Features and diversity of symptoms of moyamoya disease in adolescents: A cluster analysis

Aims: The purpose of this study is to explore the symptoms experienced by adolescents with moyamoya disease and to identify the characteristics of each symptom cluster associated with moyamoya disease. Design: A retrospective and descriptive design, which is a secondary data analysis study based on electronic medical record data from hospitals. Methods: To assess the symptoms associated with moyamoya disease, a qualitative study was conducted on 12 adolescents, 12 caregivers and 12 experts on moyamoya disease. According to a qualitative study, 12 main symptoms (limb weakness, numbness, pins and needles, difficulty in speech, blurred vision, facial paralysis, hand tremors, involuntary movements, convulsions, dizziness, nausea/vomiting and headaches) were selected. Data were collected around these symptoms. The data collection was carried out through the Electronic Medical Record (EMR) data of 303 adolescents aged 13–19 who were diagnosed with moyamoya disease (ICD 10 Code: I67.5) between January 2010–December 2019 in a hospital in Seoul, South Korea. Cluster analysis was applied to identify symptom clusters with the hierarchical cluster agglomerative approach. We used the log-likelihood distance to measure the similarity of variables. Proximity between groups of variables was measured using the two-step method. Results: The physical symptoms experienced by adolescents with moyamoya disease were ‘limb weakness’ – the most common – followed by a ‘headache,’ ‘difficulty in speech,’ and ‘nausea/vomiting.’ A total of five symptom clusters were derived: cluster 1 was characterized by ‘limb weakness’; cluster 2 participants were asymptomatic or experienced ‘convulsions’; cluster 3 experienced ‘difficulty in speech’ and ‘facial paralysis’; cluster 4 is prone to ‘dizziness’ and ‘pins and needles’; and cluster 5 displays ‘headaches’ and ‘nausea/vomiting’. Conclusion: This study offers a multidimensional approach for identifying differences in clinical symptoms of moyamoya disease among adolescents. Impact: These results will help provide interventions concerning the characteristics of the symptoms of moyamoya disease among adolescents.