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Collins-Sawaragi YC, Ferner R, Vassallo G, De Agrò G, Eccles S, Cadwgan J, Hargrave D, Hupton E, Eelloo J, Lunt L, Tang V, Burkitt Wright E, Lascelles K. Location, symptoms, and management of plexiform neurofibromas in 127 children with neurofibromatosis 1, attending the National Complex Neurofibromatosis 1 service, 2018-2019. Am J Med Genet A 2022; 188:1723-1727. [PMID: 35178860 DOI: 10.1002/ajmg.a.62691] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 06/18/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/10/2022]
Abstract
We report on the location, symptoms, and management of plexiform neurofibroma (PN) in children with Neurofibromatosis Type 1 (NF1) attending the 2 National Complex Neurofibromatosis 1 Services at Guy's and St. Thomas' NHS Foundation Trust, London and St Mary's Hospital, Manchester. Retrospective data collection was performed from patient chart reviews from April 2018 to April 2019. There were 127 NF1 patients with PN, age range 0.8-17.0, mean age was 9.9 years (SD ± 4.2 years). The main location of the PN was craniofacial in 35%, and limb in 19%. Disfigurement was present in 57%, pain in 28%, impairment of function in 23%, and threat to function in 9% of children. Fifty-four percent of patients were managed conservatively, 28% surgically, and 19% are either taking or due to start a mitogen-activated protein kinase kinase (MEK) inhibitor (selumetinib or trametinib), either through a clinical trial or compassionate usage scheme. This national study provides a comprehensive overview of the management of children with PN in an era where new therapies (MEK inhibitors) are becoming more widely available. We anticipate that there will be a shift to more patients receiving MEK inhibitor therapy and combination therapy (surgery and MEK inhibitor) in the future.
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Affiliation(s)
- Yoshua Colyn Collins-Sawaragi
- National Complex Neurofibromatosis 1 Service, Guy's and St. Thomas' NHS Foundation Trust and Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK
| | - Rosalie Ferner
- National Complex Neurofibromatosis 1 Service, Department of Neurology, National Neurofibromatosis Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Grace Vassallo
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Germana De Agrò
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Simon Eccles
- National Complex Neurofibromatosis 1 Service, Guy's and St. Thomas' NHS Foundation Trust and Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK
| | - Jill Cadwgan
- National Complex Neurofibromatosis 1 Service, Guy's and St. Thomas' NHS Foundation Trust and Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK
| | - Darren Hargrave
- National Complex Neurofibromatosis 1 Service, Guy's and St. Thomas' NHS Foundation Trust and Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK.,Developmental Biology and Cancer, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Eileen Hupton
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Judith Eelloo
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lauren Lunt
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vivian Tang
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma Burkitt Wright
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - Karine Lascelles
- National Complex Neurofibromatosis 1 Service, Guy's and St. Thomas' NHS Foundation Trust and Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK.,National Complex Neurofibromatosis 1 Service, Department of Neurology, National Neurofibromatosis Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
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2
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Ireland A, Riddell A, Prentice A, Eelloo J, Mughal MZ, Ward KA. Development of tibia & fibula bone deficits in children with neurofibromatosis type I - A longitudinal case-control comparison. Bone 2022; 154:116183. [PMID: 34600162 DOI: 10.1016/j.bone.2021.116183] [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: 06/08/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
Neurofibromatosis type 1 (NF1) is associated with lower bone mass and increased risk of fracture. Children with NF1 display faltering growth from mid-childhood. However, to date tibia bone development in children with NF1 across childhood and the role of body size have not been explored. Therefore, we recruited 24 children with NF1 (12 girls, mean age 8.2 ± 1.1y) and 104 children without NF1 (52 girls, mean age 11 ± 1.7y). Tibia and fibula bone characteristics were assessed at 4% and 38% distal-proximal tibia length in all children at baseline using peripheral quantitative computed tomography (pQCT). Longitudinal scans were obtained in 21 children with NF1 (12 girls) over 3.4 ± 0.3y and 71 children without NF1 (34 girls) over 1.1 ± 0.1y, such that at follow-up mean age of both groups (NF1 10.9 ± 1.3y, controls 11.4 ± 1.4y) were similar. Effects of group (NF1/control) on bone outcomes as well as group-by-age interactions, indicating differences in rate of change in bone outcome bone outcomes were assessed via linear mixed effects models with adjustment for sex, age, pubertal status and in additional models with adjustment for height and weight Z-scores. Group (NF1/control)-by-age interactions indicated a slower rate of tibia and fibula bone mass accrual in children with NF1 at all measured sites. These associations were attenuated by 25-50% by adjustment for height and weight Z-scores. At the 4% site, deficits in bone mass at older ages were related to slower trabecular BMD accrual. At the 38% site, group-by-age interactions suggested that bone mass deficits resulted from poorer accrual of cortical CSA and to a lesser extent cortical BMD. Lower limb bone mass deficits evident in children with NF1 appear to be progressive and emerge in mid-childhood. In part, they are related to development of a similar pattern of deficits in longitudinal growth and body weight in NF1. Interventions promoting muscle development or physical activity may be partially effective in attenuating bone mass accrual deficits in this population.
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Affiliation(s)
- Alex Ireland
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK.
| | - Amy Riddell
- Institute for Infection and Immunity, Paediatric Infectious Diseases Research Group, St. George's University of London, UK; previously at MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - Ann Prentice
- previously at MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK; MRC Nutrition and Bone Health Group, Cambridge, UK
| | - Judith Eelloo
- Nationally Commissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Zulf Mughal
- Nationally Commissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Kate A Ward
- MRC Lifecourse Epidemiology Unit, Human Development and Health, University of Southampton, Southampton, UK
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Chinoy A, Vassallo GR, Wright EB, Eelloo J, West S, Hupton E, Galloway P, Pilkington A, Padidela R, Mughal MZ. The skeletal muscle phenotype of children with Neurofibromatosis Type 1 - A clinical perspective. J Musculoskelet Neuronal Interact 2022; 22:70-78. [PMID: 35234161 PMCID: PMC8919663] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Neurofibromatosis type 1 (NF1) can affect multiple systems in the body. An under recognised phenotype is one of muscle weakness. Clinical studies using dynamometry and jumping mechanography have demonstrated that children with NF1 are more likely to have reduced muscle force and power. Many children with NF1 are unable to undertake physical activities to the same level as their peers, and report leg pains on physical activity and aching hands on writing. Children and adolescents with NF1 reporting symptoms of muscle weakness should have a focused assessment to exclude alternative causes of muscle weakness. Assessments of muscle strength and fine motor skills by physiotherapists and occupational therapists can provide objective evidence of muscle function and deficits, allowing supporting systems in education and at home to be implemented. In the absence of an evidence base for management of NF1-related muscle weakness, we recommend muscle-strengthening exercises and generic strategies for pain and fatigue management. Currently, trials are underway involving whole-body vibration therapy and carnitine supplementation as potential future management options.
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Affiliation(s)
- Amish Chinoy
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK,Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK,Corresponding author: Amish Chinoy, Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Oxford Road, Manchester, M13 9WL, UK E-mail:
| | - Grace R. Vassallo
- NHSE Highly Specialised Service for Complex NF1, Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK,Department of Paediatric Neurology, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma Burkitt Wright
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK, NHSE Highly Specialised Service for Complex NF1, Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Judith Eelloo
- NHSE Highly Specialised Service for Complex NF1, Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Siobhan West
- NHSE Highly Specialised Service for Complex NF1, Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK,Department of Paediatric Neurology, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Eileen Hupton
- NHSE Highly Specialised Service for Complex NF1, Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Paula Galloway
- Therapy and Dietetic Department, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Amy Pilkington
- Therapy and Dietetic Department, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK,Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - M. Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK,Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK, NHSE Highly Specialised Service for Complex NF1, Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Pobric G, Taylor JR, Ramalingam HM, Pye E, Robinson L, Vassallo G, Jung J, Bhandary M, Szumanska-Ryt K, Theodosiou L, Evans DG, Eelloo J, Burkitt-Wright E, Hulleman J, Green J, Garg S. Cognitive and Electrophysiological Correlates of Working Memory Impairments in Neurofibromatosis Type 1. J Autism Dev Disord 2021; 52:1478-1494. [PMID: 33963966 PMCID: PMC8938373 DOI: 10.1007/s10803-021-05043-3] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/03/2022]
Abstract
Neurofibromatosis 1 (NF1) is a single gene disorder associated with working Memory (WM) impairments. The aim of this study was to investigate P300 event-related potential (ERP) associated with WM in NF1. Sixteen adolescents with NF1 were compared with controls on measures of WM and EEG was recorded during a WM nback task. The NF1 group showed poorer performance on measures of WM as compared to the control group. No group differences were observed in P300 amplitude at Pz, but P300 latency was shorter in the NF1 group. Topographic analyses of P300 amplitude showed group differences indicating neural processing differences in the NF1 group relative to controls, which possibly contribute to the cognitive deficits seen in this population.
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Affiliation(s)
- Gorana Pobric
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Room 3.310 Jean McFarlane Building, Oxford Road, Manchester, M13 9WL , UK
| | - Jason R Taylor
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Room 3.310 Jean McFarlane Building, Oxford Road, Manchester, M13 9WL , UK
| | - Hemavathy M Ramalingam
- Child & Adolescent Mental Health Services, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Emily Pye
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Room 3.310 Jean McFarlane Building, Oxford Road, Manchester, M13 9WL , UK
| | - Louise Robinson
- Child & Adolescent Mental Health Services, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Grace Vassallo
- Nationally Commissioned Complex NF1 Service, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - JeYoung Jung
- School of Psychology, Precision Imaging Beacon, University of Nottingham, Nottingham, UK
| | - Misty Bhandary
- Child & Adolescent Mental Health Services, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Karolina Szumanska-Ryt
- Child & Adolescent Mental Health Services, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Louise Theodosiou
- Child & Adolescent Mental Health Services, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - D Gareth Evans
- Nationally Commissioned Complex NF1 Service, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.,Faculty of Biology, Division of Evolution and Genomic Sciences, Manchester Centre for Genomic Medicine, Medicine and Health, North West Genomics Hub, University of Manchester, Manchester, UK
| | - Judith Eelloo
- Nationally Commissioned Complex NF1 Service, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Emma Burkitt-Wright
- Nationally Commissioned Complex NF1 Service, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Johan Hulleman
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Room 3.310 Jean McFarlane Building, Oxford Road, Manchester, M13 9WL , UK
| | - Jonathan Green
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Room 3.310 Jean McFarlane Building, Oxford Road, Manchester, M13 9WL , UK.,Child & Adolescent Mental Health Services, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Shruti Garg
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Room 3.310 Jean McFarlane Building, Oxford Road, Manchester, M13 9WL , UK. .,Child & Adolescent Mental Health Services, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.
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5
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Vassallo G, Mughal Z, Robinson L, Weisberg D, Roberts SA, Hupton E, Eelloo J, Burkitt Wright EM, Garg S, Lewis L, Evans DG, Stivaros SM. Perceived fatigue in children and young adults with neurofibromatosis type 1. J Paediatr Child Health 2020; 56:878-883. [PMID: 31916647 DOI: 10.1111/jpc.14764] [Citation(s) in RCA: 9] [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: 08/08/2019] [Revised: 11/24/2019] [Accepted: 12/15/2019] [Indexed: 12/15/2022]
Abstract
AIM This study describes the prevalence and severity of perceived fatigue in a young neurofibromatosis type 1 (NF1) population. METHODS Ethical approval was obtained and NF1 affected Individuals aged 2-18 years from the Manchester's NF1 clinic invited along with any unaffected siblings. The PedsQL Multidimensional Fatigue Scale Parental and child report was used. This validated measure explores cognitive, physical and sleep/rest domains on a 0-100 scale. Higher scores indicate less fatigue. Fatigue scores in affected children were compared to unaffected siblings after adjusting for age, sex and Index of Multiple Deprivation and with published population standards using z-scores. RESULTS A total of 286 families were invited and 75 affected and 16 siblings participated. There were significant differences between NF1 and controls in the aggregated fatigue core (child report 55 ± 19 vs. 75 (14), P < 0.001; parent 54 ± 20 vs. 73 ± 18, P = 0.001) and the three sub-domains: cognitive (child 48 ± 27 vs. 75 ± 23, P < 0.001), physical (child 59 ± 19 vs. 82 ± 14, P < 0.001) and sleep/rest (child 59 ± 19 vs. 71 ± 15, P = 0.018). Similar differences were seen when compared with published controls (aggregated child z-score -1.9 ± 1.4, P < 0.001; parent -3.2 ± 1.8, P < 0.001). Prevalence of severe fatigue indicated by scores <2 standard deviation below published means for healthy controls were also higher for children with NF on both parent and child reports. Agreement between child and parent reports were limited as is frequently seen in the literature. CONCLUSION This study suggests that children with NF1 are affected by perceived fatigue when compared with healthy children who do not have NF1.
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Affiliation(s)
- Grace Vassallo
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,NW Genomics Hub, Manchester Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, United Kingdom
| | - Zulf Mughal
- Department of Paediatric Endocrinology and Bone Metabolism, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Louise Robinson
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Daniel Weisberg
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Stephen A Roberts
- Centres for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Eileen Hupton
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Judith Eelloo
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Emma Mm Burkitt Wright
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,NW Genomics Hub, Manchester Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, United Kingdom
| | - Shruti Garg
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Lauren Lewis
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - D Gareth Evans
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,NW Genomics Hub, Manchester Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, United Kingdom
| | - Stavros M Stivaros
- Nationally Commissioned Complex NF1 Service, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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6
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Murphy C, Vassallo G, Burkitt-Wright E, Hupton E, Eelloo J, Lewis L, Huson S, Stivaros S, Kamaly-Asl I. A retrospective regional study of aqueduct stenosis and fourth ventricle outflow obstruction in the paediatric complex neurofibromatosis type 1 population; Aetiology, clinical presentation and management. Clin Neurol Neurosurg 2020; 193:105791. [PMID: 32208299 DOI: 10.1016/j.clineuro.2020.105791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/31/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Aqueduct stenosis (AS) and fourth ventricle outflow obstruction are rare associations of neurofibromatosis type 1 (NF1), resulting in ventriculomegaly and hydrocephalus requiring surgical treatment. This study aims to identify the prevalence of AS and its patterns of clinical presentation, aetiology and treatment in the paediatric complex NF1 population. PATIENTS AND METHODS Patients with NF-1 aged 0-18 years were recruited from the Regional Genetic Family Register, following institutional review board approval. Magnetic resonance imaging data and clinical documents were reviewed with respect to clinical presentation, degree of ventriculomegaly, aetiological factors and management of AS and fourth ventricle outflow obstruction. RESULTS 24 of the 233 paediatric patients seen within the NHS highly specialised service for complex NF1 were found to have AS or and fourth ventricle outflow obstruction. This included 13 males and 11 females with a mean age of 9 years 5 months (range 8 months - 17 years). The majority of patients with AS or fourth ventricle outflow obstruction presented with symptoms of raised intracranial pressure associated with ventriculomegaly and/or hydrocephalus (n = 18). However, in 25 % of patients, AS was an incidental finding on MRI and was observed both in the presence (n = 2) and absence (n = 4) of ventriculomegaly. In the majority of cases a single cause of AS was identified (n = 16), of which tectal plate thickening (n = 7) was most frequently observed. The remaining 8 patients had multiple causes of AS, in which tectal plate thickening (n = 7) and aqueductal webs (n = 5) were the most common observations. Surgery was performed on all patients with evidence of raised pressure (n = 8) by performing endoscopic third ventriculostomy (ETV) (n = 5) or ventriculoperitoneal (VP)-shunting (n = 3). Tectal plate thickening was most frequently observed in patients who underwent ETV (n = 3), followed by aqueductal web (n = 1) and T2-signal changes in the tectal plate (n = 1). Patients treated with VP-shunt had 4th ventricle outflow obstruction (n = 2) and a tectal plate tumour (n = 1). CONCLUSION This study identifies that AS is more prevalent amongst the paediatric complex NF-1 population than previously reported, occurring in 10 % of cases. Our findings demonstrate that AS is most commonly symptomatic in presentation but can be asymptomatic in 25 % of paediatric complex NF1 patients. In this population, AS can occur both in the presence and absence of ventriculomegaly and therefore requires careful monitoring for development of hydrocephalus. In this study, over one third of patients (9 of 24 patients) with AS eventually required treatment.
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Affiliation(s)
- Christopher Murphy
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom,; Department of Pediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, M13 9WL, UK.
| | - Grace Vassallo
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Emma Burkitt-Wright
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Eileen Hupton
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Judith Eelloo
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Lauren Lewis
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Susan Huson
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Stavros Stivaros
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom; Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ian Kamaly-Asl
- Department of Pediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, M13 9WL, UK
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7
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Hockett CW, Eelloo J, Huson SM, Roberts SA, Berry JL, Chaloner C, Rawer R, Mughal MZ. Vitamin D status and muscle function in children with neurofibromatosis type 1 (NF1). J Musculoskelet Neuronal Interact 2013; 13:111-119. [PMID: 23445921] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The aim of this cross-sectional study was to assess the vitamin D status and muscle function in children with NF1 compared with their unaffected siblings. METHODS NF1 children between 5 and 18 years of age and who had at least one unaffected sibling were identified. Serum concentrations of 25-hydroxyvitamin D (25(OH)D), calcium, inorganic phosphate, alkaline phosphate, parathyroid hormone and 1,25-dihydroxyvitamin D were measured. The Leonardo Mechanography Ground Reaction Force Platform (GRFP) was used to measure EFI, jump power, force and height. RESULTS There was no significant difference in 25(OH)D between NF1 subjects and unaffected siblings. Relative jump power and force were found to be significantly different. The adjusted means (95% confidence limits) of non-NF1 and NF1 children for relative jump power (W/kg), controlling for body mass and age, were 37.31 (34.14, 40.49) and 32.51 (29.34, 35.68), respectively (P=0.054); and force (N/kg), controlling for body mass, age and gender, were 25.79 (24.28, 27.30) and 21.12 (19.61, 22.63), respectively (P<0.0001). Jumping parameters were not related to serum 25(OH)D. CONCLUSIONS There was no significant relationship between vitamin D status and NF1 status in children. NF1 children had significantly impaired jumping power and force, when compared to their unaffected siblings.
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Affiliation(s)
- C W Hockett
- Department of Epidemiology, Colorado School of Public Health, Denver, CO, USA
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8
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Ealing J, Soh C, Eelloo J, Huson S. 064 An unusual cause of myelopathy in neurofibromatosis type one. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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9
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Mughal MZ, Eelloo J, Roberts SA, Maresh M, Ward KA, Ashby R, Sibley CP, Adams JE. Body composition and bone status of children born to mothers with type 1 diabetes mellitus. Arch Dis Child 2010; 95:281-5. [PMID: 20335237 DOI: 10.1136/adc.2008.151555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Altered growth, body composition and abnormalities of skeletal mineralisation have been reported in offspring of mothers with type 1 and type 2 diabetes mellitus. AIMS The authors hypothesised that children born to mothers with type 1 diabetes mellitus (CDM) would be taller, have higher body mass index (BMI), greater fat mass, thicker diaphyseal bone cortices and reduced trabecular bone mineral density (BMD), as compared to those born to non-diabetic mothers. METHODS Anthropometric, body composition and bone parameters were assessed using dual-energy x-ray absorptiometry (DXA) and peripheral quantitative CT in 67 white Caucasian CDM (35 boys; age 5-18 years) and in 246 (121 boys) age-matched controls. RESULTS CDM were taller (p<0.0001), heavier (p<0.0001) and had higher BMI (p=0.02), and had 32% more total body fat mass and 7.5% more total body lean mass than controls. At the total body and lumbar spine (L1-L4) sites, CDM had significantly higher bone area and bone mineral content compared with controls. However, areal BMD at both these sites and lumbar spine bone mineral apparent density were not significantly different in the two groups, indicating that CDM have bigger bones compared with controls but their mineral content per unit area or volume is not substantially different. The distal radial trabecular and total volumetric BMD in CDM was not demonstrably different from controls. At the mid-radius, both periosteal (2.4%; p=0.03) and endosteal circumferences (5.7%; p=0.02) were bigger in CDM compared with controls. CONCLUSION The authors speculate that the intrauterine diabetic environment is associated with an increase in linear growth, adiposity and larger bone dimensions during childhood and adolescence.
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Affiliation(s)
- M Z Mughal
- Department of Paediatric Medicine, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.
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