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Pierron L, Tezenas du Montcel S, Heinzmann A, Coarelli G, Héron D, Heide S, Herson A, Hennessy J, Petit E, Gargiulo M, Durr A. Reproductive choices and intrafamilial communication in neurogenetic diseases with different self-estimated severities. J Med Genet 2023; 60:346-351. [PMID: 36270767 DOI: 10.1136/jmg-2022-108477] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Low uptake of presymptomatic testing and medically assisted reproduction in families impacted by neurogenetic diseases prompted us to investigate how reproductive options are considered and whether there is a relationship with perceived severity of the disease. We hypothesised that self-estimated severity would influence opinion on reproductive options and that prenatal/preimplantation diagnosis would be a motivation to inform relatives about their risk. METHODS We invited people impacted by neurogenetic diseases to evaluate the severity of their familial disease using analogic visual scales and to answer questionnaires about reproductive choices and intrafamilial communication. We compared answers between diseases and with the perceived severity of each disease. RESULTS We analysed 562 questionnaires. Participants were impacted by Huntington disease (n=307), spinocerebellar ataxias (n=114), Steinert myotonic dystrophy (n=82) and amyotrophic lateral sclerosis/frontotemporal dementia (n=59). Self-estimated severity differed between pathologies (p<0.0001). Overall, participants considered prenatal diagnosis (78.0±34.4 out of 100) and preimplantation diagnosis (75.2±36.1 out of 100) justified more than termination of pregnancy (68.6±38.5 out of 100). They were less in favour of gamete donation (48.3±39.8 out of 100) or pregnancy abstention (43.3±40.3 out of 100). The greater the perceived severity of the disease, the more reproductive options were considered justified, except for gamete donation. Prenatal/preimplantation diagnosis was a motivation to inform relatives for only 55.3% of participants (p=0.01). CONCLUSION Self-estimated severity minimally impacts opinions towards reproductive options. Medically assisted reproduction procedures are rarely sought and do not motivate familial communication.
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Affiliation(s)
- Lucie Pierron
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
| | - Sophie Tezenas du Montcel
- Institut Pierre Louis de Santé Publique, Medical Information Unit, Sorbonne Université, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Anna Heinzmann
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Giulia Coarelli
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Delphine Héron
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
| | - Solveig Heide
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
| | - Ariane Herson
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
| | - Juliette Hennessy
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Elodie Petit
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Marcela Gargiulo
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Université Sorbonne Paris Cité, Boulogne-Billancourt, France
| | - Alexandra Durr
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
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Amador MDM, Gargiulo M, Boucher C, Herson A, Staraci S, Salachas F, Clot F, Cazeneuve C, Le Ber I, Durr A. Who and Why? Requests for Presymptomatic Genetic Testing for Amyotrophic Lateral Sclerosis/Frontotemporal Dementia vs Huntington Disease. Neurol Genet 2020; 7:e538. [PMID: 33376800 PMCID: PMC7768924 DOI: 10.1212/nxg.0000000000000538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/20/2020] [Indexed: 11/15/2022]
Abstract
Objective We aimed to describe the population of subjects seeking presymptomatic counseling for amyotrophic lateral sclerosis and/or frontotemporal dementia (ALS/FTD) and compared them with those demanding the well-established presymptomatic test for Huntington disease (HD). Methods We retrospectively examined the requests of a cohort of individuals at risk of familial ALS/FTD and 1 at risk of HD over the same time frame of 11 years. The individuals were seen in the referral center of our neurogenetics unit. Results Of the 106 presymptomatic testing (PT) requests from subjects at risk of ALS/FTD, 65% were seen in the last 3 years. Over two-thirds of the subjects were at risk of carrying mutations responsible for ALS, FTD, or both. Sixty-two percent of the subjects came from families with a known hexanucleotide repeat expansion in C9ORF72. During the same period, we counseled 840 subjects at risk of HD. Subjects at risk of ALS/FTD had the presymptomatic test significantly sooner after being aware of their risk, but were older than those at risk of HD. The youngest subjects requesting the test had the highest disease load in the family (p < 0.05). Conclusions Demands for PT for ALS/FTD have been increasingly growing, particularly since the discovery of the C9ORF72 gene. The major specificity of the genetic counseling for these diseases is the unpredictability of the clinical phenotype for most of the genes involved. Awareness of this added uncertainty does not prevent individuals from taking the test, as the dropout rate is not higher than that for HD.
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Affiliation(s)
- Maria Del Mar Amador
- Maria del Mar Amador, Département de Neurologie (M.d.M.A., F.S.), Centre de Référence SLA de Paris, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Département de Génétique (M.d.M.A., M.G., C.B., A.H., S.S., A.D.), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Laboratory of Clinical Psychology (M.G.), Psychopathology and Psychoanalysis PCPP, EA 4056, University Paris Descartes, Sorbonne Paris City, Psychology Institute, Boulogne-Billancourt, France; Département de Génétique (F.C., C.C.), UF de Neurogénétique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière; Centre de Référence des Démences Rares ou Précoces (I.L.B.), IM2A, Département de Neurologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; and Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM) (I.L.B., A.D.), Assistance Publique-Hôpitaux de Paris, INSERM, CNRS, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France
| | - Marcela Gargiulo
- Maria del Mar Amador, Département de Neurologie (M.d.M.A., F.S.), Centre de Référence SLA de Paris, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Département de Génétique (M.d.M.A., M.G., C.B., A.H., S.S., A.D.), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Laboratory of Clinical Psychology (M.G.), Psychopathology and Psychoanalysis PCPP, EA 4056, University Paris Descartes, Sorbonne Paris City, Psychology Institute, Boulogne-Billancourt, France; Département de Génétique (F.C., C.C.), UF de Neurogénétique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière; Centre de Référence des Démences Rares ou Précoces (I.L.B.), IM2A, Département de Neurologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; and Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM) (I.L.B., A.D.), Assistance Publique-Hôpitaux de Paris, INSERM, CNRS, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France
| | - Christilla Boucher
- Maria del Mar Amador, Département de Neurologie (M.d.M.A., F.S.), Centre de Référence SLA de Paris, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Département de Génétique (M.d.M.A., M.G., C.B., A.H., S.S., A.D.), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Laboratory of Clinical Psychology (M.G.), Psychopathology and Psychoanalysis PCPP, EA 4056, University Paris Descartes, Sorbonne Paris City, Psychology Institute, Boulogne-Billancourt, France; Département de Génétique (F.C., C.C.), UF de Neurogénétique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière; Centre de Référence des Démences Rares ou Précoces (I.L.B.), IM2A, Département de Neurologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; and Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM) (I.L.B., A.D.), Assistance Publique-Hôpitaux de Paris, INSERM, CNRS, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France
| | - Ariane Herson
- Maria del Mar Amador, Département de Neurologie (M.d.M.A., F.S.), Centre de Référence SLA de Paris, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Département de Génétique (M.d.M.A., M.G., C.B., A.H., S.S., A.D.), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Laboratory of Clinical Psychology (M.G.), Psychopathology and Psychoanalysis PCPP, EA 4056, University Paris Descartes, Sorbonne Paris City, Psychology Institute, Boulogne-Billancourt, France; Département de Génétique (F.C., C.C.), UF de Neurogénétique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière; Centre de Référence des Démences Rares ou Précoces (I.L.B.), IM2A, Département de Neurologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; and Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM) (I.L.B., A.D.), Assistance Publique-Hôpitaux de Paris, INSERM, CNRS, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France
| | - Stéphanie Staraci
- Maria del Mar Amador, Département de Neurologie (M.d.M.A., F.S.), Centre de Référence SLA de Paris, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Département de Génétique (M.d.M.A., M.G., C.B., A.H., S.S., A.D.), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Laboratory of Clinical Psychology (M.G.), Psychopathology and Psychoanalysis PCPP, EA 4056, University Paris Descartes, Sorbonne Paris City, Psychology Institute, Boulogne-Billancourt, France; Département de Génétique (F.C., C.C.), UF de Neurogénétique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière; Centre de Référence des Démences Rares ou Précoces (I.L.B.), IM2A, Département de Neurologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; and Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM) (I.L.B., A.D.), Assistance Publique-Hôpitaux de Paris, INSERM, CNRS, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France
| | - François Salachas
- Maria del Mar Amador, Département de Neurologie (M.d.M.A., F.S.), Centre de Référence SLA de Paris, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Département de Génétique (M.d.M.A., M.G., C.B., A.H., S.S., A.D.), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Laboratory of Clinical Psychology (M.G.), Psychopathology and Psychoanalysis PCPP, EA 4056, University Paris Descartes, Sorbonne Paris City, Psychology Institute, Boulogne-Billancourt, France; Département de Génétique (F.C., C.C.), UF de Neurogénétique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière; Centre de Référence des Démences Rares ou Précoces (I.L.B.), IM2A, Département de Neurologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; and Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM) (I.L.B., A.D.), Assistance Publique-Hôpitaux de Paris, INSERM, CNRS, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France
| | - Fabienne Clot
- Maria del Mar Amador, Département de Neurologie (M.d.M.A., F.S.), Centre de Référence SLA de Paris, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Département de Génétique (M.d.M.A., M.G., C.B., A.H., S.S., A.D.), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Laboratory of Clinical Psychology (M.G.), Psychopathology and Psychoanalysis PCPP, EA 4056, University Paris Descartes, Sorbonne Paris City, Psychology Institute, Boulogne-Billancourt, France; Département de Génétique (F.C., C.C.), UF de Neurogénétique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière; Centre de Référence des Démences Rares ou Précoces (I.L.B.), IM2A, Département de Neurologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; and Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM) (I.L.B., A.D.), Assistance Publique-Hôpitaux de Paris, INSERM, CNRS, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France
| | - Cécile Cazeneuve
- Maria del Mar Amador, Département de Neurologie (M.d.M.A., F.S.), Centre de Référence SLA de Paris, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Département de Génétique (M.d.M.A., M.G., C.B., A.H., S.S., A.D.), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Laboratory of Clinical Psychology (M.G.), Psychopathology and Psychoanalysis PCPP, EA 4056, University Paris Descartes, Sorbonne Paris City, Psychology Institute, Boulogne-Billancourt, France; Département de Génétique (F.C., C.C.), UF de Neurogénétique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière; Centre de Référence des Démences Rares ou Précoces (I.L.B.), IM2A, Département de Neurologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; and Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM) (I.L.B., A.D.), Assistance Publique-Hôpitaux de Paris, INSERM, CNRS, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France
| | - Isabelle Le Ber
- Maria del Mar Amador, Département de Neurologie (M.d.M.A., F.S.), Centre de Référence SLA de Paris, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Département de Génétique (M.d.M.A., M.G., C.B., A.H., S.S., A.D.), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Laboratory of Clinical Psychology (M.G.), Psychopathology and Psychoanalysis PCPP, EA 4056, University Paris Descartes, Sorbonne Paris City, Psychology Institute, Boulogne-Billancourt, France; Département de Génétique (F.C., C.C.), UF de Neurogénétique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière; Centre de Référence des Démences Rares ou Précoces (I.L.B.), IM2A, Département de Neurologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; and Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM) (I.L.B., A.D.), Assistance Publique-Hôpitaux de Paris, INSERM, CNRS, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France
| | - Alexandra Durr
- Maria del Mar Amador, Département de Neurologie (M.d.M.A., F.S.), Centre de Référence SLA de Paris, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Département de Génétique (M.d.M.A., M.G., C.B., A.H., S.S., A.D.), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; Laboratory of Clinical Psychology (M.G.), Psychopathology and Psychoanalysis PCPP, EA 4056, University Paris Descartes, Sorbonne Paris City, Psychology Institute, Boulogne-Billancourt, France; Département de Génétique (F.C., C.C.), UF de Neurogénétique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière; Centre de Référence des Démences Rares ou Précoces (I.L.B.), IM2A, Département de Neurologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France; and Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM) (I.L.B., A.D.), Assistance Publique-Hôpitaux de Paris, INSERM, CNRS, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France
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Pierron L, Hennessy J, Tezenas du Montcel S, Coarelli G, Heinzmann A, Schaerer E, Herson A, Petit E, Gargiulo M, Durr A. Informing about genetic risk in families with Huntington disease: comparison of attitudes across two decades. Eur J Hum Genet 2020; 29:672-679. [PMID: 33299145 DOI: 10.1038/s41431-020-00776-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/09/2020] [Accepted: 11/13/2020] [Indexed: 01/01/2023] Open
Abstract
The low uptake of presymptomatic testing in Huntington disease prompted us to question family members on how they handle the transmission of information regarding genetic risk. We hypothesised that in 2019, parents would inform their at-risk children about their genetic risk more and at a younger age than in 2000, given the availability of prenatal diagnosis, French legislation changes since 2011, and recent therapeutic advances. We made a questionnaire available about the transmission of genetic information within families with Huntington disease in 2000 and 2019. We obtained 443 questionnaires (295 in 2019 and 148 in 2000). Participants were mainly at-risk for Huntington disease (n = 113), affected (n = 85), and spouses (n = 154). In 2019, participants had a higher mean education level (p < 0.01) and a mean age of 44.1 ± 15.1 years (vs 48.1 ± 11.4 years in 2000, p < 0.01). They had been informed about the risk of being a carrier at around 30 years of age (29.0 ± 14.2 in 2019 vs 32.2 ± 13.8 in 2000, p = 0.09). However, they would inform at an earlier age (≤18 years, 67% vs 59%, p = 0.16). Information on transmission risk had been given primarily by parents (45% vs 30%, p = 0.06). In addition, genetic testing for relatives unaware of their status was recommended more frequently in 2019 (46% vs 32%, p < 0.001). Respondents in 2019 recommended genetic testing more often but overall attitudes towards information and testing have not changed significantly over the 19-year time period since the questionnaire was first delivered even despite recent clinical trials potential disease modifying therapies.
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Affiliation(s)
- Lucie Pierron
- AP-HP, Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France
| | - Juliette Hennessy
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, INSERM, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | - Sophie Tezenas du Montcel
- Sorbonne Université, Medical Information Unit, AP-HP, INSERM, Institut Pierre Louis de Santé Publique, Pitié-Salpêtrière University Hospital, Paris, France
| | - Giulia Coarelli
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, INSERM, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | - Anna Heinzmann
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, INSERM, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | - Elodie Schaerer
- AP-HP, Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France.,AP-HP, Institute of Myology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Ariane Herson
- AP-HP, Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France.,AP-HP, Institute of Myology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Elodie Petit
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, INSERM, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | - Marcela Gargiulo
- AP-HP, Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France. .,AP-HP, Institute of Myology, Pitié-Salpêtrière University Hospital, Paris, France. .,Université de Paris, Laboratoire de Psychologie Clinique et Psychopathologie, Sorbonne Paris Cité, Institut de Psychologie, EA 4056, Paris, France.
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, INSERM, CNRS, Pitié-Salpêtrière University Hospital, Paris, France.
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