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Patki R, Douglas R, Rimareva N, Kondamudi N. Uncontrollable movements of right upper and lower extremities in a child: A diagnostic puzzle. J Am Coll Emerg Physicians Open 2021; 2:e12497. [PMID: 34223447 PMCID: PMC8243254 DOI: 10.1002/emp2.12497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 11/22/2022] Open
Abstract
We describe a case of a 9-year-old child who presented with uncontrollable, involuntary movements associated with a recent streptococcal infection and echocardiographic evidence of valvulitis. These findings are consistent with the diagnosis of Sydenham's chorea, a rare but important movement disorder and one of the major "Jones criteria" for the diagnosis of acute rheumatic fever. Because of its rarity, patients with Sydenham's chorea often are misdiagnosed as having a behavioral or psychiatric illness. Early recognition and appropriate management can prevent the potential severe sequelae associated with acute rheumatic fever.
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Affiliation(s)
- Rucha Patki
- Department of PediatricsThe Brooklyn Hospital CenterNew YorkUSA
| | | | | | - Noah Kondamudi
- Department of PediatricsThe Brooklyn Hospital CenterNew YorkUSA
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2
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Thabit MN, Sadek AA, Motawe ES, Ali RAE, Mohamed MM. Non-epileptic paroxysmal events in paediatric patients: A single tertiary centre study in Egypt. Seizure 2021; 86:123-128. [PMID: 33607445 DOI: 10.1016/j.seizure.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/09/2021] [Accepted: 02/01/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The misdiagnosis of non-epileptic seizures (NES) as epilepsy is one of the most common pitfalls in neuropsychiatric practice. This study aimed to describe the percentage and types of NES among children who were referred for a diagnosis of epilepsy in Upper Egypt. METHODS We recruited a total of 876 patients who were referred to Sohag University Hospital, a tertiary referral centre in Upper Egypt, for the evaluation of suspected epilepsy. Relevant methods for the diagnosis of epilepsy, including medical history and examination, EEG, video-EEG, laboratory investigations, and brain imaging, were performed for all study participants. RESULTS Among the 876 patients who were referred for the diagnosis of suspected epilepsy during the period from June 2017 to October 2018, 171 patients (19.5 %) were diagnosed as having NES. In general, we found that NES in the paediatric age groups did not differ from that reported in various studies across several different populations. The most prevalent NES in our study was breath-holding spells (32.2 %), followed by syncope (17.5 %), psychogenic nonepileptic seizures (12.3 %), motor tics (9.9 %), and benign sleep myoclonus (7.6 %). Other less frequent NES included infantile masturbation (7 %), spasmus nutans (5.3 %), migraine (2.9 %), benign paroxysmal torticollis (2.9 %), night terrors (1.8 %), and shuddering attacks (0.6 %). CONCLUSION Ideally, neurologists should not misdiagnose NES as epilepsy, and whenever the diagnosis of NES is uncertain, an accurate diagnosis should be made using long-term video-EEG monitoring, especially in younger paediatric patients.
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Affiliation(s)
- Mohamed N Thabit
- Department of Neurology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.
| | - Abdelrahim A Sadek
- Department of Paediatrics, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Eman S Motawe
- Department of Paediatrics, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Rasha Abd Elhameed Ali
- Department of Public Health and Community Medicine, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Montaser M Mohamed
- Department of Paediatrics, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
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3
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Mastino L, Mai R, Cenzato M, D'Aliberti G, Talamonti G. Movement Disorder as Unusual Manifestation of Chiari Malformation Type II in a Newborn. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1718378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractChiari malformation type II (CM-II) is a hindbrain developmental malformation. Movement disorders are rarely described as associated with this condition. We describe the case of a newborn affected by CM-II presenting with head and neck tremors a few days after myelomeningocele repair surgery. Later, self-resolving episodes of expiratory apneas arose. Cranial ultrasounds showed progressive ventricular dilatation. She underwent ventriculoperitoneal shunt followed by craniocervical bony decompression. After surgery, both apnea and tremors disappeared. This particular presentation of CM-II is very rare and potentially difficult to diagnose.
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Affiliation(s)
- Lara Mastino
- Department of Neurosurgery, Niguarda Ca'Granda Hospital, Milan, Italy
- Department of Human Neurosciences, Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Roberto Mai
- Department of Neurology, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Marco Cenzato
- Department of Neurosurgery, Niguarda Ca'Granda Hospital, Milan, Italy
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Kentab A. PANDAS versus Hashimoto's encephalopathy: a diagnostic dilemma in a Saudi girl. Sudan J Paediatr 2019; 19:149-155. [DOI: 10.24911/sjp.106-1555859744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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5
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Wilkinson B, John RM. Understanding Masturbation in the Pediatric Patient. J Pediatr Health Care 2018; 32:639-643. [PMID: 30075984 DOI: 10.1016/j.pedhc.2018.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 05/02/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Brooke Wilkinson
- Brooke Wilkinson, CPNP-PC, Columbia University School of Nursing, New York, NY.Rita Marie John, Director, Pediatric Primary Care Nurse Practitioner Program, and Associate Professor of Nursing, Columbia University Medical Center, New York, NY..
| | - Rita Marie John
- Brooke Wilkinson, CPNP-PC, Columbia University School of Nursing, New York, NY.Rita Marie John, Director, Pediatric Primary Care Nurse Practitioner Program, and Associate Professor of Nursing, Columbia University Medical Center, New York, NY
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Kırık S, Özkars MY. Non-epileptic paroxysmal events in early childhood and role of EEG: A single center experience. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.416320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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7
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Tatlı B, Güler S. Non epileptic paroxysmal events in childhood. TURK PEDIATRI ARSIVI 2017; 52:59-65. [PMID: 28747835 DOI: 10.5152/turkpediatriars.2017.4588] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/25/2016] [Indexed: 01/03/2023]
Abstract
Non epileptic paroxysmal events are recurrent movement disorders with acute onset and ending, which may mimic epilepsy. The duration, place, timing of the attacks, and state of conciousness may confuse pediatricians about the diagnosis of epilepsy and non epileptic paroxysmal events. The key point in the diagnosis is taking an accurate and detailed history. Wrong diagnosis can give rise to anxiety of both the family and the child, interruptions in the child's education, limitations in career planning, and irreversible damages in the long term. The diagnosis can prevent unnecessary drug use and psychological damage. This review aims to discuss the clinical findings, treatment, and differential diagnoses of non epileptic paroxysmal events, and to increase awareness about non epileptic paroxysmal events among pediatricians.
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Affiliation(s)
- Burak Tatlı
- Department of Pediatrics, Division of Pediatric Neurology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Serhat Güler
- Clinic of Pediatrics, Division of Pediatric Neurology, The Ministry of Health Edirne Public Hospital, Edirne, Turkey
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Specht MW, Mahone EM, Kline T, Waranch R, Brabson L, Thompson CB, Singer HS. Efficacy of parent-delivered behavioral therapy for primary complex motor stereotypies. Dev Med Child Neurol 2017; 59:168-173. [PMID: 27259464 PMCID: PMC5136513 DOI: 10.1111/dmcn.13164] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 12/27/2022]
Abstract
AIM Primary complex motor stereotypies (CMS) are persistent, patterned, repetitive, rhythmic movements in young people with typical development. This study evaluated the efficacy of an instructional DVD as a home-based, parent-administered, behavioral therapy for primary CMS. METHOD Eighty-one children with primary CMS were enrolled. Primary outcome measures included the Stereotypy Severity Scale (SSS) - Motor and Impairment scores, and Stereotypy Linear Analog Scale (SLAS). Mean CMS onset was 13.4 months (SD 13.1). Eligibility required observed CMS. Psychiatric disorders were not exclusionary and a stable medication regimen was required. Intellectual disability, neurological disorder, autism spectrum disorder, and tics were exclusionary. Initial assessments were completed via REDCap before receipt of the DVD. Fifty-four of the 81 children (34 male, 20 female; mean age 8y 2mo, SD 1.42, range 7-14y) completed assessments at 1, 2, or 3 months after receiving the DVD. RESULTS Reductions (baseline to last assessment) in SSS Motor, SSS Impairment, and SLAS scores (all p<0.001) represented change ratios of -15%, -24%, and a -20% respectively. Greatest relative treatment benefit was observed by younger children (ages 7-8y), and by 1 month after receipt of DVD, while a parent global assessment scale showed progressive improvement throughout the study. INTERPRETATION An instructional DVD for parent-delivered behavioral therapy was a safe, effective intervention for primary CMS.
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Affiliation(s)
| | - E Mark Mahone
- Johns Hopkins University School of Medicine, Baltimore, MD,Kennedy Krieger Institute, Baltimore, MD
| | - Tina Kline
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Laurel Brabson
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carol B Thompson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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10
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Esposito S, Bianchini S, Baggi E, Fattizzo M, Rigante D. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: an overview. Eur J Clin Microbiol Infect Dis 2014; 33:2105-9. [PMID: 24953744 DOI: 10.1007/s10096-014-2185-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/09/2014] [Indexed: 11/28/2022]
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McBride SD, Parker MO. The disrupted basal ganglia and behavioural control: an integrative cross-domain perspective of spontaneous stereotypy. Behav Brain Res 2014; 276:45-58. [PMID: 25052167 DOI: 10.1016/j.bbr.2014.05.057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/16/2014] [Accepted: 05/26/2014] [Indexed: 12/21/2022]
Abstract
Spontaneous stereotypic behaviour (SB) is common in many captive animal species, as well as in humans with some severe psychiatric disorders, and is often cited as being related to general basal ganglia dysfunction. Despite this assertion, there is little in the literature examining SB specifically in terms of the basal ganglia mechanics. In this review, we attempt to fill this gap by offering an integrative, cross-domain perspective of SB by linking what we currently understand about the SB phenotype with the ever-growing literature on the anatomy and functionality of the basal ganglia. After outlining current models of SB from different theoretical perspectives, we offer a broad but detailed overview of normally functioning basal ganglia mechanics, and attempt to link this with current neurophysiological evidence related to spontaneous SB. Based on this we present an empirically derived theoretical framework, which proposes that SB is the result of a dysfunctional action selection system that may reflect dysregulation of excitatory (direct) and inhibitory (indirect and hyperdirect) pathways as well as alterations in mechanisms of behavioural switching. This approach also suggests behaviours that specifically become stereotypic may reflect inbuilt low selection threshold behavioural sequences associated with early development and the species-specific ethogram or, low threshold behavioural sequences that are the result of stress-induced dopamine exposure at the time of performance.
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Affiliation(s)
- Sebastian D McBride
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
| | - Matthew O Parker
- School of Biological and Chemical Sciences, Queen Mary University of London, London E1 4NS, UK.
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Houdayer E, Walthall J, Belluscio BA, Vorbach S, Singer HS, Hallett M. Absent movement-related cortical potentials in children with primary motor stereotypies. Mov Disord 2013; 29:1134-40. [PMID: 24259275 DOI: 10.1002/mds.25753] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 10/01/2013] [Accepted: 10/18/2013] [Indexed: 11/06/2022] Open
Abstract
The underlying pathophysiologic mechanism for complex motor stereotypies in children is unknown, with hypotheses ranging from an arousal to a motor control disorder. Movement-related cortical potentials (MRCPs), representing the activation of cerebral areas involved in the generation of movements, precede and accompany self-initiated voluntary movements. The goal of this study was to compare cerebral activity associated with stereotypies to that seen with voluntary movements in children with primary complex motor stereotypies. Electroencephalographic (EEG) activity synchronized with video recording was recorded in 10 children diagnosed with primary motor stereotypies and 7 controls. EEG activity related to stereotypies and self-paced arm movements were analyzed for presence or absence of early or late MRCP, a steep negativity beginning about 1 second before the onset of a voluntary movement. Early MRCPs preceded self-paced arm movements in 8 of 10 children with motor stereotypies and in 6 of 7 controls. Observed MRCPs did not differ between groups. No MRCP was identified before the appearance of a complex motor stereotypy. Unlike voluntary movements, stereotypies are not preceded by MRCPs. This indicates that premotor areas are likely not involved in the preparation of these complex movements and suggests that stereotypies are initiated by mechanisms different from voluntary movements. Further studies are required to determine the site of the motor control abnormality within cortico-striatal-thalamo-cortical pathways and to identify whether similar findings would be found in children with secondary stereotypies.
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Affiliation(s)
- Elise Houdayer
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland, USA; Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
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13
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Rödöö P, Hellberg D. Girls who masturbate in early infancy: diagnostics, natural course and a long-term follow-up. Acta Paediatr 2013; 102:762-6. [PMID: 23488732 DOI: 10.1111/apa.12231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 11/21/2012] [Accepted: 03/07/2013] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the natural course, onset, diagnostics and long-term follow-up masturbation in infant girls, which up to now has only been described in case reports. METHODS Nineteen consecutive healthy, masturbating girls, diagnosed in early infancy between three and 15 months, were followed up for an average of 8 years. All were diagnosed in the same Swedish hospital between May 1996 and June 2010. Ten girls were videotaped and/or directly observed while masturbating. RESULTS Mean age at onset of masturbation was 10.4 months. The diagnosis was based on history taking and clinical observation. Parents reported that masturbation ranged from a few times a week to two-to-fifty episodes a day. Twelve girls had stopped masturbating when this study was written, after a mean duration of 66 months. Their symptoms and diagnostics are described in detail. CONCLUSION This is the first follow-up study of girls who started masturbating in early infancy, with a mean duration of five-and-a-half years. Diagnosis may be difficult, but with awareness and knowledge of the condition, a normal physical and neurological examination, a detailed history from the parents and, in particular, video documentation, it can be settled without extensive investigations and the parents reassured.
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Affiliation(s)
- Peo Rödöö
- Department of Pediatrics, Falun Hospital, Falun, Sweden.
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Manganelli F, Dubbioso R, Esposito M, Marinò C, Pisciotta C, Pignatelli S, Santoro L. A case of congenital cataracts, facial dysmorphisms, neuropathy, and hyperkinetic movement disorder. Mov Disord 2013; 28:559-60. [DOI: 10.1002/mds.25308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/29/2012] [Accepted: 11/05/2012] [Indexed: 01/01/2023] Open
Affiliation(s)
- Fiore Manganelli
- Department of Neurological Sciences; University Federico II of Naples; Naples; Italy
| | - Raffaele Dubbioso
- Department of Neurological Sciences; University Federico II of Naples; Naples; Italy
| | - Marcello Esposito
- Department of Neurological Sciences; University Federico II of Naples; Naples; Italy
| | - Caterina Marinò
- Dipartimento di Assistenza Riabilitativa Territoriale Area Eta' Evolutiva ASL TA2; Taranto; Italy
| | - Chiara Pisciotta
- Department of Neurological Sciences; University Federico II of Naples; Naples; Italy
| | - Salvatore Pignatelli
- Dipartimento di Assistenza Riabilitativa Territoriale Area Eta' Evolutiva ASL TA2; Taranto; Italy
| | - Lucio Santoro
- Department of Neurological Sciences; University Federico II of Naples; Naples; Italy
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Goldman S, O’Brien LM, Filipek PA, Rapin I, Herbert MR. Motor stereotypies and volumetric brain alterations in children with Autistic Disorder. RESEARCH IN AUTISM SPECTRUM DISORDERS 2013; 7:82-92. [PMID: 23637709 PMCID: PMC3639008 DOI: 10.1016/j.rasd.2012.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Motor stereotypies are defined as patterned, repetitive, purposeless movements. These stigmatizing motor behaviors represent one manifestation of the third core criterion for an Autistic Disorder (AD) diagnosis, and are becoming viewed as potential early markers of autism. Moreover, motor stereotypies might be a tangible expression of the underlying neurobiology of this neurodevelopmental disorder. In this study, we videoscored stereotypies recorded during semi-structured play sessions from school age children with AD. We examined the effect of severity and persistence over time of stereotypies on brain volumetric changes. Our findings confirmed that the brain volume of school age children with AD is, on average, larger than that of age-matched typically developing children. However, we have failed to detect any sign of volumetric differences in brain regions thought to be particularly linked to the pathophysiology of stereotypies. This negative finding may suggest that, at least with respect to motor stereotypies, functional rather than structural alterations might be the underpinning of these disruptive motor manifestations of autism.
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Affiliation(s)
- Sylvie Goldman
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, United States
- Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, United States
- Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, United States
| | - Liam M. O’Brien
- Department of Mathematics and Statistics, Colby College, 5838 Mayflower Hill, Waterville, ME 04901, United States
- College of Graduate Programs in Public Health, University of New England, 716 Stevens Avenue, Portland, ME, United States
| | - Pauline A. Filipek
- Department of Pediatrics, Children’s Learning Institute, and the Division of Child and Adolescent Neurology, University of Texas Health Science Center, 7000 Fannin, Suite 2478, Houston, TX 77030, United States
| | - Isabelle Rapin
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, United States
- Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, United States
- Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, United States
| | - Martha R. Herbert
- Pediatric Neurology, Martinos Center for Biomedical Imaging, 149 13th Street, 10th Floor, Charlestown, MA 02129, United States
- TRANSCEND Research Program, Massachusetts General Hospital, 149 13th Street, 10th Floor, Charlestown, MA 02129, United States
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Kapadia M, Sakic B. Autoimmune and inflammatory mechanisms of CNS damage. Prog Neurobiol 2011; 95:301-33. [DOI: 10.1016/j.pneurobio.2011.08.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 12/13/2022]
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Wills S, Rossi CC, Bennett J, Martinez-Cerdeño V, Ashwood P, Amaral DG, Van de Water J. Further characterization of autoantibodies to GABAergic neurons in the central nervous system produced by a subset of children with autism. Mol Autism 2011; 2:5. [PMID: 21521495 PMCID: PMC3108923 DOI: 10.1186/2040-2392-2-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 04/26/2011] [Indexed: 11/10/2022] Open
Abstract
Background Autism is a neurodevelopmental disorder characterized by impairments in social interaction and deficits in verbal and nonverbal communication, together with the presence of repetitive behaviors or a limited repertoire of activities and interests. The causes of autism are currently unclear. In a previous study, we determined that 21% of children with autism have plasma autoantibodies that are immunoreactive with a population of neurons in the cerebellum that appear to be Golgi cells, which are GABAergic interneurons. Methods We have extended this analysis by examining plasma immunoreactivity in the remainder of the brain. To determine cell specificity, double-labeling studies that included one of the calcium-binding proteins that are commonly colocalized in GABAergic neurons (calbindin, parvalbumin or calretinin) were also carried out to determine which GABAergic neurons are immunoreactive. Coronal sections through the rostrocaudal extent of the macaque monkey brain were reacted with plasma from each of seven individuals with autism who had previously demonstrated positive Golgi cell staining, as well as six negative controls. In addition, brain sections from adult male mice were similarly examined. Results In each case, specific staining was observed for neurons that had the morphological appearance of interneurons. By double-labeling sections with plasma and with antibodies directed against γ-aminobutyric acid (GABA), we determined that all autoantibody-positive neurons were GABAergic. However, not all GABAergic neurons were autoantibody-positive. Calbindin was colabeled in several of the autoantibody-labeled cells, while parvalbumin colabeling was less frequently observed. Autoantibody-positive cells rarely expressed calretinin. Sections from the mouse brain processed similarly to the primate sections also demonstrated immunoreactivity to interneurons distributed throughout the neocortex and many subcortical regions. Some cell populations stained in the primate (such as the Golgi neurons in the cerebellum) were not as robustly immunoreactive in the mouse brain. Conclusions These results suggest that the earlier report of autoantibody immunoreactivity to specific cells in the cerebellum extend to other regions of the brain. Further, these findings confirm the autoantibody-targeted cells to be a subpopulation of GABAergic interneurons. The potential impact of these autoantibodies on GABAergic disruption with respect to the etiology of autism is discussed herein.
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Affiliation(s)
- Sharifia Wills
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, 451 Health Sciences Drive, Suite 6510 GBSF, Davis, CA 95616, USA.,NIEHS Center for Children's Environmental Health, University of California, Davis, Davis, CA 95616, USA
| | - Christy C Rossi
- Department of Psychiatry and Behavioral Sciences, Center for Neuroscience, California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA.,The M.I.N.D. Institute, University of California Davis Medical Center, Sacramento, CA 95817 USA
| | - Jeffrey Bennett
- Department of Psychiatry and Behavioral Sciences, Center for Neuroscience, California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA.,The M.I.N.D. Institute, University of California Davis Medical Center, Sacramento, CA 95817 USA
| | - Veronica Martinez-Cerdeño
- Department of Psychiatry and Behavioral Sciences, Center for Neuroscience, California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA.,The M.I.N.D. Institute, University of California Davis Medical Center, Sacramento, CA 95817 USA
| | - Paul Ashwood
- Department of Medical Microbiology and Immunology, University of California at Davis, Davis, CA 95616, USA.,The M.I.N.D. Institute, University of California Davis Medical Center, Sacramento, CA 95817 USA.,NIEHS Center for Children's Environmental Health, University of California, Davis, Davis, CA 95616, USA
| | - David G Amaral
- Department of Psychiatry and Behavioral Sciences, Center for Neuroscience, California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA.,The M.I.N.D. Institute, University of California Davis Medical Center, Sacramento, CA 95817 USA
| | - Judy Van de Water
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, 451 Health Sciences Drive, Suite 6510 GBSF, Davis, CA 95616, USA.,The M.I.N.D. Institute, University of California Davis Medical Center, Sacramento, CA 95817 USA.,NIEHS Center for Children's Environmental Health, University of California, Davis, Davis, CA 95616, USA
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Rajapakse T, Pringsheim T. Pharmacotherapeutics of Tourette syndrome and stereotypies in autism. Semin Pediatr Neurol 2010; 17:254-60. [PMID: 21183132 DOI: 10.1016/j.spen.2010.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tourette syndrome (TS) and stereotypy in autism spectrum disorders (ASDs) are 2 common movement disorders in childhood. The objective of this review was to summarize randomized controlled trials published over the past 5 years as an update of the current pharmacotherapeutic options for the treatment of tics, TS, and motor stereotypies in children with ASD. We searched MEDLINE (2005-May 2010) for randomized controlled trials of medications used for the treatment of these disorders. For the treatment of tics in TS, 2 trials suggest that levetiracetam is not effective, whereas 1 trial found that topiramate was effective. Single clinical trials of metoclopramide, atomoxetine, and ondansetron were of limited quality, preventing conclusions to be made regarding the usefulness of these treatments for tic disorders. For the treatment of stereotypy in children with ASD, risperidone has been shown in both a Cochrane review in 2006 and 2 subsequent randomized control trials to be effective. The addition of pentoxifylline to risperidone may have added benefit. Haloperidol did not improve stereotypy and was poorly tolerated. There is good evidence that aripiprazole is effective in the treatment of sterotypies in children with ASD. A large randomized trial of citalopram did not show any improvement in stereotypy. Single trials of levetiracetam, guanfacine, and atomoxetine suggest they are not useful in the reduction of stereotypy in children with ASD.
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Affiliation(s)
- Thilinie Rajapakse
- Department of Clinical Neurosciences and Pediatrics, University of Calgary, Calgary, Canada
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Walker KG. An update on the treatment of Sydenham's chorea: the evidence for established and evolving interventions. Ther Adv Neurol Disord 2010; 3:301-9. [PMID: 21179620 PMCID: PMC3002660 DOI: 10.1177/1756285610382063] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Over 320 years after Thomas Sydenham described the condition labelled Sydenham's chorea, it remains poorly understood. The disorder is an antineuronal antibody-mediated neuropsychiatric disorder caused by a poststreptococcal, autoimmune condition affecting control of movement, mood, behaviour and potentially the heart. The treatment remains empirical, and is less than optimal. There are few large clinically controlled trials. Recommendations for optimal management remain inconsistent and are hampered by the side effects from pharmacotherapy. Care for patients should be targeted at primary treatment (penicillin and bed rest), secondary palliation (symptomatic medication) and supportive (social) care. Small studies have demonstrated trends to support the use of immunoglobulins and steroids as therapeutic interventions for children affected by Sydenham's chorea.
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Affiliation(s)
- Kathleen G. Walker
- K. G. Walker, S25/26 Neurology OPD, Red Cross Children’s Hospital, Klipfontein Road, Rondebosch, 7700 Western Cape, South Africa
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Bos KJ, Zeanah CH, Smyke AT, Fox NA, Nelson CA. Stereotypies in children with a history of early institutional care. ACTA ACUST UNITED AC 2010; 164:406-11. [PMID: 20439790 DOI: 10.1001/archpediatrics.2010.47] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To investigate the prevalence of stereotypies in children with a history of early institutional care, evaluate the efficacy of a foster care intervention compared with institutional care on the course of stereotypies, and describe correlates in language, cognition, and anxiety for children who exhibit stereotypies. DESIGN Randomized controlled trial. SETTING Institutions in Bucharest, Romania. PARTICIPANTS One hundred thirty-six children with a history of early institutional care. Intervention Comparison of a foster care intervention with continued care as usual in an institution. MAIN OUTCOME MEASURES The presence of stereotypies as well as outcomes in language, cognition, and anxiety. RESULTS At the baseline assessment prior to placement in foster care (average age of 22 months), more than 60% of children in institutional care exhibited stereotypies. Follow-up assessments at 30 months, 42 months, and 54 months indicated that being placed in families significantly reduced stereotypies, and with earlier and longer placements, reductions became larger. For children in the foster care group, but not in the care as usual group, stereotypies were significantly associated with lower outcomes on measures of language and cognition. CONCLUSIONS Stereotypies are prevalent in children with a history of institutional care. A foster care intervention appears to have a beneficial/moderating role on reducing stereotypies, underscoring the need for early placement in home-based care for abandoned children. Children who continue to exhibit stereotypies after foster care placement are significantly more impaired on outcomes of language and cognition than children without stereotypies and thus may be a target for further assessments or interventions.
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Affiliation(s)
- Karen J Bos
- Laboratories of Cognitive Neuroscience, Children's Hospital Boston, 1 Autumn Street, Boston, MA 02115-5365, USA
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Fusco FR, Pompa A, Bernardi G, Ottaviani F, Giampà C, Laurenti D, Morello M, Bernardini S, Nuccetelli M, Sabatini U, Paolucci S. A case of PANDAS treated with tetrabenazine and tonsillectomy. J Child Neurol 2010; 25:614-5. [PMID: 20207613 DOI: 10.1177/0883073809355824] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) is a rare clinical syndrome characterized by the presence of tics, Tourette syndrome, obsessive-compulsive disorder, or chorea in the context of an immediately precedent streptococcal infection. In this report, we describe the case of an 11-year-old boy who developed PANDAS with severe choreic movements. The criteria for PANDAS diagnosis were met. Moreover, serum antibrain antibodies were present. The patient was initially treated with tetrabenazine 12.5 mg twice daily with remission of the neurological symptoms. Subsequently, the patient underwent tonsillectomy and has been asymptomatic since, with antistreptolysin O titer levels in range.
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Affiliation(s)
- Francesca Romana Fusco
- Santa Lucia Foundation IRCCS Hospital, Department F and Laboratory of Neuroanatomy, Santa Lucia Foundation IRCCS at the European Center for Brain Research, Rome, Italy.
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Cabo López I, García Ruiz Espiga P, Herranz Bárcenas A, Bustamante de Garnica I. PANDAS: adult variant. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Cabo López I, García Ruiz Espiga P, Herranz Bárcenas A, Bustamante de Garnica I. PANDAS, variante del adulto. Neurologia 2010. [DOI: 10.1016/s0213-4853(10)70026-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Varga LI, Ako-Agugua N, Colasante J, Hertweck L, Houser T, Smith J, Watty AA, Nagar S, Raffa RB. Critical review of ropinirole and pramipexole - putative dopamine D3-receptor selective agonists - for the treatment of RLS. J Clin Pharm Ther 2009; 34:493-505. [DOI: 10.1111/j.1365-2710.2009.01025.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schmeisser MJ, Unrath A, Otto M, Tumani H, Abler B. Moyamoya disease precipitating Sydenham's chorea in a 19-year-old Caucasian woman. Mov Disord 2009; 24:1401-3. [DOI: 10.1002/mds.22548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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