of pregnancies that resulted in a live birth was 63% (783/1252) among women NF1 and 68% (8432/12 465) among the comparisons, yielding a PR of 0.95 (95% CI 0.90 to 1.00). The proportions of stillbirths (PR 2.83; 95% CI 1.63 to 4.93) and spontaneous abortions (PR 1.40; 95% CI 1.09 to 1.79) were increased in women with NF1. CONCLUSIONS A similar hazard for pregnancy was observed for women with NF1 and population comparisons after adjustment for potential medical consequences of NF1. However, women with NF1 experienced more spontaneous abortions and stillbirths.
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Affiliation(s)
- Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Cristina Boschini
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne O Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Thomas T Nielsen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Sven Asger Sørensen
- Department of Neurogenetics, Institute of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Hove
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John R Østergaard
- Center for Rare Diseases, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Oklahoma City, OK, USA
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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9
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Riva M, Martorana D, Uliana V, Caleffi E, Boschi E, Garavelli L, Ponti G, Sangiorgi L, Graziano C, Bigoni S, Rocchetti LM, Madeo S, Soli F, Grosso E, Carli D, Goldoni M, Pisani F, Percesepe A. Recurrent NF1 gene variants and their genotype/phenotype correlations in patients with Neurofibromatosis type I. Genes Chromosomes Cancer 2021; 61:10-21. [PMID: 34427956 PMCID: PMC9291954 DOI: 10.1002/gcc.22997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/08/2022] Open
Abstract
Neurofibromatosis type I, a genetic condition due to pathogenic variants in the NF1 gene, is burdened by a high rate of complications, including neoplasms, which increase morbidity and mortality for the disease. We retrospectively re-evaluated the NF1 gene variants found in the period 2000-2019 and we studied for genotype/phenotype correlations of disease complications and neoplasms 34 variants, which were shared by at least two unrelated families (range 2-11) for a total 141 of probands and 21 relatives affected by Neurofibromatosis type I. Recurrent variants could be ascribed to the most common mutational mechanisms (C to T transition, microsatellite slippage, non-homologous recombination). In genotype/phenotype correlations, the variants p.Arg440*, p.Tyr489Cys, and p.Arg1947*, together with the gross gene deletions, displayed the highest rates of complications. When considering neoplasms, carriers of variants falling in the extradomain region at the 5' end of NF1 had a lower age-related cancer frequency than the rest of the gene sequence, showing a borderline significance (p = 0.045), which was not conserved after correction with covariates. We conclude that (1) hotspots in NF1 occur via different mutational mechanisms, (2) several variants are associated with high rates of complications and cancers, and (3) there is an initial evidence toward a lower cancer risk for carriers of variants in the 5' end of the NF1 gene although not significant at the multivariate analysis.
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Affiliation(s)
- Matteo Riva
- Medical Genetics, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | | | - Elena Boschi
- Plastic Surgery, University Hospital of Parma, Parma, Italy
| | - Livia Garavelli
- Medical Genetics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Giovanni Ponti
- Division of Clinical Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Sangiorgi
- Medical Genetics and Skeletal Rare Diseases, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Graziano
- Medical Genetics, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Stefania Bigoni
- Medical Genetics, Ferrara University Hospital, Ferrara, Italy
| | | | - Simona Madeo
- Pediatrics, University Hospital of Modena, Italy
| | - Fiorenza Soli
- Medical Genetics, Santa Chiara Hospital, Trento, Italy
| | - Enrico Grosso
- Medical Genetics, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Diana Carli
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Matteo Goldoni
- Statistics, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Pisani
- Children's Neuropsycological Services, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Percesepe
- Medical Genetics, Department of Medicine and Surgery, University of Parma, Parma, Italy.,University Hospital of Parma, Parma, Italy
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10
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Kenborg L, Andersen EW, Duun-Henriksen AK, Jepsen JRM, Doser K, Dalton SO, Bidstrup PE, Krøyer A, Frederiksen LE, Johansen C, Østergaard JR, Hove H, Sørensen SA, Riccardi VM, Mulvihill JJ, Winther JF. Psychiatric disorders in individuals with neurofibromatosis 1 in Denmark: A nationwide register-based cohort study. Am J Med Genet A 2021; 185:3706-3716. [PMID: 34327813 DOI: 10.1002/ajmg.a.62436] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/01/2021] [Accepted: 07/10/2021] [Indexed: 12/19/2022]
Abstract
The aim of this study was to assess the risks of psychiatric disorders in a large cohort of 905 individuals with NF1 and 7614 population comparisons matched on sex and year of birth. The cohort was linked to the Danish Psychiatric Central Research Register to ascertain information on hospital contacts for psychiatric disorders based on the International Classification of Diseases version 8 and 10. The hazard ratio (HR) for a first psychiatric hospital contact was higher in girls (4.19, 95% confidence interval [CI] 1.81-9.69) and boys with NF1 (5.02, 95% CI 3.27-7.69) <7 years of age than in the population comparisons. Both sexes had increased HRs for developmental disorders, including attention deficit/hyperactivity disorders, autism spectrum disorders, and intellectual disabilities in childhood. Females with NF1 had also increased HRs for unipolar depression, other emotional and behavioral disorders, and severe stress reaction and adjustment disorders in early adulthood. The HRs for psychoses, schizophrenia, bipolar disorders, and substance abuse were similar in individuals with NF1 and the population comparisons. Finally, the cumulative incidence of a first hospital contact due to any psychiatric disorder by age 30 years was 35% (95% CI 29-41) in females and 28% (95% CI 19-37) in males with NF1. Thus, screening for psychiatric disorders may be important for early diagnosis and facilitation of appropriate and effective treatment in individuals with NF1.
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Affiliation(s)
- Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Elisabeth W Andersen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Jens R M Jepsen
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research and Center for Neuropsychiatric Schizophrenia Research, Mental Health Service Capital Region, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, University of Copenhagen, Copenhagen, Denmark
| | - Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne O Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Line E Frederiksen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John R Østergaard
- Department of Pediatrics, Centre for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Hove
- Department of Pediatrics, Centre for Rare Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,The RareDis Database, Section of Rare Diseases, Department of Clinical Genetics and Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sven Asger Sørensen
- Department of Neurogenetics, Institute of Cellular and Molecular Medicine, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
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11
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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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12
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Tritz R, Benson T, Harris V, Hudson FZ, Mintz J, Zhang H, Kennard S, Chen W, Stepp DW, Csanyi G, Belin de Chantemèle EJ, Weintraub NL, Stansfield BK. Nf1 heterozygous mice recapitulate the anthropometric and metabolic features of human neurofibromatosis type 1. Transl Res 2021; 228:52-63. [PMID: 32781282 PMCID: PMC7779711 DOI: 10.1016/j.trsl.2020.08.001] [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: 04/27/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 12/26/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a heritable cancer predisposition syndrome resulting from mutations in the NF1 tumor suppressor gene. Genotype-phenotype correlations for NF1 are rare due to the large number of NF1 mutations and role of modifier genes in manifestations of NF1; however, emerging reports suggest that persons with NF1 display a distinct anthropometric and metabolic phenotype featuring short stature, low body mass index, increased insulin sensitivity, and protection from diabetes. Nf1 heterozygous (Nf1+/-) mice accurately reflect the dominant inheritance of NF1 and are regularly employed as a model of NF1. Here, we sought to identify whether Nf1+/- mice recapitulate the anthropometric and metabolic features identified in persons with NF1. Littermate 16-20 week-old male wildtype (WT) and Nf1+/- C57B/6J mice underwent nuclear magnetic resonance (NMR), indirect calorimetry, and glucose/insulin/pyruvate tolerance testing. In some experiments, tissues were harvested for NMR and histologic characterization. Nf1+/- mice are leaner with significantly reduced visceral and subcutaneous fat mass, which corresponds with an increased density of small adipocytes and reduced leptin levels. Additionally, Nf1+/- mice are highly reliant on carbohydrates as an energy substrate and display increased glucose clearance and insulin sensitivity, but normal response to pyruvate suggesting enhanced glucose utilization and preserved gluconeogenesis. Finally, WT and Nf1+/- mice subjected to high glucose diet were protected from diet-induced obesity and hyperglycemia. Our data suggest that Nf1+/- mice closely recapitulate the anthropometric and metabolic phenotype identified in persons with NF1, which will impact the interpretation of previous and future translational studies of NF1.
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Affiliation(s)
- Rebekah Tritz
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Tyler Benson
- Vascular Biology Center, Augusta University, Augusta, Georgia
| | - Valerie Harris
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Farlyn Z Hudson
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - James Mintz
- Vascular Biology Center, Augusta University, Augusta, Georgia
| | - Hanfang Zhang
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Simone Kennard
- Vascular Biology Center, Augusta University, Augusta, Georgia
| | - Weiqin Chen
- Vascular Biology Center, Augusta University, Augusta, Georgia
| | - David W Stepp
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Gabor Csanyi
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Eric J Belin de Chantemèle
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Neal L Weintraub
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Brian K Stansfield
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia.
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13
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Kallionpää RA, Ahramo K, Aaltonen M, Pennanen P, Peltonen J, Peltonen S. Circulating free DNA in the plasma of individuals with neurofibromatosis type 1. Am J Med Genet A 2021; 185:1098-1104. [PMID: 33484105 DOI: 10.1002/ajmg.a.62081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/26/2020] [Indexed: 02/06/2023]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant syndrome whose characteristic manifestations include benign neurofibromas, yet NF1 is also associated with a high risk of cancer. Measurements of circulating free plasma DNA (cfDNA) are gaining wider applicability in cancer diagnostics, targeting of therapy, and monitoring of therapeutic response. Individuals with NF1 are likely to be followed up using this method, but the effects of NF1 and neurofibromas on cfDNA levels are not known. We studied peripheral blood samples from 19 adults with NF1 and 12 healthy controls. The cfDNA was isolated from plasma with QIAamp Circulating Nucleic Acid Kit and quantified using the Qubit 2.0 Fluorometer. The cfDNA concentration of each sample was normalized relative to the plasma protein concentration. The normalized median concentration of cfDNA in plasma was 19.3 ng/ml (range 6.6-78.6) among individuals with NF1 and 15.9 ng/ml (range 4.8-47.0) among controls (p = .369). Individuals with NF1 who also had plexiform neurofibroma (pNF) showed non-significantly elevated cfDNA concentration compared to individuals with NF1 and without known pNF (median 25.4 vs. 18.8 ng/ml, p = .122). The effect of NF1 on cfDNA seems to be relatively small and NF1 is therefore unlikely to hamper the use of cfDNA-based assays.
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Affiliation(s)
- Roope A Kallionpää
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kaisa Ahramo
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Marianna Aaltonen
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| | - Paula Pennanen
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Juha Peltonen
- Department of Cell Biology and Anatomy, Institute of Biomedicine, 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
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14
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Bernardo P, Cinalli G, Santoro C. Epilepsy in NF1: a systematic review of the literature. Childs Nerv Syst 2020; 36:2333-2350. [PMID: 32613422 DOI: 10.1007/s00381-020-04710-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 12/11/2022]
Abstract
Epilepsy is one of the possible neurological manifestations of the neurofibromatosis type 1 (NF1) that represents the most common neurocutaneous disorder. We performed a systematic review of the literature on epilepsy associated with NF1 since 1995 in order to better define prevalence and describe type and causes of seizures. Data on type, nature of studies, number of patients, gender, and inheritance of NF1 were recorded as well as data on causes, type, EEGs, brain imaging, intellectual disability (ID), surgical treatment, and outcome of epilepsy. We identified a total of 141 references through the literature search of Pubmed and Embase. After screening, 42 records were identified, including 11617 individuals with NF1 (53% of males). Overall prevalence was estimated at 5.4% lifelong with values that seemed to be slightly lower in children, 3.7% (p 0.0016). Neither gender differences nor correlation with NF1 inheritance was found. Focal with or without bilateral tonic-clonic seizures were the most common seizure type encountered (60.9%). Structural causes were identified in half of cases (114/226). Low-grade gliomas were the most frequent associated lesions followed by mesial temporal sclerosis, malformation of cortical development, dysembryoplastic neuroepithelial tumor, and cerebrovascular lesions. In these cases, the surgical approach improved the epileptic outcome. Prevalence of epilepsy is higher in subjects with NF1 respect of the general population, with values apparently significantly lower in pediatric age. Brain tumors and cytoarchitectural abnormalities are the most frequent causes of epilepsy in this population, although many other brain complications should be taken in account.
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Affiliation(s)
- Pia Bernardo
- Pediatric Psychiatry and Neurology, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy.,Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Cinalli
- Pediatric Neurosurgery, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Claudia Santoro
- Pediatric Psychiatry and Neurology, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy. .,Pediatric Neurosurgery, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy. .,Referral Centre of Neurofibromatosis, Department of Woman and Child, Specialistic and General Surgery, "Luigi Vanvitelli" University of Campania, Via Luigi de Crecchio, 2, 80138, Naples, Italy.
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15
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Kallionpää RA, Peltonen S, Leppävirta J, Pöyhönen M, Auranen K, Järveläinen H, Peltonen J. Haploinsufficiency of the NF1 gene is associated with protection against diabetes. J Med Genet 2020; 58:378-384. [PMID: 32571896 PMCID: PMC8142421 DOI: 10.1136/jmedgenet-2020-107062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022]
Abstract
Background The hereditary predisposition to diabetes is only partially explained by genes identified so far. Neurofibromatosis type 1 (NF1) is a rare monogenic dominant syndrome caused by aberrations of the NF1 gene. Here, we used a cohort of 1410 patients with NF1 to study the association of the NF1 gene with type 1 (T1D) and type 2 diabetes (T2D). Methods A total of 1410 patients were confirmed to fulfil the National Institutes of Health diagnostic criteria for NF1 by individually reviewing their medical records. The patients with NF1 were compared with 14 017 controls matched for age, sex and area of residence as well as 1881 non-NF1 siblings of the patients with NF1. Register-based information on purchases of antidiabetic medication and hospital encounters related to diabetes were retrieved. The Cox proportional hazards model was used to calculate the relative risk for diabetes in NF1. Results Patients with NF1 showed a lower rate of T2D when compared with a 10-fold control cohort (HR 0.27, 95% CI 0.17 to 0.43) or with their siblings without NF1 (HR 0.28, 95% CI 0.16 to 0.47). The estimates remained practically unchanged after adjusting the analyses for history of obesity and dyslipidaemias. The rate of T1D in NF1 was decreased although statistically non-significantly (HR 0.58, 95% CI 0.27 to 1.25). Conclusion Haploinsufficiency of the NF1 gene may protect against T2D and probably T1D. Since NF1 negatively regulates the Ras signalling pathway, the results suggest that the Ras pathway may be involved in the pathogenesis of diabetes.
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Affiliation(s)
| | - Sirkku Peltonen
- Department of Dermatology and Venereology, University of Turku, Turku, Finland.,Department of Dermatology, Turku University Hospital, Turku, Finland
| | - Jussi Leppävirta
- Department of Clinical Genetics, HUSLAB, Helsinki University Hospital (HUS) Diagnostic Center, Helsinki, Finland.,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Minna Pöyhönen
- Department of Clinical Genetics, HUSLAB, Helsinki University Hospital (HUS) Diagnostic Center, Helsinki, Finland.,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Kari Auranen
- Department of Mathematics and Statistics and Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Hannu Järveläinen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Department of Internal Medicine, Satakunta Central Hospital, Pori, Finland
| | - Juha Peltonen
- Institute of Biomedicine, University of Turku, Turku, Finland
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