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Freier A, Lawson McLean AC, Loeschner D, Rosahl SK, Kruse J. The impact of mental health on health-related quality of life in patients with NF2-related Schwannomatosis. Sci Rep 2024; 14:6934. [PMID: 38521834 PMCID: PMC10960868 DOI: 10.1038/s41598-024-57401-7] [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: 08/26/2023] [Accepted: 03/18/2024] [Indexed: 03/25/2024] Open
Abstract
NF2-related schwannomatosis (NF2-SWN) is a rare genetic disorder and is associated with progressive morbidities. This study aimed to investigate the relationship between NF2-SWN disease severity, health-related Quality of Life (QoL), and mental health aspects of patients. Standardised questionnaires assessing mental health problems (symptoms of depression, anxiety, and somatic burden), psychological factors (resilience, loneliness, and personality functioning), and health-related QoL were administered to 97 patients with NF2-SWN. The results of these questionnaires were compared with physician-rated disease severity. Questionnaires were completed by 77 patients. Physician-rated disease severity scores were available for 55 patients. NF2-SWN patients showed a high prevalence of clinically relevant symptoms of depression (30%), anxiety (16%), and somatic burden (32%). Almost all variables showed moderate to high correlations with NF2-SWN-related QoL. NF2-SWN-related QoL was associated with physician-reported disease severity (r = 0.614). In the stepwise hierarchical linear regression analysis, a significant model with four predictors (disease severity type, depression symptoms, personality functioning, and gender) explained 64% of the variance in NF2-SWN-related QoL. Our results showed a strong association between NF2-SWN-related QoL and depression symptoms. Moreover, personality functioning is an important influencing factor, representing a modifiable construct that can be targeted by prevention programs or psychotherapy.
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Affiliation(s)
- Anna Freier
- Department of Psychosomatic Medicine and Psychotherapy, Phillips University Marburg, Marburg, Germany.
| | - Anna C Lawson McLean
- Department of Neurosurgery, Helios Klinikum Erfurt, Health and Medical University (HMU), Erfurt, Germany
- Department of Neurosurgery, University Hospital Jena, Jena, Germany
| | - Denise Loeschner
- Department of Neurosurgery, Helios Klinikum Erfurt, Health and Medical University (HMU), Erfurt, Germany
| | - Steffen K Rosahl
- Department of Neurosurgery, Helios Klinikum Erfurt, Health and Medical University (HMU), Erfurt, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Phillips University Marburg, Marburg, Germany
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
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2
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Mohanty AJ, DeVahl J, Kutz WJ, Rozen SM. Neurofibromatosis Type II and Facial Paralysis: Clinical Evaluation and Management. Plast Reconstr Surg 2024; 153:415e-423e. [PMID: 37075282 DOI: 10.1097/prs.0000000000010561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Facial paralysis secondary to neurofibromatosis type 2 (NF2) presents the reconstructive surgeon with unique challenges because of its pathognomonic feature of bilateral acoustic neuromas, involvement of multiple cranial nerves, use of antineoplastic agents, and management. Facial reanimation literature on managing this patient population is scant. METHODS A comprehensive literature review was performed. All patients with NF2-related facial paralysis who presented in the past 13 years were reviewed retrospectively for type and degree of paralysis, NF2 sequelae, number of cranial nerves involved, interventional modalities, and surgical notes. RESULTS Twelve patients with NF2-related facial paralysis were identified. All patients presented after resection of vestibular schwannoma. Mean duration of weakness before surgical intervention was 8 months. On presentation, one patient had bilateral facial weakness, 11 had multiple cranial nerve involvement, and seven were treated with antineoplastic agents. Two patients underwent gracilis free functional muscle transfer, five underwent masseteric-to-facial nerve transfer (of whom two were dually innervated with a crossfacial nerve graft), and one patient underwent depressor anguli oris myectomy. Trigeminal schwannomas did not affect reconstructive outcomes if trigeminal nerve motor function on clinical examination was normal. In addition, antineoplastic agents such as bevacizumab and temsirolimus did not affect outcomes if stopped in the perioperative period. CONCLUSIONS Effectively managing patients with NF2-related facial paralysis necessitates understanding the progressive and systemic nature of the disease, bilateral facial nerve and multiple cranial nerve involvement, and common antineoplastic treatments. Neither antineoplastic agents nor trigeminal nerve schwannomas associated with normal examination affected outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
| | | | - Walter J Kutz
- Otolaryngology and Head and Neck Surgery, University of Texas Southwestern Medical Center
| | - Shai M Rozen
- From the Departments of Plastic and Reconstructive Surgery
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Ben-Harosh L, Barker-Collo S, Nowacka A, Garrett J, Miles A. Quality of life and broader experiences of those with acoustic neuroma: a mixed methods approach. BRAIN IMPAIR 2024; 25:IB23072. [PMID: 38566292 DOI: 10.1071/ib23072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 04/04/2024]
Abstract
Background Acoustic neuromas (ANs) are consistently associated with decreased quality of life (QOL) related to the physical and psychosocial impacts of symptoms experienced from the tumour and its treatment. This study explored patient-reported experiences of ANs in New Zealand, with a focus on the impact on QOL and the provision of information, support and services. Methods A mixed methods approach was taken, conducting an online community survey that included the Penn Acoustic Neuroma Quality of Life Scale (N = 52). Those who indicated interest were offered semi-structured interviews after the survey (N = 17), which were analysed using content analysis. Results A negative impact on QOL was found, highlighting five key themes in the experiences of people: (1) ongoing physical, social and psychological impacts; (2) information and support from the medical system; (3) autonomy and decision-making; (4) the importance of peer support; and (5) remaining positive - life goes on. Conclusions Our findings indicate areas for improvement that may benefit people's healthcare experience and QOL. Both quantitative and qualitative results identified gaps associated with person-centred care and the need for information, education, emotional support and access to services. Recommendations include a need for more information (verbal and written) during all stages of diagnosis and treatment, shared decision-making and increased access to allied health, including psychological services and support groups.
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Affiliation(s)
- Lior Ben-Harosh
- School of Psychology, The University of Auckland, New Zealand
| | | | - Alicja Nowacka
- School of Psychology, The University of Auckland, New Zealand
| | - Joanne Garrett
- School of Psychology, The University of Auckland, New Zealand
| | - Anna Miles
- School of Psychology, The University of Auckland, New Zealand
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Vranceanu AM, Manglani HR, Choukas NR, Kanaya MR, Lester E, Zale EL, Plotkin SR, Jordan J, Macklin E, Bakhshaie J. Effect of Mind-Body Skills Training on Quality of Life for Geographically Diverse Adults With Neurofibromatosis: A Fully Remote Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2320599. [PMID: 37378983 PMCID: PMC10308247 DOI: 10.1001/jamanetworkopen.2023.20599] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/14/2023] [Indexed: 06/29/2023] Open
Abstract
Importance Neurofibromatoses (NF; NF1, NF2, and schwannomatosis) are hereditary tumor predisposition syndromes with a risk for poor quality of life (QOL) and no evidence-based treatments. Objective To compare a mind-body skills training program, the Relaxation Response Resiliency Program for NF (3RP-NF), with a health education program (Health Enhancement Program for NF; HEP-NF) for improvement of quality of life among adults with NF. Design, Setting, and Participants This single-blind, remote randomized clinical trial randomly assigned 228 English-speaking adults with NF from around the world on a 1:1 basis, stratified by NF type, between October 1, 2017, and January 31, 2021, with the last follow-up February 28, 2022. Interventions Eight 90-minute group virtual sessions of 3RP-NF or HEP-NF. Main Outcomes and Measures Outcomes were collected at baseline, after treatment, and at 6-month and 1-year follow-up. The primary outcomes were physical health and psychological domain scores of the World Health Organization Quality of Life Brief Version (WHOQOL-BREF). Secondary outcomes were the social relationships and environment domain scores of the WHOQOL-BREF. Scores are reported as transformed domain scores (range, 0-100, with higher scores indicating higher QOL). Analysis was performed on an intention-to-treat basis. Results Of 371 participants who underwent screening, 228 were randomized (mean [SD] age, 42.7 [14.5] years; 170 women [75%]), and 217 attended 6 or more of 8 sessions and provided posttest data. Participants in both programs improved from baseline to after treatment in primary outcomes of physical health QOL score (3RP-NF, 5.1; 95% CI, 3.2-7.0; P < .001; HEP-NF, 6.4; 95% CI, 4.6-8.3; P < .001) and psychological QOL score (3RP-NF, 8.5; 95% CI, 6.4-10.7; P < .001; HEP-NF, 9.2; 95% CI, 7.1-11.2; P < .001). Participants in the 3RP-NF group showed sustained improvements after treatment to 12 months; posttreatment improvements for the HEP-NF group diminished (between-group difference for physical health QOL score, 4.9; 95% CI, 2.1-7.7; P = .001; effect size [ES] = 0.3; and psychological QOL score, 3.7; 95% CI, 0.2-7.6; P = .06; ES = 0.2). Results were similar for secondary outcomes of social relationships and environmental QOL. There were significant between-group differences from baseline to 12 months in favor of the 3RP-NF for physical health QOL score (3.6; 95% CI, 0.5-6.6; P = .02; ES = 0.2), social relationships QOL score (6.9; 95% CI, 1.2-12.7; P = .02; ES = 0.3), and environmental QOL score (3.5; 95% CI, 0.4-6.5; P = .02; ES = 0.2). Conclusions and Relevance In this randomized clinical trial of 3RP-NF vs HEP-NF, benefits from 3RP-NF and HEP-NF were comparable after treatment, but at 12 months from baseline, 3RP-NF was superior to HEP-NF on all primary and secondary outcomes. Results support the implementation of 3RP-NF in routine care. Trial Registration ClinicalTrials.gov Identifier: NCT03406208.
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Affiliation(s)
- Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Heena R. Manglani
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Nathaniel R. Choukas
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Millan R. Kanaya
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Ethan Lester
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Emily L. Zale
- Department of Psychology, Harpur College of Arts and Sciences, Binghamton University, Binghamton, New York
| | - Scott R. Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston
| | - Justin Jordan
- Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston
| | - Eric Macklin
- Harvard Medical School, Boston, Massachusetts
- Biostatistics Center, Massachusetts General Hospital, Boston
| | - Jafar Bakhshaie
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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Okoshi H, Yamauchi T, Suka M, Yanagisawa H, Fujii M, Nishigori C. Loss of social independence in patients with neurofibromatosis type 2: a follow-up study using a national registry in Japan. Environ Health Prev Med 2023; 28:46. [PMID: 37599081 PMCID: PMC10460997 DOI: 10.1265/ehpm.22-00222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 06/09/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND For patients with neurofibromatosis type 2 (NF2), maintaining an independent state of living is important. The present study aimed to examine the loss of social independence (i.e., a status that patients can work and go to school) and its contributing factors in patients with NF2 using data from a national registry in Japan. METHODS This longitudinal study used a registry database containing information on patients with NF2 who had submitted initial claims to receive medical expense subsidies between 2004 and 2010. Patients with "employed," "studying," and "housekeeping" categories were classified as "socially independent." Patients who were socially independent at baseline were followed-up for up to nine years. The primary outcome of the present study was the loss of social independence during the follow-up period, which was defined as the change in status from being socially independent to socially dependent. First, we examined longitudinal associations between demographic variables and neurological symptoms at baseline and the loss of social independence. Second, we examined whether the occurrence of neurological symptoms is associated with a loss of social independence in patients. RESULTS A total of 156 patients were included in the present study. During the follow-up period, 37 (23.7%) patients experienced a loss of social independence. In the first analysis, the multivariate logistic regression model showed that the loss of social independence was significantly more frequent among patients with spinal dysfunction than among patients without. In the second analysis, logistic regression analyses showed that neurological symptoms, including bilateral hearing loss, facial nerve palsy, cerebellar dysfunction, decreased facial sensation, speech dysfunction (dysphagia/dysarthria and aphasia), double vision, blindness, hemiparesis, and seizures, were significantly associated with loss of social independence. CONCLUSIONS The occurrence of various neurological symptoms of NF2 can hinder social independence in the long term. Medical service providers need to observe patients while considering the risks, and provide appropriate support to address neurological symptoms that can restrict social independence, as this will lead to maintaining social engagement.
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Affiliation(s)
- Hiroto Okoshi
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yamauchi
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Machi Suka
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Masazumi Fujii
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
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Bannon SM, Hopkins SW, Grunberg VA, Vranceanu AM. Psychosocial profiles of risk and resiliency in neurofibromatoses: a person-centered analysis of illness adaptation. J Neurooncol 2022; 156:519-527. [PMID: 35064449 DOI: 10.1007/s11060-021-03928-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We sought to characterize psychosocial profiles of adaptation to neurofibromatosis (NF). METHODS Participants (N = 224) completed self-report measures of psychosocial functioning, including risk (i.e., perceived stress, depression, anxiety) and resiliency (i.e., gratitude, optimism, coping, social support, mindfulness, empathy). We used a TwoStep hierarchical cluster analysis to determine clusters reflecting adaptation to NF. RESULTS The analysis revealed two distinct groups, with the "Low Adaptation" group defined by high emotional distress and low resiliency (n = 130; 57% of participants), and the "High Adaptation" group defined by low emotional distress and high resiliency (n = 85; 37% of participants). Clusters differed significantly across nearly all criterion variables, as well as quality of life and pain interference. CONCLUSION Both risk and resiliency factors are important for understanding psychosocial adaptation to NF. Findings suggest that clinical providers should prioritize screening and intervention methods targeting these variables to promote positive adaptation to NF. TRIAL REGISTRATION ClinicalTrials.gov NCT03406208; https://clinicaltrials.gov/ct2/show/NCT03406208 (Archived by WebCite at http://www.webcitation.org/72ZoTDQ6h ).
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Affiliation(s)
- Sarah M Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square Suite 100, Boston, MA, USA
| | - Sarah W Hopkins
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square Suite 100, Boston, MA, USA
| | - Victoria A Grunberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square Suite 100, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square Suite 100, Boston, MA, USA.
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Tadokoro K, Bartindale MR, El-Kouri N, Moore D, Britt C, Kircher M. Cochlear Implantation in Vestibular Schwannoma: A Systematic Literature Review. J Neurol Surg B Skull Base 2021; 82:643-651. [PMID: 34745832 DOI: 10.1055/s-0040-1715606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/22/2020] [Indexed: 01/21/2023] Open
Abstract
Objective Ipsilateral cochlear implantation (CI) in vestibular schwannoma (VS) has been an emerging trend over the last two decades. We conducted the first systematic review of hearing outcomes comparing neurofibromatosis 2 (NF2) and sporadic VS undergoing CI. A comparison of the two populations and predictor of outcome was assessed. This is an update to a previously presented study. Data Sources Systemic data searches were performed in PubMed NCBI and Scopus by an academic librarian. No restrictions based on the year of publication were used. Study Selection Studies were selected if patients had a diagnosis of NF2 and a CI placed in the affected side with reports of hearing outcome. Two independent reviewers screened each abstract and full-text article. Data Extraction Studies were extracted at the patient level, and the assessment of quality and bias was evaluated according to the National Institutes of Health Quality Assessment Tool. Main Outcome Measures Outcome predictors were determined by using the chi-square test and Student's t -test. Results Overall, most CI recipients functioned in the high-to-intermediate performer category for both sporadic and NF2-related VS. Median AzBio (Arizona Biomedical Institute Sentence Test) was 72% (interquartile range [IQR]: 50) in NF2 patients and 70% (IQR: 7.25) in sporadic patients. Larger tumor size predicted a poorer final audiometric outcome. Conclusions Categorization of hearing outcome into superior performance and inferior performance based on sentence recognition revealed a generally good hearing outcome regardless of treatment or patient population. Select patients with sporadic and NF2 VS may benefit from CI.
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Affiliation(s)
- Kent Tadokoro
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
| | | | - Nadeem El-Kouri
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Dennis Moore
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Christopher Britt
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Matthew Kircher
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
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Effects of a mind-body program on symptoms of depression and perceived stress among adults with neurofibromatosis type 2 who are deaf: A live-video randomized controlled trial. Complement Ther Med 2020; 56:102581. [PMID: 33197677 DOI: 10.1016/j.ctim.2020.102581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Neurofibromatosis type 2 (NF2) is a rare, progressive and incurable genetic disorder associated with progressive hearing loss and eventual deafness. As a group, patients with NF report high levels of stress and depressive symptoms. However, no studies have explored improvement in these symptoms after psychosocial interventions. We have previously shown that a mind-body program tailored to adults with NF2 who are deaf (the Relaxation Response and Resiliency Program for Deaf NF2, d3RP-NF2) improves quality of life and resiliency over and above a Health Enhancement program when both are delivered via live-video and assisted by Communication Access Realtime Translation (CART). Here we tested the effects of the programs on depression and perceived stress. METHODS Forty-five patients with NF2 and significant hearing loss were randomized to the d3RP-NF2 or Health-Enhancement program and completed measures of depression (PHQ-9) and perceived stress (PSS-10) at baseline, post-intervention, and six-month follow-up. RESULTS Patients randomized to the d3RP-NF2 program, but not to the control condition, experienced significant decreases on both measures from baseline to post-test, which were maintained at follow-up (within group tests). However, improvements following the d3RP-NF2 program was not significantly higher than those observed in the control group (between group tests). CONCLUSION Results provide the first evidence of improvement in symptoms of depression and perceived stress among deaf patients living with NF2 who participate in a virtual mind-body program.
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Radtke HB, Bergner AL, Goetsch AL, McGowan C, Panzer K, Cannon A. Genetic Counseling for Neurofibromatosis 1, Neurofibromatosis 2, and Schwannomatosis—Practice Resource of the National Society of Genetic Counselors. J Genet Couns 2020; 29:692-714. [DOI: 10.1002/jgc4.1303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Heather B. Radtke
- Department of Pediatrics Medical College of Wisconsin Milwaukee Wisconsin USA
- Children’s Tumor Foundation New York New York USA
| | - Amanda L. Bergner
- Department of Genetics and Development Columbia University New York New York USA
| | - Allison L. Goetsch
- Division of Genetics Birth Defects and Metabolism, Ann and Robert H. Lurie Children’s Hospital of Chicago Chicago Illinois USA
- Department of Pediatrics Northwestern University Chicago Illinois USA
| | - Caroline McGowan
- Division of Genetics and Genomics Boston Children’s Hospital Boston Massachusetts USA
| | - Karin Panzer
- Department of Pediatrics University of Iowa Hospitals and Clinics Iowa City Iowa USA
| | - Ashley Cannon
- Department of Genetics University of Alabama at Birmingham Birmingham Alabama USA
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Quarmby LM, Dalton LJ, Woolrich RA, Clarke R, Emmanouil B, Patel S, Rands G, Parry A, Halliday D. Screening and intervening: Psychological distress in neurofibromatosis type 2 (NF2). Psychooncology 2019; 28:1583-1587. [PMID: 31033096 DOI: 10.1002/pon.5099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/13/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Louise May Quarmby
- Oxford & SW NF2 Service, Neurosciences, The West Wing, John Radcliffe HospitalOxford University Hospitals NHS Foundation Trust Oxford UK
- Specialist Surgery Psychology Team, The Oxford Psychological Medicine Centre, Russell Cairns Unit, West Wing, John Radcliffe HospitalOxford University Hospitals NHS Foundation Trust Oxford UK
| | - Louise J. Dalton
- Oxford & SW NF2 Service, Neurosciences, The West Wing, John Radcliffe HospitalOxford University Hospitals NHS Foundation Trust Oxford UK
- Specialist Surgery Psychology Team, The Oxford Psychological Medicine Centre, Russell Cairns Unit, West Wing, John Radcliffe HospitalOxford University Hospitals NHS Foundation Trust Oxford UK
| | - Rachel A. Woolrich
- Oxford & SW NF2 Service, Neurosciences, The West Wing, John Radcliffe HospitalOxford University Hospitals NHS Foundation Trust Oxford UK
- Specialist Surgery Psychology Team, The Oxford Psychological Medicine Centre, Russell Cairns Unit, West Wing, John Radcliffe HospitalOxford University Hospitals NHS Foundation Trust Oxford UK
| | - Rachel Clarke
- Derriford HospitalPlymouth Hospitals NHS Trust Plymouth UK
| | - Beatrice Emmanouil
- Oxford & SW NF2 Service, Neurosciences, The West Wing, John Radcliffe HospitalOxford University Hospitals NHS Foundation Trust Oxford UK
- Department of Psychology, Health and Professional Development, Faculty of Health and Life SciencesOxford Brookes University Oxford UK
| | - Sonia Patel
- NF2 ServiceCentral Manchester University Hospitals NHS Foundation Trust Manchester UK
| | - Gabriella Rands
- NF2 ServiceCambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Allyson Parry
- Oxford & SW NF2 Service, Neurosciences, The West Wing, John Radcliffe HospitalOxford University Hospitals NHS Foundation Trust Oxford UK
| | - Dorothy Halliday
- Oxford & SW NF2 Service, Neurosciences, The West Wing, John Radcliffe HospitalOxford University Hospitals NHS Foundation Trust Oxford UK
- Oxford Centre for Genomic Medicine, Nuffield Orthopaedic CentreOxford University Hospitals NHS Foundation Trust Oxford UK
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Halliday D, Emmanouil B, Vassallo G, Lascelles K, Nicholson J, Chandratre S, Anand G, Wasik M, Pretorius P, Evans DG, Parry A, Axon P, Gair J, Smyth C, Afridi SK, Obholzer R, Everett V, Jarvis N, Henshaw K, Hanemann CO, Howard W, May A, Redman C, Rattihalli R, Tomkins H. Trends in phenotype in the English paediatric neurofibromatosis type 2 cohort stratified by genetic severity. Clin Genet 2019; 96:151-162. [DOI: 10.1111/cge.13551] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Dorothy Halliday
- Oxford Centre for Genomic MedicineOxford University Hospitals NHS Trust Oxford UK
- Oxford NF2 Unit, Oxford University Hospitals NHS Trust Oxford UK
| | - Beatrice Emmanouil
- Oxford NF2 Unit, Oxford University Hospitals NHS Trust Oxford UK
- Oxford Brookes University, Faculty of Health and Life Sciences, Department of Psychology, Health and Professional Development Oxford UK
| | - Grace Vassallo
- Department of Paediatric NeurologyCentral Manchester University Hospitals NHS Foundation Trust Manchester UK
| | - Karine Lascelles
- Department of Paediatric NeurologyGuy's and St Thomas' NHS Foundation Trust London UK
| | - James Nicholson
- Department of Paediatric OncologyCambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Saleel Chandratre
- Department of Paediatric NeurologyOxford University Hospitals NHS Foundation Trust Oxford UK
| | - Geetha Anand
- Department of PaediatricsOxford University Hospitals NHS Foundation Trust Oxford UK
| | - Martin Wasik
- Department of OphthalmologyOxford University Hospitals NHS Foundation Trust Oxford UK
| | - Pieter Pretorius
- Depatment of NeuroradiologyOxford University Hospitals NHS Foundation Trust Oxford UK
| | - D. Gareth Evans
- Genomic Medicine, Division of Evolution and Genomic Sciences, MAHSCUniversity of Manchester, St Mary's Hospital Manchester UK
| | - Allyson Parry
- Oxford NF2 Unit, Oxford University Hospitals NHS Trust Oxford UK
- Department of NeurosciencesOxford University Hospitals NHS Foundation Trust Oxford UK
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Abstract
OBJECTIVE The aim of the study was to describe the mobility outcomes of neurofibromatosis (NF) patients who received acute inpatient rehabilitation. DESIGN This is a retrospective study of 62 consecutive neurofibromatosis patients of any age who received physical medicine and rehabilitation consultations at a comprehensive cancer center. Postoperative, inpatient rehabilitation admission and discharge functional independence measures (FIM scores) of transfers and gait and length of hospital stay were obtained from 37 patients who were transferred to inpatient rehabilitation (acute rehabilitation) and 25 who had an alternative disposition (consultation only). RESULTS Mean age was 34 yrs. Both groups had similar postoperative FIM transfer and gait scores; however, at approximately postoperative day 10, the consultation only group was discharged with median FIM of 5 (supervision level) as compared with the acute rehabilitation group FIM of 4 (P = 0.000). The acute rehabilitation group had improved mobility FIM scores from postoperative to rehabilitation admission and again from rehabilitation admission to discharge (P < 0.0001). At discharge, the acute rehabilitation group ambulated a significantly longer distance (500 f. vs. 300 ft) (P = 0.04). The median length of hospital stay for the acute rehabilitation and consultation only groups was 20 and 10 days, respectively (P = 0.004). CONCLUSIONS Acute inpatient rehabilitation leads to improvement in mobility-associated FIM scores for neurofibromatosis patients minimizing caregiver needs at home.
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Shew M, Bertsch J, Camarata P, Staecker H. Magnetic Resonance Imaging in a Neurofibromatosis Type 2 Patient with a Novel MRI-Compatible Auditory Brainstem Implant. J Neurol Surg Rep 2017; 78:e12-e14. [PMID: 28210535 PMCID: PMC5309127 DOI: 10.1055/s-0036-1597588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Auditory brainstem implantation has become a key technique for the rehabilitation of hearing in patients with neurofibromatosis type 2. The nature of this devastating genetic disease requires ongoing MRI for the patient's lifespan. Today, most auditory brainstem implants require removal of the magnet that connects the internal device to the external speech processor to undergo imaging as their disease progresses. Patients have the option of having a short procedure to have the magnet taken out and replaced each time, or alternately using a headband to secure the processor over the receiver coil of the internal device. Novel magnet technology has led to the development of a freely rotating magnet that can be used inside the magnetic field of an MRI scanner without losing magnet strength and without being displaced from the body of the device. We report one of the first patients implanted with a Med-El Synchrony ABI in the United States who subsequently underwent successful imaging with MRI 1.5 tesla to follow for other existing schwannomas.
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Affiliation(s)
- Matthew Shew
- Department of Otolaryngology Head and Neck Surgery, University of Kansas School Medical Center, Kansas City, Kansas, United States
| | - Judson Bertsch
- Department of Diagnostic Radiology, University of Kansas School Medical Center, Kansas City, Kansas, United States
| | - Paul Camarata
- Department of Neurosurgery, University of Kansas School Medical Center, Kansas City, Kansas, United States
| | - Hinrich Staecker
- Department of Otolaryngology Head and Neck Surgery, University of Kansas School Medical Center, Kansas City, Kansas, United States
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Demopoulos C, Yu N, Paul LK, Sherr EH, Marco EJ. Corpus callosum in cognitive and sensory processing: insights into autism. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.14.70] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Atypical corpus callosum size and functional connectivity have been repeatedly implicated in autism spectrum disorders (ASDs). Conversely, individuals with agenesis of the corpus callosum often present with diagnostic features characteristic of autism. An emerging literature has identified genetic and environmental factors which may contribute to both ASD symptomatology and the neuroanatomic finding of altered white matter in the corpus callosum. In this review, we consider what is known about the structure and function of the corpus callosum and provide an update on research identifying corpus callosum abnormalities in individuals with ASD. We also review the literature on behaviors characteristic of autism that are observed in individuals with agenesis of the corpus callosum in an effort to identify some of the neuropathology that is likely to be associated with these behaviors. Finally, we suggest a conceptual model of ‘sensory processing inefficiency’ for future research aimed at elucidating some of the phenotypic variation in individuals with social communication challenges.
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Affiliation(s)
- Carly Demopoulos
- Department of Radiology & Biomedical Imaging, University of California-San Francisco, 513 Parnassus Avenue, S362, San Francisco, CA 94143-0628, USA
| | - Nina Yu
- Department of Neurology, University of California-San Francisco, 675 Nelson Rising Lane, San Francisco, CA 94143, USA
| | - Lynn K Paul
- Division of Humanities & Social Sciences, California Institute of Technology, Caltech MC 228-77, Pasadena, CA 91125, USA
| | - Elliott H Sherr
- Department of Neurology, University of California-San Francisco, 675 Nelson Rising Lane, San Francisco, CA 94143, USA
- Department of Pediatrics, University of California-San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Elysa J Marco
- Department of Neurology, University of California-San Francisco, 675 Nelson Rising Lane, San Francisco, CA 94143, USA
- Department of Pediatrics, University of California-San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA
- Department of Psychiatry, University of California-San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
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15
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Aboukais R, Zairi F, Bonne NX, Baroncini M, Schapira S, Vincent C, Lejeune JP. Causes of mortality in neurofibromatosis type 2. Br J Neurosurg 2014; 29:37-40. [DOI: 10.3109/02688697.2014.952266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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MRI Without Magnet Removal in Neurofibromatosis Type 2 Patients With Cochlear and Auditory Brainstem Implants. Otol Neurotol 2014; 35:821-5. [DOI: 10.1097/mao.0000000000000330] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Ferner RE, Shaw A, Evans DG, McAleer D, Halliday D, Parry A, Raymond FL, Durie-Gair J, Hanemann CO, Hornigold R, Axon P, Golding JF. Longitudinal evaluation of quality of life in 288 patients with neurofibromatosis 2. J Neurol 2014; 261:963-9. [PMID: 24619350 PMCID: PMC4008785 DOI: 10.1007/s00415-014-7303-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 11/28/2022]
Abstract
Advances in molecular biology have resulted in novel therapy for neurofibromatosis 2-related (NF2) tumours, highlighting the need for robust outcome measures. The disease-focused NF2 impact on quality of life (NFTI-QOL) patient questionnaire was assessed as an outcome measure for treatment in a multi-centre study. NFTI-QOL was related to clinician-rated severity (ClinSev) and genetic severity (GenSev) over repeated visits. Data were evaluated for 288 NF2 patients (n = 464 visits) attending the English national NF2 clinics from 2010 to 2012. The male-to-female ratio was equal and the mean age was 42.2 (SD 17.8) years. The analysis included NFTI-QOL eight-item score, ClinSev graded as mild, moderate, or severe, and GenSev as a rank order of the number of NF2 mutations (graded as mild, moderate, severe). The mean (SD) 8.7 (5.4) score for NFTI-QOL for either a first visit or all visits 9.2 (5.4) was similar to the published norm of 9.4 (5.5), with no significant relationships with age or gender. NFTI-QOL internal reliability was good, with a Cronbach’s alpha score of 0.85 and test re-test reliability r = 0.84. NFTI related to ClinSev (r = 0.41, p < 0.001; r = 0.46 for all visits), but weakly to GenSev (r = 0.16, p < 0.05; r = 0.15 for all visits). ClinSev related to GenSev (r = 0.41, p < 0.001; r = 0.42 for all visits). NFTI-QOL showed a good reliability and ability to detect significant longitudinal changes in the QOL of individuals. The moderate relationships of NFTI-QOL with clinician- and genetic-rated severity suggest that NFTI-QOL taps into NF2 patient experiences that are not encompassed by ClinSev rating or genotype.
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18
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Karajannis MA, Legault G, Hagiwara M, Giancotti FG, Filatov A, Derman A, Hochman T, Goldberg JD, Vega E, Wisoff JH, Golfinos JG, Merkelson A, Roland JT, Allen JC. Phase II study of everolimus in children and adults with neurofibromatosis type 2 and progressive vestibular schwannomas. Neuro Oncol 2013; 16:292-7. [PMID: 24311643 DOI: 10.1093/neuonc/not150] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Activation of the mammalian target of rapamycin (mTOR) signaling pathway is thought to be a key driver of tumor growth in Merlin (NF2)-deficient tumors. Everolimus is an oral inhibitor of mTOR complex 1 (mTORC1) with antitumor activity in a variety of cancers. METHODS We conducted a single-institution, prospective, 2-stage, open-label phase II study to estimate the response rate to everolimus in neurofibromatosis type 2 (NF2) patients with progressive vestibular schwannoma (VS). Ten eligible patients were enrolled, including 2 pediatric patients. Everolimus was administered at a daily dose of 10 mg (adults) or 5 mg/m(2)/day (children <18 y) orally in continuous 28-day courses, for up to 12 courses. Response was assessed every 3 months with MRI, using 3-dimensional volumetric tumor analysis, and audiograms. Nine patients were evaluable for the primary response, defined as ≥15% decrease in VS volume. Hearing response was evaluable as a secondary endpoint in 8 patients. RESULTS None of the 9 patients with evaluable disease experienced a clinical or MRI response. No objective imaging or hearing responses were observed in stage 1 of the trial, and the study was closed according to predefined stopping rules. CONCLUSION Everolimus is ineffective for the treatment of progressive VS in NF2 patients. We are currently conducting a pharmacokinetic/pharmacodynamic ("phase 0") study of everolimus in presurgical VS patients to elucidate the biological basis for apparent treatment resistance to mTORC1 inhibition in these tumors.
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Affiliation(s)
- Matthias A Karajannis
- Corresponding author: Matthias A. Karajannis, MD, MS, NYU Langone Medical Center, Hassenfeld Children's Center for Cancer and Blood Disorders, 160 East 32nd Street, 2nd floor, New York, NY 10016.
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19
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Smith KB, Wang DL, Plotkin SR, Park ER. Appearance concerns among women with neurofibromatosis: examining sexual/bodily and social self-consciousness. Psychooncology 2013; 22:2711-9. [DOI: 10.1002/pon.3350] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 05/31/2013] [Accepted: 06/17/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Kelly B. Smith
- Department of Obstetrics & Gynaecology; University of British Columbia; BC Canada
| | - Daphne L. Wang
- Department of Neurology and Cancer Center; Massachusetts General Hospital/Harvard Medical School; MA USA
| | - Scott R. Plotkin
- Department of Neurology and Cancer Center; Massachusetts General Hospital/Harvard Medical School; MA USA
| | - Elyse R. Park
- Department of Psychiatry; Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital/Harvard Medical School; MA USA
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Hornigold RE, Golding JF, Leschziner G, Obholzer R, Gleeson MJ, Thomas N, Walsh D, Saeed S, Ferner RE. The NFTI-QOL: A Disease-Specific Quality of Life Questionnaire for Neurofibromatosis 2. J Neurol Surg B Skull Base 2013; 73:104-11. [PMID: 23543835 DOI: 10.1055/s-0032-1301396] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 10/11/2011] [Indexed: 01/01/2023] Open
Abstract
The objective of this study was to develop a reliable, validated disease-specific score measuring quality of life (QOL) in clinical practice and treatment trials in Neurofibromatosis 2 (NF2) individuals. In NF2 patients, qualitative interviews (n = 15) and a focus group session (n = 30) generated items for a pilot questionnaire. This was tested and refined (n = 20). The final version (NFTI-QOL) was validated (n = 50) with two generic QOL questionnaires (SF-36 and EuroQOL). The NFTI-QOL was also administered to patients with solitary vestibular schwannoma (SVS) (n = 30) and normal controls (n = 30). The participants were NF2 patients, SVS patients, and normal controls. NFTI-QOL score, SF-36 score, and EuroQOL score were the main outcome measures. Mean NFTI-QOL score was 9.4 (range: 0 to 20, maximum possible score = 24). The NFTI-QOL score correlated strongly with EuroQOL (r = 0.71, p < 0.001) and SF-36 (r = 0.81, p < 0.001). NF2 individuals were significantly worse than the SVS patients, who in turn were worse than the controls on the NIFTI-QOL. The NFTI-QOL showed good internal reliability (Cronbach's α = 0.87). We developed an eight-item disease-specific QOL score for NF2 patients, validated against SF-36 and EuroQOL. It correlated strongly with clinician-rated disease severity in NF2, with better correlation than the SF-36 in this regard.
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Affiliation(s)
- Rachael E Hornigold
- National Specialist Commissioning Team Neurofibromatosis Unit, Department of Neurology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom ; Department of ENT, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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