1
|
Yıldız N, Serdaroğlu E, Kart PÖ, Besen S, Kanmaz S, Toprak DE, Kilic B, Ersoy O, Gencpinar P, Dundar NO, Okuyaz C, Serdaroglu A, Carman KB, Yarar C, Ekici B, Tatlı B, Erol İ, Aydın K, Tekgül H, Cansu A. Evaluation of seizure semiology, genetics, magnetic resonance imaging, and electroencephalogram findings in children with Rett syndrome: A multicenter retrospective study. Epilepsy Res 2024; 205:107399. [PMID: 39003968 DOI: 10.1016/j.eplepsyres.2024.107399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/13/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES This study aimed to evaluate seizure semiology, electroencephalogram (EEG), magnetic resonance imaging (MRI), and genetic findings, as well as treatment choices in Rett syndrome (RTT). METHODS A retrospective analysis was conducted on one hundred and twenty cases diagnosed with RTT with a genetic mutation. Data were obtained from nine participating centers. RESULTS In this study, 93.3 % of patients were female, with typical RTT found in 70 % of cases. Genetic etiology revealed MECP2, FoxG1, and CDKL5 in 93.8 %, 2.7 %, and 1.8 % of cases, respectively. Atypical RTT clinics were observed in 50 % of male cases, with the first EEG being normal in atypical RTT cases (p = 0.01). Generalized tonic-clonic and myoclonic epilepsy were the most common seizure semiologies, while absence and focal epilepsy were less prevalent. Valproate, levetiracetam, lamotrigine, and clobazam were the most commonly used antiepileptic drugs, affecting the severity and frequency of seizures (p = 0.015, p=<0.001, p = 0.022, and p=<0.001, respectively). No significant differences were observed in EEG findings. The initiation of anti-seizure medications significantly altered seizure characteristics (Table 4). A ketogenic diet and vagal nerve stimulation (VNS) correlated with a 50 % improvement in cognitive function, while steroid treatment showed a 60 % improvement. Remarkably, seizures were substantially reduced after VNS application. CONCLUSION This study underscores the importance of genetic diagnosis in RTT cases with a clinical diagnosis. These preliminary results will be further validated with the inclusion of clinically diagnosed RTT cases in our ongoing study.
Collapse
Affiliation(s)
- Nihal Yıldız
- Faculty of Medicine, Department of Pediatric Neurology, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey.
| | - Esra Serdaroğlu
- Faculty of Medicine, Department of Pediatric Neurology, Gazi University, Ankara, Turkey.
| | - Pınar Özkan Kart
- Faculty of Medicine, Department of Pediatric Neurology, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - Seyda Besen
- Faculty of Medicine, Department of Pediatric Neurology, Baskent University, Adana, Turkey
| | - Seda Kanmaz
- Faculty of Medicine, Department of Pediatric Neurology, Ege University, İzmir, Turkey.
| | - Dilara Ece Toprak
- Faculty of Medicine, Department of Pediatric Neurology, Ege University, İzmir, Turkey
| | - Betul Kilic
- Faculty of Medicine, Department of Pediatric Neurology, Medipol University, İstanbul Turkey
| | - Ozlem Ersoy
- Faculty of Medicine, Department of Pediatric Neurology, Mersin University, Mersin, Turkey
| | - Pınar Gencpinar
- Faculty of Medicine, Department of Pediatric Neurology, Katip Celebi University, İzmir, Turkey
| | - Nihal Olgac Dundar
- Faculty of Medicine, Department of Pediatric Neurology, Katip Celebi University, İzmir, Turkey
| | - Cetin Okuyaz
- Faculty of Medicine, Department of Pediatric Neurology, Mersin University, Mersin, Turkey
| | - Ayse Serdaroglu
- Faculty of Medicine, Department of Pediatric Neurology, Gazi University, Ankara, Turkey.
| | - Kursat Bora Carman
- Faculty of Medicine, Department of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Coşkun Yarar
- Faculty of Medicine, Department of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Barış Ekici
- Faculty of Medicine, Department of Pediatric Neurology, İstanbul Pediatric Neurology Center, İstanbul, Turkey
| | - Burak Tatlı
- Faculty of Medicine, Department of Pediatric Neurology, İstanbul Pediatric Neurology Center, İstanbul, Turkey
| | - İlknur Erol
- Faculty of Medicine, Department of Pediatric Neurology, Baskent University, Adana, Turkey
| | - Kürşad Aydın
- Faculty of Medicine, Department of Pediatric Neurology, Medipol University, İstanbul Turkey
| | - Hasan Tekgül
- Faculty of Medicine, Department of Pediatric Neurology, Ege University, İzmir, Turkey.
| | - Ali Cansu
- Faculty of Medicine, Department of Pediatric Neurology, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| |
Collapse
|
2
|
Kolb RL, McComas JJ, Girtler SN, Simacek J, Dimian AF, Unholz-Bowden EK, Shipchandler AH. Teaching Requesting to Individuals with Rett Syndrome Using Alternative Augmentative Communication (AAC) Through Caregiver Coaching via Telehealth. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2023; 35:1063-1090. [PMID: 38053943 PMCID: PMC10697698 DOI: 10.1007/s10882-023-09894-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 12/07/2023]
Abstract
Rett syndrome is a severe neurodevelopmental disorder that results in both motor and language skill regression with a wide range of severity in symptom presentation. Communication intervention may be particularly challenging for this population due to the decline in speech, motor skills, and motor planning difficulties that characterize the disorder (Townend et al., 2020), often resulting in the need for augmentative and alternative communication (AAC) technology. Very limited research has evaluated communication interventions for individuals with Rett syndrome and even fewer have targeted expressive communication, an important skill required for improved autonomy and quality of life (Sigafoos et al., 2009; Townend et al., 2020). The current study sought to systematically replicate the Simacek et al. (2017) mand training procedures to teach three girls with Rett Syndrome to use AAC to make requests through caregiver coaching by researchers via telehealth. Results suggest that mand training was successful in increasing AAC use for all three participants. Barriers to intervention for this population and implications of results for future research and clinical practice are discussed.
Collapse
Affiliation(s)
- Rebecca L. Kolb
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| | - Jennifer J. McComas
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| | - Shawn N. Girtler
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| | - Jessica Simacek
- Institute on Community Integration, University of Minnesota, 2025 E River Pkwy, Minneapolis, MN 55414, USA
| | - Adele F. Dimian
- Institute on Community Integration, University of Minnesota, 2025 E River Pkwy, Minneapolis, MN 55414, USA
| | - Emily K. Unholz-Bowden
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| | - Alefyah H. Shipchandler
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| |
Collapse
|
3
|
McComas JJ, Kolb R, Girtler S. The Effect of Caregiver-Implemented Training on Augmentative Alternative Communication Use by Individuals with Rett Syndrome: Remote Coaching via Telehealth. Dev Neurorehabil 2023; 26:436-449. [PMID: 38183414 DOI: 10.1080/17518423.2023.2301617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Abstract
Limited published literature exists demonstrating functional relations between idiosyncratic responses or augmentative alternative communication (AAC) and social reinforcement for individuals with Rett syndrome. In this study, six females with Rett syndrome ages 2-25 demonstrated requesting for preferred items using both idiosyncratic responses (e.g, looking, reaching) and AAC (e.g. single response microswitches). Researchers connected remotely via telehealth to coach caregivers to implement all sessions in home environments. Researchers individualized response prompt delays during AAC sessions (request/mand training) based on each participants' latency to respond during baseline. Implications for practice and directions for future research are discussed.
Collapse
Affiliation(s)
| | - Rebecca Kolb
- The University of Minnesota, Minneapolis, MN, USA
| | | |
Collapse
|
4
|
Hirano D, Goto Y, Shoji H, Taniguchi T. Relationship between hand stereotypies and purposeful hand use and factors causing skin injuries and joint contractures in individuals with Rett syndrome. Early Hum Dev 2023; 183:105821. [PMID: 37429197 DOI: 10.1016/j.earlhumdev.2023.105821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Skin injuries and joint contractures in the upper limbs are observed in approximately 50 % of individuals with Rett syndrome, respectively. AIMS To investigate the relationship between stereotypic hand movements and purposeful hand skills, items related to these, and factors that cause upper extremity skin injuries and joint contractures in individuals with Rett syndrome. STUDY DESIGN We conducted a cross-sectional observational study in 2020 with families belonging to either of the two largest Rett syndrome organizations in Japan. SUBJECTS In 2020, we sent a questionnaire to 194 Japanese families. OUTCOME MEASURES We used descriptive statistics to indicate frequency in each question. We analysed the association between hand stereotypies and purposeful hand use, their associations with each questionnaire item, and the relationship between the occurrence of skin injuries and joint contractures. RESULTS We acquired information from 72 cases. We found correlations between stereotypy frequency with reaching and between purposeful hand use with intellectual development grade and hand function. Hand and finger skin injuries and elbow and finger joint contractures were associated with wringing/washing, grasping, locomotion, reaching, and intellectual development grade. We identified cut-off points for the occurrence of elbow and finger joint contractures of 10 years 6 months, ability to roll over, finger feeds only, and understanding of simple words. CONCLUSIONS Direct interventions can reduce hand stereotypies and increase purposeful hand use, while related items can be addressed with indirect interventions. Evaluations of factors that cause skin injuries and joint contractures can prevent their occurrence.
Collapse
Affiliation(s)
- Daisuke Hirano
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, 4-1-26 Akasaka, Minato, Tokyo 107-8402, Japan; Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara, Tochigi 324-8501, Japan.
| | - Yoshinobu Goto
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, 4-1-26 Akasaka, Minato, Tokyo 107-8402, Japan; Department of Physiology, Faculty of Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba 286-8686, Japan; Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa, Fukuoka 831-8501, Japan
| | - Hiroaki Shoji
- Laboratory of Physiology, College of Education, Ibaraki University, 2-1-1 Bunkyo, Mito, Ibaraki 310-8512, Japan
| | - Takamichi Taniguchi
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, 4-1-26 Akasaka, Minato, Tokyo 107-8402, Japan; Department of Occupational Therapy, School of Health Sciences at Narita, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba 286-8686, Japan
| |
Collapse
|
5
|
McGraw SA, Smith-Hicks C, Nutter J, Henne JC, Abler V. Meaningful Improvements in Rett Syndrome: A Qualitative Study of Caregivers. J Child Neurol 2023:8830738231172066. [PMID: 37161302 DOI: 10.1177/08830738231172066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Rett syndrome is a rare neurodevelopmental disorder primarily affecting females. This syndrome is associated with many comorbidities and impairments related to motor function, breathing, sleep, expressive language, and repetitive hand movements. The Rett Syndrome Behaviour Questionnaire (RSBQ) is one measure used to assess changes in Rett syndrome-related manifestations or core symptoms. Little is known about how caregivers think about meaningful changes in the items that make up the RSBQ scale. METHODS This qualitative study explored how caregivers of individuals with Rett syndrome viewed changes in the symptoms covered in the RSBQ. We conducted semistructured interviews with 40 caregivers and employed thematic analysis, identifying themes using an iterative process. RESULTS Two factors characterized caregivers' thoughts about meaningful changes in Rett syndrome manifestations. First, general features of these symptoms rendered them bothersome: the extent of bother compared to other symptoms, if or how they prevented desirable behaviors and their temporal qualities. Second, caregivers evaluated the meaning of improvements by considering the decrease in bother and the potential benefits of change. Improvements had social and psychological consequences for individuals with Rett syndrome and caregivers. In addition, implications for health, fine and gross motor skills, and communication were also substantial.
Collapse
Affiliation(s)
| | | | | | | | - Victor Abler
- Medical Affairs, Acadia Pharmaceuticals, Inc, San Diego, CA, USA
| |
Collapse
|
6
|
Downs J, Blackmore AM, Wong K, Buckley N, Lotan M, Elefant C, Leonard H, Stahlhut M. Can telehealth increase physical activity in individuals with Rett syndrome? A multicentre randomized controlled trial. Dev Med Child Neurol 2023; 65:489-497. [PMID: 36284370 DOI: 10.1111/dmcn.15436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the effects of a physical activity programme on sedentary behaviour and physical activity in ambulant individuals with Rett syndrome (RTT). METHOD In this multicentre randomized waitlist-controlled trial, we recruited 43 ambulatory individuals with RTT in Australia and Denmark. Adequate baseline data were obtained from 38 participants (mean age 20 years, range 6-41, SD 10 years 6 months, one male). All completed the trial. Participants received 12 weeks of usual care (n = 19) or a goal-based, telehealth-supported programme in which activities occurred in their familiar environments (n = 19). Sedentary time and daily steps were assessed at baseline, post-test, and 12-week follow-up. The data analyst was blinded to group allocation. RESULTS Sedentary time decreased in the intervention group by 2.7% (95% confidence interval [CI] -6.0 to 0.6) and increased in the control group by 1.3% (95% CI -4.8 to 7.4). Intervention and control groups increased the number of their steps per day by 264.7 (95% CI -72.2 to 601.5) and 104.8 (95% CI -178.1 to 387.7) respectively. No significant differences were found on any outcomes at post-test. There were three minor adverse events. INTERPRETATION A goal-based telehealth intervention seemed to produce small improvements in physical activity for individuals with RTT. Families require more support to increase these individuals' extremely low physical activity levels. WHAT THIS PAPER ADDS A telehealth-supported intervention may produce small changes in physical activity in Rett syndrome (RTT). Increasing physical activity in individuals with RTT is challenging for caregivers. Families require substantial out-of-home support to increase their children's activity levels.
Collapse
Affiliation(s)
- Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - A Marie Blackmore
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Nicholas Buckley
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Meir Lotan
- Department of Physiotherapy, Ariel University, Ariel, Israel
- Rett Syndrome National Clinic, Sheba Hospital, Ramat-Gan, Israel
| | - Cochavit Elefant
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Michelle Stahlhut
- Department of Paediatrics and Adolescent Medicine, Center for Rett Syndrome, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
7
|
Hirano D, Goto Y, Shoji H, Taniguchi T. Comparison of the presence and absence of an intervention to reduce hand stereotypies in individuals with Rett syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:607-622. [PMID: 34962025 DOI: 10.1111/jar.12973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 11/29/2021] [Accepted: 12/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated how many individuals with Rett syndrome were undergoing interventions to reduce stereotypic hand movements and the factors determining the presence or absence of an intervention. METHOD A questionnaire was sent to 194 families. Each survey item was compared between the intervention and non-intervention groups according to the presence or absence of interventions to reduce hand stereotypies. RESULTS Information was acquired from 72 cases; 72.1% of individuals had received an intervention to reduce stereotypies at some point in their lives. An upper limb splint was the most common intervention. Age, locomotor and reaching function, diagnostic age, frequency and type of stereotypy, joint contractures and stereotypy-associated problems separated the presence or absence of a current or past intervention. CONCLUSIONS Interventions for stereotypy-associated problems are important and there are several variables related to whether an intervention is received.
Collapse
Affiliation(s)
- Daisuke Hirano
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Tokyo, Japan.,Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Japan
| | - Yoshinobu Goto
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Tokyo, Japan.,Faculty of Medicine, School of Medicine, International University of Health and Welfare, Chiba, Japan.,Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - Hiroaki Shoji
- Laboratory of Physiology, College of Education, Ibaraki University, Ibaraki, Japan
| | - Takamichi Taniguchi
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Tokyo, Japan.,Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Japan
| |
Collapse
|
8
|
Downs J, Lotan M, Elefant C, Leonard H, Wong K, Buckley N, Stahlhut M. Implementing telehealth support to increase physical activity in girls and women with Rett syndrome -ActivRett: protocol for a waitlist randomised controlled trial. BMJ Open 2020; 10:e042446. [PMID: 33376177 PMCID: PMC7778785 DOI: 10.1136/bmjopen-2020-042446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Individuals with Rett syndrome (RTT) experience impaired gross motor skills, limiting their capacity to engage in physical activities and participation in activities. There is limited evidence of the effectiveness of supported physical activity interventions. This study aims to evaluate the effects of a telehealth-delivered physical activity programme on physical activity, sedentary behaviour and quality of life in RTT. METHODS AND ANALYSIS This is a multicentre study, conducted in Australia, Denmark and Israel. It is a randomised waitlist-controlled trial comparing an intervention to support physical activity with usual care. Participants are children and adults with RTT, recruited from the Australian Rett Syndrome Database, the Danish Center for Rett Syndrome and the Rett Syndrome Association of Israel. The intervention duration is 12 weeks, including fortnightly telephone contact to plan, monitor and develop individual activity programmes. Outcomes are measured at baseline, at 13 weeks and then at 25 weeks. The primary outcomes are sedentary behaviour assessed with an activPAL accelerometer and the number of daily steps measured with a StepWatch Activity Monitor. Secondary outcomes include sleep, behaviour and quality of life. Caregiver experiences will be assessed immediately after the intervention using a satisfaction questionnaire. Group differences for each outcome will be evaluated with analysis of covariance, adjusting for baseline values on an intention-to-treat basis. ETHICS AND DISSEMINATION Ethics approval has been obtained in Western Australia from the Child and Adolescent Health Services (RGS3371), in Denmark from the Capital Region Ethics Committee (H-19040514) and in Israel from the Ariel University Institutional Review Board (AU-HEA-ML-20190331). Manuscripts on the development of the intervention from pilot work and the results of the intervention will be submitted to peer-reviewed journals. Results will be presented at conferences and consumer forums. We will develop an online resource documenting the physical activity programme and available supporting evidence. TRIAL REGISTRATION NUMBER NCT04167059; Pre-results.
Collapse
Affiliation(s)
- Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Meir Lotan
- Department of Physiotherapy, Ariel University, Ariel, Israel
| | - Cochavit Elefant
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Nicholas Buckley
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Michelle Stahlhut
- Department of Paediatrics and Adolescent Medicine, Center for Rett Syndrome, Copenhagen, Denmark
| |
Collapse
|