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Tarantino S, Proietti Checchi M, Papetti L, Monte G, Ferilli MAN, Valeriani M. Parental Experiences in Pediatric Multiple Sclerosis: Insights from Quantitative Research. CHILDREN (BASEL, SWITZERLAND) 2024; 11:71. [PMID: 38255384 PMCID: PMC10814813 DOI: 10.3390/children11010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/31/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Multiple sclerosis (MS) is a chronic and unpredictable inflammatory disease impacting the central nervous system. The disabling nature of this disease is not limited to only physical symptoms. MS, even at a pediatric age, often includes cognitive impairment, fatigue, and psychological issues, affecting education and social life, causing emotional distress, and reducing quality of life. Despite the paucity of quantitative data in the existing literature, our review demonstrates that the impact of pediatric MS extends beyond the patients themselves, affecting their parents as well. There is evidence suggesting that having a child with MS may be associated with a reduction in the parental quality of life, even in families of MS patients with low or no disability and without clinical relapses. Moreover, an increased risk of parents' mental illness has been described, particularly in mothers, leading to a heightened utilization of mental health services. Research data show that inadequate information about MS may impact parents' anxiety and their sense of competence. Since parents' involvement has been found to also play a role in their child's adherence to treatment, special attention should be paid to parental psychological health. Additional research exploring family adaptation to their children's illness is required.
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Affiliation(s)
- Samuela Tarantino
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy (L.P.); (M.V.)
| | - Martina Proietti Checchi
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy (L.P.); (M.V.)
| | - Laura Papetti
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy (L.P.); (M.V.)
| | - Gabriele Monte
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy (L.P.); (M.V.)
| | - Michela Ada Noris Ferilli
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy (L.P.); (M.V.)
| | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy (L.P.); (M.V.)
- Systems Medicine Department, Tor Vergata University of Rome, 00133 Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, 9220 Aalborg, Denmark
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O’Mahony J, Marrie RA, Laporte A, Brown A. Addressing Health-Related Quality of Life Among Children With Multiple Sclerosis. Int J MS Care 2023; 25:35-42. [PMID: 36711221 PMCID: PMC9881424 DOI: 10.7224/1537-2073.2022-017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Children with the chronic disease multiple sclerosis (MS) report lower health-related quality of life (HRQOL) compared with children who experience transient illness. The relationship between an MS diagnosis and the HRQOL of affected children is mediated by parental HRQOL. Interventions to improve the HRQOL of children with MS should, therefore, include parents of affected children. METHODS We performed a configurative review for improvements in the HRQOL of children facing diseases similar to MS and their parents. We used the generated concepts to form theories. Next, we performed qualitative interviews with clinicians who care for children with MS to characterize overlap between the proposed theories and usual care. Finally, we generated recommendations for improving the HRQOL of children with MS and their parents. RESULTS We theorize that the HRQOL of children with MS and their parents may be improved by strengthening self-concept, hope, and knowledge. Qualitative interviews with 7 clinicians who care for children with MS revealed no common psychosocial care protocol. The interviews did, however, reveal sources of psychosocial care that overlap with the proposed theories and barriers to optimizing such care. CONCLUSIONS Grounded in theory and clinically oriented practice, recommendations to improve the HRQOL of children with MS and their parents are to implement standardized screening, pool provider counseling strategies, create computer applications with psychosocial interventions, promote age-appropriate education resources, and secure positions for MS specialists.
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Affiliation(s)
- Julia O’Mahony
- From the Department of Internal Medicine (JO'M), University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- From the Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences (RAM), University of Manitoba, Winnipeg, MB, Canada
| | - Audrey Laporte
- From the Institute of Health Policy, Management, and Evaluation (AL), University of Toronto, Toronto, ON, Canada
| | - Adalsteinn Brown
- From the Dalla Lana School of Public Health (AB), University of Toronto, Toronto, ON, Canada
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Luca M, Ortega-Castro N, Patti F. Paediatric Multiple Sclerosis: A Scoping Review of Patients' and Parents' Perspectives. CHILDREN (BASEL, SWITZERLAND) 2021; 9:11. [PMID: 35053636 PMCID: PMC8773986 DOI: 10.3390/children9010011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022]
Abstract
Dealing with paediatric-onset multiple sclerosis is particularly challenging for the young patients and their families, due to its unpredictable symptoms and uncertain outcome. This review aimed at synthesising the qualitative evidence regarding the perspectives about paediatric-onset multiple sclerosis, as expressed by the patients and/or their parents. A literature search was conducted on PubMed and CINAHL. The advanced multi-field search allowed to perform an abstract/title search in both databases, using keywords, combined through Boolean operators. Additional search strategies were adopted: searching the reference list of the selected papers; searching for key authors in the field. All the relevant papers were thoroughly revised using The Joanna Briggs Institute's data extraction form for qualitative evidence as a guidance. Eight papers were selected. The analysis of these papers allowed to identify some common issues pertaining paediatric-onset multiple sclerosis: (1) onset of symptoms, (2) diagnostic process, (3) reaction to the diagnosis, (4) management and acceptance of multiple sclerosis. The burden of multiple sclerosis was confirmed. However, the young patients and their parents can adjust to the disease. Both the community and the health care professionals must strive to prevent the families dealing with multiple sclerosis from experiencing solitude and rejection.
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Affiliation(s)
- Maria Luca
- Centre for Addiction, Via Pò 2, 95031 Adrano, Italy
| | | | - Francesco Patti
- Department “GF Ingrassia”, Section of Neurosciences, University of Catania, 95125 Catania, Italy;
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Ghai S, Kasilingam E, Lanzillo R, Malenica M, van Pesch V, Burke NC, Carotenuto A, Maguire R. Needs and Experiences of Children and Adolescents with Pediatric Multiple Sclerosis and Their Caregivers: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:445. [PMID: 34070298 PMCID: PMC8226634 DOI: 10.3390/children8060445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 01/21/2023]
Abstract
In the present study we conduct a systematic review to evaluate the needs and experience of people with pediatric multiple sclerosis (MS) and their caregivers. The literature search was conducted across 10 academic databases, adhering to PRISMA-P guidelines. Quality appraisal was conducted using the mixed method appraisal test for individual studies, and GRADE-CERQual to establish overall confidence of findings. Results were analyzed using a process of narrative synthesis. We identified 26 studies which included 2253 children/adolescents with MS (CAMS) and 1608 caregivers. MS was reported to negatively impact experiences for CAMS in domains such as of school performance, social relationships, mental health, and overall physical functioning. Specifically, fatigue and social support were reported as the most important barriers and facilitators for CAMS, respectively. In terms of caregiver experience, negative impacts were reported on social functioning, mental health, and quality of life. Additionally, lack of awareness concerning MS was one of the biggest challenges reported. Caregivers expressed needs for psychological and social support. This study provides the first evidence regarding the needs and experiences of CAMS and their caregivers. Findings can be used to address policy gaps for supporting families affected by pediatric MS.
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Affiliation(s)
- Shashank Ghai
- School of Physical and Occupational Therapy, McGill University, Montréal, QC H3G 1Y5, Canada
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital—CISSS Laval, a Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada
- Department of Family Medicine, McGill University, Montréal, QC GRM MDI, Canada
| | | | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80138 Naples, Italy; (R.L.); (A.C.)
| | - Masa Malenica
- Department of Child Neurology, Associated Member of the ERN EpiCARE, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia;
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium;
| | - Niamh Caitlin Burke
- Department of Psychology, Maynooth University, Maynooth W23 F2K8, Ireland; (N.C.B.); (R.M.)
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80138 Naples, Italy; (R.L.); (A.C.)
| | - Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth W23 F2K8, Ireland; (N.C.B.); (R.M.)
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Cross TP, Shanks AK, Duffy LV, Rintell DJ. Families' Experience of Pediatric Onset Multiple Sclerosis. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:425-435. [PMID: 32318212 PMCID: PMC7163806 DOI: 10.1007/s40653-018-0243-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study interviewed parents to understand families' experience with pediatric onset multiple sclerosis (POMS), which make up 2.7% to 10.5% of all MS cases. 21 sets of parents of children with a confirmed diagnosis of POMS were recruited from two pediatric MS centers. Families experienced stress from the uncertainty prior to diagnosis, anxiety over symptoms and possible progression of the disease, frustrations with the uncertain effects of disease-modifying treatments (DMTs), and difficulties with injections. Families had to cope with cognitive and physical effects of POMS at school, decisions about expectations and independence for the child, and extra demands POMS placed on the family. Most parents reported benefitting from support from physicians, the National Multiple Sclerosis Society, and the MS community. Families had benefitted from DMTs, and, despite the stresses, most had adapted successfully to the illness. Advice from interviewees to other parents and recommendations for improving family support are presented.
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Affiliation(s)
- Theodore P. Cross
- Children and Family Research Center, University of Illinois at Urbana-Champaign, 1010 W. Nevada St, Urbana, IL 61801 USA
| | - Alane K. Shanks
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA USA
- Present Address: Renga Consulting, Brookline, MA 02445 USA
| | - Lisa V. Duffy
- Pediatric Multiple Sclerosis & Related Disorders Program, Department of Neurology, Boston Children’s Hospital, Boston, MA USA
- Bouve College of Health Sciences, Northeastern University, Boston, MA USA
| | - David J. Rintell
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA USA
- Present Address: BridgeBio, Palo Alto, CA USA
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Hebert D, Geisthardt C, Hoffman H. Insights and Recommendations From Parents Receiving a Diagnosis of Pediatric Multiple Sclerosis for Their Child. J Child Neurol 2019; 34:464-471. [PMID: 31012369 DOI: 10.1177/0883073819842420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Forty-two parents of 41 children reported on their experiences receiving a diagnosis of pediatric-onset multiple sclerosis for their child through semistructured phone interviews. Time to diagnosis ranged from 8 hours to 16 years, with the mean age at diagnosis of 13.7 years. The most common initial symptoms included visual disturbances and numbness. The mean number of medical visits to receive a diagnosis was 3.6. Parents reported feeling frustrated and overwhelmed during the diagnosis process, as well as shocked when told their child had multiple sclerosis. Parents emphasized the need for more awareness of pediatric-onset multiple sclerosis. Numerous parents reported encountering physicians who believed multiple sclerosis did not occur in childhood, contributing to a longer time to diagnosis. Parents preferred physicians first share the diagnosis with the parents without the child present. Finally, parents appreciated when physicians provided a variety of resources to help them cope with the diagnosis.
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Affiliation(s)
- Danielle Hebert
- 1 Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Cheryl Geisthardt
- 2 College of Education and Human Services, Central Michigan University, Mount Pleasant, MI, USA
| | - Holly Hoffman
- 2 College of Education and Human Services, Central Michigan University, Mount Pleasant, MI, USA
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Pétrin J, Fiander M, Doss PMIA, Yeh EA. A Scoping Review of Modifiable Risk Factors in Pediatric Onset Multiple Sclerosis: Building for the Future. CHILDREN-BASEL 2018; 5:children5110146. [PMID: 30373215 PMCID: PMC6262383 DOI: 10.3390/children5110146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/20/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022]
Abstract
Knowledge of the effect of modifiable lifestyle factors in the pediatric multiple sclerosis (MS) population is limited. We therefore conducted a scoping review, following the framework provided by Arksey and O’Malley. Four databases were searched for pediatric MS and modifiable lifestyle factors using index terms and keywords, from inception to May 2018. All quantitative and qualitative primary articles were included and limited to English and full text. Of the 7202 articles identified and screened, 25 full-text articles were relevant to our objective and were included. These articles focused on diet obesity, physical activity, and sleep. In cross-sectional analyses, these lifestyle factors were associated with increased risk of pediatric onset MS (POMS), and increased disease activity. Diet, particularly vitamin D and vegetable intake, was associated with reduced relapse rate. Obesity was linked to increased risk of POMS, and physical activity was associated with reduced relapse rate and sleep/rest fatigue. Thus, available studies of lifestyle related outcomes in pediatric MS suggest specific lifestyle related factors, including obesity, higher vitamin D levels, and higher physical activity may associate with lower disease burden in POMS. Studies reviewed are limited by their observational designs. Future studies with longitudinal and experimental designs may further clarify the role of modifiable lifestyle factors in this population.
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Affiliation(s)
- Julie Pétrin
- Department of Rehabilitation Sciences, School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George St, Kingston, ON K7L 3N6, Canada.
| | - Max Fiander
- Faculty of Medicine, Dalhousie University, Sir Charles Tupper Building, 5850 College Street, Halifax, NS B3H 4R2, Canada.
| | - Prenitha Mercy Ignatius Arokia Doss
- Department of Neurosciences, Faculty of Medicine, Université Laval, Pavillon Ferdinand Vandry, 1050, Medecine Avenue, Quebec City, QC G1V 0A6, Canada.
| | - E Ann Yeh
- Hospital for Sick Children, Division of Neurology, SickKids Research Institute, Neurosciences and Mental Health, University of Toronto, 27 King's College Cir, Toronto, ON M5S 3H7, Canada.
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Ghezzi A, Bianchi A, Baroncini D, Bertolotto A, Malucchi S, Bresciamorra V, Lanzillo R, Milani N, Martinelli V, Patti F, Chisari C, Rottoli M, Simone M, Paolicelli D, Visconti A. A multicenter, observational, prospective study of self- and parent-reported quality of life in adolescent multiple sclerosis patients self-administering interferon-β1a using RebiSmart™-the FUTURE study. Neurol Sci 2017; 38:1999-2005. [PMID: 28831635 DOI: 10.1007/s10072-017-3091-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/07/2017] [Indexed: 11/28/2022]
Abstract
Besides the impact of disease per se, the use of immunomodulatory therapies in adolescents with relapsing-remitting multiple sclerosis (RRMS) may have an effect on quality of life (QL). The FUTURE (Quality of liFe in adolescent sUbjecTs affected by mUltiple sclerosis treated with immunomodulatoRy agEnt using self-injecting device) study was designed to evaluate the changes in QL of Italian adolescents with RRMS receiving treatment with IFN-β1a (Rebif; 22 μg), administered subcutaneously three times weekly using the RebiSmart™ electronic autoinjection device over a 52-week period. Fifty adolescents with RRMS were enrolled and 40 completed the study. Changes from baseline to end of treatment (EoT) in adolescent self-reported and parent-reported QL were assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL), which has been validated for use in pediatric MS and for which an Italian version is available. The adolescent self-reported total PedsQL4.0 score and all of its subscales tended to increase from baseline to EoT, the only exception being "Emotional functioning." In parent-reported measures, the total PedsQL4.0 score increased significantly from baseline to EoT (+ 5.27 points, p = 0.041). Significant increases were also evident for parent-reported "Psychosocial health summary score" (+ 5.90 points; p = 0.015) and "School functioning" (+ 7.84 points; p = 0.029). Our results indicate that adolescents with RRMS using the electronic injection device RebiSmart™ for self-administration of Rebif® can experience long-term improvements in QL.
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Affiliation(s)
- A Ghezzi
- Azienda Ospedaliera S. Antonio Abate, Gallarate, Italy.
| | - A Bianchi
- Azienda Ospedaliera S. Antonio Abate, Gallarate, Italy
| | - D Baroncini
- Azienda Ospedaliera S. Antonio Abate, Gallarate, Italy
| | - A Bertolotto
- AOU S. Luigi Gonzaga Neurologia 2 CRESM, Orbassano, Italy
| | - S Malucchi
- AOU S. Luigi Gonzaga Neurologia 2 CRESM, Orbassano, Italy
| | - V Bresciamorra
- Azienda Ospedaliero Universitaria Policlinico Federico II, Naples, Italy
| | - R Lanzillo
- Azienda Ospedaliero Universitaria Policlinico Federico II, Naples, Italy
| | - N Milani
- Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - F Patti
- Department of Medical and Surgical Sciences, and Advanced Technologies, Neuroscience Section, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - C Chisari
- Department of Medical and Surgical Sciences, and Advanced Technologies, Neuroscience Section, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - M Rottoli
- Neurologia USS Malattie Autoimmuni - Centro Sclerosi Multipla ASST Papa Giovanni XXIII, Bergamo, Italy
| | - M Simone
- Dip di Scienze mediche di Base, Neuroscienze ed Organi di Senso Università di Bari, Bari, Italy
| | - D Paolicelli
- Dip di Scienze mediche di Base, Neuroscienze ed Organi di Senso Università di Bari, Bari, Italy
| | - A Visconti
- Medical Affair Department Merck Serono, Rome, Italy
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Charmaz K. Teaching Theory Construction With Initial Grounded Theory Tools: A Reflection on Lessons and Learning. QUALITATIVE HEALTH RESEARCH 2015; 25:1610-22. [PMID: 26646825 DOI: 10.1177/1049732315613982] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This article addresses criticisms of qualitative research for spawning studies that lack analytic development and theoretical import. It focuses on teaching initial grounded theory tools while interviewing, coding, and writing memos for the purpose of scaling up the analytic level of students' research and advancing theory construction. Adopting these tools can improve teaching qualitative methods at all levels although doctoral education is emphasized here. What teachers cover in qualitative methods courses matters. The pedagogy presented here requires a supportive environment and relies on demonstration, collective participation, measured tasks, progressive analytic complexity, and accountability. Lessons learned from using initial grounded theory tools are exemplified in a doctoral student's coding and memo-writing excerpts that demonstrate progressive analytic development. The conclusion calls for increasing the number and depth of qualitative methods courses and for creating a cadre of expert qualitative methodologists.
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Affiliation(s)
- Kathy Charmaz
- Sonoma State University, Rohnert Park, California, USA
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Methley AM, Mutch K, Moore P, Jacob A. Development of a patient-centred conceptual framework of health-related quality of life in neuromyelitis optica: a qualitative study. Health Expect 2015; 20:47-58. [PMID: 26599425 PMCID: PMC5217881 DOI: 10.1111/hex.12432] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 12/27/2022] Open
Abstract
Background Neuromyelitis optica (NMO) is an auto‐immune disease that can cause severe visual and mobility impairments. Research on health‐related quality of life (HRQoL) in NMO is scarce, limiting knowledge on factors influencing HRQoL and support needs. Aim This study provides the first qualitative exploration of HRQoL in NMO, conducted to provide a conceptual framework for the development of an NMO patient‐reported outcome measure. Method Fifteen people with NMO (aged 18–74; 11 women, 4 men) participated in semi‐structured interviews; data were analysed using constant comparative analysis. Results HRQoL in NMO is a multifaceted concept incorporating highly subjective perceptions of normality and meaning. Four major themes were identified: impact of physical symptoms on daily living, utilizing support to achieve independence, expectations for life and meaningful roles in life and purpose. Discussion Themes highlighted the importance of perceived normality, and its relationship to attaining life goals comparable to peers, as underpinning evaluations of HRQoL. Many people with severe disability reported a high HRQoL, suggesting the inappropriateness of assuming a negative HRQoL on the basis of an individual's neurological impairment. Conclusions These findings further the conceptual understanding of HRQoL in NMO, informing patient‐care approaches and the development of an NMO‐specific patient‐reported outcome measure.
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Affiliation(s)
- Abigail M Methley
- School of Psychological Sciences, University of Manchester, Manchester, Lancashire, UK.,Walton Centre NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Kerry Mutch
- NMO Clinical Service, Walton Centre NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Perry Moore
- Neuropsychology Department, Walton Centre NHS Foundation Trust, Liverpool, Merseyside, UK.,Cardiff University, Glamorgan, UK
| | - Anu Jacob
- NMO Clinical Service, Walton Centre NHS Foundation Trust, Liverpool, Merseyside, UK
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