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Heath O, Hammerl E, Spitzinger A, Wortmann SB. Ending an Odyssey? The Psychosocial Experiences of Parents after the Genetic Diagnosis of a Mitochondrial Disease in Children. J Pers Med 2024; 14:523. [PMID: 38793105 PMCID: PMC11122152 DOI: 10.3390/jpm14050523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Obtaining a genetic diagnosis of a primary mitochondrial disease (PMD) is often framed as a diagnostic odyssey. Yet, even after receiving a diagnosis, parents of affected children experience ongoing therapeutic and prognostic uncertainty and considerable psychosocial challenges. Semi-structured interviews (N = 24) were conducted with parents of 13 children (aged 2-19 years) with a genetically confirmed PMD. Paternal (N = 11) and maternal (N = 13) perspectives were obtained, and thematic analysis was performed on all interviews. A genetic diagnosis was valuable and empowering for parents, despite eliciting varied emotional responses. While the diagnosis helped focus management decisions, families often felt overwhelmed and unsupported in navigating the healthcare system. Most parents reported a serious impact on their romantic relationship. The sources of social support varied, with a preference for established friendship and family support networks over disease-specific community support groups. Most parents favored prenatal genetic testing in the event of a future pregnancy. This study provides insight into the lived experiences of parents after a genetic diagnosis of PMD in their children. The findings draw awareness to supportive care needs and highlight important gaps that should be addressed to ensure that parents feel supported within a holistic framework of management for PMDs.
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Affiliation(s)
- Oliver Heath
- University Children’s Hospital, Salzburger Landeskliniken (SALK), Paracelsus Medical University (PMU), Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (O.H.); (E.H.); (A.S.)
| | - Emma Hammerl
- University Children’s Hospital, Salzburger Landeskliniken (SALK), Paracelsus Medical University (PMU), Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (O.H.); (E.H.); (A.S.)
| | - Anna Spitzinger
- University Children’s Hospital, Salzburger Landeskliniken (SALK), Paracelsus Medical University (PMU), Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (O.H.); (E.H.); (A.S.)
- Institut für Klinische Psychologie der UK für Psychiatrie, Psychotherapie und Psychosomatik der PMU, 5020 Salzburg, Austria
| | - Saskia B. Wortmann
- University Children’s Hospital, Salzburger Landeskliniken (SALK), Paracelsus Medical University (PMU), Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (O.H.); (E.H.); (A.S.)
- Nijmegen Centre for Mitochondrial Disorders (NCMD), Amalia Children’s Hospital, Radboudumc, 6525 Nijmegen, The Netherlands
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Cognitive functioning and mental health in children with a primary mitochondrial disease. Orphanet J Rare Dis 2022; 17:368. [PMID: 36183138 PMCID: PMC9526923 DOI: 10.1186/s13023-022-02510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Studies regarding cognitive and mental health functioning in children with mitochondrial disease (MD) are scarce, while both are important issues given their impact on QoL. Knowledge on these aspects of functioning and its relationship with disease parameters is essential to gather more insight in working mechanisms and provide recommendations for future research and patientcare. The aim of this study was to map the cognitive functioning and mental health in children with MD in relation to disease specific factors.
Methods Pediatric patients (< 18 year) with a genetically confirmed MD were included. Demographic and disease specific factors (International Paediatric Mitochondrial Disease Scale) were assessed, as well as cognitive functioning (intelligence, attention, working memory (WM)), and mental health (psychological functioning and quality of life). Individual patient data was described.
Results Thirty-three children with MD were included. Intellectual functioning ranged from a clinically low IQ (36% of the patients, N = 12/33) to an average or above average IQ (39%, N = 13/33). A higher verbal versus performance IQ was observed (36% N = 5/14), a lower processing speed (43%, N = 6/14), attentional problems (50%, N = 7/14), and verbal WM problems (11%, N = 2/18). Regarding mental health, general behavioral problems were reported (45%, N = 10/22), and on subscale level, attention problems (45%, N = 10), withdrawn/depressed (36%, N = 8/22) and anxious/depressed behavior (14%, N = 3/22). Furthermore, QoL impairments were reported (42%, N = 5/12). The specific intelligence profiles, cognitive impairments, behavioral problems and QoL impairments occurred in every intelligence subgroup. Children with an average or above general intellectual functioning had a generally lower and less variability in IPMDS scores, less frequently epilepsy, vision and hearing problems, and a relatively later age of onset, as compared to patients with a clinically low intellectual functioning. Conclusions Despite considerable heterogeneity, overall results showed a high rate of impairments in both cognitive and mental health functioning. Also in children with an average or above level of intellectual functioning, specific cognitive impairments were observed. Children with a clinically low intellectual functioning more often had disease related impairments compared to children with a higher intellectual functioning. The importance of structural assessment of cognitive functioning and mental health is warranted, also in children with mild disease related symptoms.
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Klein IL, van de Loo KFE, Smeitink JAM, Janssen MCH, Kessels RPC, van Karnebeek CD, van der Veer E, Custers JAE, Verhaak CM. Cognitive functioning and mental health in mitochondrial disease: A systematic scoping review. Neurosci Biobehav Rev 2021; 125:57-77. [PMID: 33582231 DOI: 10.1016/j.neubiorev.2021.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/06/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
Mitochondrial diseases (MDs) are rare, heterogeneous, hereditary and progressive in nature. In addition to the serious somatic symptoms, patients with MD also experience problems regarding their cognitive functioning and mental health. We provide an overview of all published studies reporting on any aspect of cognitive functioning and/or mental health in patients with MD and their relatives. A total of 58 research articles and 45 case studies were included and critically reviewed. Cognitive impairments in multiple domains were reported. Mental disorders were frequently reported, especially depression and anxiety. Furthermore, most studies showed impairments in self-reported psychological functioning and high prevalence of mental health problems in (matrilineal) relatives. The included studies showed heterogeneity regarding patient samples, measurement instruments and reference groups, making comparisons cautious. Results highlight a high prevalence of cognitive impairments and mental disorders in patients with MD. Recommendations for further research as well as tailored patientcare with standardized follow-up are provided. Key gaps in the literature are identified, of which studies on natural history are of highest importance.
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Affiliation(s)
- Inge-Lot Klein
- Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Kim F E van de Loo
- Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Jan A M Smeitink
- Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial Medicine, Department of Pediatrics, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands; Khondrion BV, Philips van Leydenlaan 15, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Mirian C H Janssen
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial Medicine, Department of Internal Medicine, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Roy P C Kessels
- Radboud University Medical Center, Department of Medical Psychology, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Thomas van Aquinostraat 4, Postbus 9104, 6500 HE, Nijmegen, the Netherlands; Vincent van Gogh Institute for Psychiatry, d'n Herk 90, 5803 DN, Venray, the Netherlands
| | - Clara D van Karnebeek
- Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial Medicine, Department of Pediatrics, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Elja van der Veer
- International Mito Patients Association, 2861 AD, Bergambacht, the Netherlands
| | - José A E Custers
- Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Christianne M Verhaak
- Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
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Shurtleff H, Barry D, Chanprasert S, Firman T, Warner M, Saneto RP. Cognitive characteristics of mitochondrial diseases in children. Epilepsy Behav 2018; 88:235-243. [PMID: 30316150 DOI: 10.1016/j.yebeh.2018.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION This retrospective descriptive study was undertaken to further define the intelligence profiles of children with mitochondrial disorders, in the context of seizures and age of symptom onset. METHODS We retrospectively identified forty-nine pediatric patients with definitive mitochondrial disease diagnoses and complete intelligence or adaptive functioning testing data. Patients were 0-216 months at onset of symptoms and 61-250 months of age at testing. Twenty-four of 49 patients had seizures. Twenty-one of the 24 patients with seizures had medically intractable seizures. All patients had Wechsler Intellectual Quotient (IQ) testing, except nine patients with seizures who were unable to engage in IQ testing and were assessed with a structured parent interview measure, the Vineland Adaptive Behavior Scales. We used descriptive and exploratory data analysis methods to characterize test results. RESULTS Distribution of ages for patients with the Vineland assessment was younger than those given the Wechsler. The median overall score (combining Wechsler and Vineland summary scores) for all patients was 85 (interquartile range [IQR]: 50, 102), with the group without seizures obtaining a higher median Full Scale IQ (FSIQ) of 100 (IQR: 86, 109), compared to the group with seizures with a median FSIQ of 67 (IQR: 49.5, 89), a difference that is both statistically and clinically different (Δ = 33; 95% CI: 9, 52). The adaptive function measure was composed of patients only with intractable epilepsy and yielded the lowest overall median summary score of 43 (IQR: 37, 50). This general trend in differences between the FSIQ scores of the groups with and without seizures was also seen across all subscale measures analyzed-IQ index scores and two subtest scores, Digit Span and Coding-though differences were not always statistically different. Vargha-Delaney's A effect sizes ranged between 0.68 and 0.90, trends that mirrored those of distributional and median differences. Groups without versus with seizures differed most distinctly in Performance IQ (PIQ), with the group without seizures' median PIQ being 100 (IQR 94, 112) versus the group with seizures' median PIQ being 63 (IQR 54, 84), a difference of 37 points (95% CI). DISCUSSION Results suggest that patients with mitochondrial diseases with seizures and early onset disease represent a worse cognitive phenotype, as compared with those with no seizures, who can have average intelligence. Results are discussed in the context of current literature.
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Affiliation(s)
- Hillary Shurtleff
- Department of Neurology, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | - Dwight Barry
- Seattle Children's Hospital, Seattle, WA, USA; Enterprise Analytics, Seattle Children's Hospital, Seattle, WA, USA
| | - Sirisak Chanprasert
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Tim Firman
- Seattle Children's Hospital, Seattle, WA, USA
| | - Molly Warner
- Department of Neurology, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | - Russell P Saneto
- Department of Neurology, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, WA, USA; Center for Integrative Brain Research, Neuroscience Institute, Seattle Children's Hospital, Seattle, WA, USA.
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Abstract
Mitochondrial diseases are a group of genetic disorders that are characterized by defects in oxidative phosphorylation and caused by mutations in genes in the nuclear DNA (nDNA) and mitochondrial DNA (mtDNA) that encode structural mitochondrial proteins or proteins involved in mitochondrial function. Mitochondrial diseases are the most common group of inherited metabolic disorders and are among the most common forms of inherited neurological disorders. One of the challenges of mitochondrial diseases is the marked clinical variation seen in patients, which can delay diagnosis. However, advances in next-generation sequencing techniques have substantially improved diagnosis, particularly in children. Establishing a genetic diagnosis allows patients with mitochondrial diseases to have reproductive options, but this is more challenging for women with pathogenetic mtDNA mutations that are strictly maternally inherited. Recent advances in in vitro fertilization techniques, including mitochondrial donation, will offer a better reproductive choice for these women in the future. The treatment of patients with mitochondrial diseases remains a challenge, but guidelines are available to manage the complications of disease. Moreover, an increasing number of therapeutic options are being considered, and with the development of large cohorts of patients and biomarkers, several clinical trials are in progress.
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Ioannides ZA, McGill J, Robertson T, Henderson RD. Neurological disorders that may deteriorate with intensive physical rehabilitation. Intern Med J 2015; 45:1193-5. [PMID: 26347994 DOI: 10.1111/imj.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/06/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Z A Ioannides
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - J McGill
- Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - T Robertson
- Department of Anatomical Pathology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - R D Henderson
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Abstract
Mitochondrial diseases represent a genetically and clinically heterogeneous group of inherited metabolic disorders, often resulting in poor functional and survival outcomes for the patient and considerable psychosocial distress for the caregiver. The systematic review undertaken in the present paper emphasizes the critical role of the caregiver in the management of a child with mitochondrial disease, with focus on the burden of mitochondrial disease on the caregiver, the family, and society.
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Affiliation(s)
- Kalliopi Sofou
- Department of Pediatrics, University of Gothenburg, The Queen Silvia's Children Hospital, Gothenburg, Sweden.
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Rodeck B, Zimmer KP. Stoffwechselerkrankungen. PÄDIATRISCHE GASTROENTEROLOGIE, HEPATOLOGIE UND ERNÄHRUNG 2013. [PMCID: PMC7498805 DOI: 10.1007/978-3-642-24710-1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Entsprechend ihrer Wanderung bei isoelektrischer Fokussierung werden die allelen Varianten des α1-AT als Proteinaseinhibitorphänotypen (Pi) klassifiziert. Die dominierende Isoform ist der normale Phänotyp M, daneben gibt es die Mangelvarianten S und Z sowie eine 0-Variante.
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Affiliation(s)
- Burkhard Rodeck
- Zentrum für Kinder- und Jugendmedizin, Christliches Kinderhospital Osnabrück, Johannisfreiheit 1, 49074 Osnabrück, Deutschland
| | - Klaus-Peter Zimmer
- grid.411067.50000000085849230Abteilung Allgemeine Pädiatrie und Neonatalogie, Universitätsklinikum Gießen und Marburg GmbH, Zentrum für Kinderheilkunde und Jugendmedizin, Feulgenstr. 12, 35392 Gießen, Deutschland
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Millichap JG. Outcome of Mitochondrial Diseases. Pediatr Neurol Briefs 2011. [DOI: 10.15844/pedneurbriefs-25-5-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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