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Clinical Phenotype of South African Children With Neurofibromatosis 1

Department of Paediatric Neurology, University of Cape Town, Verushka{at}rmh.uct.ac.za., Department of Paediatric Neurodevelopment, University of Cape Town

Colleen Adnams, FCP

Department of Paediatric Neurodevelopment, University of Cape Town

Alvin Ndondo, FCP

Department of Paediatric Neurology, University of Cape Town

Graham Fieggen, FCS

Department of Neurosurgery, University of Cape Town

Karen Fieggen, FCP

Department of Genetics, Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Rondebosch, Cape Town, South Africa

Jo Wilmshurst, FCP

Department of Paediatric Neurology, University of Cape Town

Forty-eight children with neurofibromatosis 1 presenting between 2000 and 2004 were reviewed for their clinical phenotype, and data were compared with published reports. The median age at presentation was 4 years (range 10 days to 12 years). The male to female ratio was similar (22 male:26 female). There were frequencies of café au lait spots, axillary freckling, Lisch nodules, and new mutations comparable to those cited in the literature. Fewer patients had neurofibromas (4%), but more patients had plexiform neurofibromas of the head and neck (16%). Three patients of the 22 who had neuroimaging had optic gliomas (14%). The most consistent disability, with maximum impact, related to the patient's cognitive level of functioning. School problems, defined as learning and behavioral problems observed in the classroom, were reported in 70% of school-aged children (n = 21), compared with international figures of 29.8% to 45%. This high prevalence has reinforced the clinic service policy of formal neuropsychology assessments in all children with reported school problems. In addition, earlier referral of children to the service (preschool n = 18) has enabled formal developmental assessments and planning of specific educational placement to optimize learning. This is the first description of the neurofibromatosis 1 phenotype from the African continent. The multidisciplinary approach to management has proved beneficial in the South African context. The combined clinic has resulted in a holistic approach to patient care, early detection of pathology, consistent therapies across the specialties, and better patient attendance and compliance. (J Child Neurol 2006;21:63—70).

Journal of Child Neurology, Vol. 21, No. 1, 63-70 (2006)
DOI: 10.1177/08830738060210011501


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