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van Hal AFRL, Vlot J, van Rosmalen J, Wijnen RMH, van Gils-Frijters APJM, Gischler SJ, Staals LM, IJsselstijn H, Rietman AB. Minimally invasive surgical approach in children treated for oesophageal atresia is associated with attention problems at school age: a prospective cohort study. Eur J Pediatr 2024; 183:2131-2140. [PMID: 38363392 PMCID: PMC11035457 DOI: 10.1007/s00431-024-05449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 02/17/2024]
Abstract
The long-term neurodevelopment of children born with oesophageal atresia (OA) is unclear. Therefore, we assessed the neurocognitive domains and their predictors. Patients born with OA between February 2006 and December 2014, who were routinely seen at eight years as part of a structured prospective longitudinal follow-up program, were included. Main outcome measures were need for school support, performance in various neurocognitive domains and potential predictors of neurocognitive problems. We analysed data of 65 children with a mean (SD) age of 8.1 (0.2) years, of whom 89% with OA type C. Thirty-five (54%) surgical corrections were minimally invasive; the median (interquartile range) duration of exposure to anaesthetics in the first 24 months was 398 (296 - 710) minutes. Forty-four (68%) attended regular education without extra support and intelligence was within normal range (99-108). More than 50% had z-scores ≤ -2 on one or more neurocognitive domains, of which attention was the most frequently affected domain. The speed on the sustained attention task was significantly below normal (z-score -1.48 (2.12), p < .001), as was fluctuation of sustained attention (z-score -3.19 (3.80), p < .001). The minimally invasive approach and a lower socio-economic status (both p = 0.006) proved significant predictors for sustained attention problems in multivariable analyses. Conclusion: Children who undergo minimally invasive surgery for OA correction are at risk for sustained attention problems at school age. Future studies unravelling the effects of perioperative events on neurodevelopment should lead to optimal surgical, anaesthesiological, and intensive care management in the neonatal period. What is Known: • School-aged children born with oesophageal atresia have normal intelligence but problems with sustained attention at eight years. What is New: • Oesophageal atresia patients, who undergo minimally invasive surgery or who have a background of lower socioeconomic status are at serious risk for sustained attention problems at school age. • Moreover, those who have been intubated for a longer period are at risk for stronger fluctuations in sustained attention.
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Affiliation(s)
- Anne-Fleur R L van Hal
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - John Vlot
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Annabel P J M van Gils-Frijters
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Saskia J Gischler
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Lonneke M Staals
- Department of Anaesthesiology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - André B Rietman
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
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Hagenaar DA, Bindels-de Heus KGCB, Lubbers K, Ten Hoopen LW, Rietman AB, de Nijs PFA, Hillegers MHJ, Moll HA, de Wit MCY, Dieleman GC, Mous SE. Child characteristics associated with child quality of life and parenting stress in Angelman syndrome. J Intellect Disabil Res 2024; 68:248-263. [PMID: 38009976 DOI: 10.1111/jir.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Angelman syndrome (AS) is a rare neurodevelopmental disorder characterised by severe intellectual disability, movement disorder, epilepsy, sleeping problems, and behavioural issues. Little is known on child health-related quality of life (HRQoL) in AS. AS family studies have reported elevated parenting stress and a high impact of the child's syndrome on the parent. It is unclear which factors influence child HRQoL and parenting stress/impact in AS. METHODS We collected data prospectively through standardised clinical assessments of children with AS at the ENCORE Expertise centre for Angelman Syndrome at the Erasmus MC Sophia Children's Hospital. A linear regression analysis was conducted for the following outcome variables: (1) child HRQoL (Infant and Toddler Quality of Life Questionnaire); (2) the impact of the child's syndrome on the parent (Infant and Toddler Quality of Life Questionnaire); and (3) parenting stress (Parenting Stress Index). Predictor variables were child genotype, epilepsy, sleeping problems (Sleep Disturbance Scale for Children), cognitive developmental level (Bayley Cognition Scale), autistic features (Autism Diagnostic Observation Schedule) and emotional/behavioural problems (Child Behaviour Checklist). Covariates were sex, age and socio-economic status. RESULTS The study sample consisted of 73 children with AS, mean age = 9.1 years, range = 2-18 years. Emotional/behavioural problems were the strongest significant predictor of lowered child HRQoL. Internalising problems were driving this effect. In addition, having the deletion genotype and higher age was related to lower child HRQoL. Sleeping problems were related to a higher impact of the child's syndrome on the parent. Finally, emotional/behavioural problems were associated with higher parenting stress. Cognitive developmental level, autistic features and epilepsy were not a significant predictor of child HRQoL and parenting stress/impact. CONCLUSIONS These results suggest that interventions aimed at increasing child HRQoL and decreasing parenting stress/impact in AS should focus on child emotional/behavioural problems and sleeping problems, using a family-centred approach.
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Affiliation(s)
- D A Hagenaar
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - K G C B Bindels-de Heus
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - K Lubbers
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - L W Ten Hoopen
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - A B Rietman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - P F A de Nijs
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - M H J Hillegers
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - H A Moll
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - M C Y de Wit
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Neurology and Paediatric Neurology, Erasmus MC, Rotterdam, the Netherlands
| | - G C Dieleman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - S E Mous
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
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3
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Hermans MM, Schappin R, de Laat PCJ, Mendels EJ, Breur JMPJ, Langeveld HR, Raphael MF, de Graaf M, Breugem CC, de Wildt SN, Okkerse JME, Pasmans SGMA, Rietman AB. Mental Health of School-Aged Children Treated with Propranolol or Atenolol for Infantile Hemangioma and Their Parents. Dermatology 2024; 240:216-225. [PMID: 38228125 PMCID: PMC10997238 DOI: 10.1159/000536144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Infants with infantile hemangioma (IH) have been effectively treated with propranolol or atenolol. Concerns were raised about the mental health of these children at school age, due to central nervous system effects of propranolol and visible nature of IH. OBJECTIVE This study aimed to compare the mental health at school age of children treated with propranolol to children treated with atenolol for IHs and their parents. METHODS This two-centered cross-sectional study included children aged ≥6 years and treated with either propranolol or atenolol for IH during infancy. Children's outcomes were performance-based affect recognition (Dutch version of the Developmental Neuropsychological Assessment-II [NEPSY-II-NL]), parent-reported emotional and behavioral functioning (Child Behavioral Checklist [CBCL]), and health-related quality of life (KIDSCREEN-27). Parents' outcome was parenting stress (Parenting Stress Questionnaire [OBVL]). RESULTS Data of 105 children (36 propranolol, 69 atenolol; 6.0-11.8 years) were analyzed. Mental health outcomes did not differ between both β-blocker groups. Although overall functioning was in line with norms, children presented specific problems concerning affect recognition, parent-reported attention, and social quality of life. Parents showed increased physical symptoms, depressive symptoms, and parent-child relationship problems. CONCLUSION No difference in mental health at school age was found between children treated with propranolol or atenolol for IH. Although few overall mental health problems were found, specific problems require follow-up. Follow-up of children should be directed toward affect recognition, attention, and social functioning in daily life. Problems reported by parents could be ameliorated by mental health support during and after their infant's β-blocker treatment.
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Affiliation(s)
- Mireille M Hermans
- Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands,
| | - Renske Schappin
- Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Rotterdam, The Netherlands
| | - Peter C J de Laat
- Department of Pediatrics (-Hemato-oncology), Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Utrecht, The Netherlands
| | - Elodie J Mendels
- Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hester R Langeveld
- Department of Intensive Care and Pediatric Surgery, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martine F Raphael
- Department of Dermatology, UMC Utrecht Center for Vascular Anomalies, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies de Graaf
- Department of Dermatology, UMC Utrecht Center for Vascular Anomalies, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic Surgery, UMC Utrecht Center for Vascular Anomalies, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia N de Wildt
- Department of Pharmacology and Toxicology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jolanda M E Okkerse
- Department of Child and Adolescent Psychology/Psychiatry, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - André B Rietman
- Department of Child and Adolescent Psychology/Psychiatry, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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4
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Müller AR, den Hollander B, van de Ven PM, Roes KCB, Geertjens L, Bruining H, van Karnebeek CDM, Jansen FE, de Wit MCY, Ten Hoopen LW, Rietman AB, Dierckx B, Wijburg FA, Boot E, Brands MMG, van Eeghen AM. Cannabidiol (Epidyolex®) for severe behavioral manifestations in patients with tuberous sclerosis complex, mucopolysaccharidosis type III and fragile X syndrome: protocol for a series of randomized, placebo-controlled N-of-1 trials. BMC Psychiatry 2024; 24:23. [PMID: 38177999 PMCID: PMC10768432 DOI: 10.1186/s12888-023-05422-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Many rare genetic neurodevelopmental disorders (RGNDs) are characterized by intellectual disability (ID), severe cognitive and behavioral impairments, potentially diagnosed as a comorbid autism spectrum disorder or attention-deficit hyperactivity disorder. Quality of life is often impaired due to irritability, aggression and self-injurious behavior, generally refractory to standard therapies. There are indications from previous (case) studies and patient reporting that cannabidiol (CBD) may be an effective treatment for severe behavioral manifestations in RGNDs. However, clear evidence is lacking and interventional research is challenging due to the rarity as well as the heterogeneity within and between disease groups and interindividual differences in treatment response. Our objective is to examine the effectiveness of CBD on severe behavioral manifestations in three RGNDs, including Tuberous Sclerosis Complex (TSC), mucopolysaccharidosis type III (MPS III), and Fragile X syndrome (FXS), using an innovative trial design. METHODS We aim to conduct placebo-controlled, double-blind, block-randomized, multiple crossover N-of-1 studies with oral CBD (twice daily) in 30 patients (aged ≥ 6 years) with confirmed TSC, MPS III or FXS and severe behavioral manifestations. The treatment is oral CBD up to a maximum of 25 mg/kg/day, twice daily. The primary outcome measure is the subscale irritability of the Aberrant Behavior Checklist. Secondary outcome measures include (personalized) patient-reported outcome measures with regard to behavioral and psychiatric outcomes, disease-specific outcome measures, parental stress, seizure frequency, and adverse effects of CBD. Questionnaires will be completed and study medication will be taken at the participants' natural setting. Individual treatment effects will be determined based on summary statistics. A mixed model analysis will be applied for analyzing the effectiveness of the intervention per disorder and across disorders combining data from the individual N-of-1 trials. DISCUSSION These N-of-1 trials address an unmet medical need and will provide information on the effectiveness of CBD for severe behavioral manifestations in RGNDs, potentially generating generalizable knowledge at an individual-, disorder- and RGND population level. TRIAL REGISTRATION EudraCT: 2021-003250-23, registered 25 August 2022, https://www.clinicaltrialsregister.eu/ctr-search/trial/2021-003250-23/NL .
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Affiliation(s)
- A R Müller
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- 's Heeren Loo Care Group, Amersfoort, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - B den Hollander
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- United for Metabolic Diseases, Amsterdam, The Netherlands
| | - P M van de Ven
- Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K C B Roes
- Department of Health Evidence, Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Geertjens
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam UMC, Amsterdam Neuroscience, Amsterdam Reproduction and Development, N=You Neurodevelopmental Precision Center, Amsterdam, The Netherlands
| | - H Bruining
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam UMC, Amsterdam Neuroscience, Amsterdam Reproduction and Development, N=You Neurodevelopmental Precision Center, Amsterdam, The Netherlands
- Levvel, Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - C D M van Karnebeek
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- United for Metabolic Diseases, Amsterdam, The Netherlands
- Department of Human Genetics, Amsterdam UMC, Amsterdam, The Netherlands
| | - F E Jansen
- Department of Pediatric Neurology, Brain, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C Y de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L W Ten Hoopen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A B Rietman
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Dierckx
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F A Wijburg
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - E Boot
- 's Heeren Loo Care Group, Amersfoort, The Netherlands
- The Dalglish Family 22Q Clinic, Toronto, ON, Canada
- Department of Psychiatry & Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - M M G Brands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- United for Metabolic Diseases, Amsterdam, The Netherlands
| | - A M van Eeghen
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
- 's Heeren Loo Care Group, Amersfoort, The Netherlands.
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands.
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5
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Ten Kate CA, Koese HJH, Hop MJ, Rietman AB, Wijnen RMH, Vermeulen MJ, Keyzer-Dekker CMG. Psychometric Performance of the Stony Brook Scar Evaluation Scale and SCAR-Q Questionnaire in Dutch Children after Pediatric Surgery. Int J Environ Res Public Health 2023; 21:57. [PMID: 38248522 PMCID: PMC10815752 DOI: 10.3390/ijerph21010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024]
Abstract
Introduction: The growing population of survivors following pediatric surgery emphasizes the importance of long-term follow-up. The impact of surgical scars on daily life can be evaluated through patient-reported outcome measurements. The Stony Brook Scar Evaluation Scale (SBSES) and SCAR-Q questionnaire are two interesting instruments for this purpose. We evaluated their psychometric performance in Dutch children after pediatric surgery. Methods: After English-Dutch translation, we evaluated-following the COSMIN guidelines-the feasibility, reliability (internal and external), and validity (construct, criterion, and convergent) of the SBSES and SCAR-Q in Dutch patients < 18 years old with surgical scars. Results: Three independent observers completed the SB for 100 children (58% boys, median age 7.3 (IQR 2.5-12.1) years) in whom surgery had been performed a median of 2.8 (0.5-7.9) years ago. Forty-six of these children (61% boys, median age 12.1 (9.3-16.2) years) completed the SCAR-Q. Feasibility and internal reliability (Cronbach's alpha > 0.7) was good for both instruments. For the SB, external reliability was poor to moderate (interobserver variability: ICC 0.46-0.56; intraobserver variability: ICC 0.74). For the SCAR-Q, external reliability was good (test-retest agreement: ICC 0.79-0.93). Validity tests (construct, criterion, and convergent) showed poor to moderate results for both instruments. Conclusions: The Dutch-translated SBSES and SCAR-Q showed good feasibility and internal reliability. External reliability and validity were likely affected by differences in conceptual content between the questionnaires. Combining them would provide insight in the impact of scars on patients. Implementation of these instruments in longitudinal follow-up programs could provide new insights into the long-term psychological outcome after pediatric surgery.
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Affiliation(s)
- Chantal A. Ten Kate
- Department of Pediatric Surgery and Intensive Care Children, Erasmus MC Sophia Children’s Hospital, Wytemaweg 80, 3015 CD Rotterdam, The Netherlands; (C.A.T.K.); (H.J.H.K.); (A.B.R.); (R.M.H.W.)
| | - Hilde J. H. Koese
- Department of Pediatric Surgery and Intensive Care Children, Erasmus MC Sophia Children’s Hospital, Wytemaweg 80, 3015 CD Rotterdam, The Netherlands; (C.A.T.K.); (H.J.H.K.); (A.B.R.); (R.M.H.W.)
| | - M. Jenda Hop
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, 3015 CD Rotterdam, The Netherlands;
| | - André B. Rietman
- Department of Pediatric Surgery and Intensive Care Children, Erasmus MC Sophia Children’s Hospital, Wytemaweg 80, 3015 CD Rotterdam, The Netherlands; (C.A.T.K.); (H.J.H.K.); (A.B.R.); (R.M.H.W.)
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, 3015 CD Rotterdam, The Netherlands
| | - René M. H. Wijnen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus MC Sophia Children’s Hospital, Wytemaweg 80, 3015 CD Rotterdam, The Netherlands; (C.A.T.K.); (H.J.H.K.); (A.B.R.); (R.M.H.W.)
| | - Marijn J. Vermeulen
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children’s Hospital, 3015 CD Rotterdam, The Netherlands;
| | - Claudia M. G. Keyzer-Dekker
- Department of Pediatric Surgery and Intensive Care Children, Erasmus MC Sophia Children’s Hospital, Wytemaweg 80, 3015 CD Rotterdam, The Netherlands; (C.A.T.K.); (H.J.H.K.); (A.B.R.); (R.M.H.W.)
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6
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Dijkhuizen EI, de Munck S, de Jonge RCJ, Dulfer K, van Beynum IM, Hunfeld M, Rietman AB, Joosten KFM, van Haren NEM. Early brain magnetic resonance imaging findings and neurodevelopmental outcome in children with congenital heart disease: A systematic review. Dev Med Child Neurol 2023; 65:1557-1572. [PMID: 37035939 DOI: 10.1111/dmcn.15588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 04/11/2023]
Abstract
AIM To investigate the association between early brain magnetic resonance imaging (MRI) findings and neurodevelopmental outcome (NDO) in children with congenital heart disease (CHD). METHOD A search for studies was conducted in Embase, Medline, Web of Science, Cochrane Central, PsycINFO, and Google Scholar. Observational and interventional studies were included, in which patients with CHD underwent surgery before 2 months of age, a brain MRI scan in the first year of life, and neurodevelopmental assessment beyond the age of 1 year. RESULTS Eighteen studies were included. Thirteen found an association between either quantitative or qualitative brain metrics and NDO: 5 out of 7 studies showed decreased brain volume was significantly associated with worse NDO, as did 7 out of 10 studies on brain injury. Scanning protocols and neurodevelopmental tests varied strongly. INTERPRETATION Reduced brain volume and brain injury in patients with CHD can be associated with impaired NDO, yet standardized scanning protocols and neurodevelopmental assessment are needed to further unravel trajectories of impaired brain development and its effects on outcome.
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Affiliation(s)
- Emma I Dijkhuizen
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sophie de Munck
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Rogier C J de Jonge
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Karolijn Dulfer
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Ingrid M van Beynum
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Maayke Hunfeld
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Pediatric Neurology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - André B Rietman
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Koen F M Joosten
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Neeltje E M van Haren
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
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7
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Müller AR, Luijten MAJ, Haverman L, de Ranitz-Greven WL, Janssens P, Rietman AB, Hoopen LWT, de Graaff LCG, de Wit MC, Jansen AC, Gipson T, Capal JK, de Vries PJ, van Eeghen AM. Correction: Understanding the impact of tuberous sclerosis complex: development and validation of the TSC-PROM. BMC Med 2023; 21:401. [PMID: 37872559 PMCID: PMC10594910 DOI: 10.1186/s12916-023-03092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Affiliation(s)
- Annelieke R Müller
- 'S Heeren Loo, Amersfoort, The Netherlands
- Emma Center for Personalized Medicine, Department of Pediatrics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology and Mental Health and Personalized Medicine, Amsterdam, The Netherlands
| | - Michiel A J Luijten
- Amsterdam Public Health Research Institute, Methodology and Mental Health and Personalized Medicine, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Child Development, Amsterdam, The Netherlands
| | - Lotte Haverman
- Amsterdam Public Health Research Institute, Methodology and Mental Health and Personalized Medicine, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Child Development, Amsterdam, The Netherlands
| | | | - Peter Janssens
- Department of Nephrology and Arterial Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium
| | - André B Rietman
- Department of Child and Adolescent Psychiatry/Psychology and ENCORE Expertise Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Leontine W Ten Hoopen
- Department of Child and Adolescent Psychiatry/Psychology and ENCORE Expertise Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Laura C G de Graaff
- Center for Adults With Rare Genetic Syndromes, Division of Endocrinology, Department of Internal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marie-Claire de Wit
- Department of Pediatric Neurology and ENCORE Expertise Center, Erasmus Medical Center Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anna C Jansen
- Neurogenetics Research Group, Reproduction Genetics and Regenerative Medicine Research Cluster, Vrije Universiteit Brussel, Brussels, Belgium
- Pediatric Neurology Unit, Department of Pediatrics, Antwerp University Hospital, Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Tanjala Gipson
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, USA
- Le Bonheur Children's Hospital and Boling Center for Developmental Disabilities, Memphis, TN, USA
| | - Jamie K Capal
- Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Petrus J de Vries
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Agnies M van Eeghen
- 'S Heeren Loo, Amersfoort, The Netherlands.
- Emma Center for Personalized Medicine, Department of Pediatrics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Methodology and Mental Health and Personalized Medicine, Amsterdam, The Netherlands.
- Amsterdam Reproduction & Development, Child Development, Amsterdam, The Netherlands.
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8
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Hermans MM, Rietman AB, Schappin R, de Laat PCJ, Mendels EJ, Breur JMPJ, Langeveld HR, de Wildt SN, Breugem CC, de Graaf M, Raphael MF, Pasmans SGMA. Correction to: Long-term neurocognitive functioning of children treated with propranolol or atenolol for infantile hemangioma. Eur J Pediatr 2023; 182:4285-4287. [PMID: 37358627 PMCID: PMC10570211 DOI: 10.1007/s00431-023-05059-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Affiliation(s)
- Mireille M Hermans
- Department of Dermatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, Rotterdam, Netherlands
| | - André B Rietman
- Department of Child and Adolescent Psychology/Psychiatry, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Renske Schappin
- Department of Dermatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, Rotterdam, Netherlands
- Department of Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Peter C J de Laat
- Department of Pediatrics(-Hemato-Oncology), Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Elodie J Mendels
- Department of Dermatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, Rotterdam, Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hester R Langeveld
- Department of Intensive Care and Pediatric Surgery, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Saskia N de Wildt
- Department of Pharmacology and Toxicology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Corstiaan C Breugem
- Department of Plastic Surgery, UMC Utrecht Center for Vascular Anomalies, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, UMC Location University of Amsterdam, Utrecht, Netherlands
| | - Marlies de Graaf
- Department of Dermatology, UMC Utrecht Center for Vascular Anomalies, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Martine F Raphael
- Department of Dermatology, UMC Utrecht Center for Vascular Anomalies, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
- Department Emma Children's Hospital, UMC Location University of Amsterdam, Amsterdam, Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, Rotterdam, Netherlands.
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9
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Hermans MM, Pasmans SGMA, De Graaf M, Ragamin A, Mendels EJ, Breur JMPJ, Langeveld HR, Raphael MF, De Laat PCJ, De Wildt SN, Rietman AB, Breugem CC, Schappin R. Prognostic Factors for Long-term Aesthetic Outcome of Infantile Haemangioma Treated with Beta-blockers. Acta Derm Venereol 2023; 103:adv5286. [PMID: 37649330 PMCID: PMC10506515 DOI: 10.2340/actadv.v103.5286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/16/2022] [Indexed: 09/01/2023] Open
Abstract
Parents of infants treated with beta-blockers for infantile haemangioma are often concerned about the long-term aesthetic outcome. This cross-sectional study assessed the influence on the long-term aesthetic outcome of characteristics of the infantile haemangioma, the beta-blocker treatment, and the infant. The study included 103 children aged 6-12 years, treated with beta-blockers (propranolol or atenolol) for infantile haemangioma during infancy (age at treatment initiation ≤1 year) for ≥6 months. Dermatologists and parents scored the Patient Observer Scar Assessment Scale, and the child scored a visual analogue scale. Dermatologists identified whether telangiectasia, fibrofatty tissue, and atrophic scar tissue were present. The long-term aesthetic outcome of infantile haemangioma was judged more negatively by dermatologists and parents in case of a superficial component, ulceration, older age at treatment initiation, higher cumulative dose, and/or shorter follow-up time. According to children, infantile haemangioma located on the head had better aesthetic outcome than infantile haemangioma located elsewhere. Close monitoring, particularly of infantile haemangioma with a superficial component, is essential for early initiation of treatment, and to prevent or treat ulceration. These outcome data can support parental counselling and guide treatment strategy.
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Affiliation(s)
- Mireille M Hermans
- Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, The Netherlands
| | - Suzanne G M A Pasmans
- Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, The Netherlands.
| | - Marlies De Graaf
- Department of Dermatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, UMC Utrecht Center for Vascular Anomalies, The Netherlands
| | - Aviël Ragamin
- Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, The Netherlands
| | - Elodie J Mendels
- Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, The Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Hester R Langeveld
- Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Department of Intensive Care and Pediatric Surgery, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, The Netherlands
| | - Martine F Raphael
- Department of Dermatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, UMC Utrecht Center for Vascular Anomalies, The Netherlands
| | - Peter C J De Laat
- Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Department of Pediatrics (-Hemato-oncology), Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, The Netherlands
| | - Saskia N De Wildt
- Department of Pharmacology and Toxicology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - André B Rietman
- Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Department of Child and Adolescent Psychology/Psychiatry, the Netherlands
| | - Corstiaan C Breugem
- Department of Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, UMC Utrecht Center for Vascular Anomalies, The Netherlands
| | - Renske Schappin
- Department of Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
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10
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Müller AR, Luijten MAJ, Haverman L, de Ranitz-Greven WL, Janssens P, Rietman AB, Ten Hoopen LW, de Graaff LCG, de Wit MC, Jansen AC, Gipson T, Capal JK, de Vries PJ, van Eeghen AM. Understanding the impact of tuberous sclerosis complex: development and validation of the TSC-PROM. BMC Med 2023; 21:298. [PMID: 37553648 PMCID: PMC10408092 DOI: 10.1186/s12916-023-03012-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a rare and complex genetic disorder, associated with tumor growth in various organ systems, epilepsy, and a range of neuropsychiatric manifestations including intellectual disability. With improving patient-centered care and targeted therapies, patient-reported outcome measures (PROMs) are needed to measure the impact of TSC manifestations on daily functioning. The aim of this study was to develop a TSC-specific PROM for adults that captures the impact of TSC on physical functions, mental functions, activity and participation, and the social support individuals with TSC receive, called the TSC-PROM. METHODS COSMIN methodology was used to develop a self-reported and proxy-reported version. Development and validation consisted of the following studies: PROM development, content validity, structural validity, internal consistency, and construct validity. The International Classification of Functioning and Disability was used as a framework. Content validity was examined by a multidisciplinary expert group and cognitive interview study. Structural and construct validity, and internal consistency were examined in a large cohort, using confirmatory factor analysis, hypotheses testing, and Cronbach's alpha. RESULTS The study resulted in an 82-item self version and 75-item proxy version of the TSC-PROM with four subscales (physical functions 18 and 19 items, mental functions 37 and 28 items, activities and participation 13 and 14 items, social support 13 items, for self version and proxy version respectively). Sufficient results were found for structural validity with sufficient unidimensionality for each subscale. With regard to construct validity, 82% of the hypotheses were met for the self version and 59% for the proxy version. The PROM showed good internal consistency (Cronbach's alpha 0.78-0.97). CONCLUSIONS We developed a PROM for adults with TSC, named TSC-PROM, showing sufficient evidence for reliability and validity that can be used in clinical and research settings to systematically gain insight into their experiences. It is the first PROM in TSC that addresses the impact of specific TSC manifestations on functioning, providing a valuable, patient-centered addition to the current clinical outcomes.
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Affiliation(s)
- Annelieke R Müller
- 's Heeren Loo, Amersfoort, The Netherlands
- Emma Center for Personalized Medicine, Department of Pediatrics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology and Mental Health and Personalized Medicine, Amsterdam, The Netherlands
| | - Michiel A J Luijten
- Amsterdam Public Health Research Institute, Methodology and Mental Health and Personalized Medicine, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Child Development, Amsterdam, The Netherlands
| | - Lotte Haverman
- Amsterdam Public Health Research Institute, Methodology and Mental Health and Personalized Medicine, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Child Development, Amsterdam, The Netherlands
| | | | - Peter Janssens
- Department of Nephrology and Arterial Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium
| | - André B Rietman
- Department of Child and Adolescent Psychiatry/Psychology and ENCORE Expertise Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Leontine W Ten Hoopen
- Department of Child and Adolescent Psychiatry/Psychology and ENCORE Expertise Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Laura C G de Graaff
- Center for Adults With Rare Genetic Syndromes, Division of Endocrinology, Department of Internal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marie-Claire de Wit
- Department of Pediatric Neurology and ENCORE Expertise Center, Erasmus Medical Center Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anna C Jansen
- Neurogenetics Research Group, Reproduction Genetics and Regenerative Medicine Research Cluster, Vrije Universiteit Brussel, Brussels, Belgium
- Pediatric Neurology Unit, Department of Pediatrics, Antwerp University Hospital; Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Tanjala Gipson
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, USA
- Le Bonheur Children's Hospital and Boling Center for Developmental Disabilities, Memphis, TN, USA
| | - Jamie K Capal
- Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Petrus J de Vries
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Agnies M van Eeghen
- 's Heeren Loo, Amersfoort, The Netherlands.
- Emma Center for Personalized Medicine, Department of Pediatrics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Methodology and Mental Health and Personalized Medicine, Amsterdam, The Netherlands.
- Amsterdam Reproduction & Development, Child Development, Amsterdam, The Netherlands.
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11
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Sreeram II, Schnater JM, van Rosmalen J, Cochius-den Otter SCM, Peters NCJ, Rottier RJ, Gischler SJ, Wijnen RMH, IJsselstijn H, Rietman AB. Longitudinal Health Status and Quality of Life in Congenital Diaphragmatic Hernia. Pediatrics 2023:191286. [PMID: 37199110 DOI: 10.1542/peds.2022-060385] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES To longitudinally evaluate self-reported health status (HS) and quality of life (QoL) in 8- and 12-year-old survivors of congenital diaphragmatic hernia (CDH). We hypothesized that HS would improve with age-as associated health problems tend to decline-whereas QoL would decrease, as the children start to compare themselves with peers. METHODS Self-reported HS and QoL of 133 children born between 1999 and 2013 who had joined our standardized follow-up program were routinely assessed at the ages of 8 and 12 with generic, internationally validated, standardized instruments. Longitudinal evaluation of total and subscale scores was performed using general linear model analyses. In addition, we compared these scores to sex- and age-specific normative data. RESULTS Between ages 8 and 12, boys born with CDH perceived a decline in HS (mean difference -7.15, P < .001). Self-reported QoL did not change over time in both boys and girls. At both ages, HS was significantly lower than that of healthy peers (effect size = 0.71, P = .001 for boys, and effect size = 0.69, P = .003 for girls), whereas differences in QoL were small. CONCLUSIONS Children born with CDH are at risk for declining HS between 8 and 12 years, but not QoL, compared with healthy peers. Given that children born with CDH tend to grow into deficits, our findings highlight the need for continued somatic and psychological assessments in adolescent and adult CDH survivors.
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Affiliation(s)
| | | | - Joost van Rosmalen
- Departments of Biostatistics, and
- Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Nina C J Peters
- Obstetrics and Gynecology, Subdivision of Obstetrics and Fetal Medicine
| | | | | | | | | | - André B Rietman
- Departments of Pediatric Surgery and Intensive Care
- Child and Adolescent Psychiatry and Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
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12
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Kersten CM, Hermelijn SM, Dossche LWJ, Muthialu N, Losty PD, Schurink M, Rietman AB, Poley MJ, van Rosmalen J, Zanen-van den Adel TPL, Ciet P, von der Thüsen J, Brosens E, Ijsselstijn H, Tiddens HAWM, Wijnen RMH, Schnater JM. COllaborative Neonatal Network for the first European CPAM Trial (CONNECT): a study protocol for a randomised controlled trial. BMJ Open 2023; 13:e071989. [PMID: 36931672 PMCID: PMC10030930 DOI: 10.1136/bmjopen-2023-071989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION Consensus is lacking on the optimal management of asymptomatic congenital pulmonary airway malformation (CPAM). For future studies, the CONNECT consortium (the COllaborative Neonatal Network for the first European CPAM Trial)-an international collaboration of specialised caregivers-has established consensus on a core outcome set of outcome parameters concerning respiratory insufficiency, surgical complications, mass effect and multifocal disease. These outcome parameters have been incorporated in the CONNECT trial, a randomised controlled trial which, in order to develop evidence-based practice, aims to compare conservative and surgical management of patients with an asymptomatic CPAM. METHODS AND ANALYSIS Children are eligible for inclusion after the CPAM diagnosis has been confirmed on postnatal chest CT scan and they remain asymptomatic. On inclusion, children are randomised to receive either conservative or surgical management. Subsequently, children in both groups are enrolled into a standardised, 5-year follow-up programme with three visits, including a repeat chest CT scan at 2.5 years and a standardised exercise tolerance test at 5 years.The primary outcome is exercise tolerance at age 5 years, measured according to the Bruce treadmill protocol. Secondary outcome measures are molecular genetic diagnostics, validated questionnaires-on parental anxiety, quality of life and healthcare consumption-, repeated imaging and pulmonary morbidity during follow-up, as well as surgical complications and histopathology. This trial aims to end the continuous debate surrounding the optimal management of asymptomatic CPAM. ETHICS AND DISSEMINATION This study is being conducted in accordance with the Declaration of Helsinki. The Medical Ethics Review Board of Erasmus University Medical Centre Rotterdam, The Netherlands, has approved this protocol (MEC-2022-0441). Results will be disseminated through peer-reviewed scientific journals and conference presentations. TRIAL REGISTRATION NUMBER NCT05701514.
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Affiliation(s)
- Casper M Kersten
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Sergei M Hermelijn
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Louis W J Dossche
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Nagarajan Muthialu
- Tracheal Team, Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Paul D Losty
- Paediatric Surgery, Institute Of Life Course And Medical Sciences, University of Liverpool, Liverpool, UK
- Paediatric Surgery, Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Maarten Schurink
- Paediatric Surgery, Radboud University Medical Centre Amalia Children's Hospital, Nijmegen, the Netherlands, Nijmegen, Netherlands
| | - André B Rietman
- Child and Adolescent Psychiatry, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Marten J Poley
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Biostatistics, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
- Epidemiology, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | | | - Pierluigi Ciet
- Radiology and Nuclear Medicine, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Paediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Radiology and Medical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Erwin Brosens
- Clinical Genetics, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Erasmus MC Cancer Centre, Rotterdam, Zuid-Holland, Netherlands
| | - Hanneke Ijsselstijn
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Harm A W M Tiddens
- Radiology and Nuclear Medicine, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Paediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Rene M H Wijnen
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - J Marco Schnater
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Tracheal Team, Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
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13
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de Munck S, Otter SCMCD, Schnater JM, van Rosmalen J, Peters NCJ, van Gils-Frijters APJM, van Haren NEM, Gischler SJ, IJsselstijn H, Rietman AB. Neuropsychological outcome in survivors of congenital diaphragmatic hernia at 5 years of age, what does it tell? Eur J Pediatr 2023; 182:1057-1066. [PMID: 36565322 PMCID: PMC10023636 DOI: 10.1007/s00431-022-04696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/24/2022] [Accepted: 11/05/2022] [Indexed: 12/25/2022]
Abstract
Previous studies have frequently reported neurocognitive deficits in children born with congenital diaphragmatic hernia (CDH) at school age, which may contribute to academic difficulties. Yet, age at onset of these deficits is currently unknown. We evaluated neurocognitive skills with possible determinants in preschool children born with CDH. Eligible 5-year-old children born with CDH (2010-2015) who participated in our prospective structural follow-up program were included. We used the WPPSI-III to assess intelligence, subtests of the Kaufman-ABC for memory, and NEPSY-II to assess inhibition and attention. We included 63 children. Their test scores generally were within or significantly above normal range: total IQ = 103.4 (15.7) (p = 0.13); Verbal memory = 10.2 (2.8) (p = 0.61); Visuospatial memory = 11.4 (2.6) (p < 0.01); Inhibition = 10.5 (2.2), (p = 0.10). In univariable analyses, length of ICU-stay was negatively associated with IQ, and maximum vasoactive inotropic score and open repair were negatively associated with inhibition skills. In multivariable regression analysis, the latter association remained (B = 5.52, p = 0.04 (CI 0.32-10.72)). Conclusions: In these tested 5-year-old children born with CDH, neuropsychological outcome was normal on average. While problems in 8-year-olds are common, we did not detect onset of these problems at age 5. Yet, we cannot rule out that this cohort had a relatively mild level of disease severity; therefore, conclusions should be interpreted with caution. However, given the growing-into-deficit hypothesis, meaning that deviant brain development in early life is revealed once higher cognitive brain functions are demanded, follow-up should be conducted up to school age, and preferably beyond. What is Known: • Children born with CDH are at risk for academic difficulties at school age. • Whether these difficulties can be detected already before school age is unknown. What is New: • At age 5 years, intelligence, inhibition, attention, and memory skills were all within normal range, or even above, in children with CDH. This is supportive of the growing-into-deficit hypothesis in this patient population. • Those who underwent open surgical correction had poorer inhibition skills than those who were corrected with minimal access surgery.
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Affiliation(s)
- Sophie de Munck
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Suzan C M Cochius-den Otter
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - J Marco Schnater
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Nina C J Peters
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Annabel P J M van Gils-Frijters
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
| | - Neeltje E M van Haren
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
| | - Saskia J Gischler
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - André B Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
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14
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Ten Kate CA, Teunissen NM, van Rosmalen J, Kamphuis LS, van Wijk MP, Joosten M, van Tuyll van Serooskerken ES, Wijnen R, IJsselstijn H, Rietman AB, Spaander MCW. Development and validation of a condition-specific quality of life instrument for adults with esophageal atresia: the SQEA questionnaire. Dis Esophagus 2022; 36:6957244. [PMID: 36562092 DOI: 10.1093/dote/doac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/01/2022] [Indexed: 12/24/2022]
Abstract
The importance of multidisciplinary long-term follow-up for adults born with esophageal atresia (EA) is increasingly recognized. Hence, a valid, condition-specific instrument to measure health-related quality of life (HRQoL) becomes imperative. This study aimed to develop and validate such an instrument for adults with EA. The Specific Quality of life in Esophageal atresia Adults (SQEA) questionnaire was developed through focus group-based item generation, pilot testing, item reduction and a multicenter, nationwide field test to evaluate the feasibility, reliability (internal and retest) and validity (structural, construct, criterion and convergent), in compliance with the consensus-based standards for the selection of health measurement instruments guidelines. After pilot testing (n = 42), items were reduced from 144 to 36 questions. After field testing (n = 447), three items were discarded based on item-response theory results. The final SQEA questionnaire (33 items) forms a unidimensional scale generating an unweighted total score. Feasibility, internal reliability (Cronbach's alpha 0.94) and test-retest agreement (intra-class coefficient 0.92) were good. Construct validity was discriminative for esophageal replacement (P < 0.001), dysphagia (P < 0.001) and airway obstruction (P = 0.029). Criterion validity showed a good correlation with dysphagia (area under the receiver operating characteristic 0.736). SQEA scores correlated well with other validated disease-specific HRQoL scales such as the GIQLI and SGRQ, but poorly with the more generic RAND-36. Overall, this first condition-specific instrument for EA adults showed satisfactory feasibility, reliability and validity. Additionally, it shows discriminative ability to detect disease burden. Therefore, the SQEA questionnaire is both a valid instrument to assess the HRQoL in EA adults and an interesting signaling tool, enabling clinicians to recognize more severely affected patients.
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Affiliation(s)
- Chantal A Ten Kate
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nadine M Teunissen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Lieke S Kamphuis
- Department of Pulmonology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Michiel P van Wijk
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers-Emma Children's Hospital, Amsterdam, The Netherlands
| | - Maja Joosten
- Department of Pediatric Surgery, Radboud University Medical Center-Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - René Wijnen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - André B Rietman
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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15
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Houwen S, Cox RFA, Roza M, Oude Lansink F, van Wolferen J, Rietman AB. Sensory processing in young children with visual impairments: Use and extension of the Sensory Profile. Res Dev Disabil 2022; 127:104251. [PMID: 35569170 DOI: 10.1016/j.ridd.2022.104251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/25/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Children with visual impairments (VI) are at risk for sensory processing difficulties. A widely used measure for sensory processing is the Sensory Profile (SP). However, the SP requires adaptation to accommodate for how children with VI experience sensory information. AIMS (1) To examine sensory processing patterns in young children with VI, (2) to develop VI-specific items to use in conjunction with the SP and to determine internal consistency and construct validity of these newly developed items, and (3) to examine the association between sensory processing and and emotional and behavioral problems. METHODS Twenty-six VI-specific items were added to the SP. The SP and these items were completed by caregivers of 90 children with VI between 3 and 8 years old. The Child Behavior Checklist (CBCL) was used to assess emotional and behavioral problems. RESULTS Three- to five-year-old children with VI have significantly more difficulties in three quadrants of the SP as compared to the norm group. Six- to eight-year-old children with VI have more difficulties in all quadrants. A reliable and valid VI-specific set of 15 items was established following psychometric evaluation. Age-related differences were found in the associations between the SP and CBCL. CONCLUSION Although further validation is recommended, this evaluation of the VI-specific item set suggests it has the potential to be a useful measure for children with VI.
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Affiliation(s)
- Suzanne Houwen
- University of Groningen, Faculty of Behavioral and Social Sciences, Inclusive and Special Needs Education Unit, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands.
| | - Ralf F A Cox
- University of Groningen, Faculty of Behavioral and Social Sciences, Department of Psychology, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands.
| | - Minette Roza
- Bartiméus Expertise Centre for the Visually Impaired, Postbus 1003, 3700 BA Zeist, the Netherlands.
| | - Femke Oude Lansink
- Bartiméus Expertise Centre for the Visually Impaired, Postbus 1003, 3700 BA Zeist, the Netherlands.
| | - Jannemieke van Wolferen
- Bartiméus Expertise Centre for the Visually Impaired, Postbus 1003, 3700 BA Zeist, the Netherlands.
| | - André B Rietman
- Erasmus Medical Center Sophia Children's Hospital, Department of Child and Adolescent Psychiatry/Psychology, Wytemaweg 80, 3015 CN Rotterdam, the Netherlands.
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16
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Hermans MM, Breugem CC, Schappin R, Jonge Poerink E, Mendels EJ, Ragamin A, Breur JM, Langeveld HR, Raphael MF, De Laat PC, De Wildt SN, Rietman AB, Pasmans SG, De Graaf M. Aesthetic Outcome of Propranolol vs Atenolol Treatment of Children with Infantile Haemangioma. Acta Derm Venereol 2022; 102:adv00788. [DOI: 10.2340/actadv.v102.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Infantile haemangiomas are common benign tumours of infancy, which can be treated effectively with beta-blockers such as propranolol and atenolol. Different types of beta-blockers may result in different long-term aesthetic outcomes. This study evaluated the difference in long-term aesthetic outcomes between infantile haemangiomas treated with either propranolol or atenolol, including the perspective of physicians, parents, and children. Children, aged ≥6 years, treated with propranolol or atenolol for infantile haemangioma during infancy, participated in this 2-centre cross-sectional study. The primary endpoint was change in appearance of the infantile haemangioma from pre-treatment to follow-up, using a physician-rated visual analogue scale (VAS). Secondary outcomes were the Patient Observer Scar Assessment Scale (physician- and parent-rated) and a VAS (child-rated), assessing the residual lesion. In total, 103 children (35 treated with propranolol, 68 with atenolol) were analysed. No differences were found between children treated with propranolol and children treated with atenolol on physician-rated VAS (p = 0.10) or any secondary outcomes. Physicians indicated a large aesthetic improvement from pre-treatment to follow-up. Physicians, parents and children were positive about the current state of the residual lesion. Minor sequelae were common (86%). These results, in combination with the favourable safety profile of atenolol, should be considered when choosing beta-blocker treatment for infantile haemangioma
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17
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Abstract
OBJECTIVE Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder that is associated with cognitive disabilities, including attention and motor learning problems. These disabilities have been extensively studied in children with NF1 but limited studies have been performed in adults. METHOD Attention, motor learning and intellectual performance were studied with neuropsychological tasks in 32 adults with NF1 and 32 controls. RESULTS The NF1 and control group performed similarly on attention and motor learning tasks, although controls had shorter reaction times than adults with NF1 during the motor learning task (t[60] = -2.20, p = .03). Measures of attention or motor learning were not significantly associated with reduced intellectual performance in NF1. CONCLUSION In contrast to many studies in children with NF1, our findings did not provide evidence for presence of attention or motor learning problems in adults with NF1 in neuropsychological tasks. Our observations may be of clinical importance to determine treatment focus in adults with NF1.
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Affiliation(s)
- Jesminne Castricum
- Erasmus University Medical Center, Rotterdam, The Netherlands,The ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, the Netherlands
| | - Joke H. M. Tulen
- Erasmus University Medical Center, Rotterdam, The Netherlands,The ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, the Netherlands
| | - Walter Taal
- Erasmus University Medical Center, Rotterdam, The Netherlands,The ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, the Netherlands
| | - André B. Rietman
- The ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, the Netherlands,Erasmus University Medical Center Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Ype Elgersma
- Erasmus University Medical Center, Rotterdam, The Netherlands,The ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, the Netherlands,Ype Elgersma, Department of Clinical Genetics, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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18
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Lubbers K, Stijl EM, Dierckx B, Hagenaar DA, Ten Hoopen LW, Legerstee JS, de Nijs PFA, Rietman AB, Greaves-Lord K, Hillegers MHJ, Dieleman GC, Mous SE. Autism Symptoms in Children and Young Adults With Fragile X Syndrome, Angelman Syndrome, Tuberous Sclerosis Complex, and Neurofibromatosis Type 1: A Cross-Syndrome Comparison. Front Psychiatry 2022; 13:852208. [PMID: 35651825 PMCID: PMC9149157 DOI: 10.3389/fpsyt.2022.852208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/26/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The etiology of autism spectrum disorder (ASD) remains unclear, due to genetic heterogeneity and heterogeneity in symptoms across individuals. This study compares ASD symptomatology between monogenetic syndromes with a high ASD prevalence, in order to reveal syndrome specific vulnerabilities and to clarify how genetic variations affect ASD symptom presentation. METHODS We assessed ASD symptom severity in children and young adults (aged 0-28 years) with Fragile X Syndrome (FXS, n = 60), Angelman Syndrome (AS, n = 91), Neurofibromatosis Type 1 (NF1, n = 279) and Tuberous Sclerosis Complex (TSC, n = 110), using the Autism Diagnostic Observation Schedule and Social Responsiveness Scale. Assessments were part of routine clinical care at the ENCORE expertise center in Rotterdam, the Netherlands. First, we compared the syndrome groups on the ASD classification prevalence and ASD severity scores. Then, we compared individuals in our syndrome groups with an ASD classification to a non-syndromic ASD group (nsASD, n = 335), on both ASD severity scores and ASD symptom profiles. Severity scores were compared using MANCOVAs with IQ and gender as covariates. RESULTS Overall, ASD severity scores were highest for the FXS group and lowest for the NF1 group. Compared to nsASD, individuals with an ASD classification in our syndrome groups showed less problems on the instruments' social domains. We found a relative strength in the AS group on the social cognition, communication and motivation domains and a relative challenge in creativity; a relative strength of the NF1 group on the restricted interests and repetitive behavior scale; and a relative challenge in the FXS and TSC groups on the restricted interests and repetitive behavior domain. CONCLUSION The syndrome-specific strengths and challenges we found provide a frame of reference to evaluate an individual's symptoms relative to the larger syndromic population and to guide treatment decisions. Our findings support the need for personalized care and a dimensional, symptom-based diagnostic approach, in contrast to a dichotomous ASD diagnosis used as a prerequisite for access to healthcare services. Similarities in ASD symptom profiles between AS and FXS, and between NF1 and TSC may reflect similarities in their neurobiology. Deep phenotyping studies are required to link neurobiological markers to ASD symptomatology.
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Affiliation(s)
- Kyra Lubbers
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Eefje M Stijl
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Bram Dierckx
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Doesjka A Hagenaar
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of General Paediatrics, Erasmus MC, Rotterdam, Netherlands
| | - Leontine W Ten Hoopen
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jeroen S Legerstee
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Pieter F A de Nijs
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - André B Rietman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Kirstin Greaves-Lord
- Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Clinical Psychology and Experimental Psychopathology Unit, Department of Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands.,Yulius Mental Health, Dordrecht, Netherlands.,Jonx Autism Team Northern-Netherlands, Lentis Mental Health, Groningen, Netherlands
| | - Manon H J Hillegers
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Gwendolyn C Dieleman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sabine E Mous
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
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19
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Hijkoop A, Ten Kate CA, Madderom MJ, IJsselstijn H, Reuser JA, Koopman H, van Rosmalen J, Rietman AB. Sex differences in children's health status as measured by the Pediatric Quality of Life Inventory (PedsQL)™: cross-sectional findings from a large school-based sample in the Netherlands. BMC Pediatr 2021; 21:580. [PMID: 34922476 PMCID: PMC8683815 DOI: 10.1186/s12887-021-03059-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/01/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Previous research has shown that female adolescents and adults report lower health status than their male peers. Possibly, this discrepancy already develops during childhood. We collected sex-specific data with the Pediatric Quality of Life Inventory (PedsQL) in a large school-based sample. METHODS The online version of the PedsQL was administered to healthy Dutch children aged 5-7 years (parent proxy-report), 8-12 years (parent proxy-report and child self-report), and 13-17 years (parent proxy-report and child self-report), recruited through regular primary and secondary schools. Sex differences were assessed using t-tests or Mann-Whitney U-tests. Wilcoxon signed-rank tests and intraclass correlation coefficients served to compare parent proxy-reports with child self-reports. Multivariable linear regression analyses were used to assess the associations of sex of the child, age, and parental educational level with PedsQL scores. RESULTS Eight hundred eighty-two parents and five hundred eighty one children were recruited from 15 different schools in the Netherlands. Parents of 8-to-12-year-olds reported higher scores on School Functioning for girls than for boys (mean difference [MD]: 6.56, p < 0.001). Parents of 13-to-17-year-olds reported lower scores on Physical and Emotional Functioning for girls than for boys (MDs: 2.14 and 5.79, p = 0.014 and p < 0.001, respectively). Girls aged 8-12 years reported lower scores than boys in this age group on Physical Functioning (MD: 3.09, p = 0.005). Girls aged 13-17 years reported lower scores than boys in this age group on Physical Functioning (MD: 3.67, p < 0.001), Emotional Functioning (MD: 8.11, p < 0.001), and the Total Score (MD 3.26, p = 0.004). No sex differences were found in children aged 5-7 years. Agreement between child self-reports and parent proxy-reports was poor to moderate. CONCLUSIONS Girls generally had lower PedsQL scores than boys, both in parent proxy-reports and in child self-reports. We recommend to apply sex-specific data when assessing health status using the PedsQL.
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Affiliation(s)
- Annelieke Hijkoop
- Department of Paediatric Surgery and Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Chantal A Ten Kate
- Department of Paediatric Surgery and Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marlous J Madderom
- Department of Paediatric Surgery and Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery and Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Julie A Reuser
- Department of Developmental and Educational Psychology, Faculty of Social Sciences, Leiden University, Leiden, the Netherlands
| | - Hendrik Koopman
- Department of Clinical Psychology, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - André B Rietman
- Department of Paediatric Surgery and Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
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20
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Ten Kate CA, Rietman AB, van de Wijngaert Y, van Gils-Frijters A, Gischler SJ, Keyzer-Dekker CMG, Wijnen RMH, IJsselstijn H. Longitudinal Health Status and Quality of Life After Esophageal Atresia Repair. J Pediatr Gastroenterol Nutr 2021; 73:695-702. [PMID: 34508046 DOI: 10.1097/mpg.0000000000003293] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To longitudinally evaluate self-reported and proxy-reported health status (HS) and quality of life (QoL) of school-aged children born with esophageal atresia (EA). METHODS We obtained Pediatric Quality of Life Inventory (HS) and DUX-25 (QoL) questionnaires from children born with EA between 1999 and 2011 at 8 and/or 12 years old. Children completed self-reports during neuropsychological assessments in a prospective longitudinal follow-up program. Parents filled out proxy-reports at home. Total and subscale scores were evaluated longitudinally and compared with sex-specific reference norms. RESULTS In total, 110 participants (62% boys) were included. Self-reported HS improved significantly between 8 and 12 years for both boys (mean difference [md] 4.35, effect size [ES] 0.54, P = 0.009) and girls (md 3.26, ES 0.63, P = 0.004). Proxy-reported HS tended to improve over time, while self-reported and proxy-reported QoL tended to decline. Self-reported HS at 8 years was below normal for both boys (md -5.44, ES -0.35, P < 0.001) and girls (md -7.61, ES -0.32, P < 0.001). Girls' self-reported QoL was below normal at 8 (md -5.00, ES -0.18, P = 0.019) and 12 years (md -10.50, ES -0.26, P = 0.001). Parents reported normal HS at both ages, whereas they rated the QoL of their daughters below normal at 12 years (md -10.00, ES -0.16, P = 0.022). All above results are total scores. CONCLUSIONS Self-reported and proxy-reported HS of children with EA improved between 8 and 12 years, while their QoL tended to decline. We recommend to consider HS and QoL as two separate concepts and to measure both simultaneously and longitudinally when evaluating the burden of disease.
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Affiliation(s)
- Chantal A Ten Kate
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
| | - André B Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Yannick van de Wijngaert
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Annabel van Gils-Frijters
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Saskia J Gischler
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
| | - Claudia M G Keyzer-Dekker
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
| | - René M H Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
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21
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Ten Kate CA, Rietman AB, Kamphuis LS, Gischler S, Lee D, Fruithof J, Wijnen RMH, Spaander MCM. Patient-driven healthcare recommendations for adults with esophageal atresia and their families. J Pediatr Surg 2021; 56:1932-1939. [PMID: 33455804 DOI: 10.1016/j.jpedsurg.2020.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adults with esophageal atresia (EA) require a multidisciplinary follow-up approach, taking into account gastroesophageal problems, respiratory problems and psychosocial wellbeing. Too little is known about the full scope of these individuals' healthcare needs. We aimed to map all medical and psychosocial needs of adults with EA and their family members, and to formulate healthcare recommendations for daily practice. METHODS A qualitative study was performed, using data from recorded semi-structured interviews with two focus groups, one consisting of adult patients with EA (n = 15) and one of their family members (n = 13). After verbatim transcription and computerized thematic analysis, results were organized according to the International Classification of Functioning, Disability and Health. Ethical approval had been obtained. RESULTS Healthcare needs were described through 74 codes, classified into 20 themes. Most important findings for patients included the impact of gastrointestinal and pulmonary problems on daily life, long-term emotional distress of patients and parents and the need of a standardized multidisciplinary follow-up program during both child- and adulthood. CONCLUSION The focus groups revealed numerous physical and mental health problems, as well as social difficulties, that require attention from different healthcare providers. We have formulated several healthcare recommendations that physicians may use in long-term follow-up.
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Affiliation(s)
- Chantal A Ten Kate
- Department of Pediatric Surgery and Pediatric Intensive Care Unit, Erasmus University Medical Centre - Sophia Children's Hospital, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - André B Rietman
- Department of Pediatric Surgery and Pediatric Intensive Care Unit, Erasmus University Medical Centre - Sophia Children's Hospital, P.O. Box 2040, 3000 CA Rotterdam, Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre - Sophia Children's Hospital, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Lieke S Kamphuis
- Department of Pulmonology, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Saskia Gischler
- Department of Pediatric Surgery and Pediatric Intensive Care Unit, Erasmus University Medical Centre - Sophia Children's Hospital, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Demi Lee
- Department of Pediatric Surgery and Pediatric Intensive Care Unit, Erasmus University Medical Centre - Sophia Children's Hospital, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - JoAnne Fruithof
- Esophageal Atresia and Tracheoesophageal Fistula Support Federation & VOKS, Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery and Pediatric Intensive Care Unit, Erasmus University Medical Centre - Sophia Children's Hospital, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Manon C M Spaander
- Department of Hepatology and Gastroenterology, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Netherlands.
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22
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Sreeram II, ten Kate CA, van Rosmalen J, Schnater JM, Gischler SJ, Wijnen RMH, IJsselstijn H, Rietman AB. Patient-Reported Outcome Measures and Clinical Outcomes in Children with Foregut Anomalies. Children (Basel) 2021; 8:children8070587. [PMID: 34356566 PMCID: PMC8307606 DOI: 10.3390/children8070587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/02/2022]
Abstract
Increasing numbers of children and adults with chronic disease status highlight the need for a value-based healthcare system. Patient-reported outcome measures (PROMs) are essential to value-based healthcare, yet it remains unclear how they relate to clinical outcomes such as health and daily functioning. We aimed to assess the added value of self-reported PROMs for health status (HS) and quality of life (QoL) in the long-term follow-up of children with foregut anomalies. We evaluated data of PROMs for HS and/or QoL among eight-year-olds born with congenital diaphragmatic hernia (CDH), esophageal atresia (EA), or congenital lung malformations (CLM), collected within the infrastructure of a multidisciplinary, longitudinal follow-up program. Clinical outcomes were categorized into different outcome domains, and their relationships with self-reported HS and QoL were assessed through multivariable linear regression analyses. A total of 220 children completed HS and/or QoL self-reports. In children with CDH and EA, lower cognition was significantly associated with lower self-reported HS. Due to the low number of cases, multivariable linear regression analysis was not possible in children with CLM. HS, QoL, and clinical outcomes represent different aspects of a child’s wellbeing and should be measured simultaneously to facilitate a more holistic approach to clinical decision making.
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Affiliation(s)
- Isabel I. Sreeram
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Chantal A. ten Kate
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Centre, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands;
- Department of Epidemiology, Erasmus University Medical Centre, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Johannes M. Schnater
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Saskia J. Gischler
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - René M. H. Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - André B. Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-(0)-10-7040209
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23
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Bindels-de Heus KGCB, Mous SE, Ten Hooven-Radstaake M, van Iperen-Kolk BM, Navis C, Rietman AB, Ten Hoopen LW, Brooks AS, Elgersma Y, Moll HA, de Wit MCY. An overview of health issues and development in a large clinical cohort of children with Angelman syndrome. Am J Med Genet A 2019; 182:53-63. [PMID: 31729827 PMCID: PMC6916553 DOI: 10.1002/ajmg.a.61382] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 01/22/2023]
Abstract
This study presents a broad overview of health issues and psychomotor development of 100 children with Angelman syndrome (AS), seen at the ENCORE Expertise Center for AS in Rotterdam, the Netherlands. We aimed to further delineate the phenotype of AS, to evaluate the association of the phenotype with genotype and other determinants such as epilepsy and to get insight in possible targets for intervention. We confirmed the presence of a more severe phenotype in the 15q11.2‐q13 deletion subtype. Novel findings were an association of (early onset of) epilepsy with a negative effect on development, a high occurrence of nonconvulsive status epilepticus, a high rate of crouch gait in the older children with risk of deterioration of mobility, a relatively low occurrence of microcephaly, a higher mean weight for height in all genetic subtypes with a significant higher mean in the nondeletion children, and a high occurrence of hyperphagia across all genetic subtypes. Natural history data are needed to design future trials. With this large clinical cohort with structured prospective and multidisciplinary follow‐up, we provide unbiased data on AS to support further intervention studies to optimize outcome and quality of life of children with AS and their family.
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Affiliation(s)
- Karen G C B Bindels-de Heus
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
| | - Sabine E Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Maartje Ten Hooven-Radstaake
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
| | - Bianca M van Iperen-Kolk
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Physical Therapy, Erasmus MC, Rotterdam, The Netherlands
| | - Cindy Navis
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of ENT (Speech & Language Pathology), Erasmus MC, Rotterdam, The Netherlands
| | - André B Rietman
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Leontine W Ten Hoopen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Alice S Brooks
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | | | - Ype Elgersma
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
| | - Marie-Claire Y de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Neurology and Pediatric Neurology, Erasmus MC, Rotterdam, The Netherlands
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24
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Hijkoop A, Rietman AB, Wijnen RMH, Tibboel D, Cohen-Overbeek TE, van Rosmalen J, IJsselstijn H. Omphalocele at school age: What do parents report? A call for long-term follow-up of complex omphalocele patients. Early Hum Dev 2019; 137:104830. [PMID: 31374454 DOI: 10.1016/j.earlhumdev.2019.104830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Many children with omphalocele experience morbidity in early life, which could affect long-term outcomes. We determined parent-reported outcomes in school-aged children treated for minor or giant omphalocele. STUDY DESIGN We sent paper questionnaires to the parents of all children treated for omphalocele in 2000-2012. Giant omphalocele was defined as defect diameter ≥ 5 cm with liver protruding. Motor function (MABC-2 Checklist) was compared with Dutch reference data; cognition (PedsPCF), health status (PedsQL), quality of life (DUX-25) and behavior (Strengths and Difficulties Questionnaire; SDQ) were compared with those of controls (two per child) matched for age, gender and maternal education level. Possible predictors of cognition and behavior were evaluated using linear regression analyses. RESULTS Of 54 eligible participants, 31 (57%) returned the questionnaires. MABC-2 Checklist scores were normal for 21/26 (81%) children. Cognition, health status, quality of life and behavior were similar to scores of matched controls. One quarter (26%) of children with omphalocele scored ≤ - 1 standard deviation on the PedsPCF, compared with 9% of matched controls (p = 0.07). Giant omphalocele and presence of multiple congenital anomalies (MCA) were most prominently associated with lower PedsPCF scores (giant omphalocele: β -22.11 (95% CI: -43.65 to -0.57); MCA -23.58 (-40.02 to -7.13)), although not significantly after correction for multiple testing. CONCLUSIONS Parent-reported outcomes of children with omphalocele at school age are reassuring. Children with an isolated, minor omphalocele do not need extensive long-term follow-up of daily functioning. Those with a giant omphalocele or MCA might be at risk for delayed cognitive functioning at school age; we recommend long-term follow-up to offer timely intervention.
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Affiliation(s)
- Annelieke Hijkoop
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - André B Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Titia E Cohen-Overbeek
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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25
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Leeuwen L, Schiller RM, Rietman AB, van Rosmalen J, Wildschut ED, Houmes RJM, Tibboel D, IJsselstijn H. Risk Factors of Impaired Neuropsychologic Outcome in School-Aged Survivors of Neonatal Critical Illness. Crit Care Med 2019; 46:401-410. [PMID: 29194146 DOI: 10.1097/ccm.0000000000002869] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Until now, long-term outcome studies have focused on general cognitive functioning and its risk factors following neonatal extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia. However, it is currently unknown which neuropsychological domains are most affected in these patients and which clinical variables can be used to predict specific neuropsychological problems. This study aimed to identify affected neuropsychological domains and its clinical determinants in survivors of neonatal extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia. DESIGN Prospective follow-up study. SETTING Tertiary university hospital. PATIENTS Sixty-five 8-year-old survivors of neonatal extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Intelligence, attention, memory, executive functioning and visuospatial processing were evaluated using validated tests and compared with Dutch reference data. Assessed risk factors of outcome were illness severity indicators, number of anesthetic procedures in the first year of life, and growth at 1 year. Patients had average intelligence (mean intelligence quotient ± SD, 95 ± 16), but significantly poorer sustained attention (mean z score ± SD, -2.73 ± 2.57), verbal (immediate, -1.09 ± 1.27; delayed, -1.14 ± 1.86), and visuospatial memory (immediate, -1.48 ± 1.02; delayed, -1.57 ± 1.01; recognition, -1.07 ± 3.10) than the norm. Extracorporeal membrane oxygenation-treated congenital diaphragmatic hernia patients had significantly lower mean intelligence quotient (84 ± 12) than other neonatal extracorporeal membrane oxygenation patients (94 ± 10) and congenital diaphragmatic hernia patients not treated with extracorporeal membrane oxygenation (100 ± 20). Maximum vasoactive-inotropic score was negatively associated with delayed verbal (B = -0.02; 95% CI, -0.03 to -0.002; p = 0.026) and visuospatial memory (B = -0.01; 95% CI, -0.02 to -0.001; p = 0.024). CONCLUSIONS We found memory and attention deficits in 8-year-old neonatal extracorporeal membrane oxygenation and congenital diaphragmatic hernia survivors. The maximum dose of vasoactive medication was negatively associated with verbal and visuospatial memory, which may suggest an effect of early cerebral hypoperfusion in determining these abnormalities.
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Affiliation(s)
- Lisette Leeuwen
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Raisa M Schiller
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - André B Rietman
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Enno D Wildschut
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Robert Jan M Houmes
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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26
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Overwater IE, Rietman AB, van Eeghen AM, de Wit MCY. Everolimus for the treatment of refractory seizures associated with tuberous sclerosis complex (TSC): current perspectives. Ther Clin Risk Manag 2019; 15:951-955. [PMID: 31440057 PMCID: PMC6666377 DOI: 10.2147/tcrm.s145630] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/26/2019] [Indexed: 12/21/2022] Open
Abstract
Up to 90% of patients with tuberous sclerosis complex (TSC) have epilepsy, and in over half of patients seizure control cannot be achieved by regular antiepileptic drugs. The underlying problem is mTOR hyperactivation due to loss of function of the TSC proteins. Treatment with everolimus, an mTOR inhibitor, has been shown to be of great benefit to TSC patients, both in reducing tumor growth and as a treatment for intractable epilepsy. Up to 40% of TSC patients with intractable epilepsy show a clinically relevant seizure response to everolimus. It has not yet fully lived up to its promise as a disease-modifying drug, however, as half of TSC patients with intractable epilepsy do not show a clinically relevant seizure frequency reduction. There is no evidence yet of a positive effect on the cognitive and neuropsychiatric deficits in TSC patients. In preclinical studies, mTOR inhibition can rescue abnormal neuronal migration and synapse formation that is caused by mTOR hyperactivation. These studies show a critical time window that suggests that mTOR inhibition may be most beneficial in young children. The trials done so far have not studied treatment in children under 2 years of age, although case series suggest that the safety profile is similar to that in older children. Further studies into the optimal time window, dosing schedules and possibly combination with other drugs may further improve the benefit of everolimus for TSC patients.
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Affiliation(s)
- Iris E Overwater
- Department of Pediatric Neurology and ENCORE Expertise Center, Erasmus MC, Rotterdam, the Netherlands
| | - André B Rietman
- Department of Child and Adolescent Psychiatry/Psychology and ENCORE Expertise Center, Erasmus MC, Rotterdam, the Netherlands
| | - Agnies M van Eeghen
- Heeren Loo Care Group and ENCORE Expertise Center, Erasmus MC, Rotterdam, the Netherlands
| | - Marie Claire Y de Wit
- Department of Pediatric Neurology and ENCORE Expertise Center, Erasmus MC, Rotterdam, the Netherlands
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27
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Eijk S, Mous SE, Dieleman GC, Dierckx B, Rietman AB, de Nijs PFA, Ten Hoopen LW, van Minkelen R, Elgersma Y, Catsman-Berrevoets CE, Oostenbrink R, Legerstee JS. Autism Spectrum Disorder in an Unselected Cohort of Children with Neurofibromatosis Type 1 (NF1). J Autism Dev Disord 2019; 48:2278-2285. [PMID: 29423604 PMCID: PMC5995999 DOI: 10.1007/s10803-018-3478-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In a non-selected sample of children with Neurofibromatosis type 1 (NF1) the prevalence rate of autism spectrum disorder (ASD) and predictive value of an observational (ADOS)—and questionnaire-based screening instrument were assessed. Complete data was available for 128 children. The prevalence rate for clinical ASD was 10.9%, which is clearly higher than in the general population. This prevalence rate is presumably more accurate than in previous studies that examined children with NF1 with an ASD presumption or solely based on screening instruments. The combined observational- and screening based classifications demonstrated the highest positive predictive value for DSM-IV diagnosis, highlighting the importance of using both instruments in children with NF1.
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Affiliation(s)
- S Eijk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - S E Mous
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - G C Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - B Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - A B Rietman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - P F A de Nijs
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - L W Ten Hoopen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - R van Minkelen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Y Elgersma
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus Medical Centre Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - C E Catsman-Berrevoets
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,Department of Pediatric Neurology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - R Oostenbrink
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,Department of General Paediatrics, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - J S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. .,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. .,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Room Sp-2509, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
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28
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Overwater IE, Rietman AB, Mous SE, Bindels-de Heus K, Rizopoulos D, Ten Hoopen LW, van der Vaart T, Jansen FE, Elgersma Y, Moll HA, de Wit MCY. A randomized controlled trial with everolimus for IQ and autism in tuberous sclerosis complex. Neurology 2019; 93:e200-e209. [PMID: 31217257 DOI: 10.1212/wnl.0000000000007749] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/04/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate whether mammalian target of rapamycin inhibitor everolimus can improve intellectual disability, autism, and other neuropsychological deficits in children with tuberous sclerosis complex (TSC). METHODS In this 12-month, randomized, double-blind, placebo-controlled trial, we attempted to enroll 60 children with TSC and IQ <80, learning disability, special schooling, or autism, aged 4-17 years, without intractable seizures to be assigned to receive everolimus or placebo. Everolimus was titrated to blood trough levels of 5-10 ng/mL. Primary outcome was full-scale IQ; secondary outcomes included autism, neuropsychological functioning, and behavioral problems. RESULTS Thirty-two children with TSC were randomized. Intention-to-treat analysis showed no benefit of everolimus on full-scale IQ (treatment effect -5.6 IQ points, 95% confidence interval -12.3 to 1.0). No effect was found on secondary outcomes, including autism and neuropsychological functioning, and questionnaires examining behavioral problems, social functioning, communication skills, executive functioning, sleep, quality of life, and sensory processing. All patients had adverse events. Two patients on everolimus and 2 patients on placebo discontinued treatment due to adverse events. CONCLUSIONS Everolimus did not improve cognitive functioning, autism, or neuropsychological deficits in children with TSC. The use of everolimus in children with TSC with the aim of improving cognitive function and behavior should not be encouraged in this age group. CLINICALTRIALSGOV IDENTIFIER NCT01730209. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for children with TSC, everolimus does not improve intellectual disability, autism, behavioral problems, or other neuropsychological deficits.
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Affiliation(s)
- Iris E Overwater
- From the ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., S.E.M., K.B.-d.H., L.W.t.H., T.v.d.V., Y.E., H.A.M., M.-C.Y.d.W.) and Departments of Neurology (I.E.O., T.v.d.V., M.-C.Y.d.W.), Child and Adolescent Psychiatry and Psychology (A.B.R., S.E.M., L.W.t.H.), and Pediatrics (K.B.-d.H., H.A.M.), Erasmus MC-Sophia Children's Hospital; Departments of Biostatistics (D.R.) and Neuroscience (Y.E.), Erasmus MC, Rotterdam; and Department of Child Neurology (F.E.J.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - André B Rietman
- From the ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., S.E.M., K.B.-d.H., L.W.t.H., T.v.d.V., Y.E., H.A.M., M.-C.Y.d.W.) and Departments of Neurology (I.E.O., T.v.d.V., M.-C.Y.d.W.), Child and Adolescent Psychiatry and Psychology (A.B.R., S.E.M., L.W.t.H.), and Pediatrics (K.B.-d.H., H.A.M.), Erasmus MC-Sophia Children's Hospital; Departments of Biostatistics (D.R.) and Neuroscience (Y.E.), Erasmus MC, Rotterdam; and Department of Child Neurology (F.E.J.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Sabine E Mous
- From the ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., S.E.M., K.B.-d.H., L.W.t.H., T.v.d.V., Y.E., H.A.M., M.-C.Y.d.W.) and Departments of Neurology (I.E.O., T.v.d.V., M.-C.Y.d.W.), Child and Adolescent Psychiatry and Psychology (A.B.R., S.E.M., L.W.t.H.), and Pediatrics (K.B.-d.H., H.A.M.), Erasmus MC-Sophia Children's Hospital; Departments of Biostatistics (D.R.) and Neuroscience (Y.E.), Erasmus MC, Rotterdam; and Department of Child Neurology (F.E.J.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Karen Bindels-de Heus
- From the ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., S.E.M., K.B.-d.H., L.W.t.H., T.v.d.V., Y.E., H.A.M., M.-C.Y.d.W.) and Departments of Neurology (I.E.O., T.v.d.V., M.-C.Y.d.W.), Child and Adolescent Psychiatry and Psychology (A.B.R., S.E.M., L.W.t.H.), and Pediatrics (K.B.-d.H., H.A.M.), Erasmus MC-Sophia Children's Hospital; Departments of Biostatistics (D.R.) and Neuroscience (Y.E.), Erasmus MC, Rotterdam; and Department of Child Neurology (F.E.J.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Dimitris Rizopoulos
- From the ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., S.E.M., K.B.-d.H., L.W.t.H., T.v.d.V., Y.E., H.A.M., M.-C.Y.d.W.) and Departments of Neurology (I.E.O., T.v.d.V., M.-C.Y.d.W.), Child and Adolescent Psychiatry and Psychology (A.B.R., S.E.M., L.W.t.H.), and Pediatrics (K.B.-d.H., H.A.M.), Erasmus MC-Sophia Children's Hospital; Departments of Biostatistics (D.R.) and Neuroscience (Y.E.), Erasmus MC, Rotterdam; and Department of Child Neurology (F.E.J.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Leontine W Ten Hoopen
- From the ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., S.E.M., K.B.-d.H., L.W.t.H., T.v.d.V., Y.E., H.A.M., M.-C.Y.d.W.) and Departments of Neurology (I.E.O., T.v.d.V., M.-C.Y.d.W.), Child and Adolescent Psychiatry and Psychology (A.B.R., S.E.M., L.W.t.H.), and Pediatrics (K.B.-d.H., H.A.M.), Erasmus MC-Sophia Children's Hospital; Departments of Biostatistics (D.R.) and Neuroscience (Y.E.), Erasmus MC, Rotterdam; and Department of Child Neurology (F.E.J.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Thijs van der Vaart
- From the ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., S.E.M., K.B.-d.H., L.W.t.H., T.v.d.V., Y.E., H.A.M., M.-C.Y.d.W.) and Departments of Neurology (I.E.O., T.v.d.V., M.-C.Y.d.W.), Child and Adolescent Psychiatry and Psychology (A.B.R., S.E.M., L.W.t.H.), and Pediatrics (K.B.-d.H., H.A.M.), Erasmus MC-Sophia Children's Hospital; Departments of Biostatistics (D.R.) and Neuroscience (Y.E.), Erasmus MC, Rotterdam; and Department of Child Neurology (F.E.J.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Floor E Jansen
- From the ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., S.E.M., K.B.-d.H., L.W.t.H., T.v.d.V., Y.E., H.A.M., M.-C.Y.d.W.) and Departments of Neurology (I.E.O., T.v.d.V., M.-C.Y.d.W.), Child and Adolescent Psychiatry and Psychology (A.B.R., S.E.M., L.W.t.H.), and Pediatrics (K.B.-d.H., H.A.M.), Erasmus MC-Sophia Children's Hospital; Departments of Biostatistics (D.R.) and Neuroscience (Y.E.), Erasmus MC, Rotterdam; and Department of Child Neurology (F.E.J.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Ype Elgersma
- From the ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., S.E.M., K.B.-d.H., L.W.t.H., T.v.d.V., Y.E., H.A.M., M.-C.Y.d.W.) and Departments of Neurology (I.E.O., T.v.d.V., M.-C.Y.d.W.), Child and Adolescent Psychiatry and Psychology (A.B.R., S.E.M., L.W.t.H.), and Pediatrics (K.B.-d.H., H.A.M.), Erasmus MC-Sophia Children's Hospital; Departments of Biostatistics (D.R.) and Neuroscience (Y.E.), Erasmus MC, Rotterdam; and Department of Child Neurology (F.E.J.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands.
| | - Henriette A Moll
- From the ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., S.E.M., K.B.-d.H., L.W.t.H., T.v.d.V., Y.E., H.A.M., M.-C.Y.d.W.) and Departments of Neurology (I.E.O., T.v.d.V., M.-C.Y.d.W.), Child and Adolescent Psychiatry and Psychology (A.B.R., S.E.M., L.W.t.H.), and Pediatrics (K.B.-d.H., H.A.M.), Erasmus MC-Sophia Children's Hospital; Departments of Biostatistics (D.R.) and Neuroscience (Y.E.), Erasmus MC, Rotterdam; and Department of Child Neurology (F.E.J.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands.
| | - Marie-Claire Y de Wit
- From the ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., S.E.M., K.B.-d.H., L.W.t.H., T.v.d.V., Y.E., H.A.M., M.-C.Y.d.W.) and Departments of Neurology (I.E.O., T.v.d.V., M.-C.Y.d.W.), Child and Adolescent Psychiatry and Psychology (A.B.R., S.E.M., L.W.t.H.), and Pediatrics (K.B.-d.H., H.A.M.), Erasmus MC-Sophia Children's Hospital; Departments of Biostatistics (D.R.) and Neuroscience (Y.E.), Erasmus MC, Rotterdam; and Department of Child Neurology (F.E.J.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands.
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Hijkoop A, Rietman AB, Wijnen RMH, Tibboel D, Cohen-Overbeek TE, van Rosmalen J, IJsselstijn H. Gastroschisis at school age: what do parents report? Eur J Pediatr 2019; 178:1405-1412. [PMID: 31325028 PMCID: PMC6694033 DOI: 10.1007/s00431-019-03417-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 01/27/2023]
Abstract
Children with gastroschisis are at high risk of morbidity in early life, which could affect long-term outcomes. We determined parent-reported outcomes in school-aged children born in 2000-2012, using paper questionnaires. Parent-perceived child vulnerability and motor function were compared with the Dutch reference data; parent-rated data on cognition, health status, quality of life, and behavior were compared with those of controls matched for age, gender, and maternal education level. Of 77 eligible participants, 31 (40%) returned the questionnaires. Parent-reported motor function was normal in 23 (74%) children. Total scores on health status, quality of life, and behavior did not differ significantly from those of matched controls. Children with gastroschisis had lower scores on cognition (median (interquartile range); 109 (87-127)) than their matched controls (124 (113-140); p = 0.04). Neonatal intestinal failure and increased parent-perceived vulnerability were associated with lower scores on cognition (β - 25.66 (95% confidence interval - 49.41, - 1.91); - 2.76 (- 5.27, - 0.25), respectively).Conclusion: Parent-reported outcomes of school-aged children with gastroschisis were mainly reassuring. Clinicians and parents should be aware of the higher risk of cognitive problems, especially in those with neonatal intestinal failure or increased parent-perceived vulnerability. We recommend multidisciplinary follow-up at school age of children with gastroschisis and neonatal intestinal failure. What is Known: • Many infants with gastroschisis experience morbidity in early life. • Data on developmental outcomes and daily functioning in children with gastroschisis beyond the age of 5 years are scarce and conflicting. What is New: • Parents of school-aged children treated for gastroschisis report normal motor function, health status, quality of life, and behavior. • Children with gastroschisis, especially those with intestinal failure, may be at risk for cognitive problems at school age. Parents who reported their child as being more vulnerable also reported more cognitive problems at school age.
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Affiliation(s)
- Annelieke Hijkoop
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Room SP-3506, P.O. Box 2060, 3000, CB, Rotterdam, The Netherlands.
| | - André B. Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC–Sophia Children’s Hospital, Room SP-3506, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands ,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - René M. H. Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC–Sophia Children’s Hospital, Room SP-3506, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC–Sophia Children’s Hospital, Room SP-3506, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Titia E. Cohen-Overbeek
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | | | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC–Sophia Children’s Hospital, Room SP-3506, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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Rietman AB, van der Vaart T, Plasschaert E, Nicholson BA, Oostenbrink R, Krab LC, Descheemaeker MJ, Wit MCYD, Moll HA, Legius E, Nijs PFAD. Emotional and behavioral problems in children and adolescents with neurofibromatosis type 1. Am J Med Genet B Neuropsychiatr Genet 2018; 177:319-328. [PMID: 29243874 DOI: 10.1002/ajmg.b.32612] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022]
Abstract
To assess emotional and behavioral problems in children and adolescents with neurofibromatosis type 1,parents of 183 individuals aged 10.8 ± 3.1 years (range 6-17) completed the Child Behavior Checklist (CBCL). Also, 173 teachers completed the Teacher's Report Form (TRF), and 88 adolescents (children from 11 to 17 years) completed the Youth Self-Report (YSR). According to parental ratings, 32% scored in the clinical range (above the 90th percentile). This percentage was much lower when rated by teachers or adolescents themselves. Scores from all informants on scales for Somatic complaints, Social problems, and Attention problems were significantly different from normative scores. Attentional problems were associated with lower verbal IQ, male gender, younger age, and ADHD-symptoms. Disease-related factors did not predict behavioral problems scores. Substantial emotional and behavioral problems were reported by parents, teachers, and to a lesser extent by adolescents with NF1 themselves. Possibly, a positive illusory bias affects the observation of behavioral problems by adolescents with NF1.
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Affiliation(s)
- André B Rietman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Thijs van der Vaart
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Neuroscience, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Ellen Plasschaert
- Centre for Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Bethany A Nicholson
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Rianne Oostenbrink
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Lianne C Krab
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Marie-Claire Y de Wit
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pediatric Neurology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Henriëtte A Moll
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Eric Legius
- Centre for Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Pieter F A de Nijs
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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Rietman AB, Oostenbrink R, van Noort K, Franken MCJP, Catsman-Berrevoets CE, Aarsen FK, Hendriksen JG, de Nijs PFA. Development of emotional and behavioral problems in neurofibromatosis type 1 during young childhood. Am J Med Genet A 2017. [DOI: 10.1002/ajmg.a.38323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- André B. Rietman
- Department of Pediatric Neurology; Erasmus MC-Sophia Children's Hospital and ENCORE Expertise Centre for Neurodevelopmental Disorders; Rotterdam The Netherlands
| | - Rianne Oostenbrink
- Department of General Pediatrics; Erasmus MC-Sophia Children's Hospital and ENCORE Expertise Centre for Neurodevelopmental Disorders; Rotterdam The Netherlands
| | - Kimberley van Noort
- Department of Pediatric Neurology; Erasmus MC-Sophia Children's Hospital and ENCORE Expertise Centre for Neurodevelopmental Disorders; Rotterdam The Netherlands
| | - Marie-Christine J. P. Franken
- Department of Otorhinolaryngology; Erasmus MC-Sophia Children's Hospital and ENCORE Expertise Centre for Neurodevelopmental Disorders; Rotterdam The Netherlands
| | - Coriene E. Catsman-Berrevoets
- Department of Pediatric Neurology; Erasmus MC-Sophia Children's Hospital and ENCORE Expertise Centre for Neurodevelopmental Disorders; Rotterdam The Netherlands
| | - Femke K. Aarsen
- Department of Pediatric Neurology; Erasmus MC-Sophia Children's Hospital and ENCORE Expertise Centre for Neurodevelopmental Disorders; Rotterdam The Netherlands
| | - Jos G. Hendriksen
- Center for Neurological Learning Disorders; Kempenhaeghe Expertise Centre for Epilepsy, Sleeping Problems and Neurocognitive Disorders; Heeze The Netherlands
| | - Pieter F. A. de Nijs
- Department of Child and Adolescent Psychiatry/Psychology; Erasmus MC-Sophia Children's Hospital and ENCORE Expertise Centre for Neurodevelopmental Disorders; Rotterdam The Netherlands
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Rietman AB, Oostenbrink R, Bongers S, Gaukema E, van Abeelen S, Hendriksen JG, Looman CWN, de Nijs PFA, de Wit MC. Motor problems in children with neurofibromatosis type 1. J Neurodev Disord 2017; 9:19. [PMID: 28529667 PMCID: PMC5437487 DOI: 10.1186/s11689-017-9198-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 05/02/2017] [Indexed: 11/15/2022] Open
Abstract
Background Children with the neurogenetic disorder neurofibromatosis type 1 (NF1) often have problems with learning and behaviour. In both parent reports and neuropsychological assessment, motor problems are reported in approximately one third to one half of the children with NF1. Studies using broad motor performance test batteries with relatively large groups of children with NF1 are limited. The aim of this cross-sectional observational study was to describe the severity of motor problems in children with NF1 and to explore the predictive value of demographics, intelligence, and behavioural problems. Methods From 2002 to 2014, 69 children with NF1, aged 4 to 16 years (age = 9.5 ± 2.8 years; 29 girls) had a motor, psychological, and neurological evaluation in an NF1 expertise centre. Data were collected about (1) motor performance (M-ABC: Movement Assessment Battery for Children), (2) intelligence, and (3) emotional and behavioural problems as rated by parents. Results Sixty-one percent of these children scored within the clinical range of the M-ABC. In ordinal logistic regression analyses, motor problems were associated with symptoms of attention-deficit/hyperactivity disorder (ADHD), symptoms of autism spectrum disorder (ASD), and externalising behavioural problems. Motor outcome was not predicted by age, intelligence, scoliosis, hypotonia, nor hypermobility. Conclusions Motor problems are among the most common comorbid developmental problems in children with NF1, and these problems do not diminish with age. Because of their impact on daily functioning, motor problems need to be specifically addressed in diagnosis, follow-up, and treatment of NF1.
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Affiliation(s)
- André B Rietman
- Department of Child and Adolescent Psychiatry/Psychology, ENCORE NF1 Expertise Centre for Neurodevelopmental Disorders, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital, Room Sp 2478, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Rianne Oostenbrink
- Department of General Paediatrics, ENCORE NF1, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sanne Bongers
- Department of Child and Adolescent Psychiatry/Psychology, ENCORE NF1 Expertise Centre for Neurodevelopmental Disorders, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Eddy Gaukema
- Kempenhaeghe Centre for neurological learning disabilities, Heeze, The Netherlands
| | - Sandra van Abeelen
- Kempenhaeghe Centre for neurological learning disabilities, Heeze, The Netherlands
| | - Jos G Hendriksen
- Kempenhaeghe Centre for neurological learning disabilities, Heeze, The Netherlands
| | - Caspar W N Looman
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Pieter F A de Nijs
- Department of Child and Adolescent Psychiatry/Psychology, ENCORE NF1 Expertise Centre for Neurodevelopmental Disorders, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marie-Claire de Wit
- Department of Paediatric Neurology, ENCORE NF1, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
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Overwater IE, Rietman AB, Bindels-de Heus K, Looman CWN, Rizopoulos D, Sibindi TM, Cherian PJ, Jansen FE, Moll HA, Elgersma Y, de Wit MCY. Sirolimus for epilepsy in children with tuberous sclerosis complex: A randomized controlled trial. Neurology 2016; 87:1011-8. [PMID: 27511181 DOI: 10.1212/wnl.0000000000003077] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/20/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate whether mammalian target of rapamycin complex 1 (mTORC1) inhibitors could reduce seizure frequency in children with tuberous sclerosis complex (TSC). METHODS Due to slow inclusion rate, target inclusion of 30 children was not reached. Twenty-three children with TSC and intractable epilepsy (age 1.8-10.9 years) were randomly assigned (1:1) to open-label, add-on sirolimus treatment immediately or after 6 months. Sirolimus was titrated to trough levels of 5-10 ng/mL. Primary endpoint was seizure frequency change during the sixth month of sirolimus treatment. RESULTS Intention-to-treat analysis showed sirolimus treatment resulted in 41% seizure frequency decrease (95% confidence interval [CI] -69% to +14%; p = 0.11) compared to the standard-care period. Per protocol analysis of 14 children who reached sirolimus target trough levels in the sixth sirolimus month showed a seizure frequency decrease of 61% (95% CI -86% to +6%; p = 0.06). Cognitive development did not change. All children had adverse events. Five children discontinued sirolimus prematurely. CONCLUSIONS We describe a randomized controlled trial for a non-antiepileptic drug that directly targets a presumed causal mechanism of epileptogenesis in a genetic disorder. Although seizure frequency decreased, especially in children reaching target trough levels, we could not show a significant benefit. Larger trials or meta-analyses are needed to investigate if patients with TSC with seizures benefit from mTORC1 inhibition. This trial was registered at trialregister.nl (NTR3178) and supported by the Dutch Epilepsy Foundation. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that sirolimus does not significantly reduce seizure frequency in children with TSC and intractable epilepsy. The study lacked the precision to exclude a benefit from sirolimus.
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Affiliation(s)
- Iris E Overwater
- From the Departments of Neurology (I.E.O., A.B.R., M.-C.Y.d.W.), Pediatrics (K.B.-d.H., H.A.M.), Public Health (C.W.N.L.), Biostatistics (D.R.), Neurophysiology (T.M.S., P.J.C.), and Neuroscience (Y.E.), ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., K.B.-d.H., H.A.M., Y.E., M.-C.Y.d.W.), Erasmus University Medical Centre, Rotterdam; and the Department of Pediatric Neurology (F.E.J.), Brain Center Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - André B Rietman
- From the Departments of Neurology (I.E.O., A.B.R., M.-C.Y.d.W.), Pediatrics (K.B.-d.H., H.A.M.), Public Health (C.W.N.L.), Biostatistics (D.R.), Neurophysiology (T.M.S., P.J.C.), and Neuroscience (Y.E.), ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., K.B.-d.H., H.A.M., Y.E., M.-C.Y.d.W.), Erasmus University Medical Centre, Rotterdam; and the Department of Pediatric Neurology (F.E.J.), Brain Center Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Karen Bindels-de Heus
- From the Departments of Neurology (I.E.O., A.B.R., M.-C.Y.d.W.), Pediatrics (K.B.-d.H., H.A.M.), Public Health (C.W.N.L.), Biostatistics (D.R.), Neurophysiology (T.M.S., P.J.C.), and Neuroscience (Y.E.), ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., K.B.-d.H., H.A.M., Y.E., M.-C.Y.d.W.), Erasmus University Medical Centre, Rotterdam; and the Department of Pediatric Neurology (F.E.J.), Brain Center Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Caspar W N Looman
- From the Departments of Neurology (I.E.O., A.B.R., M.-C.Y.d.W.), Pediatrics (K.B.-d.H., H.A.M.), Public Health (C.W.N.L.), Biostatistics (D.R.), Neurophysiology (T.M.S., P.J.C.), and Neuroscience (Y.E.), ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., K.B.-d.H., H.A.M., Y.E., M.-C.Y.d.W.), Erasmus University Medical Centre, Rotterdam; and the Department of Pediatric Neurology (F.E.J.), Brain Center Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Dimitris Rizopoulos
- From the Departments of Neurology (I.E.O., A.B.R., M.-C.Y.d.W.), Pediatrics (K.B.-d.H., H.A.M.), Public Health (C.W.N.L.), Biostatistics (D.R.), Neurophysiology (T.M.S., P.J.C.), and Neuroscience (Y.E.), ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., K.B.-d.H., H.A.M., Y.E., M.-C.Y.d.W.), Erasmus University Medical Centre, Rotterdam; and the Department of Pediatric Neurology (F.E.J.), Brain Center Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Tafadzwa M Sibindi
- From the Departments of Neurology (I.E.O., A.B.R., M.-C.Y.d.W.), Pediatrics (K.B.-d.H., H.A.M.), Public Health (C.W.N.L.), Biostatistics (D.R.), Neurophysiology (T.M.S., P.J.C.), and Neuroscience (Y.E.), ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., K.B.-d.H., H.A.M., Y.E., M.-C.Y.d.W.), Erasmus University Medical Centre, Rotterdam; and the Department of Pediatric Neurology (F.E.J.), Brain Center Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Perumpillichira J Cherian
- From the Departments of Neurology (I.E.O., A.B.R., M.-C.Y.d.W.), Pediatrics (K.B.-d.H., H.A.M.), Public Health (C.W.N.L.), Biostatistics (D.R.), Neurophysiology (T.M.S., P.J.C.), and Neuroscience (Y.E.), ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., K.B.-d.H., H.A.M., Y.E., M.-C.Y.d.W.), Erasmus University Medical Centre, Rotterdam; and the Department of Pediatric Neurology (F.E.J.), Brain Center Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Floor E Jansen
- From the Departments of Neurology (I.E.O., A.B.R., M.-C.Y.d.W.), Pediatrics (K.B.-d.H., H.A.M.), Public Health (C.W.N.L.), Biostatistics (D.R.), Neurophysiology (T.M.S., P.J.C.), and Neuroscience (Y.E.), ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., K.B.-d.H., H.A.M., Y.E., M.-C.Y.d.W.), Erasmus University Medical Centre, Rotterdam; and the Department of Pediatric Neurology (F.E.J.), Brain Center Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Henriëtte A Moll
- From the Departments of Neurology (I.E.O., A.B.R., M.-C.Y.d.W.), Pediatrics (K.B.-d.H., H.A.M.), Public Health (C.W.N.L.), Biostatistics (D.R.), Neurophysiology (T.M.S., P.J.C.), and Neuroscience (Y.E.), ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., K.B.-d.H., H.A.M., Y.E., M.-C.Y.d.W.), Erasmus University Medical Centre, Rotterdam; and the Department of Pediatric Neurology (F.E.J.), Brain Center Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
| | - Ype Elgersma
- From the Departments of Neurology (I.E.O., A.B.R., M.-C.Y.d.W.), Pediatrics (K.B.-d.H., H.A.M.), Public Health (C.W.N.L.), Biostatistics (D.R.), Neurophysiology (T.M.S., P.J.C.), and Neuroscience (Y.E.), ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., K.B.-d.H., H.A.M., Y.E., M.-C.Y.d.W.), Erasmus University Medical Centre, Rotterdam; and the Department of Pediatric Neurology (F.E.J.), Brain Center Rudolf Magnus, University Medical Centre Utrecht, the Netherlands.
| | - Marie-Claire Y de Wit
- From the Departments of Neurology (I.E.O., A.B.R., M.-C.Y.d.W.), Pediatrics (K.B.-d.H., H.A.M.), Public Health (C.W.N.L.), Biostatistics (D.R.), Neurophysiology (T.M.S., P.J.C.), and Neuroscience (Y.E.), ENCORE Expertise Centre for Neurodevelopmental Disorders (I.E.O., A.B.R., K.B.-d.H., H.A.M., Y.E., M.-C.Y.d.W.), Erasmus University Medical Centre, Rotterdam; and the Department of Pediatric Neurology (F.E.J.), Brain Center Rudolf Magnus, University Medical Centre Utrecht, the Netherlands.
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Walsh KS, Janusz J, Wolters PL, Moll HA, van der Vaart T, Rietman AB. Behavioral and cognitive outcomes for clinical trials in children with neurofibromatosis type 1. Neurology 2016; 86:1849-50. [PMID: 27164720 PMCID: PMC10687622 DOI: 10.1212/wnl.0000000000002687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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van der Vaart T, Rietman AB, Plasschaert E, Legius E, Elgersma Y, Moll HA. Behavioral and cognitive outcomes for clinical trials in children with neurofibromatosis type 1. Neurology 2015; 86:154-60. [PMID: 26519538 DOI: 10.1212/wnl.0000000000002118] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/09/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the appropriateness of cognitive and behavioral outcome measures in clinical trials in neurofibromatosis type 1 (NF1) by analyzing the degree of deficits compared to reference groups, test-retest reliability, and how scores correlate between outcome measures. METHODS Data were analyzed from the Simvastatin for cognitive deficits and behavioral problems in patients with neurofibromatosis type 1 (NF1-SIMCODA) trial, a randomized placebo-controlled trial of simvastatin for cognitive deficits and behavioral problems in children with NF1. Outcome measures were compared with age-specific reference groups to identify domains of dysfunction. Pearson r was computed for before and after measurements within the placebo group to assess test-retest reliability. Principal component analysis was used to identify the internal structure in the outcome data. RESULTS Strongest mean score deviations from the reference groups were observed for full-scale intelligence (-1.1 SD), Rey Complex Figure Test delayed recall (-2.0 SD), attention problems (-1.2 SD), and social problems (-1.1 SD). Long-term test-retest reliability were excellent for Wechsler scales (r > 0.88), but poor to moderate for other neuropsychological tests (r range 0.52-0.81) and Child Behavioral Checklist subscales (r range 0.40-0.79). The correlation structure revealed 2 strong components in the outcome measures behavior and cognition, with no correlation between these components. Scores on psychosocial quality of life correlate strongly with behavioral problems and less with cognitive deficits. CONCLUSIONS Children with NF1 show distinct deficits in multiple domains. Many outcome measures showed weak test-retest correlations over the 1-year trial period. Cognitive and behavioral outcomes are complementary. This analysis demonstrates the need to include reliable outcome measures on a variety of cognitive and behavioral domains in clinical trials for NF1.
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Affiliation(s)
- Thijs van der Vaart
- From the Departments of Neuroscience (T.v.d.V., Y.E.), Pediatrics (T.v.d.V., H.A.M.), and Neurology (A.B.R.), and ENCORE-Expertise Center for Neurodevelopmental Disorders (T.v.d.V., A.B.R., Y.E., H.A.M.), Erasmus MC: University Medical Centre, Rotterdam, the Netherlands; the Department of Human Genetics (E.P., E.L.), Catholic University Leuven; and the Centre for Human Genetics at University Hospital Leuven (E.P., E.L.), Belgium
| | - André B Rietman
- From the Departments of Neuroscience (T.v.d.V., Y.E.), Pediatrics (T.v.d.V., H.A.M.), and Neurology (A.B.R.), and ENCORE-Expertise Center for Neurodevelopmental Disorders (T.v.d.V., A.B.R., Y.E., H.A.M.), Erasmus MC: University Medical Centre, Rotterdam, the Netherlands; the Department of Human Genetics (E.P., E.L.), Catholic University Leuven; and the Centre for Human Genetics at University Hospital Leuven (E.P., E.L.), Belgium
| | - Ellen Plasschaert
- From the Departments of Neuroscience (T.v.d.V., Y.E.), Pediatrics (T.v.d.V., H.A.M.), and Neurology (A.B.R.), and ENCORE-Expertise Center for Neurodevelopmental Disorders (T.v.d.V., A.B.R., Y.E., H.A.M.), Erasmus MC: University Medical Centre, Rotterdam, the Netherlands; the Department of Human Genetics (E.P., E.L.), Catholic University Leuven; and the Centre for Human Genetics at University Hospital Leuven (E.P., E.L.), Belgium
| | - Eric Legius
- From the Departments of Neuroscience (T.v.d.V., Y.E.), Pediatrics (T.v.d.V., H.A.M.), and Neurology (A.B.R.), and ENCORE-Expertise Center for Neurodevelopmental Disorders (T.v.d.V., A.B.R., Y.E., H.A.M.), Erasmus MC: University Medical Centre, Rotterdam, the Netherlands; the Department of Human Genetics (E.P., E.L.), Catholic University Leuven; and the Centre for Human Genetics at University Hospital Leuven (E.P., E.L.), Belgium
| | - Ype Elgersma
- From the Departments of Neuroscience (T.v.d.V., Y.E.), Pediatrics (T.v.d.V., H.A.M.), and Neurology (A.B.R.), and ENCORE-Expertise Center for Neurodevelopmental Disorders (T.v.d.V., A.B.R., Y.E., H.A.M.), Erasmus MC: University Medical Centre, Rotterdam, the Netherlands; the Department of Human Genetics (E.P., E.L.), Catholic University Leuven; and the Centre for Human Genetics at University Hospital Leuven (E.P., E.L.), Belgium
| | - Henriëtte A Moll
- From the Departments of Neuroscience (T.v.d.V., Y.E.), Pediatrics (T.v.d.V., H.A.M.), and Neurology (A.B.R.), and ENCORE-Expertise Center for Neurodevelopmental Disorders (T.v.d.V., A.B.R., Y.E., H.A.M.), Erasmus MC: University Medical Centre, Rotterdam, the Netherlands; the Department of Human Genetics (E.P., E.L.), Catholic University Leuven; and the Centre for Human Genetics at University Hospital Leuven (E.P., E.L.), Belgium.
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Overwater IE, Bindels-de Heus K, Rietman AB, ten Hoopen LW, Vergouwe Y, Moll HA, de Wit MCY. Epilepsy in children with tuberous sclerosis complex: Chance of remission and response to antiepileptic drugs. Epilepsia 2015; 56:1239-45. [DOI: 10.1111/epi.13050] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Iris E. Overwater
- Department of Neurology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - Karen Bindels-de Heus
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- Department of Pediatrics; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - André B. Rietman
- Department of Neurology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - Leontine W. ten Hoopen
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - Yvonne Vergouwe
- Department of Public Health; Erasmus MC Rotterdam; Rotterdam The Netherlands
| | - Henriette A. Moll
- Department of Pediatrics; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - Marie-Claire Y. de Wit
- Department of Neurology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
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Overwater IE, Rietman AB, Elgersma Y, de Wit MCY. Treatment of intractable epilepsy in tuberous sclerosis complex with everolimus is not yet evidence-based. Ann Neurol 2014; 75:163-4. [PMID: 24243580 DOI: 10.1002/ana.24047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 07/19/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Iris E Overwater
- Departments of Neurology, ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; Neuroscience, ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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van der Vaart T, Plasschaert E, Rietman AB, Renard M, Oostenbrink R, Vogels A, de Wit MCY, Descheemaeker MJ, Vergouwe Y, Catsman-Berrevoets CE, Legius E, Elgersma Y, Moll HA. Simvastatin for cognitive deficits and behavioural problems in patients with neurofibromatosis type 1 (NF1-SIMCODA): a randomised, placebo-controlled trial. Lancet Neurol 2013; 12:1076-83. [PMID: 24090588 DOI: 10.1016/s1474-4422(13)70227-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Neurofibromatosis type 1 is a common genetic disorder characterised by neurocutaneous manifestations and cognitive and behavioural problems. Statins were shown to reduce analogous learning deficits in a mouse model of the disease, but a short-term trial in humans was inconclusive. We aimed to assess the use of simvastatin for the improvement of cognitive and behavioural deficits in children with neurofibromatosis type 1 for 12 months. METHODS In this randomised, double-masked, placebo-controlled trial, we recruited children with genetically confirmed neurofibromatosis type 1 aged 8-16 years from two national referral centres in the Netherlands and Belgium. Those with symptomatic CNS abnormalities or on neurotropic medication, including stimulants, were excluded. Eligible patients were randomly assigned (1:1) via a computer-generated, permuted-block list to simvastatin (10 mg per day in month 1, 20 mg per day in month 2, and 20-40 mg per day in months 3-12) or placebo for 12 months. Investigators, participants, and parents were masked to treatment assignment. Primary outcome measures were full-scale intelligence (Wechsler intelligence scale for children), attention problems (child behaviour checklist, parent-rated [CBCL]), and internalising behavioural problems (CBCL). We did intention-to-treat analyses (of all patients who had outcome data) using linear regression of the 12 month outcome scores, adjusted for baseline performance. This trial is registered with the Netherlands Trial Register, number NTR2150. FINDINGS We randomly assigned 84 children to a treatment group (43 to simvastatin, 41 to placebo) between March 9, 2010, and March 6, 2012. We did not assess outcomes in two patients in the placebo group because they needed additional drug therapy. Simvastatin for 12 months had no effect on full-scale intelligence (treatment effect compared with placebo -1·3 IQ points [95% CI -3·8 to 1·3]; p=0·33), attention problems (-1·6 T-score points [-4·3 to 1·0]; p=0·23), and internalising behavioural problems (-0·1 T-score points [-3·3 to 3·1]; p=0·96). 38 (88%) of 43 patients on simvastatin and 39 (95%) of 41 patients on placebo reported adverse events, which were serious in two and four patients, respectively. INTERPRETATION 12 month simvastatin treatment did not ameliorate cognitive deficits or behavioural problems in children with neurofibromatosis type 1. The use of 20-40 mg simvastatin per day for cognitive enhancement in children with neurofibromatosis type 1 is not recommended. FUNDING The Netherlands Organization for Health Research and Development (ZonMw), Research Foundation Flanders (FWO-Vlaanderen), Marguerite-Marie Delacroix Foundation, and the Dutch Neurofibromatosis Association (NFVN).
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Affiliation(s)
- Thijs van der Vaart
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, Netherlands; Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, Netherlands; ENCORE Expertise Centre For Neurodevelopmental Disorders, Erasmus University Medical Centre, Rotterdam, Netherlands
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Taal MN, Rietman AB, Meulen SVD, Schipper M, Dejonckere PH. Children with specific language impairment show difficulties in sensory modulation. LOGOP PHONIATR VOCO 2012; 38:70-8. [PMID: 22612473 DOI: 10.3109/14015439.2012.687760] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study is to investigate whether a group of 116 Dutch children with specific language impairment (SLI) shows differences in sensory processing when compared to a control group of age-matched 4-7-year-old typical peers. The Sensory Profile-NL-a standardized questionnaire of 125 items-was completed by caregivers of children in both groups. Children with SLI differed significantly from the control group on all 14 section scores and 4 quadrant scores of the Sensory Profile-NL. The effect size of the difference in sensory modulation patterns of children with and without SLI on this measure was large (Cohen's d ≥ 0.80). Difficulties in sensory modulation can be characterized as frequent co-morbid problems in children with SLI.
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