Rett Syndrome Tip Sheet
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10Neurodevelopmental Effects of Childhood Exposure to Heavy
Neurodevelopmental E¤ects of Childhood Exposure to Heavy Metals: 10 Lessons from Pediatric Lead Poisoning Theodore I. Lidsky, Agnes T. Heaney, Jay S. Schneider, and John F. Rosen Increasing industrialization has led to increased exposure to neurotoxic metals. By far the most heavily studied of these metals is lead, a neurotoxin that is particularly dangerous to the developing nervous system of children. Awareness that lead poison- ing poses a special risk for children dates back over 100 years, and there has been increasing research on the developmental e¤ects of this poison over the past 60 years. Despite this research and growing public awareness of the dangers of lead to chil- dren, government regulation has lagged scientific knowledge; legislation has been in- e¤ectual in critical areas, and many new cases of poisoning occur each year. Lead, however, is not the only neurotoxic metal that presents a danger to children. Several other heavy metals, such as mercury and manganese, are also neurotoxic, have adverse e¤ects on the developing brain, and can be encountered by children. Al- though these other neurotoxic metals have not been as heavily studied as lead, there has been important research describing their e¤ects on the brain. The purpose of the present chapter is to review the neurotoxicology of lead poisoning as well as what is known concerning the neurtoxicology of mercury and manganese. The purpose of this review is to provide information that might be of some help in avoiding repeti- tion of the mistakes that were made in attempting to protect children from the dan- gers of lead poisoning. -
Retted Q&A: Epilepsy Incidence, Treatments and Research Dr. Eric
RettEd Q&A: Epilepsy Incidence, Treatments and Research Dr. Eric Marsh, MD PhD, Medical Director Rett Clinic, NHS Investigator, and Basic Scientist, Children’s Hospital of Philadelphia Webcast 09/11/2018 Facilitator: Paige Nues, Rettsyndrome.org Recording link: https://attendee.gotowebinar.com/recording/2303318923907771398 ATTENDEE QUESTIONS RESPONSE REFERENCES AED Questions: Treatments and Triggers I want to know what about relation between Stressors are anecdotally reported to lower the seizure pain, digestive pain, apnea and seizure threshold- these would all be stressful features that could discharge. lower seizure threshold and theoretically increase seizure frequency. Any opinions on fycompa? Very limited experience so far to make a clear judgment. I have tried it in 2 Rett patients without great success, both in patients with very severe seizures. Is there a way to tell the difference between There is a slide in the talk that goes over some features, such a seizure and a “Rett spell” other than EEG? as retained awareness, repetitive nature of the events, that can give some hints as to the nature of the event, but only EEG can definitively discern the difference. My daughter has epilepsy and always has Without knowing all of her clinical details, it is hard for me to seizures. She takes medication Onfi and give recommendations. Depending on seizure types, EEG, Keppra and still have seizures. What should and previous medications tried, I would suggest other meds I do? I need help and ideas thanks. such as Rufinamide, valproic acid or trying the ketogenic diet. Do you see seizures connected to puberty or You can look at Jane Lane’s RettEd about puberty. -
Child Neurology: Hereditary Spastic Paraplegia in Children S.T
RESIDENT & FELLOW SECTION Child Neurology: Section Editor Hereditary spastic paraplegia in children Mitchell S.V. Elkind, MD, MS S.T. de Bot, MD Because the medical literature on hereditary spastic clinical feature is progressive lower limb spasticity B.P.C. van de paraplegia (HSP) is dominated by descriptions of secondary to pyramidal tract dysfunction. HSP is Warrenburg, MD, adult case series, there is less emphasis on the genetic classified as pure if neurologic signs are limited to the PhD evaluation in suspected pediatric cases of HSP. The lower limbs (although urinary urgency and mild im- H.P.H. Kremer, differential diagnosis of progressive spastic paraplegia pairment of vibration perception in the distal lower MD, PhD strongly depends on the age at onset, as well as the ac- extremities may occur). In contrast, complicated M.A.A.P. Willemsen, companying clinical features, possible abnormalities on forms of HSP display additional neurologic and MRI abnormalities such as ataxia, more significant periph- MD, PhD MRI, and family history. In order to develop a rational eral neuropathy, mental retardation, or a thin corpus diagnostic strategy for pediatric HSP cases, we per- callosum. HSP may be inherited as an autosomal formed a literature search focusing on presenting signs Address correspondence and dominant, autosomal recessive, or X-linked disease. reprint requests to Dr. S.T. de and symptoms, age at onset, and genotype. We present Over 40 loci and nearly 20 genes have already been Bot, Radboud University a case of a young boy with a REEP1 (SPG31) mutation. Nijmegen Medical Centre, identified.1 Autosomal dominant transmission is ob- Department of Neurology, PO served in 70% to 80% of all cases and typically re- Box 9101, 6500 HB, Nijmegen, CASE REPORT A 4-year-old boy presented with 2 the Netherlands progressive walking difficulties from the time he sults in pure HSP. -
Communication Intervention in Rett Syndrome: a Systematic Review Research in Autism Spectrum Disorders
Research in Autism Spectrum Disorders 3 (2009) 304–318 Contents lists available at ScienceDirect Research in Autism Spectrum Disorders Journal homepage: http://ees.elsevier.com/RASD/default.asp Review Communication intervention in Rett syndrome: A systematic review Jeff Sigafoos a,*, Vanessa A. Green a, Ralf Schlosser b, Mark F. O’eilly c, Giulio E. Lancioni d, Mandy Rispoli c, Russell Lang c a Victoria University of Wellington, New Zealand b Northeastern University, Boston and Childrens Hospital Boston at Waltham, MA, USA c Meadows Center for Preventing Educational Risk, The University of Texas at Austin, Austin, TX, USA d University of Bari, Bari, Italy ARTICLE INFO ABSTRACT Article history: We reviewed communication intervention studies involving people Received 25 September 2008 with Rett syndrome. Systematic searches of five electronic databases, Accepted 26 September 2008 selected journals, and reference lists identified nine studies meeting the inclusion criteria. These studies were evaluated in terms of: (a) Keywords: participant characteristics, (b) target skills, (c) procedures, (d) main Communication intervention findings, and (e) certainty of evidence. Across the nine studies, Rett syndrome intervention was provided to a total of 31 participants aged 2:7–17:0 Systematic review (years:months). Communication modes included speech, gestures, communication boards, and computer-based systems. Targeted communication functions included imitative speech, requesting, naming/commenting, and various receptive language skills (e.g., respond to requests, answer questions, receptively identify symbols). Intervention approaches included early intensive behavioral inter- vention, systematic instruction, and music therapy. Positive out- comes were reported for 26 (84%) of the 31 participants. However, these outcomes must be interpreted with caution because the certainty of evidence was inconclusive for all but one of the studies. -
Accelerating Research. Empowering Families
RESEARCH STRATEGY AND MISSION We aggressively pursue research to identify treatments and a cure for Rett syndrome. New Mecp2 female mouse model developed AMO receives FDA Orphan Drug Designation 2018 + BEYOND With your support, we can Neuren begins plans for trofinetide Phase 3 continue to blaze a trail in Rett syndrome research and family 2017 14 clinics designated empowerment to transform lives. as Rett Syndrome Clinical Research First multi-site, Centers of Excellence multi-country clinical Join us in our mission: trial begins: sarizotan • Make a donation 2015 • Coordinate a Fundraiser Clinical trial for • Participate in an Event trofinetide begins • Advocate for Rett syndrome NIH funding of the NHS begins Visit www.rettsyndrome.org or Drug screening Scout program begins call 1.800.719.8214 2014 First multi-site clinical trial Rettsyndrome.org is a 501(c)3 organization in RTT begins: NNZ-2566 (trofinetide) Accelerating dedicated to accelerating research for treatments and a cure for Rett syndrome and related disorders, 2013 while providing family empowerment. As a Established stem Research. leading organization for Rett syndrome research, cell model for Rettsyndrome.org is committed to funding high- drug screening First clinical trial quality, peer-reviewed research grants and programs. in RTT supported by Rettsyndrome.org: IGF-1 Empowering Genetic manipulation 2010 and biochemical Families. intervention improve Rett-like symptoms in a mouse model 2007 4600 Devitt Drive Cincinnati, OH 45246-1104 ‘‘ (800) 818-7388 www.rettsyndrome.org I am very thankful that Rettsyndrome.org has taken such a strong leadership role /rettsyndrome /rettsyndrome /rettsyndromeorg with advancing research. Their progress to get trofinetide to market is very exciting as it could finally be an answer to relieving some of Jill’s daily struggles. -
Hereditary Spastic Paraparesis: a Review of New Developments
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.69.2.150 on 1 August 2000. Downloaded from 150 J Neurol Neurosurg Psychiatry 2000;69:150–160 REVIEW Hereditary spastic paraparesis: a review of new developments CJ McDermott, K White, K Bushby, PJ Shaw Hereditary spastic paraparesis (HSP) or the reditary spastic paraparesis will no doubt Strümpell-Lorrain syndrome is the name given provide a more useful and relevant classifi- to a heterogeneous group of inherited disorders cation. in which the main clinical feature is progressive lower limb spasticity. Before the advent of Epidemiology molecular genetic studies into these disorders, The prevalence of HSP varies in diVerent several classifications had been proposed, studies. Such variation is probably due to a based on the mode of inheritance, the age of combination of diVering diagnostic criteria, onset of symptoms, and the presence or other- variable epidemiological methodology, and wise of additional clinical features. Families geographical factors. Some studies in which with autosomal dominant, autosomal recessive, similar criteria and methods were employed and X-linked inheritance have been described. found the prevalance of HSP/100 000 to be 2.7 in Molise Italy, 4.3 in Valle d’Aosta Italy, and 10–12 Historical aspects 2.0 in Portugal. These studies employed the In 1880 Strümpell published what is consid- diagnostic criteria suggested by Harding and ered to be the first clear description of HSP.He utilised all health institutions and various reported a family in which two brothers were health care professionals in ascertaining cases aVected by spastic paraplegia. The father was from the specific region. -
Cerebral Palsy the ABC's of CP
Cerebral Palsy The ABC’s of CP Toni Benton, M.D. Continuum of Care Project UNM HSC School of Medicine April 20, 2006 Cerebral Palsy Outline I. Definition II. Incidence, Epidemiology and Distribution III. Etiology IV. Types V. Medical Management VI. Psychosocial Issues VII. Aging Cerebral Palsy-Definition Cerebral palsy is a symptom complex, (not a disease) that has multiple etiologies. CP is a disorder of tone, posture or movement due to a lesion in the developing brain. Lesion results in paralysis, weakness, incoordination or abnormal movement Not contagious, no cure. It is static, but it symptoms may change with maturation Cerebral Palsy Brain damage Occurs during developmental period Motor dysfunction Not Curable Non-progressive (static) Any regression or deterioration of motor or intellectual skills should prompt a search for a degenerative disease Therapy can help improve function Cerebral Palsy There are 2 major types of CP, depending on location of lesions: Pyramidal (Spastic) Extrapyramidal There is overlap of both symptoms and anatomic lesions. The pyramidal system carries the signal for muscle contraction. The extrapyramidal system provides regulatory influences on that contraction. Cerebral Palsy Types of brain damage Bleeding Brain malformation Trauma to brain Lack of oxygen Infection Toxins Unknown Epidemiology The overall prevalence of cerebral palsy ranges from 1.5 to 2.5 per 1000 live births. The overall prevalence of CP has remained stable since the 1960’s. Speculations that the increased survival of the VLBW preemies would cause a rise in the prevalence of CP have proven wrong. Likewise the expected decrease in CP as a result of C-section and fetal monitoring has not happened. -
Epilepsy and Rett Syndrome
EPILEPSY AND RETT SYNDROME Liisa Metsähonkala, Pediatric Neurologist Epilepsia-Helsinki, Helsinki University Hospital HUS Helsinki University Hospital RETT Epilepsy -syndrome Epilepsy in Epilepsy in Rett Rett syndrome syndrome Epilepsy may be a major or minor problem for people with Rett syndrome and their families 2 28.9.19 HUS Helsinki University Hospital EPILEPSY AND RETT SYNDROME - Some general aspects of epilepsy - Epilepsy in Rett syndrome (focus on children) - Diversity of epileptic seizures - Diversity of nonepileptic paroxysmal attacks - How to make the diagnosis? - Treatment of epilepsy 3 28.9.19 HUS Helsinki University Hospital WHAT IS EPILEPSY ? International - epilepsy is not one disease but a large group of different League disorders Against Epilepsy - an epileptic seizure is a transient occurrence of signs and/ or symptoms due to abnormal and certain kind of neuronal activity (excessive or synchronous) in the brain - versus nonepileptic symptoms - epilepsy is a disease characterized by an enduring predisposition to generate epileptic seizures – versus seizures that anyone can have because of an acute provoking factor 4 28.9.19 HUS Helsinki University Hospital Seizure types Etiology Focal Generalized Unknown onset onset onset Structural Genetic Epilepsy types Infectious Combined FocalFocal Generalized Unknown Generalized Metabolic & Focal Immune Co-morbidities Unknown Epilepsy Syndromes HUS Helsinki University Hospital Generalized seizures Focal seizures • Originate at some point within • Originate within networks and rapidly -
Whole-Genome Sequencing Reveals Principles of Brain Retrotransposition in Neurodevelopmental Disorders
Cell Research (2018) 28:187-203. © 2018 IBCB, SIBS, CAS All rights reserved 1001-0602/18 $ 32.00 ORIGINAL ARTICLE www.nature.com/cr Whole-genome sequencing reveals principles of brain retrotransposition in neurodevelopmental disorders Jasmine Jacob-Hirsch1, 2, Eran Eyal1, Binyamin A Knisbacher2, Jonathan Roth3, 5, Karen Cesarkas1, Chen Dor1, Sarit Farage-Barhom1, Vered Kunik1, Amos J Simon1, Moran Gal2, Michal Yalon4, Sharon Moshitch-Moshkovitz1, Rick Tearle6, Shlomi Constantini3, 5, Erez Y Levanon2, Ninette Amariglio1, 2, Gideon Rechavi1, 5 1Cancer Research Center and the Wohl Institute of Translational Medicine, the Chaim Sheba Medical Center, Tel Hashomer, Is- rael; 2Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Israel; 3Department of Pediatric Neurosurgery, Dana Children’s Hospital, Tel Aviv Medical Center, Israel; 4Department of Pediatric Hematology-Oncology, Edmond and Lily Sa- fra Children’s Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel; 5Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 6Complete Genomics, 2071 Stierlin Court, Mountain View, CA 94043, USA Neural progenitor cells undergo somatic retrotransposition events, mainly involving L1 elements, which can be potentially deleterious. Here, we analyze the whole genomes of 20 brain samples and 80 non-brain samples, and char- acterized the retrotransposition landscape of patients affected by a variety of neurodevelopmental disorders including Rett syndrome, tuberous sclerosis, ataxia-telangiectasia and autism. We report that the number of retrotranspositions in brain tissues is higher than that observed in non-brain samples and even higher in pathologic vs normal brains. The majority of somatic brain retrotransposons integrate into pre-existing repetitive elements, preferentially A/T rich L1 sequences, resulting in nested insertions. -
Epilepsy and Cerebral Palsy*
Arch Dis Child: first published as 10.1136/adc.31.155.1 on 1 February 1956. Downloaded from EPILEPSY AND CEREBRAL PALSY* BY BRIAN H. KIRMAN From the Fountain Hospital, Tooting, London (RECEIVED FOR PUBLICATION SEPTEMBER 6, 1955) The two conditions epilepsy and palsy in its Frequency of Epilepsy as a Complication many forms are amongst the earliest syndromes of Cerebral Palsy recorded in history. The association between Brissaud and Souques (1904) attempted to confine epilepsy and cerebral palsy in childhood is a matter the term 'Little's disease' to those cases not com- of everyday experience, and this association is of plicated by fits or mental defect, but Little's (1861-2) scientific interest as throwing light on the nature of own description of 63 cases refers specifically to the cerebral palsy and, more particularly, of epilepsy. complication ofconvulsions. Kinnier Wilson (1940) It is also of practical importance in view of recent refers to Little's disease not as 'an ailment of a well efforts to make more adequate provision for those defined character but a mere syndrome and a rather children with cerebral palsy who are educable. wide-ranging one at that'. Since epilepsy is also The existence of the two conditions in one child not a disease but a symptom of cerebral dysfunction constitutes a double handicap. The present ten- it is understandable that cerebral palsy and epilepsy dency in our educational system is for ever-increasing should often be encountered in the same patient. copyright. subdivision of educational 'types', and any child Kinnier Wilson states that in his experience 30% of who is difficult to fit into one of the artificial cate- cases of cerebral diplegia have fits which may be gories thus constructed is in danger of remaining general or one-sided. -
Cerebral Palsy
Cerebral Palsy Cerebral palsy encompasses a group of non-progressive and non-contagious motor conditions that cause physical disability in various facets of body movement. Cerebral palsy is one of the most common crippling conditions of childhood, dating to events and brain injury before, during or soon after birth. Cerebral palsy is a debilitating condition in which the developing brain is irreversibly damaged, resulting in loss of motor function and sometimes also cognitive function. Despite the large increase in medical intervention during pregnancy and childbirth, the incidence of cerebral palsy has remained relatively stable for the last 60 years. In Australia, a baby is born with cerebral palsy about every 15 hours, equivalent to 1 in 400 births. Presently, there is no cure for cerebral palsy. Classification Cerebral palsy is divided into four major classifications to describe different movement impairments. Movements can be uncontrolled or unpredictable, muscles can be stiff or tight and in some cases people have shaky movements or tremors. These classifications also reflect the areas of the brain that are damaged. The four major classifications are: spastic, ataxic, athetoid/dyskinetic and mixed. In most cases of cerebral palsy, the exact cause is unknown. Suggested possible causes include developmental abnormalities of the brain, brain injury to the fetus caused by low oxygen levels (asphyxia) or poor circulation, preterm birth, infection, and trauma. Spastic cerebral palsy leads to increased muscle tone and inability for muscles to relax (hypertonic). The brain injury usually stems from upper motor neuron in the brain. Spastic cerebral palsy is classified depending on the region of the body affected; these include: spastic hemiplegia; one side being affected, spastic monoplegia; a single limb being affected, spastic triplegia; three limbs being affected, spastic quadriplegia; all four limbs more or less equally affected. -
Epilepsy & Behavior
Epilepsy & Behavior 66 (2017) 27–33 Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh Effectiveness and tolerability of antiepileptic drugs in 104 girls with Rett syndrome Aglaia Vignoli, Miriam Nella Savini ⁎, Maria Sonia Nowbut, Angela Peron, Katherine Turner, Francesca La Briola, Maria Paola Canevini Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Italy article info abstract Article history: Approximately 60–80% of girls with Rett Syndrome (RTT) have epilepsy, which represents one of the most severe Received 29 July 2016 problems clinicians have to deal with, especially when patients are 7–12 years old. Revised 6 October 2016 The aim of this study was to analyze the antiepileptic drugs (AEDs) prescribed in RTT, and to assess their effec- Accepted 8 October 2016 tiveness and tolerability in different age groups from early infancy to adulthood. Available online xxxx We included in this study 104 girls, aged 2–42 years (mean age 13.9 years): 89 had a mutation in MECP2,5in Keywords: CDKL5,2inFOXG1, and the mutational status was unknown in the remaining 8. Rett syndrome Epilepsy was present in 82 patients (79%). Mean age at epilepsy onset was 4.1 years. Epilepsy We divided the girls into 5 groups according to age: b5, 5–9, 10–14, 15–19, 20 years and older. Antiepileptic drugs Valproic acid (VPA) was the most prescribed single therapy in young patients (b15 years), whereas carbamaze- Age-dependency pine (CBZ) was preferred by clinicians in older patients. The most frequently adopted AED combination in the pa- tients younger than 10 years and older than 15 was VPA and lamotrigine (LTG).