1
|
Neul JL, Percy AK, Benke TA, Berry-Kravis EM, Glaze DG, Peters SU, Marsh ED, An D, Bishop KM, Youakim JM. Trofinetide Treatment Demonstrates a Benefit Over Placebo for the Ability to Communicate in Rett Syndrome. Pediatr Neurol 2024; 152:63-72. [PMID: 38232652 DOI: 10.1016/j.pediatrneurol.2023.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/27/2023] [Accepted: 11/18/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Trofinetide was approved by the US Food and Drug Administration for the treatment of Rett syndrome (RTT) in March 2023. Benefiting the ability to communicate in RTT is often identified as the most important caregiver goal for new therapies. This analysis reports the communication-related end points from the phase 3 LAVENDER study of trofinetide in RTT. METHODS Females with RTT, aged five to 20 years, were randomized 1:1 to trofinetide or placebo for 12 weeks. Secondary efficacy end points related to communication were based on change from baseline to week 12 and included the caregiver-rated Communication and Symbolic Behavior Scales Developmental Profile™ Infant-Toddler Checklist (CSBS-DP-IT) Social Composite score (key secondary end point; scores ranged from 0 to 26 [higher scores indicated better communication]) and novel clinician rating scales (0 [normal] to 7 [severe impairment]) measuring the ability to communicate choices nonverbally (RTT-COMC) and verbally (RTT-VCOM). RESULTS Trofinetide demonstrated a statistically significant difference versus placebo for the CSBS-DP-IT Social Composite score (least squares mean [LSM] difference = 1.0; 95% confidence interval [CI], 0.3 to 1.7; P = 0.0064; Cohen's d effect size = 0.43) and a nominally significant difference for the RTT-COMC (LSM difference: -0.3; 95% CI, -0.6 to -0.0; P = 0.0257; Cohen's d effect size = 0.36). As expected, there was no difference for the RTT-VCOM. CONCLUSIONS Significant treatment benefit for trofinetide versus placebo was observed in scales measuring the ability to communicate. These scales may be appropriate for future clinical studies in RTT and other neurodevelopmental disorders.
Collapse
Affiliation(s)
- Jeffrey L Neul
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alan K Percy
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Timothy A Benke
- Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Daniel G Glaze
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Sarika U Peters
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric D Marsh
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Di An
- Acadia Pharmaceuticals Inc, San Diego, California
| | | | | |
Collapse
|
2
|
Zade K, Campbell C, Bach S, Fernandes H, Tropea D. Rett syndrome in Ireland: a demographic study. Orphanet J Rare Dis 2024; 19:34. [PMID: 38291497 PMCID: PMC10829226 DOI: 10.1186/s13023-024-03046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Rett syndrome (RTT) is a rare neurodevelopmental condition associated with mutations in the gene coding for the methyl-CpG-binding protein 2 (MECP2). It is primarily observed in girls and affects individuals globally. The understanding of the neurobiology of RTT and patient management has been improved by studies that describe the demographic and clinical presentation of individuals with RTT. However, in Ireland, there is a scarcity of data regarding individuals with RTT, which impedes the ability to fully characterize the Irish RTT population. Together with the Rett Syndrome Association of Ireland (RSAI), we prepared a questionnaire to determine the characteristics of RTT individuals in Ireland. Twenty-five families have participated in the study to date, providing information about demographics, genetics, familial history, clinical features, and regression. RESULTS The results show that Irish individuals with RTT have comparable presentation with respect to individuals in other countries; however, they had a better response to anti-epileptic drugs, and fewer skeletal deformities were reported. Nonetheless, seizures, involuntary movements and regression were more frequently observed in Irish individuals. One of the main findings of this study is the limited genetic information available to individuals to support the clinical diagnosis of RTT. CONCLUSIONS Despite the limited sample size, this study is the first to characterize the RTT population in Ireland and highlights the importance of having a swift access to genetic testing to sharpen the characterization of the phenotype and increase the visibility of Irish individuals in the international RTT community.
Collapse
Affiliation(s)
- Komal Zade
- Department of Psychiatry, School of Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, St James Hospital, Dublin, D08 W9RT, Ireland
| | - Ciara Campbell
- Department of Psychiatry, School of Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, St James Hospital, Dublin, D08 W9RT, Ireland
| | - Snow Bach
- Department of Psychiatry, School of Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, St James Hospital, Dublin, D08 W9RT, Ireland
| | - Hazel Fernandes
- Consultant Child and Adolescent Psychiatrist, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Daniela Tropea
- Department of Psychiatry, School of Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, St James Hospital, Dublin, D08 W9RT, Ireland.
- Neuropsychiatric Genetics, Department of Psychiatry, School of Medicine, Trinity College Dublin, Trinity Translational Medicine Institute, St James's Hospital, Dublin, Ireland.
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
- FutureNeuro, The SFI Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland.
| |
Collapse
|
3
|
Reeve BB, Lucas N, Chen D, McFatrich M, Jones HN, Gordon KL, Leiva LZ, Lin L, Coenraads M, von Hehn J, Carpenter RL, Marsh ED, Zigler CK. Validation of the Observer-Reported Communication Ability (ORCA) measure for individuals with Rett syndrome. Eur J Paediatr Neurol 2023; 46:74-81. [PMID: 37536121 DOI: 10.1016/j.ejpn.2023.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE The study goal was to validate the Observer-Reported Communication Ability (ORCA) measure for use with females with Rett Syndrome (RTT). METHODS Qualitative interviews, including concept elicitation and cognitive interviewing methods, were conducted with 19 caregivers of individuals with RTT ages 2 and older. A quantitative study was then conducted in 279 caregivers to evaluate construct validity and reliability. RESULTS After minor modifications were made, the modified ORCA measure was well understood and captured key communication concepts. Quantitative data showed evidence for reliable scores (α = 0.90, test-retest intraclass correlation = 0.88), minimal floor and no ceiling effects, and strong correlation with the Communication and Symbolic Behaviors Scale (r = 0.73). CONCLUSIONS This study provided initial support that the modified ORCA measure is an acceptable caregiver-reported measure of communication ability for females with RTT. Future work should include evaluation of longitudinal validity of the measure and its associations with clinician- and performance-based measures in diverse samples.
Collapse
Affiliation(s)
- Bryce B Reeve
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
| | - Nicole Lucas
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Dandan Chen
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Molly McFatrich
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Harrison N Jones
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kelly L Gordon
- Department of Speech Pathology and Audiology, Duke University Health System, Durham, NC, USA
| | - Leslie Zapata Leiva
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Li Lin
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | | | - Eric D Marsh
- Division of Child Neurology, Department of Pediatrics, Children's Hospital of Philadelphia and Department of Neurology, University of Pennsylvania Perelman School of Medicine Philadelphia, PA, USA
| | - Christina K Zigler
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
4
|
Mahdi SS, Jafri HA, Allana R, Amenta F, Khawaja M, Qasim SSB. Oral Manifestations of Rett Syndrome-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031162. [PMID: 33525609 PMCID: PMC7908587 DOI: 10.3390/ijerph18031162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 12/02/2022]
Abstract
Rett Syndrome is an x linked developmental disorder which becomes apparent in females after 6 to 18 months of age. It leads to severe impairments including loss of speech, loss of hand movements/manual dexterity, characteristic hand movements such as hang wringing and intellectual disability/learning problems. This systematic review was carried out to identify the dental manifestation of Rett syndrome and to shed light on treatment options available for oral health problems associated with Rett syndrome. A systematic literature search was conducted on the PubMed, Scopus, Biomed, Web of Science, Embase, Google Scholars, Cochrane and CINAHL using the following entries: Rett syndrome (n = 3790), Oral health and Rett syndrome (n = 17), dental health of Rett syndrome patients (n = 13), and the MeSH terms listed below: Rett syndrome and Oral Health (n = 17), Rett syndrome and dentistry (n = 29). The final review included 22 search articles. The most common oral findings was bruxism. Masseteric hypertrophy was also reported. Anterior open bite and non-physiological tooth wear was observed. Other oral manifestations of Rett syndrome included mouth breathing, tongue thrusting, digit/thumb sucking, high arch palate. Increased awareness and dental education amongst dentists and assistants regarding the dental manifestations of Rett syndrome and similar neurodevelopmental disorders is required to improve the level of care and empathy they can provide to these differently able patients. Research on dental aspects of Rett is scarce and this remains a neglected topic.
Collapse
Affiliation(s)
- Syed Sarosh Mahdi
- Department of Community Dentistry, Jinnah Medical and Dental College, Sohail University, Karachi 74800, Pakistan; (H.A.J.); (M.K.)
- Athena Center for Advanced Research in Healthcare, 62032 Camerino, Italy
- Centre of Clinical Research, Telemedicine and Telepharmacy, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy;
- Correspondence: ; Tel.: +92-333-351-7850
| | - Hafsa Abrar Jafri
- Department of Community Dentistry, Jinnah Medical and Dental College, Sohail University, Karachi 74800, Pakistan; (H.A.J.); (M.K.)
| | - Raheel Allana
- Department of Paediatrics & Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan;
| | - Francesco Amenta
- Centre of Clinical Research, Telemedicine and Telepharmacy, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy;
| | - Mariam Khawaja
- Department of Community Dentistry, Jinnah Medical and Dental College, Sohail University, Karachi 74800, Pakistan; (H.A.J.); (M.K.)
| | - Syed Saad B. Qasim
- Department of Bio Clinical Sciences, Faculty of Dentistry, Kuwait University, Kuwait City 12037, Kuwait;
| |
Collapse
|
5
|
Lai YYL, Wong K, King NM, Downs J, Leonard H. Oral health experiences of individuals with Rett syndrome: a retrospective study. BMC Oral Health 2018; 18:195. [PMID: 30497449 PMCID: PMC6267076 DOI: 10.1186/s12903-018-0651-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/23/2018] [Indexed: 12/24/2022] Open
Abstract
Background There is relatively little literature on the oral health experiences of individuals with Rett syndrome. This study described the incidence of dental extractions and restorations in a population-based cohort, according to a range of demographic and clinical factors. The association between bruxism and age was also investigated. Methods Existing questionnaire data in the population-based Australian Rett Syndrome Database for the years 2004, 2006, 2009 or 2011 on genetically confirmed female cases (n = 242) were analysed. Results The incidence rate of restorations and extractions were 6.8 per 100 person years (py) and 9.3 per 100 py respectively. The incidence of extractions decreased with increasing levels of income. Compared to those with a C-terminal mutation, the incidence rate of extraction was higher for those with large deletions (Incidence Rate Ratio (IRR) 4.93; 95% CI 1.46–16.7, p = 0.01). There was a 5% decrease in the risk of frequent bruxism for every one-year increase in age (Risk Ratio 0.95; 95% CI 0.94–0.97). Conclusions Social advantage may provide some protection for dental health in individuals with Rett syndrome. Those with more severe genotypes seemed to have poorer oral health outcomes.
Collapse
Affiliation(s)
- Y Y L Lai
- Department of Paediatric Dentistry, School of Dentistry, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - K Wong
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - N M King
- Department of Paediatric Dentistry, School of Dentistry, The University of Western Australia, Perth, WA, Australia
| | - J Downs
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - H Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| |
Collapse
|
6
|
Fabio RA, Gangemi A, Capri T, Budden S, Falzone A. Neurophysiological and cognitive effects of Transcranial Direct Current Stimulation in three girls with Rett Syndrome with chronic language impairments. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 76:76-87. [PMID: 29587149 DOI: 10.1016/j.ridd.2018.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 02/17/2018] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND this study was based on both neurophysiological decelerated activity and communication deficits in Rett Syndrome (RTT). AIMS the aim was to examine the neurophysiological and cognitive effects of Transcranial Direct Current Stimulation (tDCS) in three girls with RTT with chronic language impairments. METHODS AND PROCEDURES we proposed an integrated intervention: tDCS and cognitive empowerment applied to language in order to enhance speech production (new functional sounds and new words). Because maximal gains usually are achieved when tDCS is coupled with behavioral training, we applied tDCS stimulation on Broca's area together with linguistic training. OUTCOMES AND RESULTS the results indicated a general enhancement in language abilities (an increase in the number of vowel/consonant sounds and words and the production and comprehension through discrimination), motor coordination (functional movements), and neurophysiological parameters (an increase in the frequency and power of alpha, beta and theta bands). CONCLUSION AND IMPLICATIONS we assume that tDCS stimulation combined with the cognitive empowerment applied to language can significantly influence a chronic impairment even in genetic syndromes. Our results provide data that support the role of tDCS in fostering brain plasticity and in particular in empowering speech production and comprehension in girls with RTT.
Collapse
Affiliation(s)
- Rosa Angela Fabio
- Department of Cognitive Science, Psychological, Education and Cultural Studies, University of Messina, Italy.
| | - Antonio Gangemi
- Department of Cognitive Science, Psychological, Education and Cultural Studies, University of Messina, Italy.
| | - Tindara Capri
- Department of Cognitive Science, Psychological, Education and Cultural Studies, University of Messina, Italy.
| | - Sarojini Budden
- St. Vincent's Hospital and Medical Center Portland, OR, United States.
| | - Alessandra Falzone
- Department of Cognitive Science, Psychological, Education and Cultural Studies, University of Messina, Italy.
| |
Collapse
|
7
|
Urbanowicz A, Leonard H, Girdler S, Ciccone N, Downs J. Parental perspectives on the communication abilities of their daughters with Rett syndrome. Dev Neurorehabil 2016; 19:17-25. [PMID: 24564222 DOI: 10.3109/17518423.2013.879940] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study describes, from the perspective of parents, how females with Rett syndrome communicate in everyday life and the barriers and facilitators to successful communication. METHODS Sixteen interviews were conducted with parents with a daughter with Rett syndrome with a pathogenic mutation in the methyl-CpG-binding protein 2 gene. Interviews were recorded and transcribed verbatim. Transcripts were analysed using directed content analysis. RESULTS All parents reported their daughters were able to express discomfort and pleasure, and make requests and choices using a variety of modalities including vocalisations, body movements and eye gaze. Parents also reported their daughters understood most of what they said and that the level of functional abilities, such as mobility, and environmental factors, such as characteristics of the communication partner, influenced successful communication. CONCLUSIONS The perspectives of parents are integral to the assessment of communication abilities and have the potential to inform communication interventions for girls and women with Rett syndrome.
Collapse
Affiliation(s)
- Anna Urbanowicz
- a Telethon Institute for Child Health Research, The University of Western Australia , Perth , WA , Australia .,b School of Exercise and Health Sciences, Edith Cowan University , Perth , WA , Australia
| | - Helen Leonard
- a Telethon Institute for Child Health Research, The University of Western Australia , Perth , WA , Australia
| | - Sonya Girdler
- c School of Occupational Therapy and Social Work, Centre for Research into Disability and Society, Curtin University , Perth , WA , Australia
| | - Natalie Ciccone
- d School of Psychology and Social Science, Edith Cowan University , Perth , WA , Australia , and
| | - Jenny Downs
- a Telethon Institute for Child Health Research, The University of Western Australia , Perth , WA , Australia .,e School of Physiotherapy and Exercise Science, Curtin University , Perth , WA , Australia
| |
Collapse
|
8
|
Fuertes-González MC, Silvestre FJ. Oral health in a group of patients with Rett syndrome in the regions of Valencia and Murcia (Spain): a case-control study. Med Oral Patol Oral Cir Bucal 2014; 19:e598-604. [PMID: 25350594 PMCID: PMC4259377 DOI: 10.4317/medoral.19743] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/13/2014] [Indexed: 02/03/2023] Open
Abstract
Objectives: Rett syndrome (RS) is a rare disease with oral manifestations that have not been described in detail or in a standardized manner in the literature. The present study describes the oral health of the population with RS in two Spanish regions, following the protocol of the World Health Organization for conducting common oral health surveys.
Study Design: A prospective, observational case-control study was carried out, involving a group of patients with RS (n1=41) and a mean age of 13.37±3.19 years, and an age- and gender-matched control group without RS (n0=82). The data referred to oral health and habits were recorded by means of a questionnaire and oral examination was used to document caries indicators (prevalence of caries, df(t), df(s), DMF(T), DMF(S) and indices referred to dental loss, morbidity, restoration), the Community Periodontal Index (CPI), and the most characteristic oral manifestations.
Results: The most frequent oral habit in the patients with RS was diurnal bruxism, followed by stereotyped tongue movements and oral breathing. The caries scores were lower in the RS population than in the control group, but patients with RS showed greater periodontal alterations and a greater prevalence of drooling, dental wear, high-arched palate and anterior open bite.
Conclusions: The population with RS exhibits characteristic and early oral habits and alterations, and periodontal problems that are more notorious than caries disease, so that our efforts should focus on the diagnosis and early correction of the parafunctional habits, promoting restorative treatment, and providing instructions on correct oral hygiene.
Key words:Rett syndrome, oral habits, bruxism, caries.
Collapse
|
9
|
Wandin H, Lindberg P, Sonnander K. Communication intervention in Rett syndrome: a survey of speech language pathologists in Swedish health services. Disabil Rehabil 2014; 37:1324-33. [PMID: 25250808 DOI: 10.3109/09638288.2014.962109] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate communication intervention that speech language pathologists (SLPs) provide to people with Rett syndrome. METHODS A web-based survey targeting all Swedish SLPs working with people currently receiving support from habilitation services. RESULTS The SLPs reportedly followed recommended practice in the following aspects: (1) Information on communicative function was collected from several sources, including observation in well-known settings and reports from the client s social network, (2) Multimodal communication was promoted and, (3) Responsive partner strategies were largely targeted in the intervention. However, few instruments or standard procedures were used and partner instruction was given informally. Most SLPs used communication aids in the intervention and their general impression of using communication aids was positive. Further, augmentative and alternative communication (AAC) was estimated to increase and clarify communicative contributions from the person. CONCLUSIONS Communication aids were reported to have a positive influence on communicative functions. Swedish SLP services followed best practice in several aspects, but there are areas with potential for development. Tools and best practice guidelines are needed to support SLPs in the AAC process for clients with Rett syndrome. [Box: see text].
Collapse
Affiliation(s)
- Helena Wandin
- Department of Public Health and Caring Sciences, Research in Disability and Habilitation, Uppsala University , Uppsala , Sweden
| | | | | |
Collapse
|
10
|
Byiers BJ, Dimian A, Symons FJ. Functional communication training in rett syndrome: a preliminary study. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 119:340-350. [PMID: 25007298 DOI: 10.1352/1944-7558-119.4.340] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Rett syndrome (RTT) is associated with a range of serious neurodevelopmental consequences including severe communicative impairments. Currently, no evidence-based communication interventions exist for the population ( Sigafoos et al., 2009 ). The purpose of the current study was to examine the effectiveness of functional assessment (FA) and functional communication training (FCT) methods for teaching 3 individuals (ages 15-47 years) with classic RTT novel communicative behaviors. Using single-case experimental designs, functional reinforcers were identified (FA) and each participant quickly learned to activate a voice-output switch to obtain a reinforcer (FCT). These results suggest that individuals with classic RTT can learn novel communicative responses, which has important implications for future intervention research.
Collapse
|
11
|
Bartl-Pokorny KD, Marschik PB, Sigafoos J, Tager-Flusberg H, Kaufmann WE, Grossmann T, Einspieler C. Early socio-communicative forms and functions in typical Rett syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3133-8. [PMID: 23891731 PMCID: PMC5951273 DOI: 10.1016/j.ridd.2013.06.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 06/26/2013] [Indexed: 05/27/2023]
Abstract
Rett syndrome (RTT) is a severe neurological disorder characterized by a developmental regression in motor and speech-language domains. There is, however, limited research on socio-communicative development of affected children before the onset of regression. We analyzed audio-video recordings made by parents of six 9- to 12-month old girls later diagnosed with typical RTT, applying the Inventory of Potential Communicative Acts (IPCA) to identify early communicative forms and functions. Each girl used at least one communicative form (e.g., body movement, eye gaze, or vocalizations) to gain attention and answer, but none were observed to make choices or request information. Varying numbers of children were observed to perform other communicative functions according to the IPCA including social convention, rejecting or requesting an object. Non-verbal forms (e.g., reaching, moving closer, eye contact, smiling) were more common than non-linguistic verbal forms (e.g., unspecified vocalizations, pleasure vocalizations, crying). (Pre-)linguistic verbal forms (e.g., canonical or variegated babbling, proto-words) were not used for communicative purposes. These data suggest that atypical developmental patterns in the socio-communicative domain are evident prior to regression in young individuals later diagnosed with RTT.
Collapse
Affiliation(s)
- Katrin D Bartl-Pokorny
- Institute of Physiology (IN:spired; Developmental Physiology and Developmental Neuroscience), Center for Physiological Medicine, Medical University of Graz, Austria
| | - Peter B Marschik
- Institute of Physiology (IN:spired; Developmental Physiology and Developmental Neuroscience), Center for Physiological Medicine, Medical University of Graz, Austria
| | - Jeff Sigafoos
- Victoria University of Wellington, Wellington, New Zealand
| | | | | | - Tobias Grossmann
- Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Christa Einspieler
- Institute of Physiology (IN:spired; Developmental Physiology and Developmental Neuroscience), Center for Physiological Medicine, Medical University of Graz, Austria
| |
Collapse
|
12
|
Leonard H, Ravikumara M, Baikie G, Naseem N, Ellaway C, Percy A, Abraham S, Geerts S, Lane J, Jones M, Bathgate K, Downs J. Assessment and management of nutrition and growth in Rett syndrome. J Pediatr Gastroenterol Nutr 2013; 57:451-60. [PMID: 24084372 PMCID: PMC3906202 DOI: 10.1097/mpg.0b013e31829e0b65] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES We developed recommendations for the clinical management of poor growth and weight gain in Rett syndrome through evidence review and the consensus of an expert panel of clinicians. METHODS Initial draft recommendations were created based upon literature review and 34 open-ended questions in which the literature was lacking. Statements and questions were made available to an international, multidisciplinary panel of clinicians in an online format and a Microsoft Word-formatted version of the draft via e-mail. Input was sought using a 2-stage modified Delphi process to reach consensus. Items included clinical assessment of growth, anthropometry, feeding difficulties and management to increase energy intake, decrease feeding difficulties, and consideration of gastrostomy. RESULTS Agreement was achieved on 101 of 112 statements. A comprehensive approach to the management of poor growth in Rett syndrome is recommended that takes into account factors such as feeding difficulties and nutritional needs. A body mass index of approximately the 25th centile can be considered as a reasonable target in clinical practice. Gastrostomy is indicated for extremely poor growth, if there is risk of aspiration and if feeding times are prolonged. CONCLUSIONS These evidence- and consensus-based recommendations have the potential to improve care of nutrition and growth in a rare condition and stimulate research to improve the present limited evidence base.
Collapse
Affiliation(s)
- Helen Leonard
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia
| | - Madhur Ravikumara
- Department of Gastroenterology, Princess Margaret Hospital for Children, Perth, Western Australia
| | - Gordon Baikie
- Department of Developmental Medicine, Royal Children’s Hospital, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Nusrat Naseem
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia
| | - Carolyn Ellaway
- Western Sydney Genetics Program, The Children’s Hospital at Westmead, Discipline of Paediatrics and Genetic Medicine, University of Sydney, Australia
| | - Alan Percy
- Civitan International Research Centre, University of Alabama, Birmingham, Alabama, USA
| | - Suzanne Abraham
- Department of Otolaryngology Head Neck Surgery and Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Suzanne Geerts
- Civitan International Research Centre, University of Alabama, Birmingham, Alabama, USA
| | - Jane Lane
- Civitan International Research Centre, University of Alabama, Birmingham, Alabama, USA
| | - Mary Jones
- Katie's Clinic for Rett Syndrome, Children's Hospital & Research Center, Oakland, California, USA
| | - Katherine Bathgate
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia
- School of Public Health and Curtin Health Innovation Research Institute, Perth, Western Australia
| | - Jenny Downs
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia
- School of Physiotherapy and Curtin Health Innovation Research Institute, Perth, Western Australia
| |
Collapse
|
13
|
Marschik PB, Kaufmann WE, Einspieler C, Bartl-Pokorny KD, Wolin T, Pini G, Budimirovic DB, Zappella M, Sigafoos J. Profiling early socio-communicative development in five young girls with the preserved speech variant of Rett syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1749-56. [PMID: 22699249 PMCID: PMC3445809 DOI: 10.1016/j.ridd.2012.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 04/18/2012] [Indexed: 05/12/2023]
Abstract
Rett syndrome (RTT) is a developmental disorder characterized by regression of purposeful hand skills and spoken language, although some affected children retain some ability to speech. We assessed the communicative abilities of five young girls, who were later diagnosed with the preserved speech variant of RTT, during the pre-regression period (aged 12-24 months). Videotapes, obtained by parents during routine family situations and celebrations, were analyzed to identify communicative forms and functions used by these toddlers. Non-verbal communicative forms dominated over verbal-communicative forms for six of the eight identified communication functions. Although the girls used various non-verbal forms to make requests, for example, none of the individuals were observed to make choices or request information. Early peculiarities in the speech-language domain during the first year of life became more prominent and evident during the second year of life as general differences between typical development and atypical development become more obvious in RTT. These findings highlight the importance of assessing socio-communicative forms and functions at early age in children with RTT. The results suggest that speech-language functions did not appear to play a major role in the children's communicative attempts. We conclude that, even among children with the preserved speech variant, socio-communicative deficits are present before regression and persist after this period.
Collapse
Affiliation(s)
- Peter B. Marschik
- Institute of Physiology (Developmental Physiology and Developmental Neuroscience; IN:spired), Center for Physiological Medicine, Medical University of Graz, Austria
- Center for Genetic Disorders of Cognition and Behavior, Fragile X Clinic, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Walter E. Kaufmann
- Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
- Center for Genetic Disorders of Cognition and Behavior, Fragile X Clinic, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christa Einspieler
- Institute of Physiology (Developmental Physiology and Developmental Neuroscience; IN:spired), Center for Physiological Medicine, Medical University of Graz, Austria
- Corresponding author at: Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21/5, 8010 Graz, Austria. Tel.: +43 316 380 4266; fax: +43 316 380 9630.
| | - Katrin D. Bartl-Pokorny
- Institute of Physiology (Developmental Physiology and Developmental Neuroscience; IN:spired), Center for Physiological Medicine, Medical University of Graz, Austria
| | - Thomas Wolin
- Institute of Physiology (Developmental Physiology and Developmental Neuroscience; IN:spired), Center for Physiological Medicine, Medical University of Graz, Austria
| | - Giorgio Pini
- Tuscany Rett Centre Versilia Hospital, Lido di Camaiore, Italy
| | - Dejan B. Budimirovic
- Center for Genetic Disorders of Cognition and Behavior, Fragile X Clinic, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | |
Collapse
|
14
|
Marschik PB, Sigafoos J, Kaufmann WE, Wolin T, Talisa VB, Bartl-Pokorny KD, Budimirovic DB, Vollmann R, Einspieler C. Peculiarities in the gestural repertoire: an early marker for Rett syndrome? RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1715-21. [PMID: 22699245 PMCID: PMC3445810 DOI: 10.1016/j.ridd.2012.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 05/18/2012] [Indexed: 05/12/2023]
Abstract
We studied the gestures used by children with classic Rett syndrome (RTT) to provide evidence as to how this essential aspect of communicative functions develops. Seven participants with RTT were longitudinally observed between 9 and 18 months of life. The gestures used by these participants were transcribed and coded from a retrospective analysis of a video footage. Gestures were classified as deictic gestures, play schemes, and representational gestures. Results of the analysis showed that the majority of gestures observed were of deictic character. There were no gestures that could be classified as play schemes and only two (e.g., head nodding and waving bye bye) that were coded as representational or symbolic gestures. The overall repertoire of gestures, even though not necessarily delayed in it's onset, was characterized by little variability and a restricted pragmatic functionality. We conclude that the gestural abilities in girls with RTT appear to remain limited and do not constitute a compensatory mechanism for the verbal language modality.
Collapse
Affiliation(s)
- Peter B Marschik
- Institute of Physiology (Developmental Physiology and Developmental Neuroscience; IN:spired), Center for Physiological Medicine, Medical University of Graz, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Giesbers S, Didden R, Radstaake M, Korzilius H, von Gontard A, Lang R, Smeets E, Curfs LMG. Incontinence in Individuals with Rett Syndrome: A Comparative Study. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2012; 24:287-300. [PMID: 22639525 PMCID: PMC3345182 DOI: 10.1007/s10882-012-9271-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Frequency and type of incontinence and its association with other variables were assessed in females with Rett Syndrome (RS) (n = 63), using an adapted Dutch version of the 'Parental Questionnaire: Enuresis/Urinary Incontinence' (Beetz et al. 1994). Also, incontinence in RS was compared to a control group consisting of females with non-specific (mixed) intellectual disability (n = 26). Urinary incontinence (UI) (i.e., daytime incontinence and nocturnal enuresis) and faecal incontinence (FI) were found to be common problems among females with RS that occur in a high frequency of days/nights. UI and FI were mostly primary in nature and occur independent of participants' age and level of adaptive functioning. Solid stool, lower urinary tract symptoms and urinary tract infections (UTI's) were also common problems in females with RS. No differences in incontinence between RS and the control group were found, except for solid stool that was more common in RS than in the control group. It is concluded that incontinence is not part of the behavioural phenotype of RS, but that there is an increased risk for solid stool in females with RS.
Collapse
Affiliation(s)
- Sanne Giesbers
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, Nijmegen, 6500 HE The Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, Nijmegen, 6500 HE The Netherlands
| | - Maartje Radstaake
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, Nijmegen, 6500 HE The Netherlands
| | - Hubert Korzilius
- Institute for Management Research, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Russell Lang
- Clinic for Autism Research Evaluation and Support, Texas State University, San Marcos, TX USA
| | - Eric Smeets
- Department of Clinical Genetics, University of Maastricht, Maastricht, the Netherlands
| | - Leopold M. G. Curfs
- Department of Clinical Genetics, University of Maastricht, Maastricht, the Netherlands
| |
Collapse
|
16
|
Siegel MS, Smith WE. Psychiatric features in children with genetic syndromes: toward functional phenotypes. Pediatr Clin North Am 2011; 58:833-64, x. [PMID: 21855710 DOI: 10.1016/j.pcl.2011.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neurodevelopmental disorders with identified genetic etiologies present a unique opportunity to study gene-brain-behavior connections in child psychiatry. Parsing complex human behavior into dissociable components is facilitated by examining a relatively homogenous genetic population. As children with developmental delay carry a greater burden of mental illness than the general population, familiarity with the most common genetic disorders will serve practitioners seeing a general child population. In this article, basic genetic testing and 11 of the most common genetic disorders are reviewed, including the evidence base for treatment. Based on their training in child development, family systems, and multimodal treatment, child psychiatrists are well positioned to integrate cognitive, behavioral, social, psychiatric, and physical phenotypes, with a focus on functional impairment.
Collapse
Affiliation(s)
- Matthew S Siegel
- Department of Psychiatry, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02110, USA.
| | | |
Collapse
|
17
|
Wanzek M, Jenson WR, Houlihan D. Recognizing and treating Rett syndrome in schools. SCHOOL PSYCHOLOGY INTERNATIONAL 2011. [DOI: 10.1177/0143034311403058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A review of the literature on Rett syndrome (RS) for school-based professionals is presented from a behavioral perspective. A description of RS is provided, including distinctive physical, behavioral, and emotional features, diagnostic criteria for classic and formes frustes forms of RS, and stages of the disorder. The similarities and differences between RS and autism are reviewed. Controversies regarding the classification of RS are presented, including whether RS should be classified as a neurological or psychiatric condition and whether RS should remain classified as a pervasive developmental disorder. Last, a variety of options for the treatment of RS are discussed.
Collapse
|
18
|
Siegel MS, Smith WE. Psychiatric features in children with genetic syndromes: toward functional phenotypes. Child Adolesc Psychiatr Clin N Am 2010; 19:229-61, viii. [PMID: 20478498 DOI: 10.1016/j.chc.2010.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Neurodevelopmental disorders with identified genetic etiologies present a unique opportunity to study gene-brain-behavior connections in child psychiatry. Parsing complex human behavior into dissociable components is facilitated by examining a relatively homogenous genetic population. As children with developmental delay carry a greater burden of mental illness than the general population, familiarity with the most common genetic disorders will serve practitioners seeing a general child population. In this article basic genetic testing and 11 of the most common genetic disorders are reviewed, including the evidence base for treatment. Based on their training in child development, family systems, and multimodal treatment, child psychiatrists are well positioned to integrate cognitive, behavioral, social, psychiatric, and physical phenotypes, with a focus on functional impairment.
Collapse
Affiliation(s)
- Matthew S Siegel
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA 02110, USA.
| | | |
Collapse
|
19
|
Didden R, Korzilius H, Smeets E, Green VA, Lang R, Lancioni GE, Curfs LM. Communication in Individuals with Rett Syndrome: an Assessment of Forms and Functions. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2010; 22:105-118. [PMID: 20339577 PMCID: PMC2837828 DOI: 10.1007/s10882-009-9168-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In the present study we assessed the forms and functions of prelinguistic communicative behaviors for 120 children and adults with Rett syndrome using the Inventory of Potential Communicative Acts (IPCA) (Sigafoos et al. Communication Disorders Quarterly 21:77-86, 2000a). Informants completed the IPCA and the results were analysed to provide a systematic inventory and objective description of the communicative forms and functions present in each individual's repertoire. Results show that respondents reported a wide variety of communicative forms and functions. By far most girls used prelinguistic communicative behaviors of which eye contact/gazing was the most common form. The most often endorsed communicative functions were social convention, commenting, answering, requesting and choice-making. Problematic topographies (e.g., self-injury, screaming, non-compliance) were being used for communicative purposes in 10 to 41% of the sample. Exploratory analyses revealed that several communicative forms and functions were related to living environment, presence/absence of epilepsy, and age. That is, higher percentages of girls who showed some forms/functions were found in those who lived at home, who had no epilepsy and who were relatively young.
Collapse
Affiliation(s)
- Robert Didden
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Hubert Korzilius
- Institute for Management Research, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Eric Smeets
- University of Maastricht, Maastricht, The Netherlands
| | | | - Russell Lang
- The Eli and Edythe L. Broad Asperger Research Center, University of California, Santa Barbara, CA USA
| | | | | |
Collapse
|
20
|
Abstract
Rett and Angelman syndromes comprise part of the spectrum of neurologic disorders associated with autism. Their clinical presentations overlap, with both presenting in later infancy with global developmental delays, severe speech and communication impairments, progressive microcephaly, seizures, autistic behaviors, and characteristic albeit different movement disorders and stereotypic hand movements. Although other features can help differentiate these disorders, significant phenotypic overlap and variation in severity sometimes cloud the underlying diagnosis. Rett syndrome is caused by a mutation in the MECP2 gene located on Xq28, whereas Angelman syndrome results from the loss of UBE3A function on chromosomal region 15q11-q13 related to a variety of molecular genetic mechanisms. Recent advances have uncovered interactions between these and other genes that affect the function and structure of neurons in the brain. The reversal of symptoms of Rett syndrome in a mature mouse model suggests the possibility for treatment of these and perhaps other autism-related disorders in the future.
Collapse
|
21
|
Abstract
Rett syndrome (RS) is an X-linked neurodevelopmental disorder and the second most common cause of genetic mental retardation in females. Different mutations in MECP2 are found in up to 95% of typical cases of RS. This mainly neuronal expressed gene functions as a major transcription repressor. Extensive studies on girls who have RS and mouse models are aimed at finding main gene targets for MeCP2 protein and defining neuropathologic changes caused by its defects. Studies comparing autistic features in RS with idiopathic autism and mentally retarded patients are presented. Decreased dendritic arborization is common to RS and autism, leading to further research on similarities in pathogenesis, including MeCP2 protein levels in autistic brains and MeCP2 effects on genes connected to autism, like DLX5 and genes on 15q11-13 region. This area also is involved in Angelman syndrome, which has many similarities to RS. Despite these connections, MECP2 mutations in nonspecific autistic and mentally retarded populations are rare.
Collapse
Affiliation(s)
- Bruria Ben Zeev Ghidoni
- Pediatric Neurology Unit, Safra Pediatric Hospital, Sheba Medical Center, Ramat-Gan, Israel.
| |
Collapse
|