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Ottenhoff MJ, Mous SE, Castricum J, Rietman AB, Oostenbrink R, van der Vaart T, Tulen JHM, Parra A, Ramos FJ, Legius E, Moll HA, Elgersma Y, de Wit MCY. Lamotrigine for cognitive deficits associated with neurofibromatosis type 1: A phase II randomized placebo-controlled trial. Dev Med Child Neurol 2024. [PMID: 39340758 DOI: 10.1111/dmcn.16094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 07/19/2024] [Accepted: 08/19/2024] [Indexed: 09/30/2024]
Abstract
AIM To find proof-of-principle evidence for short-term treatment with lamotrigine to improve cognitive functioning of adolescents with neurofibromatosis type 1 (NF1). METHOD This was a double-blind, parallel-group, randomized, placebo-controlled clinical trial (the NF1-EXCEL trial: Examining the Cognitive and Electrophysiological benefit of Lamotrigine in Neurofibromatosis type 1; Clinicaltrials.gov identifier NCT02256124), with the aim of enrolling 60 adolescents with NF1 aged 12 to 17 years 6 months. The short-term study intervention was 200 mg of lamotrigine taken orally for 26 weeks. The primary outcome was performance IQ tested with the Wechsler Intelligence Scale for Children, Third Edition, complemented with secondary outcomes for visuospatial learning efficacy, visual perception, visual sustained attention, fine motor coordination, attention-deficit/hyperactivity problems, and executive functioning. RESULTS We screened 402 adolescents with NF1, of whom 31 (eight females) entered the study. Complete-case analysis showed no effect of lamotrigine on either performance IQ (-0.23, 95% CI -6.90 to 6.44) or most secondary outcomes. Visual sustained attention showed a trend towards better performance in the lamotrigine group (-0.81, 95% CI -1.67 to 0.04). INTERPRETATION Lamotrigine did not improve cognitive functioning in adolescents with NF1. The small treatment effects make it unlikely that a larger sample size could have changed this conclusion.
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Affiliation(s)
- Myrthe J Ottenhoff
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sabine E Mous
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Child Brain Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jesminne Castricum
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, the Netherlands
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - André B Rietman
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Child Brain Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Rianne Oostenbrink
- Department of Pediatrics, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Thijs van der Vaart
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joke H M Tulen
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Alba Parra
- Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Federico J Ramos
- Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Eric Legius
- Center for Human Genetics, University Hospital Leuven, Leuven, Belgium
- Department of Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Henriette A Moll
- Department of Pediatrics, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ype Elgersma
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marie-Claire Y de Wit
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Child Brain Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Pediatric Neurology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
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2
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Remaud J, Besnard J, Barbarot S, Roy A. Perception and recognition of primary and secondary emotions by children with neurofibromatosis type 1. Child Neuropsychol 2024; 30:188-201. [PMID: 36803641 DOI: 10.1080/09297049.2023.2181945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
Neurofibromatosis type 1 (NF1) is a genetic disease that can lead to impaired social adaptation and functioning, thus affecting quality of life. To date, studies of these children's social cognition abilities have been scant and far from exhaustive. Therefore, the purpose of the present study was to assess the ability of children with NF1, compared with controls, to process facial expressions of emotions - not only including the usual primary emotions (happiness, anger, surprise, fear, sadness and disgust), but secondary emotions, too. To do so, the links between this ability and the characteristics of the disease (mode of transmission, visibility, and severity) were examined. A total of 38 children with NF1 aged 8-16 years 11 months (mean = 11.4, SD = 2.3) and 43 sociodemographically comparable control children performed the emotion perception and recognition tests of a social cognition battery. Results confirmed that the processing of primary and secondary emotions is impaired in children with NF1, but there were no significant links with either mode of transmission, severity, or visibility. These results encourage further comprehensive assessments of emotions in NF1, and suggest that investigations should be extended to higher level social cognition skills, such as theory of mind and moral judgments.
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Affiliation(s)
- Julie Remaud
- Pays de la Loire Psychology Laboratory (LPPL), SFR Confluences, Universities of Angers & Nantes, Angers, France
| | - Jérémy Besnard
- Pays de la Loire Psychology Laboratory (LPPL), SFR Confluences, Universities of Angers & Nantes, Angers, France
| | - Sébastien Barbarot
- Nantes Neurofibromatosis Expert Center, Nantes University Hospital, Nantes, France
| | - Arnaud Roy
- Pays de la Loire Psychology Laboratory (LPPL), SFR Confluences, Universities of Angers & Nantes, Angers, France
- Nantes Neurofibromatosis Expert Center, Nantes University Hospital, Nantes, France
- Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France
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3
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Hofmann S, Winkler S, Baumann M, Zellner H. Quality of Life in Children and Adolescents with Neurofibromatosis Type 1: A Single-Center Observational Study. Neuropediatrics 2023; 54:430-432. [PMID: 37321252 DOI: 10.1055/s-0043-1768988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This article obtains an overview of the health status of children and adolescents with neurofibromatosis type 1 (NF1) with a focus on the clinical course of the disease, neuropsychodiagnostic findings, and their impact on quality of life (QoL). In this observational study, data were collected from 24 children and adolescents with NF1 who were cared for at the University Hospital in Innsbruck, Austria, from 2008 to 2022. Data were collected every 6 to 12 months from routine check-ups, including clinical features and imaging findings. Results of neuropsychodiagnostic tests and the KINDL questionnaire to assess QoL were included. Of 24 patients, 15 underwent a neuropsychological examination. Attention performance was examined in 11 of them. Eight of 11 (72%) showed an attention deficit. Assessment for specific developmental disorders showed visual-spatial difficulties in 12/15 (80%) patients. The KINDL questionnaire values ranged from 58.22 to 97.92 (0 stands for reduced QoL, 100 for very good QoL). Patients with scoliosis had a lower range of QoL (56.33-73.96). No trend in QoL was observed in children and adolescents with plexiform neurofibromas, below-average intelligence or optic gliomas. NF1 patients show very different clinical courses. Regular neuropsychological assessment especially with regard to visual-spatial skills and attention deficits is necessary to offer appropriate support, promote children's development, and thus improve their QoL.
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Affiliation(s)
- Sarah Hofmann
- Division of Pediatric Neurology, Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Sandra Winkler
- Division of Pediatric Neurology, Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Baumann
- Division of Pediatric Neurology, Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Herta Zellner
- Division of Pediatric Neurology, Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Innsbruck, Austria
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4
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Fournier H, Calcagni N, Morice-Picard F, Quintard B. Psychosocial implications of rare genetic skin diseases affecting appearance on daily life experiences, emotional state, self-perception and quality of life in adults: a systematic review. Orphanet J Rare Dis 2023; 18:39. [PMID: 36823650 PMCID: PMC9951542 DOI: 10.1186/s13023-023-02629-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Since the beginning of human genetic research, there are very few publications sharing insights of the negative impact of rare genetic skin diseases (RGSD) on patients' experiences. This systematic review assessed the psychosocial implications of these conditions in terms of daily life experiences, emotional state, self-perception, and Quality of Life (QoL). METHODOLOGY A systematic review was carried out on albinism, neurofibromatosis type 1 (NF1), birthmarks and inherited ichthyosis. The PubMed, Scopus, PsycArticle, PsychInfo, Psychology and Behavioral Sciences Collection, and SOCindex databases were queried. Inclusion criteria were adult patients with one of these RGSDs. Simple descriptive statistics and qualitative content analysis were conducted to summarize the main results reported by the authors. RESULTS Of the 9987 articles retrieved, 48 articles were included: albinism (16), NF1 (16), inherited ichthyosis (10), birthmarks (6). The majority of the studies on albinism were conducted in Africa. Twenty-seven studies quantitatively assessed diverse psychological parameters: 13 showed a significant impact of the disease on QoL, five on emotional state, two on self-representation and two others on psychiatric comorbidities. Disease severity and visibility were good predictors of QoL (except for albinism). Body image and appearance concerns were also associated with QoL and emotional state. The 19 qualitative studies highlighted recurring themes across each of these diseases: discrimination and stigma during childhood and adolescence, discomfort in social interactions, guilt of transmission, the importance of social support from family and friends, altered daily life functioning, altered romantic and sex life, limited academic and professional aspirations, lack of interest and support from the medical field, and the unpredictability of the evolution of the disease. The only two mixed-method studies in this review were unable to contribute to any inferential analyses but could corroborate some of the qualitative findings. CONCLUSION These results showed that RGSDs have a significant impact on different aspects of patients' lives. This review has demonstrated that there is a real need for support systems for patients with these diseases. Such systems should be developed to provide them with necessary information and to guide them through an appropriate care pathway.
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Affiliation(s)
- Hugo Fournier
- Laboratoire de Psychologie (LabPsy) EA4139, Univ. Bordeaux, 3 ter Place de la Victoire, Bâtiment A - 1er étage, 33000 Bordeaux, France
| | | | | | - Bruno Quintard
- Laboratoire de Psychologie (LabPsy) EA4139, Univ. Bordeaux, 3 ter Place de la Victoire, Bâtiment A - 1er étage, 33000 Bordeaux, France
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Radtke HB, Berger A, Skelton T, Goetsch Weisman A. Neurofibromatosis Type 1 (NF1): Addressing the Transition from Pediatric to Adult Care. Pediatric Health Med Ther 2023; 14:19-32. [PMID: 36798587 PMCID: PMC9925753 DOI: 10.2147/phmt.s362679] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
Health care transition, or HCT, is the process of adolescents and young adults moving from a child/family-centered model of health care to an adult/patient-centered model of health care. Healthcare providers have an essential role in this process which can be especially challenging for individuals with medical or special healthcare needs. Neurofibromatosis type 1 (NF1) is a complex multisystem disorder requiring lifelong medical surveillance, education, and psychosocial support. This review highlights the transition needs of NF1 patients and provides resources for both clinicians and families to facilitate HCT in this population. The authors propose a framework for the development of an effective NF1 transition program by using the Six Core Elements model of the Got Transition program, reviewing existing literature, and incorporating author experiences in the care and transition of NF1 patients.
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Affiliation(s)
- Heather B Radtke
- Medical College of Wisconsin, Milwaukee, WI, USA,Children’s Tumor Foundation, New York, NY, USA,Correspondence: Heather B Radtke, Email
| | - Angela Berger
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Tammi Skelton
- UAB Heersink School of Medicine, Birmingham, AL, USA
| | - Allison Goetsch Weisman
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA,Northwestern University, Chicago, IL, USA
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Cavallo ND, Maggi G, Ferraiuolo F, Sorrentino A, Perrotta S, Carotenuto M, Santangelo G, Santoro C. Neuropsychiatric Manifestations, Reduced Self-Esteem and Poor Quality of Life in Children and Adolescents with Neurofibromatosis Type 1 (NF1): The Impact of Symptom Visibility and Bullying Behavior. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020330. [PMID: 36832459 PMCID: PMC9955783 DOI: 10.3390/children10020330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant condition, associated with neurocutaneous manifestations and neuropsychiatric manifestations. The present study explored the prevalence of bullying/cyberbullying behaviors and victimization behaviors in a cohort of children and adolescents with NF1. Possible gender differences and predictors of psychological symptoms, quality of life (QoL), and self-esteem were also examined. Thirty-eight school-aged participants with NF1 completed a psychological evaluation designed to assess anxiety and depression symptomatology, QoL, self-esteem, and the prevalence and extent of bullying/cyberbullying and victimization behaviors. We found that our participants frequently reported victimization behaviors rather than bullying/cyberbullying ones. Moreover, participants complained of depressive and anxiety symptomatology together with reduced self-esteem, and low psychosocial quality of life, with females reporting more severe performances than males. Furthermore, we found that reduced self-esteem was associated with more visibility of the NF1 symptoms, and victimization behaviors were found to mediate the relationship between anxiety and psychosocial QoL. Our findings indicated the presence of a maladaptive loop in children and adolescents with NF1 patients characterized by psychological symptoms, unfavorable self-perception, low self-esteem, and psychosocial difficulties that might be worsened by experiencing victimization behaviors. These results suggest the need to use a multidisciplinary approach in the diagnosis and treatment of NF1.
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Affiliation(s)
- Nicola Davide Cavallo
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Gianpaolo Maggi
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Francesco Ferraiuolo
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Anna Sorrentino
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Silverio Perrotta
- Department of Women’s and Children’s Health, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Marco Carotenuto
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Clinic, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
- Correspondence:
| | - Claudia Santoro
- Department of Women’s and Children’s Health, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Clinic, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
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7
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Fertitta L, Bergqvist C, Armand ML, Moryousef S, Ferkal S, Jannic A, Ravaud P, Tran VT, Ezzedine K, Wolkenstein P. Quality of life in neurofibromatosis 1: development and validation of a tool dedicated to cutaneous neurofibromas in adults. J Eur Acad Dermatol Venereol 2022; 36:1359-1366. [PMID: 35412677 DOI: 10.1111/jdv.18140] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/10/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cutaneous neurofibromas (cNF), present in 95% of individuals with neurofibromatosis 1 (NF1), are considered as one of the greatest medical burden because of physical disfigurement. No specific score evaluates their impact on quality of life (QoL). OBJECTIVE To develop a specific score assessing cNF-related QoL. METHODS Through a multidisciplinary workshop including 10 patients, 3 expert-in-NF1 physicians, 3 health care workers (nurses and psychologist) and 1 methodologist, the French version of the Skindex-16 was modified by adding 3 items. The new cNF-Skindex was validated among patients with NF1 recruited in the ComPaRe online cohort, in France (N=284). Construct validity was assessed by comparing it with the EQ-5D-5L, its visual analog scale and the MYMOP2 and by assessing its association with patients' characteristics. Reliability was assessed by a test-retest. An English version of the tool was developed using a back forward translation. RESULTS A total of 228 individuals with NF1, with cNF answered the 19-item questionnaire. These items fitted into 3 domains: emotions, symptoms, functioning. One was dropped during analysis because >90% responders were not concerned. The cNF-Skindex significantly correlated with the EQ-5D-5L (N=193) and MYMOP2 (N=210) indicating good external validity: rs 0.38 (p<0.001), and 0.58 (p<0.001) respectively. Having >50 cNF was the only independent variable associated with the total score cNF-Skindex (β=15.88, 95%CI 6.96 - 24.81, p=0.001), and with the 3 sub-scores: "functioning" (β=2.65, 95%CI 0.71 - 4.59, p=0.008), "emotions" (β=17.03, 95%CI 4.11 - 29.96, p=0.010) and "symptoms" (β=3.90, 95%CI 1.95 - 5.85, p<0.001). Test-retest reliability (N=133) found an ICC at 0.96 demonstrating good reproducibility. CONCLUSION The cNF-Skindex demonstrated excellent psychometric properties. The global and sub-scores were increased with higher number of cNF arguing for its use in further trials aiming to reduce their number or prevent their development. Cross-cultural validation and evaluation of its responsiveness are the next steps.
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Affiliation(s)
- L Fertitta
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - C Bergqvist
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - M L Armand
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - S Moryousef
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - S Ferkal
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, National Referral Center for Neurofibromatoses, Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP), 94010, Créteil, France
| | - A Jannic
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - P Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France
| | - V T Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France
| | - K Ezzedine
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France.,Université Paris-Est Créteil (UPEC), 94010, Créteil, France
| | - P Wolkenstein
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France.,Université Paris-Est Créteil (UPEC), 94010, Créteil, France.,INSERM U955, 94010, Créteil, France
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8
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Hydroxychloroquine induces matrix metalloproteinase 1 expression and apoptosis in neurofibromatosis type 1 Schwann cells. J Dermatol Sci 2021; 104:142-145. [PMID: 34763989 DOI: 10.1016/j.jdermsci.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/05/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022]
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Roy A, Roulin JL, Gras-Le Guen C, Corbat ML, Barbarot S. Executive functions and quality of life in children with neurofibromatosis type 1. Orphanet J Rare Dis 2021; 16:420. [PMID: 34627329 PMCID: PMC8501592 DOI: 10.1186/s13023-021-02051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background To examine the impact of executive function disorders on health-related quality of life (QoL) in children with neurofibromatosis type 1 (NF1), we conducted a prospective single-center study among 40 children with NF1 aged 8–12 years (mean = 9.7, SD = 1.4) and their parents, comparing them with 56 healthy control children matched for age, sex, parental education level, and handedness. We collected children’s self-reports and parents’ proxy reports of QoL with the Kidscreen-52 questionnaire, and measured executive functions by combining seven performance-based tests and a daily life questionnaire completed by parents and teachers.
Results Several QoL domains were significantly impaired in the children with NF1, compared with healthy controls, mainly according to their parents’ reports (3 out of 9 scales; Cohen’s d: 0.57–0.76), with particularly low scores in the social support and peers and school environment domains. Executive function difficulties (Cohen’s d: 0.64–1.72) significantly predicted the impairment of QoL domains as perceived by the children or their parents, regardless of the indirect indicators of learning disabilities. Conclusions Both performance-based executive function scores and behavioral ratings of executive functions in daily life by parents and teachers were associated with low QoL levels in the children with NF1. The school environment and social integration appear to be particularly affected and should therefore be targeted in the management of the disease.
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Affiliation(s)
- Arnaud Roy
- LPPL, SFR Confluences, Univ. Angers, Université de Nantes, 49000, Angers, France. .,Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France. .,Neurofibromatosis Clinic, Nantes University Hospital, Nantes, France. .,Faculté des Lettres, Langues et Sciences Humaines, Université d'Angers, 11 Boulevard Lavoisier, 49045, Angers Cedex 01, France.
| | - Jean-Luc Roulin
- Psychology and Neurocognition Laboratory (LPNC), CNRS-University of Grenoble-Alpes-University of Savoie Mont-Blanc, Grenoble, France
| | - Christèle Gras-Le Guen
- Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France.,Clinical Investigation Center, Nantes University Hospital, Nantes, France
| | - Marie-Laure Corbat
- LPPL, SFR Confluences, Univ. Angers, Université de Nantes, 49000, Angers, France.,Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France.,Neurofibromatosis Clinic, Nantes University Hospital, Nantes, France
| | - Sébastien Barbarot
- Neurofibromatosis Clinic, Nantes University Hospital, Nantes, France.,Physiology of Nutritional Adaptations (PhAN) Laboratory, INRA and Dermatology Department, Nantes University Hospital, Nantes, France
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Martin S, Allen T, Toledo-Tamula MA, Struemph K, Reda S, Wolters PL, Baldwin A, Quinn M, Widemann BC. Acceptance and commitment therapy for adolescents and adults with neurofibromatosis type 1, plexiform neurofibromas, and chronic pain: Results of a randomized controlled trial. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wei G, Farooq J, Kumar A. Impact of mind-body treatment interventions on quality of life in neurofibromatosis patients: A systematic review and meta-analysis. Dermatol Ther 2020; 34:e14613. [PMID: 33258517 DOI: 10.1111/dth.14613] [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: 11/12/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Abstract
Individuals with neurofibromatosis (NF) experience poorer quality of life (QoL), in part contributed by the clinical manifestations of NF, such as functional disability, chronic pain, and altered physical appearance. Mind-body therapies (MBTs) tailored to NF have been developed, and have demonstrated promising potential to improve QoL in this population. We sought to systematically review current evidence on the effectiveness of MBTs in addressing QoL deficits in NF patients. Databases were reviewed between the date of inception and June 2020, using search terms: neurofibromatosis, schwannomatosis, psychotherapy, mind-body, mindfulness, meditation, resiliency, and behavioral therapy. Quality appraisal was assessed using the Cochrane Risk of Bias Tools and National Institutes of Health Study Quality Assessment Tools. We conducted a meta-analysis of mean differences and reported aggregate effect estimates with 95% confidence intervals. A total of 10 articles, including randomized-controlled trials and pre-post studies, were identified. Meta-analytic results of randomized-controlled trial data from six citations demonstrated MBTs were associated with improved physical (MD = 13.63, 95%CI 6.95-20.30, P < .0001, I2 = 24%), psychological (MD = 14.11, 95%CI 6.44-21.78, P = .0003, I2 = 38%), social (MD = 9.63, 95%CI 2.93-16.33, P = .005, I2 = 0%), and environmental QoL (MD = 14.14, 95%CI 8.28-20.00, P < .00001. I2 = 0%) in NF patients. These associations were maintained at 6-months follow-up for physical, psychological, and environmental QoL (P < .05). Our findings suggest that NF-adapted MBT strategies are associated with improving QoL in diverse NF populations, including NF2 patients experiencing deafness and youth NF patients. Providers and caregivers for NF should be aware of the potential benefits of MBT in chronic NF management.
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Affiliation(s)
- Grace Wei
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jeffrey Farooq
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Ambuj Kumar
- Research Methodology and Biostatistics Core, Office of Research, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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12
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An executive functioning perspective in neurofibromatosis type 1: from ADHD and autism spectrum disorder to research domains. Childs Nerv Syst 2020; 36:2321-2332. [PMID: 32617712 DOI: 10.1007/s00381-020-04745-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/11/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Neurofibromatosis type 1 (NF1) is a rare monogenic disorder associated with executive function (EF) deficits and heightened risk for attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). The goal of this paper is to understand how EFs provide a common foundation to understand vulnerabilities for ADHD and ASD within NF1. METHODS A literature review and synthesis was conducted. RESULTS EF difficulties in working memory, inhibitory control, cognitive flexibility, and planning are evident in NF1, ADHD, and ASD. However, relatively little is known about the heterogeneity of EFs and ADHD and ASD outcomes in NF1. Assessment of ADHD and ASD in NF1 is based on behavioral symptoms without understanding neurobiological contributions. Recent efforts are promoting the use of dimensional and multidisciplinary methods to better understand normal and abnormal behavior, including integrating information from genetics to self-report measures. CONCLUSION NF1 is a monogenic disease with well-developed molecular and phenotypic research as well as complementary animal models. NF1 presents an excellent opportunity to advance our understanding of the neurobiological impact of known pathogenic variation in normal and abnormal neural pathways implicated in human psychopathology. EFs are core features of NF1, ADHD, and ASD, and these neurodevelopmental outcomes are highly prevalent in NF1. We propose a multilevel approach for understanding EFs in patients with NF1.This is essential to advance targeted interventions for NF1 patients and to advance the exciting field of research in this condition.
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13
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Baudou E, Chaix Y. The value of screening tests in children with neurofibromatosis type 1 (NF1). Childs Nerv Syst 2020; 36:2311-2319. [PMID: 32524181 DOI: 10.1007/s00381-020-04711-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/28/2020] [Indexed: 11/26/2022]
Abstract
Neurofibromatosis type 1 (NF1) is one of the most prevalent rare diseases. Whilst penetrance is complete by adulthood, its expressivity is extremely variable with potential multi-systemic complications. Although NF1 is diagnosed clinically, molecular analysis has a part to play in the screening of atypical forms and in genetic counselling. The screening of complications is primarily based on a full annual clinical examination and an ophthalmological examination. Targeted paraclinical examinations will be carried out when clinical signs appear (neurological, ophthalmological, cutaneous, endocrinological, orthopaedic and cardiovascular, etc.). The implementation of routine paraclinical examinations, which are stressful for families, expensive and sometimes invasive (MRI under general anaesthetic), is only of minor interest and does not lead to any change in treatment if the child is asymptomatic. Part of the consultation should focus on evaluation of psychomotor development and learning difficulties, which are common features of this condition (50%), and impact the child's quality of life.
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Affiliation(s)
- Eloïse Baudou
- Paediatric Neurology Unit, Children's Hospital, Toulouse University Hospital , 330 Avenue de Grande-Bretagne, 31069, Toulouse, France.
- ToNIC, Toulouse NeuroImaging Center, Toulouse University Center, Inserm, UPS, Toulouse, France.
| | - Yves Chaix
- Paediatric Neurology Unit, Children's Hospital, Toulouse University Hospital , 330 Avenue de Grande-Bretagne, 31069, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University Center, Inserm, UPS, Toulouse, France
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14
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Baudou E, Nemmi F, Biotteau M, Maziero S, Assaiante C, Cignetti F, Vaugoyeau M, Audic F, Peran P, Chaix Y. Are morphological and structural MRI characteristics related to specific cognitive impairments in neurofibromatosis type 1 (NF1) children? Eur J Paediatr Neurol 2020; 28:89-100. [PMID: 32893091 DOI: 10.1016/j.ejpn.2020.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/19/2020] [Accepted: 07/03/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION NF1 children have cognitive disorders, especially in executive functions, visuospatial, and language domains, the pathophysiological mechanisms of which are still poorly understood. MATERIALS AND METHODS A correlation study was performed from neuropsychological assessments and brain MRIs of 38 NF1 patients and 42 controls, all right-handed, aged 8-12 years and matched in age and gender. The most discriminating neuropsychological tests were selected to assess their visuospatial, metaphonological and visuospatial working memory abilities. The MRI analyses focused on the presence and location of Unidentified Bright Objects (UBOs) (1), volume analysis (2) and diffusion analysis (fractional anisotropy and mean diffusivity) (3) of the regions of interest including subcortical structures and posterior fossa, as well as shape analysis of subcortical structures (4). The level of attention, intelligence quotient, age and gender of the patients were taken into account in the statistical analysis. Then, we studied how diffusion and volumes parameters were associated with neuropsychological characteristics in NF1 children. RESULTS NF1 children present different brain imaging characteristics compared to the control such as (1) UBOs in 68%, (2) enlarged total intracranial volume, involving all subcortical structures, especially thalamus, (3) increased MD and decreased FA in thalamus, corpus callosum and hippocampus. These alterations are diffuse, without shape involvement. In NF1 group, brain microstructure is all the more altered that volumes are enlarged. However, we fail to find a link between these brain characteristics and neurocognitive scores. CONCLUSION While NF1 patients have obvious pathological brain characteristics, the neuronal substrates of their cognitive deficits are still not fully understood, perhaps due to complex and multiple pathophysiological mechanisms underlying this disorder, as suggested by the heterogeneity observed in our study. However, our results are compatible with an interpretation of NF1 as a diffuse white matter disease.
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Affiliation(s)
- Eloïse Baudou
- Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France; ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France.
| | - Federico Nemmi
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
| | - Maëlle Biotteau
- Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France; ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
| | - Stéphanie Maziero
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
| | - Christine Assaiante
- CNRS, LNC, Aix Marseille Université, Marseille, France; CNRS, Fédération 3C, Aix Marseille Université, Marseille, France
| | - Fabien Cignetti
- CNRS, LNC, Aix Marseille Université, Marseille, France; CNRS, Fédération 3C, Aix Marseille Université, Marseille, France; CNRS, TIMC-IMAG, Université Grenoble Alpes, Grenoble, France
| | - Marianne Vaugoyeau
- CNRS, LNC, Aix Marseille Université, Marseille, France; CNRS, Fédération 3C, Aix Marseille Université, Marseille, France
| | - Frederique Audic
- Service de Neurologie Pédiatrique, CHU, Timone-Enfants, Marseille, France
| | - Patrice Peran
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
| | - Yves Chaix
- Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France; ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
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15
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Evaluating modified diets and dietary supplement therapies for reducing muscle lipid accumulation and improving muscle function in neurofibromatosis type 1 (NF1). PLoS One 2020; 15:e0237097. [PMID: 32810864 PMCID: PMC7446925 DOI: 10.1371/journal.pone.0237097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a genetic disorder that affects a range of tissue systems, however the associated muscle weakness and fatigability can have a profound impact on quality of life. Prior studies using the limb-specific Nf1 knockout mouse (Nf1Prx1-/-) revealed an accumulation of intramyocellular lipid (IMCL) that could be rescued by a diet supplemented with L-carnitine and enriched for medium-chain fatty acids (MCFAs). In this study we used the Nf1Prx1-/- mouse to model a range of dietary interventions designed to reduce IMCL accumulation, and analyze using other modalities including in situ muscle physiology and lipid mass spectrometry. Histological IMCL accumulation was significantly reduced by a range of treatments including L-carnitine and high MCFAs alone. A low-fat diet did not affect IMCL, but did provide improvements to muscle strength. Supplementation yielded rapid improvements in IMCL within 4 weeks, but were lost once treatment was discontinued. In situ muscle measurements were highly variable in Nf1Prx1-/- mice, attributable to the severe phenotype present in this model, with fusion of the hips and an overall small hind limb muscle size. Lipidome analysis enabled segregation of the normal and modified chow diets, and fatty acid data suggested increased muscle lipolysis with the intervention. Acylcarnitines were also affected, suggestive of a mitochondrial fatty acid oxidation disorder. These data support the theory that NF1 is a lipid storage disease that can be treated by dietary intervention, and encourages future human trials.
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16
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Doser K, Andersen EW, Kenborg L, Dalton SO, Jepsen JRM, Krøyer A, Østergaard J, Hove H, Sørensen SA, Johansen C, Mulvihill J, Winther JF, Bidstrup PE. Clinical characteristics and quality of life, depression, and anxiety in adults with neurofibromatosis type 1: A nationwide study. Am J Med Genet A 2020; 182:1704-1715. [PMID: 32484306 DOI: 10.1002/ajmg.a.61627] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/20/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a genetic condition characterized by numerous somatic manifestations. The psychosocial burden in adults has rarely been studied. We examined the prevalence of self-reported impairment of quality of life (QoL), symptoms of anxiety and depression and need for support, associated with disease severity and visibility. We conducted a nationwide cross-sectional study of all 467 adults with NF1 diagnosed between 1977 and 2016 at one of the two national centers for rare diseases in Denmark. A total of 244 (56% response rate) completed a questionnaire that included standard measures of QoL, symptoms of depression and anxiety, indicators of disease-related severity, visibility, and need for professional support. Associations between disease severity and visibility and psychosocial burden were analyzed in descriptive and multivariate models. We observed impaired QoL (mean = 81.3; 95% CI, 76.2; 86.4); 19% reported symptoms of depression (mean = 5.7; SD = 5.4), and 15% reported anxiety (mean = 5.1; SD = 5.2) at a clinical level. Adults with NF1 also reported requiring professional support for physical, psychological, and work-related problems. Disease severity and (partly) visibility were significantly (p < .0001) associated with psychosocial well-being and a requirement for support. This study provides new understanding of the factors associated with impaired QoL, indicating that follow-up care should be optimized into adult life.
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Affiliation(s)
- Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne Oksbjerg 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
| | - Jens Richardt Møllegaard Jepsen
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research and Center for Neuropsychiatric Schizophrenia Research, Mental Health Services, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Mental Health Center, Mental Health Services Capital Region Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - John Østergaard
- Center for Rare Disease, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Hove
- The RAREDIS Database, Center for Rare Diseases, Copenhagen University Hospital and Aarhus University, Copenhagen, Denmark
| | - Sven Asger Sørensen
- Department of Neurogenetics, Institute of Cellular and Molecular Medicine, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Oncology Clinic, Finsen Center, Copenhagen, Denmark
| | - John Mulvihill
- Department of Pediatrics, University of Oklahoma, Norman, Oklahoma, USA
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Faculty of Health, Department of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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17
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Vassallo G, Mughal Z, Robinson L, Weisberg D, Roberts SA, Hupton E, Eelloo J, Burkitt Wright EM, Garg S, Lewis L, Evans DG, Stivaros SM. Perceived fatigue in children and young adults with neurofibromatosis type 1. J Paediatr Child Health 2020; 56:878-883. [PMID: 31916647 DOI: 10.1111/jpc.14764] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/24/2019] [Accepted: 12/15/2019] [Indexed: 12/15/2022]
Abstract
AIM This study describes the prevalence and severity of perceived fatigue in a young neurofibromatosis type 1 (NF1) population. METHODS Ethical approval was obtained and NF1 affected Individuals aged 2-18 years from the Manchester's NF1 clinic invited along with any unaffected siblings. The PedsQL Multidimensional Fatigue Scale Parental and child report was used. This validated measure explores cognitive, physical and sleep/rest domains on a 0-100 scale. Higher scores indicate less fatigue. Fatigue scores in affected children were compared to unaffected siblings after adjusting for age, sex and Index of Multiple Deprivation and with published population standards using z-scores. RESULTS A total of 286 families were invited and 75 affected and 16 siblings participated. There were significant differences between NF1 and controls in the aggregated fatigue core (child report 55 ± 19 vs. 75 (14), P < 0.001; parent 54 ± 20 vs. 73 ± 18, P = 0.001) and the three sub-domains: cognitive (child 48 ± 27 vs. 75 ± 23, P < 0.001), physical (child 59 ± 19 vs. 82 ± 14, P < 0.001) and sleep/rest (child 59 ± 19 vs. 71 ± 15, P = 0.018). Similar differences were seen when compared with published controls (aggregated child z-score -1.9 ± 1.4, P < 0.001; parent -3.2 ± 1.8, P < 0.001). Prevalence of severe fatigue indicated by scores <2 standard deviation below published means for healthy controls were also higher for children with NF on both parent and child reports. Agreement between child and parent reports were limited as is frequently seen in the literature. CONCLUSION This study suggests that children with NF1 are affected by perceived fatigue when compared with healthy children who do not have NF1.
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Affiliation(s)
- Grace Vassallo
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,NW Genomics Hub, Manchester Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, United Kingdom
| | - Zulf Mughal
- Department of Paediatric Endocrinology and Bone Metabolism, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Louise Robinson
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Daniel Weisberg
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Stephen A Roberts
- Centres for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Eileen Hupton
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Judith Eelloo
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Emma Mm Burkitt Wright
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,NW Genomics Hub, Manchester Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, United Kingdom
| | - Shruti Garg
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Lauren Lewis
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - D Gareth Evans
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,NW Genomics Hub, Manchester Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, United Kingdom
| | - Stavros M Stivaros
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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18
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Biotteau M, Déjean S, Lelong S, Iannuzzi S, Faure-Marie N, Castelnau P, Rivier F, Lauwers-Cancès V, Baudou E, Chaix Y. Sporadic and Familial Variants in NF1: An Explanation of the Wide Variability in Neurocognitive Phenotype? Front Neurol 2020; 11:368. [PMID: 32431664 PMCID: PMC7214842 DOI: 10.3389/fneur.2020.00368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Cognitive impairment is the most common neurological manifestation in NF1 and occurs in 30–70% of NF1 cases. The onset and severity of each specific cognitive deficit varies greatly from child to child, with no apparent external causes. The wide variability of phenotype is the most complex aspect in terms of management and care. Despite multiple research, the mechanism underlying the high heterogeneity in NF1 has not yet been elucidated. While many studies have focused on the effects of specific and precise genetic mutations on the NF1 phenotype, little has been done on the impact of NF1 transmission (sporadic vs. familial cases). We used a complete neuropsychological evaluation designed to assess five large cognitive areas: general cognitive functions (WISC-IV and EVIP); reading skills (“L'Alouette,” ODEDYS-2 and Lobrot French reading tests); phonological process (ODEDYS-2 test); visual perceptual skills (JLO, Thurstone and Corsi block tests) and attention (CPT-II), as well as psychosocial adjustments (CBCL) to explore the impact of NF1 transmission on cognitive disease manifestation in 96 children affected by NF1 [55 sporadic cases (29♀, 26♂); 41 familial cases (24♀, 17♂)]. Results: Familial and Sporadic form of NF1 only differ in IQ expression. The families' socioeconomic status (SES) impacts IQ performance but not differently between sporadic and familial variants. However, SES is lower in familial variants than in the sporadic variant of NF1. No other cognitive differences emerge between sporadic and familial NF1. Conclusions: Inheritance in NF1 failed to explain the phenotype variability in its entirety. IQ differences between groups seems in part linked to the environment where the child grows up. Children with NF1, and especially those that have early diagnoses (most often in inherited cases), must obtain careful monitoring from their early childhood, at home to strengthen investment in education and in school to early detect emerging academic problems and to quickly place them into care. Trial Registration: IDRCB, IDRCB2008-A01444-51. Registered 19 January 2009.
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Affiliation(s)
- Maëlle Biotteau
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Sébastien Déjean
- Institut de Mathématiques de Toulouse, UMR5219 Université de Toulouse, CNRS UPS, Toulouse, France
| | - Sandrine Lelong
- Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Stéphanie Iannuzzi
- Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | | | - Pierre Castelnau
- UMR 1253, iBrain, University of Tours, INSERM, Tours, France.,Department of Medicine, University of Tours Francois Rabelais, Tours, France.,Pediatric Neurology, Clocheville Children's Hospital, Tours University Hospital, Tours, France
| | - François Rivier
- Department of Pediatric Neurology and Reference Center for Language Disabilities, CHU Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | | | - Eloïse Baudou
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Yves Chaix
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.,Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
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19
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Examination of the genetic factors underlying the cognitive variability associated with neurofibromatosis type 1. Genet Med 2020; 22:889-897. [PMID: 32015538 PMCID: PMC7200599 DOI: 10.1038/s41436-020-0752-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder associated with cognitive deficits. The NF1 cognitive phenotype is generally considered to be highly variable, possibly due to the observed T2-weighted hyperintensities, loss of heterozygosity, NF1-specific genetic modifiers, or allelic imbalance. Methods We investigated cognitive variability and assessed the contribution of genetic factors by performing a retrospective cohort study and a monozygotic twin case series. We included data of 497 children with genetically confirmed NF1 and an IQ assessment, including 12 monozygotic twin and 17 sibling sets. Results Individuals carrying an NF1 chromosomal microdeletion showed significant lower full-scale IQ (FSIQ) scores than individuals carrying intragenic pathogenic NF1 variants. For the intragenic subgroup, the variability in cognitive ability and the correlation of IQ between monozygotic NF1 twin pairs or between NF1 siblings is similar to the general population. Conclusions The variance and heritability of IQ in individuals with NF1 are similar to that of the general population, and hence mostly driven by genetic background differences. The only factor that significantly attenuates IQ in NF1 individuals is the NF1 chromosomal microdeletion genotype. Implications for clinical management are that individuals with intragenic NF1 variants that score <1.5–2 SD below the mean of the NF1 population should be screened for additional causes of cognitive disability.
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20
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Evaluation and Factors of Quality of Life Among Patients With Neurofibromatosis Type 1-Associated Craniofacial Plexiform Neurofibromas. J Craniofac Surg 2020; 31:347-350. [PMID: 31977693 DOI: 10.1097/scs.0000000000006015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim was to evaluate overall quality of life (QOL) and investigate impact factors in Chinese neurofibromatosis type 1 (NF1) patients, particularly in those with craniofacial plexiform neurofibromas (pNFs). METHODS The Impact of NF1 on quality of life (INF1-QOL) Questionnaire were completed from a department of plastic and reconstructive surgery by 27 patients. Patients were 3 to 49 years of age. The correlation between subdomains were calculated using Pearson correlation. The difference between groups were evaluated using Fisher exact t-test. P value <0.05 were considered significant. RESULTS In age group of craniofacial pNFs, significant difference presented in cosmetic appearance, role and outlook on life and general QOL. Higher impact on general QOL in adults (6/8) than children (1/7) pointed to more impaired QOL in adults, as well as 2 subdomains including appearance, role and outlook on life. The patients who have more than 50 cutaneous neurofibromas (cNFs) (6/7) presented a significantly greater negative impact on the role and outlook of life. No statistically significant difference of QOL were detected between craniofacial and non-craniofacial pNFs patients. CONCLUSIONS Age and cNFs were 2 main factors that have a negative impact on QOL in craniofacial pNFs patients. Adults reported lower QOL in cosmetic appearance, the role and outlook of life and general QOL. Patients with more than 50 cNFs reported more negative impact on the role and outlook of life. A multidiscipline management for these patients is required, including psychosocial intervention.
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21
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Taddei M, Erbetta A, Esposito S, Saletti V, Bulgheroni S, Riva D. Brain Tumors in NF1 Children: Influence on Neurocognitive and Behavioral Outcome. Cancers (Basel) 2019; 11:cancers11111772. [PMID: 31717965 PMCID: PMC6896178 DOI: 10.3390/cancers11111772] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 02/02/2023] Open
Abstract
Neurofibromatosis type-1 (NF1) is a monogenic tumor-predisposition syndrome creating a wide variety of cognitive and behavioral abnormalities, such as decrease in cognitive functioning, deficits in visuospatial processing, attention, and social functioning. NF1 patients are at risk to develop neurofibromas and other tumors, such as optic pathway gliomas and other tumors of the central nervous system. Few studies have investigated the impact of an additional diagnosis of brain tumor on the cognitive outcome of children with NF1, showing unclear results and without controlling by the effect of surgery, radio- or chemotherapy. In the present mono-institutional study, we compared the behavioral and cognitive outcomes of 26 children with neurofibromatosis alone (NF1) with two age-matched groups of 26 children diagnosed with NF1 and untreated optic pathway glioma (NF1 + OPG) and 19 children with NF1 and untreated other central nervous system tumors (NF1 + CT). NF1 + CT and NF1 + OPG showed significantly impaired cognitive abilities compared to NF1 group, with weaknesses in visuo-spatial abilities, visual scanning and verbal working memory, while general verbal abilities are preserved. Moreover, NF1 + OPG patients present more frequent internalizing problems and increased oppositional-deviant behaviors. These results suggest that the co-diagnosis of a brain tumor in NF1 children may partially worsen the cognitive and emotional outcome.
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Affiliation(s)
- Matilde Taddei
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (M.T.); (S.E.); (V.S.); (D.R.)
| | - Alessandra Erbetta
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy;
| | - Silvia Esposito
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (M.T.); (S.E.); (V.S.); (D.R.)
| | - Veronica Saletti
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (M.T.); (S.E.); (V.S.); (D.R.)
| | - Sara Bulgheroni
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (M.T.); (S.E.); (V.S.); (D.R.)
- Correspondence: ; Tel.: +39-02-2394-2215; Fax: +39-02-2394-2176
| | - Daria Riva
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (M.T.); (S.E.); (V.S.); (D.R.)
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22
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Sanagoo A, Jouybari L, Koohi F, Sayehmiri F. Evaluation of QoL in neurofibromatosis patients: a systematic review and meta-analysis study. BMC Neurol 2019; 19:123. [PMID: 31189476 PMCID: PMC6560778 DOI: 10.1186/s12883-019-1338-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 05/22/2019] [Indexed: 01/07/2023] Open
Abstract
Background The neurofibromatoses (NF) are a group of genetic disorders that interfere negatively with the quality of life (QoL) and influence physical, emotional and social statuses. Studying the effects of neurofibromatoses on various aspects of QoL seems important to implement beneficial strategies in increasing the QoL of NF patients. The aim of this study was to review the literature on quality of life in patients with NF and quantitatively evaluate the effects of Neurofibromatosis on various aspects of quality of life by synthesizing available studies. Methods This article is written according to the PRISMA checklist. Different databases including PubMed, Scopus, Google scholar and Web of Science were searched to identify studies that examined QoL of patients with neurofibromatosis. The relevant data obtained from these papers were analyzed by a random-effects model. The heterogeneity of studies was calculated using the I2 index and Egger test was used to determine publication bias. The information was analyzed by R and STATA Ver 14. Results Twelve studies were selected as eligible for this research and were included in the final analysis. The number of participants in the study was 7314 individuals containing 910 NF patients (642 NF1 and 268 NF2) and 6404 healthy subjects. The mean scores of sub-scales of QoL were significantly lower in NF patients compared with control except for the scale of cohesion. Family and NF patients had lower quality of life in all aspects of QoL than controls. Also, this meta-analysis shows that NF negatively effects on physical function, bodily pain, mental health, social function and general health. Subgroup analysis showed that NF had negative effects on all sub-scales of QoL if the study was conducted in adults and used a SF-36 questionnaire. Conclusion This meta-analysis suggests that NF is a broad spectrum disease, affecting physical function, bodily pain, mental health, social function and general health.
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Affiliation(s)
- Akram Sanagoo
- Nursing Research Center, Goletsan University of Medical Sciences, Gorgan, Iran
| | - Leila Jouybari
- Nursing Research Center, Goletsan University of Medical Sciences, Gorgan, Iran.
| | - Fatemeh Koohi
- Department of Epidemiology, School of Public Health, Birjand University of Medical Sciences, Birjand, South Khorasan Province, Iran
| | - Fatemeh Sayehmiri
- Student Research Committee, Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Heaney A, Wilburn J, Langmead S, Blakeley J, Huson S, Jim C, McKenna SP. A qualitative study of the impact of plexiform neurofibromas on need fulfilment in adults with neurofibromatosis type 1. SAGE Open Med 2019; 7:2050312119829680. [PMID: 30800298 PMCID: PMC6378462 DOI: 10.1177/2050312119829680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/15/2019] [Indexed: 11/16/2022] Open
Abstract
Objective To explore the impact of plexiform neurofibromas on the lives of adults with neurofibromatosis type 1. Background Neurofibromatosis type 1 is a complex neurogenetic syndrome that affects many aspects of health and functioning. A common manifestation of neurofibromatosis type 1 is plexiform neurofibromas, non-cancerous tumours that can cause disfigurement, pain and neurologic disability. Patient-reported outcome measures used in this condition have addressed symptoms and functional ability but not how the condition affects patients' lives, particularly, their ability to meet their human needs. Methods Unstructured qualitative interviews were conducted with adults with neurofibromatosis type 1-associated plexiform neurofibromas in the United Kingdom and United States. Interviewees were encouraged to describe how plexiform neurofibromas affected their ability to meet their needs. Interviews were audio-recorded and transcribed verbatim. The UK and US transcripts were combined and theoretical thematic analysis was conducted. Results In all, 42 interviews (United Kingdom = 20, United States = 22) were conducted. Transcripts revealed 696 statements on the impact of plexiform neurofibromas on need fulfilment. Five major themes emerged: appearance, relationships, independence, role fulfilment and pleasure. Conclusion Neurofibromatosis type 1-associated plexiform neurofibromas have a major effect on individuals' ability to meet their needs. An understanding of need fulfilment will complement information generated from traditional patient-reported outcome measures, particularly in a multi-faceted syndrome such as neurofibromatosis type 1.
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Affiliation(s)
| | | | - Shannon Langmead
- Johns Hopkins Comprehensive Neurofibromatosis Center, Baltimore, MD, USA
| | - Jaishri Blakeley
- Johns Hopkins Comprehensive Neurofibromatosis Center, Baltimore, MD, USA
| | - Susan Huson
- Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester, UK
| | - Carly Jim
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Stephen P McKenna
- Galen Research, Manchester, UK.,School of Health Sciences, The University of Manchester, Manchester, UK
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24
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Draucker CB, Nutakki K, Varni JW, Swigonski NL. The health-related quality of life of children, adolescents, and young adults with neurofibromatosis type 1 and their families: Analysis of narratives. J SPEC PEDIATR NURS 2017; 22. [PMID: 28198162 DOI: 10.1111/jspn.12174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/29/2016] [Accepted: 01/15/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Provide an in-depth description of the health-related quality of life (HRQoL) in youth diagnosed with neurofibromatosis type 1 (NF1) and their families. DESIGN AND METHODS Data were drawn from qualitative interviews conducted for a larger study aimed at developing the Pediatric Quality of Life Inventory™ (PedsQL™) NF1 module. RESULTS Youth with NF1 and their families experience a wide range of concerns related to HRQoL due to the varied symptom expression and uncertain trajectory of the disorder. PRACTICE IMPLICATIONS Pediatric nurses should routinely assess for HRQoL in this population and develop strategies tailored to those concerns that require intervention.
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Affiliation(s)
- Claire Burke Draucker
- Angela Barron McBride Professor of Psychiatric Mental Health Nursing, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Kavitha Nutakki
- Research Associate, Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James W Varni
- Professor Emeritus, Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas, USA
| | - Nancy L Swigonski
- Professor, Department of Pediatrics; Professor, Fairbanks School of Public Health; Affiliate Scientist, Regenstrief Institute, Inc.; Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
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25
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Gutmann DH, Ferner RE, Listernick RH, Korf BR, Wolters PL, Johnson KJ. Neurofibromatosis type 1. Nat Rev Dis Primers 2017; 3:17004. [PMID: 28230061 DOI: 10.1038/nrdp.2017.4] [Citation(s) in RCA: 418] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurofibromatosis type 1 is a complex autosomal dominant disorder caused by germline mutations in the NF1 tumour suppressor gene. Nearly all individuals with neurofibromatosis type 1 develop pigmentary lesions (café-au-lait macules, skinfold freckling and Lisch nodules) and dermal neurofibromas. Some individuals develop skeletal abnormalities (scoliosis, tibial pseudarthrosis and orbital dysplasia), brain tumours (optic pathway gliomas and glioblastoma), peripheral nerve tumours (spinal neurofibromas, plexiform neurofibromas and malignant peripheral nerve sheath tumours), learning disabilities, attention deficits, and social and behavioural problems, which can negatively affect quality of life. With the identification of NF1 and the generation of accurate preclinical mouse strains that model some of these clinical features, therapies that target the underlying molecular and cellular pathophysiology for neurofibromatosis type 1 are becoming available. Although no single treatment exists, current clinical management strategies include early detection of disease phenotypes (risk assessment) and biologically targeted therapies. Similarly, new medical and behavioural interventions are emerging to improve the quality of life of patients. Although considerable progress has been made in understanding this condition, numerous challenges remain; a collaborative and interdisciplinary approach is required to manage individuals with neurofibromatosis type1 and to develop effective treatments.
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Affiliation(s)
- David H Gutmann
- Department of Neurology, Washington University School of Medicine, Box 8111, 660 S. Euclid Avenue, St. Louis, Missouri 63110, USA
| | - Rosalie E Ferner
- Department of Neurology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert H Listernick
- Department of Academic General Pediatrics and Primary Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bruce R Korf
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
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26
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Feasibility and Preliminary Efficacy of an Internet Support Group for Parents of a Child with Neurofibromatosis Type 1: a Pilot Study. J Genet Couns 2016; 26:576-585. [PMID: 27822877 DOI: 10.1007/s10897-016-0031-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 10/03/2016] [Indexed: 12/19/2022]
Abstract
This pilot study investigated the feasibility and preliminary efficacy of an Internet Support Group (ISG) for parents of children with NF1. Eligible parents were recruited by email and completed baseline questionnaires assessing social support, self-efficacy, depression, and anxiety. The ISG involved eight weekly 90-min chat sessions and a discussion forum open 24 h/day for 8 weeks. Follow-up measures were completed immediately post-intervention and 3 months later. Parents from 33 families (29 mothers, 4 fathers) completed baseline measures. Over half of parents (52 %) rated their child's disease severity as mild, 33 % moderate, and 15 % severe. Among 21 parents who completed post-intervention measures, ratings of perceived emotional (p = .0008) and informational (p = .0003) support increased. There were no significant changes in self-efficacy, depression, or anxiety (ps > .05). The mean satisfaction rating was moderately high (7.6/10; range 4-10). Some parents commented that the chat sessions were at inconvenient times, which may have limited participation. Preliminary evidence in this small sample of parents suggests that ISGs may be a feasible and potentially efficacious method of providing support to parents of children with NF1. Having multiple weekly chat sessions held at various days and times may improve accessibility and participation. Clinicians are encouraged to help parents access online support resources.
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27
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The Role of Appearance in Adolescents’ Experiences of Neurofibromatosis Type 1: A Survey of Young People and Parents. J Genet Couns 2016; 25:1054-62. [DOI: 10.1007/s10897-016-9944-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 02/17/2016] [Indexed: 11/25/2022]
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28
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Olsen JR, Gallacher J, Finlay AY, Piguet V, Francis NA. Quality of life impact of childhood skin conditions measured using the Children's Dermatology Life Quality Index (CDLQI): a meta-analysis. Br J Dermatol 2016; 174:853-61. [PMID: 26686685 DOI: 10.1111/bjd.14361] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Children's Dermatology Life Quality Index (CDLQI) is the most widely used instrument for measuring the impact of skin disease on quality of life (QoL) in children. OBJECTIVES To provide a meta-analysis of all published QoL scores for a range of childhood skin conditions. METHODS Studies using the CDLQI questionnaire to measure QoL in skin conditions were identified by searching Medline and Embase from January 1995 (CDLQI creation) to December 2014. Studies were grouped according to condition and baseline scores were combined using meta-analysis. RESULTS Sixty-seven studies using the CDLQI met the inclusion criteria. The overall estimated CDLQI scores for conditions reported more than once were [point estimate (95% confidence interval, CI), number of studies (n), score range]: atopic eczema [8·5 (7·1-9·8), n = 38, 0-29], acne [5·3 (1·9-8·5), n = 5, 0-30], alopecia [3·1 (0-7·7), n = 2, 0-6], molluscum contagiosum [3·5 (0·6-6·7), n = 5, 0-27], psoriasis [8·0 (3·9-12·1), n = 6, 0-29], scabies [9·2 (0·0-20·3), n = 2, 1-26], urticaria [7·1 (0-15·4), n = 2, 0-22], vitiligo [6·5 (0·7-12·2), n = 2, 0-20] and warts [2·9 (0-5·8), n = 4, 0-16]. Overall, the mean effect on QoL [weighted average CDLQI score 4·6 (95% CI 3·9-5·4)] for children with these conditions was small. However, many children were found to experience a very large impact on QoL (34% of children with atopic eczema, 10% with molluscum contagiosum and 1-5% with acne) in studies where the distributions of scores were provided. CONCLUSIONS Most skin conditions in children have a 'small' mean effect on QoL. However, the range is large and a significant proportion of children with many common skin conditions will experience a very large effect on quality of life.
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Affiliation(s)
- J R Olsen
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8RZ, U.K
| | - J Gallacher
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, OX3 7JX, U.K
| | - A Y Finlay
- Department of Dermatology and Academic Wound Healing, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, CF14 4XN, U.K
| | - V Piguet
- Department of Dermatology and Academic Wound Healing, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, CF14 4XN, U.K
| | - N A Francis
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, CF14 4YS, U.K
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29
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Barke J, Coad J, Harcourt D. Parents' experiences of caring for a young person with neurofibromatosis type 1 (NF1): a qualitative study. J Community Genet 2016; 7:33-9. [PMID: 26201467 PMCID: PMC4715819 DOI: 10.1007/s12687-015-0247-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/14/2015] [Indexed: 11/27/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a variable and unpredictable genetic condition that can lead to changes to an individual's appearance. Research has started to explore children's and young people's experiences of living with the condition; however, there is a lack of research with parents. This exploratory qualitative study set out to examine parents' experiences of caring for a young person with NF1. Seven parents took part in semi structured interviews which were subjected to a thematic analysis. Three key themes were identified which related to managing the uncertainty of the condition, the impact of an altered appearance, and others' awareness and understanding of NF1. Parents felt that understanding NF1 themselves in order to support their child was beneficial whilst a perceived lack of understanding by others was cited as a significant challenge. Parents require trustworthy information and also more widely call for greater understanding and awareness of the condition.
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Affiliation(s)
- Jenny Barke
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
| | - Jane Coad
- Nursing, Midwifery and Healthcare Practice, Coventry University, Priory Street, Coventry, CV1 5FB, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
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30
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Coutinho V, Kemlin I, Dorison N, Billette de Villemeur T, Rodriguez D, Dellatolas G. Neuropsychological evaluation and parental assessment of behavioral and motor difficulties in children with neurofibromatosis type 1. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 48:220-230. [PMID: 26625207 DOI: 10.1016/j.ridd.2015.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/27/2015] [Accepted: 11/12/2015] [Indexed: 06/05/2023]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant multisystem disorder, with large inter and intrafamilial clinical variability and uncertain prognosis. In children with NF1 cognitive disorders, learning difficulties and behavioral problems are common. The present study aims to establish the neuropsychological and behavioral profiles of 78 patients with NF1, aged between 5 and 18 years, and to examine the relationship between these profiles and the transmission of NF1 (sporadic vs. familial), clinical manifestations, and environmental factors. We used several questionnaires completed by parents and neuropsychological tests. The results confirmed specific neuropsychological disabilities in children with NF1, especially involving visuospatial and fine motor skills, learning difficulties and behavioral problems. Cognitive difficulties were significantly more frequent in patients with familial than in those with sporadic NF1. All parental questionnaires were correlated with each other, but parental reports were not associated with FSIQ, SES, school status, and clinical manifestations of the disease. Neuropsychological tests were poorly related to parental reports of cognitive and behavioral difficulties.
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Affiliation(s)
- V Coutinho
- APHP, GHUEP, Hôpital Trousseau, Service de Neuropédiatrie, 26, avenue Dr. Netter, 75012 Paris, France; Centre de Référence des Neurofibromatoses, 75012 Paris, France; INSERM U1178, 16, avenue Paul Vaillant Couturier, 94807 Villejuif, France; Université Paris Descartes, France.
| | - I Kemlin
- APHP, GHUEP, Hôpital Trousseau, Service de Neuropédiatrie, 26, avenue Dr. Netter, 75012 Paris, France; Centre de Référence des Neurofibromatoses, 75012 Paris, France.
| | - N Dorison
- APHP, GHUEP, Hôpital Trousseau, Service de Neuropédiatrie, 26, avenue Dr. Netter, 75012 Paris, France; Centre de Référence des Neurofibromatoses, 75012 Paris, France.
| | - T Billette de Villemeur
- APHP, GHUEP, Hôpital Trousseau, Service de Neuropédiatrie, 26, avenue Dr. Netter, 75012 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, 75012 Paris, France; Inserm U1141, Paris, France.
| | - D Rodriguez
- APHP, GHUEP, Hôpital Trousseau, Service de Neuropédiatrie, 26, avenue Dr. Netter, 75012 Paris, France; Centre de Référence des Neurofibromatoses, 75012 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, 75012 Paris, France; Inserm U1141, Paris, France.
| | - G Dellatolas
- INSERM U1178, 16, avenue Paul Vaillant Couturier, 94807 Villejuif, France.
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Cornett KMD, North KN, Rose KJ, Burns J. Muscle weakness in children with neurofibromatosis type 1. Dev Med Child Neurol 2015; 57:733-6. [PMID: 25913846 DOI: 10.1111/dmcn.12777] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2015] [Indexed: 12/17/2022]
Abstract
AIM To investigate if children with neurofibromatosis type 1 (NF1) have reduced muscle strength compared with children with typical development. METHOD Maximal isometric strength of 15 upper and lower limb muscle groups was evaluated in 30 children with NF1 (16 males, 14 females; aged 4-16y) and 30 age-, sex-, height-, and weight-matched controls using hand-held dynamometry by a single evaluator. Both the left and right sides were assessed. RESULTS Children with NF1 were significantly weaker than children with typical development across all 15 muscle groups assessed (p<0.05). Apart from elbow flexion, there were no differences between the left and right sides (p>0.05). Magnitude of differences between the children with NF1 compared with the controls ranged from 3% to 43%. Males and females were equally affected. INTERPRETATION This study shows that children with NF1 have reduced muscle strength compared with children with typical development. This muscle weakness is present from the earliest stages of the disease assessed and persists throughout childhood with no sex difference. These results support recent evidence from mouse studies that NF1 is associated with a primary myopathy.
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Affiliation(s)
- Kayla M D Cornett
- Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Kathryn N North
- Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia
| | - Kristy J Rose
- Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Joshua Burns
- Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospital Network (Randwick and Westmead), Sydney, NSW, Australia
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32
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Quality of life among children and adolescents with neurofibromatosis 1: a systematic review of the literature. J Neurooncol 2015. [PMID: 25663248 DOI: 10.1007/s11060-015-1725-1.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
The aim of this research is to identify, within a systematic review, aspects of quality of life (QoL) that are adversely affected in children and adolescents with neurofibromatosis (NF), and to report predictors of quality of life in this population. Published reports of original research were included if they described QoL in children and/or adolescents with NF, and met methodological quality according to a list of predefined criteria. Seven studies conducted between 2006 and 2013 met inclusion criteria. All seven studies examined patients with NF1 and reported that these patients have lower general QoL compared to population norms. Parents' proxy ratings of QoL were generally lower than children's self-report ratings. By parent proxy, familial NF1 was a strong protective factor for QoL, while the opposite was found by child report. By parent proxy, male sex was significantly associated with lower scores on the parental time impact of QoL. Skin-related QoL was only slightly altered in this population, vision-specific QoL was impacted only in patients with vision loss. The majority of findings regarding predictors of QoL in children with NF1 were weak, due to a lack of studies, heterogeneity of samples, and heterogeneity of measurements/predictors assessed. Future studies should examine more comprehensively the psychosocial factors affecting the NF population, especially in young patients with NF2 and schwannomatosis, who have been neglected in prior research. The use of consistent QoL measures is preferred to allow better comparison among studies and conditions. Interventions, including comprehensive mind-body treatments, are warranted to address impaired QoL in children and adolescents with NF1.
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33
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Vranceanu AM, Merker VL, Park ER, Plotkin SR. Quality of life among children and adolescents with neurofibromatosis 1: a systematic review of the literature. J Neurooncol 2015; 122:219-28. [PMID: 25663248 DOI: 10.1007/s11060-015-1725-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/01/2015] [Indexed: 12/11/2022]
Abstract
The aim of this research is to identify, within a systematic review, aspects of quality of life (QoL) that are adversely affected in children and adolescents with neurofibromatosis (NF), and to report predictors of quality of life in this population. Published reports of original research were included if they described QoL in children and/or adolescents with NF, and met methodological quality according to a list of predefined criteria. Seven studies conducted between 2006 and 2013 met inclusion criteria. All seven studies examined patients with NF1 and reported that these patients have lower general QoL compared to population norms. Parents' proxy ratings of QoL were generally lower than children's self-report ratings. By parent proxy, familial NF1 was a strong protective factor for QoL, while the opposite was found by child report. By parent proxy, male sex was significantly associated with lower scores on the parental time impact of QoL. Skin-related QoL was only slightly altered in this population, vision-specific QoL was impacted only in patients with vision loss. The majority of findings regarding predictors of QoL in children with NF1 were weak, due to a lack of studies, heterogeneity of samples, and heterogeneity of measurements/predictors assessed. Future studies should examine more comprehensively the psychosocial factors affecting the NF population, especially in young patients with NF2 and schwannomatosis, who have been neglected in prior research. The use of consistent QoL measures is preferred to allow better comparison among studies and conditions. Interventions, including comprehensive mind-body treatments, are warranted to address impaired QoL in children and adolescents with NF1.
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Affiliation(s)
- Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, ne Bowdoin Square, Boston, MA, 02114, USA,
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Méni C, Sbidian E, Moreno JC, Lafaye S, Buffard V, Goldzal S, Wolkenstein P, Valeyrie-Allanore L. Treatment of Neurofibromas with a Carbon Dioxide Laser: A Retrospective Cross-Sectional Study of 106 Patients. Dermatology 2015; 230:263-8. [DOI: 10.1159/000368078] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 08/31/2014] [Indexed: 11/19/2022] Open
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Martin S, Schmitt SN, Wolters PL, Abel B, Toledo-Tamula MA, Baldwin A, Wicksell RK, Merchant M, Widemann B. Development and validation of the English Pain Interference Index and Pain Interference Index-Parent report. PAIN MEDICINE (MALDEN, MASS.) 2015; 16:367-73. [PMID: 25377441 PMCID: PMC7750882 DOI: 10.1111/pme.12620] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Measurement of pain interference in children is challenged by a lack of validated measures with a parent proxy report. This study investigated the psychometric properties of the Pain Interference Index (PII), a six-item questionnaire originally developed in Swedish, in chronically ill youth. METHODS We adapted the PII for English-speaking participants and created a parallel parent proxy measure. Respondents indicate how much pain has interfered with the child's life in the past 2 weeks (0-6 scale); higher scores indicate more pain interference. Eligible participants included individuals 6-25 years with neurofibromatosis type 1 (NF1) and cancer. Internal consistency was assessed; validity was examined by correlating PII scores with existing measures of pain interference (Modified Brief Pain Inventory [MBPI]) and pain intensity (visual analogue scale [VAS]), and with measures of disease severity. RESULTS Among 60 participants (mean age 14.7 years, range 6-24) and their parents, PII internal consistency was 0.84 and 0.96, respectively. PII scores correlated with MBPI (r = 0.81, P < 0.0001) and VAS (r = 0.55, P < 0.0001) scores and differentiated between patients with mild vs moderate/severe NF1 disease severity (P < 0.05). The PII-Parent was significantly correlated with the mothers' and fathers' VAS rating of the child's pain intensity (Ps < 0.01). CONCLUSIONS Internal consistency of the English PII is high; validity is supported by the PII's correlations with other measures of pain interference and pain intensity, and with disease severity in patients with NF1. Preliminary data indicate that the English PII is a reliable, valid, feasible pain interference measure for youth with NF1 and cancer.
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Affiliation(s)
- Staci Martin
- National Cancer Institute, National Institutes of Health
| | - Shawn Nelson Schmitt
- Ettenhofer Laboratory for Neurocognitive Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Brittany Abel
- National Cancer Institute, National Institutes of Health
| | - Mary Anne Toledo-Tamula
- National Laboratory for Cancer Research, Leidos Biomedical Laboratories, Frederick, Maryland
| | - Andrea Baldwin
- National Cancer Institute, National Institutes of Health
| | - Rikard K. Wicksell
- Department of Clinical Neuroscience, Karolinska Institut
- Behavior Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden
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Cohen JS, Levy HP, Sloan J, Dariotis J, Biesecker BB. Depression among adults with neurofibromatosis type 1: prevalence and impact on quality of life. Clin Genet 2015; 88:425-30. [PMID: 25534182 DOI: 10.1111/cge.12551] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/17/2014] [Accepted: 12/10/2014] [Indexed: 11/28/2022]
Abstract
Neurofibromatosis type 1 (NF1) carries a significant psychosocial burden for affected individuals. The objective of this study was to measure the prevalence of depressive symptoms among a large sample of adults with NF1 and to quantify the impact of depressive symptoms on quality of life (QoL). This cross-sectional study used an Internet-based questionnaire to collect data from 498 adults who self-reported as having NF1. Using the Center for Epidemiologic Studies Depression (CESD) scale, 55% of all participants (61% of females and 43% of males) scored above 16, indicating a high likelihood of clinical depression. In a multivariate regression model controlling for demographics and potential confounders, depressive symptoms accounted for 32% of the variance in QoL as measured by the Quality of Life Index. This study is the largest to date and found the highest prevalence of depression compared to prior studies. Our data provide more compelling evidence that individuals with NF1 are at increased risk for psychiatric morbidity and suggest that this population should be routinely screened for depression. Because depression was found to be strongly associated with QoL and accounted for nearly one-third of the variance in QoL, it is likely that effectively treating depression may significantly enhance QoL for individuals with NF1.
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Affiliation(s)
- J S Cohen
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - H P Levy
- McKusick Nathans Institute of Genetic Medicine and Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Sloan
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Dariotis
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,College of Education, Criminal Justice, and Human Services, University of Cincinnati, Cincinnati, MD, USA
| | - B B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Mautner VF, Granström S, Leark RA. Impact of ADHD in adults with neurofibromatosis type 1: associated psychological and social problems. J Atten Disord 2015; 19:35-43. [PMID: 22786884 DOI: 10.1177/1087054712450749] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze the psychological phenotype of ADHD, and the effect of ADHD on life satisfaction and personality in adults with neurofibromatosis type 1 (NF1). METHOD Adults with NF1 without (n = 26) and with ADHD (n = 22), and adults with ADHD only (n = 27) completed questionnaires on personality traits and life satisfaction. Differences between groups were analyzed. RESULTS Participants with NF1 and ADHD present an emotionally instable psychological phenotype similar to adults with ADHD only, which differed significantly from that in adults with NF1 only. Participants with NF1 and ADHD had significantly lower overall life satisfaction than NF1 participants without such symptoms, affecting general health, self-satisfaction, sexuality, and family. CONCLUSION The authors' findings show that ADHD symptoms can persist through adulthood. These NF1 patients display problems similar to those of adults with ADHD only. This finding is highly relevant to understand the behavioral and psychological phenotype in adults with NF1 and to offer psychological and/or medical treatment.
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Salek MS, Jung S, Brincat-Ruffini LA, MacFarlane L, Lewis-Jones MS, Basra MKA, Finlay AY. Clinical experience and psychometric properties of the Children's Dermatology Life Quality Index (CDLQI), 1995-2012. Br J Dermatol 2014; 169:734-59. [PMID: 23679682 DOI: 10.1111/bjd.12437] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2013] [Indexed: 11/28/2022]
Abstract
The Children's Dermatology Life Quality Index (CDLQI) is a widely used questionnaire to measure the quality of life of children aged from 4 to 16 years. The purpose of this review is to summarize all published data regarding the clinical experience of the CDLQI and its psychometric properties as a single reference source for potential users. A literature search was carried out to identify all articles describing the use of the CDLQI from 1995 to November 2012. One hundred and six articles were identified, with four excluded. The CDLQI has been used in 28 countries in 102 clinical studies and is available in 44 languages, including six cultural adaptations; a cartoon version is available in 10 languages. It has been used in 14 skin conditions and used in the assessment of 11 topical drugs, nine systemic drugs, 13 therapeutic interventions and two epidemiological and other studies. There is evidence of high internal consistency, test-retest reliability, responsiveness to change, and significant correlation with other subjective and objective measures. Rasch analysis has not been carried out and more information is needed concerning minimal clinically important difference; these are areas requiring further study.
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Affiliation(s)
- M S Salek
- Centre for Socioeconomic Research, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, U.K
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Martin S, Wolters PL, Baldwin A, Roderick MC, Toledo-Tamula MA, Gillespie A, Widemann B. Attitudes About Internet Support Groups Among Adolescents and Young Adults with Neurofibromatosis Type 1 and their Parents. J Genet Couns 2014; 23:796-804. [DOI: 10.1007/s10897-014-9688-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
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Barke J, Harcourt D, Coad J. ‘It's like a bag of pick and mix - you don't know what you are going to get’: young people's experience of neurofibromatosis Type 1. J Adv Nurs 2013; 70:1594-603. [DOI: 10.1111/jan.12319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Jenny Barke
- Centre for Appearance Research (CAR); University of the West of England; Bristol UK
| | - Diana Harcourt
- Centre for Appearance Research (CAR); University of the West of England; Bristol UK
| | - Jane Coad
- Centre for Children and Families Applied Research (CCFAR); Faculty of Health and Life Sciences; Coventry University; UK
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Pelizzo G, Nakib G, Veggiotti P, Savasta S, Raffaele A, Calcaterra V. Suicide attempt in pre-pubertal age. What quality of life in a child with incurable disease? Child Care Health Dev 2013; 39:908-9. [PMID: 23594108 DOI: 10.1111/cch.12067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G Pelizzo
- Department of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
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Pride NA, Crawford H, Payne JM, North KN. Social functioning in adults with neurofibromatosis type 1. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3393-3399. [PMID: 23911645 DOI: 10.1016/j.ridd.2013.07.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/07/2013] [Accepted: 07/09/2013] [Indexed: 06/02/2023]
Abstract
Neurofibromatosis type 1 (NF1) is a common single-gene disorder characterised by a diverse range of cutaneous, neurological and neoplastic manifestations. It is well recognised that children with NF1 have poor peer interactions and are at risk for deficits in social skills. Few studies, however, have examined social functioning in adults with NF1. We aimed to determine whether adults with NF1 are at greater risk for impairment in social skills and to identify potential risk factors for social skills deficits. We evaluated social skills in 62 adults with NF1 and 39 controls using self-report and observer-report measures of social behaviour. We demonstrate that adults with NF1 exhibit significantly less prosocial behaviour than controls. This deficit was associated with social processing abilities and was more evident in males. The frequency of antisocial behaviour was comparable between the two groups, however was significantly associated with behavioural regulation in the NF1 group. These findings suggest that poor social skills in individuals with NF1 are due to deficits in prosocial behaviour, rather than an increase in antisocial behaviour. This will aid the design of interventions aimed at improving social skills in individuals with NF1.
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Affiliation(s)
- Natalie A Pride
- The Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine, The University of Sydney, NSW 2006, Australia.
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Robertson KA, Nalepa G, Yang FC, Bowers DC, Ho CY, Hutchins GD, Croop JM, Vik TA, Denne SC, Parada LF, Hingtgen CM, Walsh LE, Yu M, Pradhan KR, Edwards-Brown MK, Cohen MD, Fletcher JW, Travers JB, Staser KW, Lee MW, Sherman MR, Davis CJ, Miller LC, Ingram DA, Clapp DW. Imatinib mesylate for plexiform neurofibromas in patients with neurofibromatosis type 1: a phase 2 trial. Lancet Oncol 2012; 13:1218-24. [PMID: 23099009 DOI: 10.1016/s1470-2045(12)70414-x] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Plexiform neurofibromas are slow-growing chemoradiotherapy-resistant tumours arising in patients with neurofibromatosis type 1 (NF1). Currently, there are no viable therapeutic options for patients with plexiform neurofibromas that cannot be surgically removed because of their proximity to vital body structures. We undertook an open-label phase 2 trial to test whether treatment with imatinib mesylate can decrease the volume burden of clinically significant plexiform neurofibromas in patients with NF1. METHODS Eligible patients had to be aged 3-65 years, and to have NF1 and a clinically significant plexiform neurofibroma. Patients were treated with daily oral imatinib mesylate at 220 mg/m(2) twice a day for children and 400 mg twice a day for adults for 6 months. The primary endpoint was a 20% or more reduction in plexiform size by sequential volumetric MRI imaging. Clinical data were analysed on an intention-to-treat basis; a secondary analysis was also done for those patients able to take imatinib mesylate for 6 months. This trial is registered with ClinicalTrials.gov, number NCT01673009. FINDINGS Six of 36 patients (17%, 95% CI 6-33), enrolled on an intention-to-treat basis, had an objective response to imatinib mesylate, with a 20% or more decrease in tumour volume. Of the 23 patients who received imatinib mesylate for at least 6 months, six (26%, 95% CI 10-48) had a 20% or more decrease in volume of one or more plexiform tumours. The most common adverse events were skin rash (five patients) and oedema with weight gain (six). More serious adverse events included reversible grade 3 neutropenia (two), grade 4 hyperglycaemia (one), and grade 4 increases in aminotransferase concentrations (one). INTERPRETATION Imatinib mesylate could be used to treat plexiform neurofibromas in patients with NF1. A multi-institutional clinical trial is warranted to confirm these results. FUNDING Novartis Pharmaceuticals, the Indiana University Simon Cancer Centre, and the Indiana University Herman B Wells Center for Pediatric Research.
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Affiliation(s)
- Kent A Robertson
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Physical, cognitive, and psychosocial predictors of functional disability and health-related quality of life in adolescents with neurofibromatosis-1. PAIN RESEARCH AND TREATMENT 2012; 2012:975364. [PMID: 23056937 PMCID: PMC3463937 DOI: 10.1155/2012/975364] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 08/27/2012] [Indexed: 11/19/2022]
Abstract
Objective. To examine physical, cognitive, and social-emotional predictors of quality of life (HRQOL) and functional disability (FD) in adolescents diagnosed with Neurofibromatosis-1. Methods. Participants were twenty-seven adolescents with a diagnosis of NF-1 who were recruited through an NF-1 specialty clinic at a large Midwestern children's hospital. Measurements of the adolescents' cognitive functioning, pain, FD, HRQOL, and social and emotional functioning were obtained with corresponding parent measures. Results. Emotional functioning significantly predicted youth-reported and parent-reported HRQOL, whereas days of pain significantly predicted youth-reported FD. Conclusions. NF-1 is a complex disease. Measurements of the overall impact of the disease tap into different aspects of the effects of NF-1 on daily life. Global outcomes such as HRQOL appear to be influenced especially by emotional functioning, whereas outcomes such as FD appear to be influenced by the physical/organic aspects of NF-1.
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Martin S, Wolters P, Baldwin A, Gillespie A, Dombi E, Walker K, Widemann B. Social-emotional functioning of children and adolescents with neurofibromatosis type 1 and plexiform neurofibromas: relationships with cognitive, disease, and environmental variables. J Pediatr Psychol 2012; 37:713-24. [PMID: 22353803 DOI: 10.1093/jpepsy/jsr124] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This descriptive cross-sectional study aimed to determine how cognitive, disease, and environmental variables relate to social-emotional functioning in youth with NF1 and plexiform neurofibromas. METHODS Psychological assessments were administered to 53 children (mean age 12.4 years); parents and teachers completed the behavior assessment system for children-second edition (BASC-2). Disease severity was quantified by nurse-practitioner ratings and tumor burden, and parents completed a life events checklist to indicate environmental stressors. RESULTS Notable proportions of children scored in the at-risk/clinically significant ranges on several parent and teacher BASC-2 subscales including somatization, attention problems, depression, and withdrawal. Combinations of cognitive, disease, and environmental variables predicted scores on parent BASC-2 internalizing problems, behavior symptoms index, and Adaptive Skills composites. CONCLUSIONS Cognitive, disease, and environmental variables relate to social-emotional outcomes in children with NF1. These youth may benefit from interventions targeting social skills, cognitive functioning, and adaptive ways of coping with NF1-related pain.
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Affiliation(s)
- Staci Martin
- National Cancer Institute, Bethesda, MD 20892-8200, USA.
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Peters KF, Petrill SA. Comparison of the background, needs, and expectations for genetic counseling of adults with experience with Down syndrome, Marfan syndrome, and neurofibromatosis. Am J Med Genet A 2011; 155A:684-96. [PMID: 21344640 DOI: 10.1002/ajmg.a.33863] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 11/28/2010] [Indexed: 12/16/2022]
Abstract
We describe an analysis of the responses of 605 adults with experience with Down syndrome, Marfan syndrome, or neurofibromatosis (NF) to the BNE Scale, a scale specifically designed to assess the background, needs, and expectations (BNE) of genetic counseling patients. Significant group differences were found. Specifically, the respondents in the Down syndrome group reported more favorable beliefs about the condition and the availability of social support than the respondents in the other groups. Respondents in the NF group reported more unsureness about their condition and a greater need for genetic information than members of the other groups. Notably, having positive feelings about the condition was negatively correlated with support group interest for respondents of the Marfan syndrome group (r = -0.159, P < 0.01). Having an affected child was associated with interest in health provider input (t = -3.4; P = 0.001) and the desire to talk about psychosocial issues (t = -2.9; P = 0.004). However, previous experience with genetic counseling was not found to affect BNE. These results support the usefulness of the BNE Scale to compare the BNE of patient groups, as well as provide important insight into the BNE of individuals seeking counseling about Down syndrome, Marfan syndrome, and NF.
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Affiliation(s)
- Kathryn F Peters
- Penn State Institute for Diabetes and Obesity, University Park, University Park, Pennsylvania, USA.
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Kluger N, Letois F, Picot MC, Guillot B, Bessis D. How much disability is caused by fibrofolliculomas during Birt-Hogg-Dubé Syndrome? J Eur Acad Dermatol Venereol 2010; 25:940-4. [DOI: 10.1111/j.1468-3083.2010.03887.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cohen JS, Biesecker BB. Quality of life in rare genetic conditions: a systematic review of the literature. Am J Med Genet A 2010; 152A:1136-56. [PMID: 20425818 DOI: 10.1002/ajmg.a.33380] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Quality of life (QoL) refers to an individual's sense of overall well-being encompassing physical, psychological, emotional, social, and spiritual dimensions. Although genetics healthcare providers strive to promote patient well-being, and the term QoL is often invoked to refer to this outcome, there is lack of clarity as to what actually constitutes QoL from the patient's perspective. This systematic literature review aims to summarize and integrate research findings to help elucidate how healthcare providers can more effectively enhance the QoL of patients affected with rare genetic conditions. Eligible studies were those that measured QoL as a primary outcome variable using a validated, multi-dimensional scale. Detailed criteria were used to rate quality of design, methodology, and analytic rigor. Fifty-eight studies were selected for inclusion in the review, and a narrative synthesis of the data was performed. A central theme emerging from the literature is that, although genetic conditions have the potential to have significant negative consequences for individuals' lives, having a genetic condition does not necessarily entail poor QoL. Evidence demonstrates that factors beyond the physical manifestations of the disease, such as psychological well-being, coping, and illness perceptions, influence QoL and may serve as potent targets for intervention. The field of research on QoL in rare genetic conditions will be advanced by uniting around a clear conceptualization of QoL and using more rigorous methodology with comprehensive measures of global QoL.
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Affiliation(s)
- Julie S Cohen
- Kennedy Krieger Institute, Baltimore, MD 21205, USA.
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Gilboa Y, Rosenblum S, Fattal-Valevski A, Josman N. Application of the International Classification of Functioning, Disability and Health in children with neurofibromatosis type 1: a review. Dev Med Child Neurol 2010; 52:612-9. [PMID: 20187887 DOI: 10.1111/j.1469-8749.2010.03624.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The World Health Organization's International Classification of Functioning, Disability and Health adapted for children and young people (ICF-CY) is a framework for describing and classifying health and health-related states. The aim of the present study was to review literature on neurofibromatosis type 1 (NF1) using ICF-CY guidelines and to highlight findings about the quality of life of children with NF1. METHOD Electronic databases were searched to identify studies involving children with NF1. Eligible studies were classified according to ICF-CY categories. RESULTS Children with NF1 have a variety of cognitive and other deficits. However, very little information is available on the impact of these deficits on their daily life. INTERPRETATION Despite the broad range of functional and structural deficits in children with NF1, the functional assessment of these children remains largely unexplored. Future studies should aim at evaluating the participation of children with NF1 in various situations, using tools with high real-world validity.
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Affiliation(s)
- Yafit Gilboa
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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