The impact of severe rare chronic neurological disease in childhood on the quality of life of families-a study on MLD and PCH2

Abstract

Background: Rare and severe neurological disorders in childhood not only heavily affect the life perspective of the patients, but also their caregivers and families. The aim of this study was to investigate the impact of such diseases on the family, especially on the quality of life and life perspectives of parents, but also on the families' everyday life, based on the model of two diseases which have been well described in recent years with respect to symptoms and course: metachromatic leukodystrophy (MLD) and pontocerebellar hypoplasia type 2 (PCH2). PCH2 is a primary severe developmental disorder, while children with MLD initially develop normally and then progressively deteriorate.

Methods: Using a semi-standardized questionnaire, 43 families with children suffering from MLD (n = 30) or PCH2 (n = 19) reported data on the severity of the illness/symptoms, on family support and the care situation, as well as on the circumstances of non-affected siblings and the parents' work situation. In addition, the quality of life of parents and general family functioning was assessed using the PedsQL™ Family Impact Module [23]. Results for the latter were compared to published data from families with children without any chronic condition using student's t-tests for independent samples. Potential factors influencing the PedsQL™ scores were analyzed using Spearman's rank correlation.

Results: Parents of children with MLD and PCH2 reported significantly lower health-related quality of life (HRQOL) compared to parents of healthy children (P < 0.001). Mothers showed significantly poorer HRQOL (P < 0.05) and were significantly more dissatisfied with their professional development (P < 0.05) than fathers, and this was seen in relation to their child's disease. Neither the form of disease ('primary' symptomatic PCH2 or 'secondary' symptomatic MLD), nor the severity of the child's illness (in terms of gross motor and speech function) had a specific impact on HRQOL in families. However, the time from diagnosis and advanced symptoms in the terminal disease stage were experienced as especially distressing.

Conclusions: This study illustrates that MLD and PCH2 affect mothers in particular, but also the entire family. This underlines the need for personalized care and counselling of parents and families, especially following diagnosis and during the end stage in a child with a severe, rare chronic neurological disorder.

Keywords: Disease burden; Metachromatic leukodystrophy; Parents; Pontocerebellar hypoplasia type 2; Quality of life.

Fig. 1

PedsQL™ Family Impact Module. Higher values equal better functioning/less negative impact. *P value is significant at < 0.05 level; **Medrano et al. [26]. Comparison between individual samples, as well as between individual samples and the ‘no chronic condition’ sample. PedsQL™, Pediatric Quality of Life Inventory [23]. MLD, metachromatic leukodystrophy. PCH2, pontocerebellar hypoplasia type 2. HRQOL, health-related quality of life

Fig. 2

Influence of parents’ time after diagnosis on Quality of Life measures. Higher values equal better functioning/less negative impact. *P value is significant at < 0.05 level. Comparison between “more distressing” and “less distressing” samples. HRQOL, health-related quality of life

Fig. 3

Comparison of HRQOL between mothers and fathers. Higher values equal better functioning/less negative impact. *P value is significant at < 0.05 level; **P value is significant at < 0.01 level. ***Medrano et al. [26]. Comparison between individual samples, as well as between individual samples and the ‘no chronic condition’ sample. MLD, metachromatic leukodystrophy. PCH2, pontocerebellar hypoplasia type 2. HRQOL, health-related quality of life. Chr., chronic

Fig. 4

Satisfaction of parents with their professional development. Higher values equal better satisfaction with professional development. *P value is significant at < 0.05 level. Comparison between mothers and fathers. MLD, metachromatic leukodystrophy. PCH2, pontocerebellar hypoplasia type 2