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Hou Y, Yu L, Liu D, Wilson-Lemoine E, Wu X, Moreira JP, Mujica BF, Mukhopadhyay ES, Novotney AN, Payne JM. Systematic Review and Meta-Analysis: Attention-Deficit/Hyperactivity Disorder Symptoms in Children With Neurofibromatosis Type 1. J Am Acad Child Adolesc Psychiatry 2025; 64:447-462. [PMID: 39709008 DOI: 10.1016/j.jaac.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 08/30/2024] [Accepted: 12/12/2024] [Indexed: 12/23/2024]
Abstract
OBJECTIVE This meta-analysis aimed to robustly estimate differences in attention-deficit/hyperactivity disorder (ADHD) symptoms between children and adolescents with and without neurofibromatosis type 1 (NF1). METHOD Systematic literature searches were conducted in Scopus, PsycINFO, Web of Science, PubMed, and ProQuest in September 2022, with a supplemental search conducted in Google Scholar in February 2023. The searches identified 2,153 unique articles. Screening identified 114 academic journal articles that assessed parent/caregiver- or teacher-reported ADHD symptoms for children/adolescents with NF1. Two researchers independently screened articles and extracted data. The primary outcome was group differences in ADHD symptoms between children/adolescents with and without NF1 (Hedges g). Data were analyzed using robust variance estimation and random-effects models. RESULTS The meta-analysis included 70 studies (138 effect sizes), involving 3,653 children/adolescents with NF1 (46% female; mean age = 9.69 years, SD = 2.60 years) and 4,895 children/adolescents without NF1 (48% female; mean age = 10.03 years, SD = 3.10 years). According to parent/caregiver reports, children/adolescents with NF1 exhibited more severe inattentive symptoms (g = 1.20; 95% CI = 1.06-1.35), hyperactive/impulsive symptoms (g = 0.85; 95% CI = 0. 68-1.03), and combined ADHD symptoms (g = 1.02; 95% CI = 0.87-1.17) than unaffected controls. Inattentive ADHD symptoms were more elevated than hyperactivity/impulsivity for children/adolescents with NF1. Larger effect sizes for inattention and hyperactivity/impulsivity were associated with older age, lower intelligence quotient (IQ), and parent/caregiver vs teacher reports. CONCLUSION NF1 is a monogenic condition that has strong associations with elevated ADHD symptoms. Findings highlight the importance of early intervention and targeted support for ADHD-related problems in children with NF1. PLAIN LANGUAGE SUMMARY Increasing evidence has suggested a higher risk for attention-deficit/hyperactivity disorder (ADHD) in individuals with neurofibromatosis type 1 (NF1). In this study of ADHD symptom severity in youth with NF1, the authors analyzed data from 70 articles. The authors found much more severe ADHD symptoms in children and adolescents with NF1 compared to youth without NF1. Inattentive symptoms were more pronounced in children with NIF who were older or had a lower IQ. STUDY PREREGISTRATION INFORMATION Compare the ADHD problems between NF1 and control groups; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=462063.
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Affiliation(s)
- Yang Hou
- Florida State University, Tallahassee, Florida, USA.
| | - Liyan Yu
- Florida State University, Tallahassee, Florida, USA
| | - Dan Liu
- Florida State University, Tallahassee, Florida, USA
| | | | - Xian Wu
- University of Kentucky, Lexington, Kentucky, USA
| | | | | | | | | | - Jonathan M Payne
- Murdoch Children's Research Institute, Australia and The University of Melbourne, Australia
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Liu D, Yu L, Wu X, Moreira J, Mujica BF, Mukhopadhyay ES, Novotney A, Rietman AB, Hou Y. Internalizing and externalizing symptoms in individuals with neurofibromatosis type 1: a systematic review and meta-analysis. Syst Rev 2025; 14:20. [PMID: 39844170 PMCID: PMC11752862 DOI: 10.1186/s13643-024-02749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Accepted: 12/20/2024] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Individuals with neurofibromatosis type 1 (NF1) frequently report psychosocial problems, among which internalizing and externalizing symptoms are the most poorly understood due to limited research and inconsistent evidence. This hinders the overall attendance of their psychosocial needs and has a major impact on their quality of life. Thus, this systematic review and meta-analysis was conducted to synthesize existing findings on the degree to which individuals with NF1 experience internalizing and externalizing symptoms, compared with the unaffected population, and explore moderators of the group disparities. METHODS Scopus, PsycINFO, Web of Science, PubMed, and ProQuest were searched from inception to March 26th, 2024, which identified 59 eligible studies (N of NF1 = 3182, mean ages 2.38 to 46.4 years). Hedges' g was calculated for differences in internalizing and externalizing symptoms between the NF1 group and the unaffected controls. Study effect sizes were pooled using robust variance estimation and random-effects models. Moderators of group differences were tested using meta-regression. RESULTS Random-effects meta-analyses indicated that compared with unaffected controls, individuals with NF1 showed more severe depressive (k = 21; g = 0.43; 95% CI [0.21, 0.65]), anxiety (k = 24; g = 0.27; 95% CI [0.01, 0.54]), somatic (k = 27; g = 0.56; 95% CI [0.30, 0.83]), total internalizing (k = 75; g = 0.50; 95% CI [0.33, 0.67]), aggression (k = 33; g = 0.33; 95% CI [0.08, 0.58]), delinquency, (k = 37; g = 0.43; 95% CI [0.26, 0.60]), and total externalizing symptoms (k = 47; g = 0.24; 95% CI [0.13, 0.35]). Studies that included more participants with NF1 who had ADHD or a lower verbal IQ reported greater group disparities in total internalizing symptoms or aggression. CONCLUSIONS Findings highlight the importance of promptly recognizing internalizing and externalizing symptoms in individuals with NF1 for timely interventions. Future research should identify predictors of internalizing and externalizing symptoms within the NF1 population to inform our knowledge and intervention development. Other implications for future research were also discussed. SYSTEMATIC REVIEW REGISTRATION The study protocol of this meta-analysis was registered at PROSPERO (CRD42023478258).
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Affiliation(s)
- Dan Liu
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL, 32306-4300, USA
| | - Liyan Yu
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL, 32306-4300, USA
| | - Xian Wu
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, USA
| | - Julia Moreira
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL, 32306-4300, USA
| | - Benjamin Felipe Mujica
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL, 32306-4300, USA
| | - Elora Shelly Mukhopadhyay
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL, 32306-4300, USA
| | - Angelena Novotney
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL, 32306-4300, USA
| | - André B Rietman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Yang Hou
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL, 32306-4300, USA.
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Maresca G, Bonanno C, Veneziani I, Buono VL, Latella D, Quartarone A, Marino S, Formica C. The Lack of Ad Hoc Neuropsychological Assessment in Adults with Neurofibromatosis: A Systematic Review. J Clin Med 2024; 13:1432. [PMID: 38592693 PMCID: PMC10931953 DOI: 10.3390/jcm13051432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Neurofibromatosis Type 1 (NF1) is a genetic autosomal dominant disorder that affects both the central and peripheral nervous systems. Children and adolescents with NF1 commonly experience neuropsychological, motor, and behavioral deficits. The cognitive profile hallmark of this disorder includes visuospatial and executive function impairments. These cognitive disorders may persist into adulthood. This study aims to analyze previous research studies that have described cognitive dysfunctions in adults with NF1. The purpose of this analysis is to review the neuropsychological and psychological assessment methods used. Methods: A total of 327 articles were identified based on the search terms in their titles and abstracts. The evaluation was conducted by scrutinizing each article's title, abstract, and text. Results: Only 16 articles were found to be eligible for inclusion based on the pre-defined criteria. The selected studies primarily focus on the development of diagnostic protocols for individuals with NF1. Conclusions: The management of NF1 disease requires a multidisciplinary approach to address symptoms, preserve neurological functions, and ensure the best possible quality of life. However, cognitive impairment can negatively affect psychological well-being. This study suggested that cognitive functions in NF1 patients were not tested using specific measures, but rather were evaluated through intelligence scales. Additionally, the findings revealed that there is no standardized neuropsychological assessment for adults with NF1. To address this gap, it would be helpful to create a specific neuropsychological battery to study cognitive function in NF1 patients during clinical studies. This battery could also serve as a tool to design models for cognitive rehabilitation by using reliable and sensitive measures of cognitive outcomes.
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Affiliation(s)
- Giuseppa Maresca
- IRCCS Centro Neurolesi Bonino Pulejo, S.S. 113-Via Palermo, C.da Casazza, 98124 Messina, Italy; (G.M.); (C.B.); (V.L.B.); (A.Q.); (S.M.); (C.F.)
| | - Carmen Bonanno
- IRCCS Centro Neurolesi Bonino Pulejo, S.S. 113-Via Palermo, C.da Casazza, 98124 Messina, Italy; (G.M.); (C.B.); (V.L.B.); (A.Q.); (S.M.); (C.F.)
| | - Isabella Veneziani
- Department of Nervous System and Behavioural Sciences, Psychology Section, University of Pavia, Piazza Botta, 11, 27100 Pavia, Italy;
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi Bonino Pulejo, S.S. 113-Via Palermo, C.da Casazza, 98124 Messina, Italy; (G.M.); (C.B.); (V.L.B.); (A.Q.); (S.M.); (C.F.)
| | - Desirèe Latella
- IRCCS Centro Neurolesi Bonino Pulejo, S.S. 113-Via Palermo, C.da Casazza, 98124 Messina, Italy; (G.M.); (C.B.); (V.L.B.); (A.Q.); (S.M.); (C.F.)
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino Pulejo, S.S. 113-Via Palermo, C.da Casazza, 98124 Messina, Italy; (G.M.); (C.B.); (V.L.B.); (A.Q.); (S.M.); (C.F.)
| | - Silvia Marino
- IRCCS Centro Neurolesi Bonino Pulejo, S.S. 113-Via Palermo, C.da Casazza, 98124 Messina, Italy; (G.M.); (C.B.); (V.L.B.); (A.Q.); (S.M.); (C.F.)
| | - Caterina Formica
- IRCCS Centro Neurolesi Bonino Pulejo, S.S. 113-Via Palermo, C.da Casazza, 98124 Messina, Italy; (G.M.); (C.B.); (V.L.B.); (A.Q.); (S.M.); (C.F.)
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Zaidman CM, Goedeker NL, Aqul AA, Butterfield RJ, Connolly AM, Crystal RG, Godwin KE, Hor KN, Mathews KD, Proud CM, Kula Smyth E, Veerapandiyan A, Watkins PB, Mendell JR. Management of Select Adverse Events Following Delandistrogene Moxeparvovec Gene Therapy for Patients With Duchenne Muscular Dystrophy. J Neuromuscul Dis 2024; 11:687-699. [PMID: 38607761 PMCID: PMC11091590 DOI: 10.3233/jnd-230185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is a rare, degenerative, recessive X-linked neuromuscular disease. Mutations in the gene encoding dystrophin lead to the absence of functional dystrophin protein. Individuals living with DMD exhibit progressive muscle weakness resulting in loss of ambulation and limb function, respiratory insufficiency, and cardiomyopathy, with multiorgan involvement. Adeno-associated virus vector-mediated gene therapy designed to enable production of functional dystrophin protein is a new therapeutic strategy. Delandistrogene moxeparvovec (Sarepta Therapeutics, Cambridge, MA) is indicated for treatment of ambulatory pediatric patients aged 4 through 5 years with DMD who have an indicated mutation in the DMD gene. OBJECTIVE Evidence-based considerations for management of potential adverse events following gene therapy treatment for DMD are lacking in clinical literature. Our goal was to provide interdisciplinary consensus considerations for selected treatment-related adverse events (TRAEs) (vomiting, acute liver injury, myocarditis, and immune-mediated myositis) that may arise following gene therapy dosing with delandistrogene moxeparvovec. METHODS An interdisciplinary panel of 12 specialists utilized a modified Delphi process to develop consensus considerations for the evaluation and management of TRAEs reported in delandistrogene moxeparvovec clinical studies. Panelists completed 2 Questionnaires prior to gathering for an in-person discussion. Consensus was defined as a majority (≥58% ; 7/12) of panelists either agreeing or disagreeing. RESULTS Panelists agreed that the choice of baseline assessments should be informed by individual clinical indications, the treating provider's judgment, and prescribing information. Corticosteroid dosing for treatment of TRAEs should be optimized by considering individual risk versus benefit for each indication. In all cases involving patients with a confirmed TRAE, consultations with appropriate specialists were suggested. CONCLUSIONS The Delphi Panel established consensus considerations for the evaluation and management of potential TRAEs for patients receiving delandistrogene moxeparvovec, including vomiting, acute liver injury, myocarditis, and immune-mediated myositis.
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Affiliation(s)
- Craig M. Zaidman
- Washington University School of Medicine and St. Louis Children’s Hospital, St Louis, MO, USA
| | - Natalie L. Goedeker
- Washington University School of Medicine and St. Louis Children’s Hospital, St Louis, MO, USA
| | - Amal A. Aqul
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Anne M. Connolly
- Center for Gene Therapy, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA; The Ohio State University, Columbus, OH, USA
| | | | | | - Kan N. Hor
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA; The Ohio State University, Columbus, OH, USA
| | | | | | | | | | - Paul B. Watkins
- Eshelman School of Pharmacy, University of North Carolina Institute for Drug Safety Sciences, Chapel Hill, NC, USA
| | - Jerry R. Mendell
- Center for Gene Therapy, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA; The Ohio State University, Columbus, OH, USA
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