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Acero-Garcés DO, Saldarriaga W, Cabal-Herrera AM, Rojas CA, Hagerman RJ. Fragile X Syndrome in children. Colomb Med (Cali) 2023; 54:e4005089. [PMID: 37664646 PMCID: PMC10469670 DOI: 10.25100/cm.v54i2.5089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 11/28/2022] [Accepted: 05/14/2023] [Indexed: 09/05/2023] Open
Abstract
Fragile X syndrome is caused by the expansion of CGG triplets in the FMR1 gene, which generates epigenetic changes that silence its expression. The absence of the protein coded by this gene, FMRP, causes cellular dysfunction, leading to impaired brain development and functional abnormalities. The physical and neurologic manifestations of the disease appear early in life and may suggest the diagnosis. However, it must be confirmed by molecular tests. It affects multiple areas of daily living and greatly burdens the affected individuals and their families. Fragile X syndrome is the most common monogenic cause of intellectual disability and autism spectrum disorder; the diagnosis should be suspected in every patient with neurodevelopmental delay. Early interventions could improve the functional prognosis of patients with Fragile X syndrome, significantly impacting their quality of life and daily functioning. Therefore, healthcare for children with Fragile X syndrome should include a multidisciplinary approach.
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Affiliation(s)
| | - Wilmar Saldarriaga
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Cali, Colombia
- Universidad del Valle, Facultad de Salud, Escuela de Ciencias Básicas, Cali, Colombia
| | | | - Christian A. Rojas
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Cali, Colombia
| | - Randi J. Hagerman
- University of California, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, Sacramento, CA, USA
- Davis Medical Center, Sacramento, CA, USA
- University of California, Department of Pediatrics, Davis, CA, USA
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Na ES, De Jesús-Cortés H, Martinez-Rivera A, Kabir ZD, Wang J, Ramesh V, Onder Y, Rajadhyaksha AM, Monteggia LM, Pieper AA. D-cycloserine improves synaptic transmission in an animal model of Rett syndrome. PLoS One 2017; 12:e0183026. [PMID: 28813484 PMCID: PMC5559075 DOI: 10.1371/journal.pone.0183026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/30/2017] [Indexed: 01/24/2023] Open
Abstract
Rett syndrome (RTT), a leading cause of intellectual disability in girls, is predominantly caused by mutations in the X-linked gene MECP2. Disruption of Mecp2 in mice recapitulates major features of RTT, including neurobehavioral abnormalities, which can be reversed by re-expression of normal Mecp2. Thus, there is reason to believe that RTT could be amenable to therapeutic intervention throughout the lifespan of patients after the onset of symptoms. A common feature underlying neuropsychiatric disorders, including RTT, is altered synaptic function in the brain. Here, we show that Mecp2tm1.1Jae/y mice display lower presynaptic function as assessed by paired pulse ratio, as well as decreased long term potentiation (LTP) at hippocampal Schaffer–collateral-CA1 synapses. Treatment of Mecp2tm1.1Jae/y mice with D-cycloserine (DCS), an FDA-approved analog of the amino acid D-alanine with antibiotic and glycinergic activity, corrected the presynaptic but not LTP deficit without affecting deficient hippocampal BDNF levels. DCS treatment did, however, partially restore lower BDNF levels in the brain stem and striatum. Thus, treatment with DCS may mitigate the severity of some of the neurobehavioral symptoms experienced by patients with Rett syndrome.
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Affiliation(s)
- Elisa S. Na
- Department of Psychology & Philosophy, Texas Woman’s University, Denton, TX, United States of America
| | - Héctor De Jesús-Cortés
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Arlene Martinez-Rivera
- Division of Pediatric Neurology, Department of Pediatrics, Weill Cornell Medicine, Cornell University, New York, NY, United States of America
- Weill Cornell Autism Research Program, Weill Cornell Medicine, Cornell University, New York, NY, United States of America
| | - Zeeba D. Kabir
- Division of Pediatric Neurology, Department of Pediatrics, Weill Cornell Medicine, Cornell University, New York, NY, United States of America
- Weill Cornell Autism Research Program, Weill Cornell Medicine, Cornell University, New York, NY, United States of America
| | - Jieqi Wang
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | - Vijayashree Ramesh
- Department of Neuroscience, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Yasemin Onder
- Department of Neuroscience, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Anjali M. Rajadhyaksha
- Division of Pediatric Neurology, Department of Pediatrics, Weill Cornell Medicine, Cornell University, New York, NY, United States of America
- Weill Cornell Autism Research Program, Weill Cornell Medicine, Cornell University, New York, NY, United States of America
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, Cornell University, New York, NY, United States of America
- * E-mail: (AMR); (LMM); (AAP)
| | - Lisa M. Monteggia
- Department of Neuroscience, UT Southwestern Medical Center, Dallas, TX, United States of America
- * E-mail: (AMR); (LMM); (AAP)
| | - Andrew A. Pieper
- Weill Cornell Autism Research Program, Weill Cornell Medicine, Cornell University, New York, NY, United States of America
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
- Department of Free Radical and Radiation Biology, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
- Department of Veterans Affairs, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
- Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
- * E-mail: (AMR); (LMM); (AAP)
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Hunter J, Rivero-Arias O, Angelov A, Kim E, Fotheringham I, Leal J. Epidemiology of fragile X syndrome: A systematic review and meta-analysis. Am J Med Genet A 2014; 164A:1648-58. [DOI: 10.1002/ajmg.a.36511] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/31/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Jessica Hunter
- Department of Human Genetics; Emory University School of Medicine; Atlanta Georgia
| | - Oliver Rivero-Arias
- Health Economics Research Centre; Nuffield Department of Population Health; University of Oxford; Oxford United Kingdom
- National Perinatal Epidemiology Unit; Nuffield Department of Population Health; University of Oxford; Oxford United Kingdom
| | - Angel Angelov
- Novartis Pharmaceutical Corporation; East Hanover New Jersey
| | - Edward Kim
- Novartis Pharmaceutical Corporation; East Hanover New Jersey
| | - Iain Fotheringham
- Value Demonstration Practice; Oxford PharmaGenesis™ Ltd; Oxford United Kingdom
| | - Jose Leal
- Health Economics Research Centre; Nuffield Department of Population Health; University of Oxford; Oxford United Kingdom
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Berger-Sweeney J. Cognitive deficits in Rett syndrome: What we know and what we need to know to treat them. Neurobiol Learn Mem 2011; 96:637-46. [DOI: 10.1016/j.nlm.2011.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 05/04/2011] [Accepted: 05/13/2011] [Indexed: 10/18/2022]
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Epilepsy in Rett syndrome: association between phenotype and genotype, and implications for practice. Seizure 2011; 20:646-9. [PMID: 21764336 DOI: 10.1016/j.seizure.2011.06.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 04/13/2011] [Accepted: 06/17/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate the association between genotype (methyl-CpG-binding protein 2 (MECP2 gene mutation)) and epileptic seizure phenotype in Rett syndrome. METHODS We used the British Isles Rett syndrome survey to identify 137 subjects with one of the nine most frequent MECP2 gene mutations and invited their parents or carers to participate in a postal questionnaire and telephone interview. The questionnaire recorded information about epileptic seizure types, non-epileptic vacant spells and treatments. Two investigators conducted telephone interviews and three epileptologists classified their epileptic seizures. RESULTS 89 subjects (65%) responded. The epilepsy prevalence was 67%, and 74% had non-epileptic vacant spells. The epilepsy prevalence within specific genotypes ranged from 47% (mutation C-terminal deletion, downstream of the Transcription Repression Domain) to 100% (mutation p.R270X, c.808C>T). The prevalence of non-epileptic vacant spells within genotypes ranged from 50% (mutation p.R306C, c.916C>T) to 100% (mutation p.R106W, c.316C>T). The epileptologists differed considerably in their classification of events, particularly of non-epileptic vacant spells. CONCLUSIONS The large majority of people with Rett syndrome have epilepsy. Most have multiple epileptic seizure types, although generalised tonic-clonic seizures are the most common. There were no significant clinical differences between genotypes. The clinical differentiation of non-epileptic vacant spells is difficult. Discordance in epileptic seizure classification between clinicians suggests that caution is needed, since the clinical history alone cannot adequately classify the epileptic seizure type in Rett syndrome.
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van Karnebeek CDM, Jansweijer MCE, Leenders AGE, Offringa M, Hennekam RCM. Diagnostic investigations in individuals with mental retardation: a systematic literature review of their usefulness. Eur J Hum Genet 2005; 13:6-25. [PMID: 15523501 DOI: 10.1038/sj.ejhg.5201279] [Citation(s) in RCA: 192] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There are no guidelines available for diagnostic studies in patients with mental retardation (MR) established in an evidence-based manner. Here we report such study, based on information from original studies on the results with respect to detected significant anomalies (yield) of six major diagnostic investigations, and evaluate whether the yield differs depending on setting, MR severity, and gender. Results for cytogenetic studies showed the mean yield of chromosome aberrations in classical cytogenetics to be 9.5% (variation: 5.4% in school populations to 13.3% in institute populations; 4.1% in borderline-mild MR to 13.3% in moderate-profound MR; more frequent structural anomalies in females). The median yield of subtelomeric studies was 4.4% (also showing female predominance). For fragile X screening, yields were 5.4% (cytogenetic studies) and 2.0% (molecular studies) (higher yield in moderate-profound MR; checklist use useful). In metabolic investigations, the mean yield of all studies was 1.0% (results depending on neonatal screening programmes; in individual populations higher yield for specific metabolic disorders). Studies on neurological examination all showed a high yield (mean 42.9%; irrespective of setting, degree of MR, and gender). The yield of neuroimaging studies for abnormalities was 30.0% (higher yield if performed on an indicated basis) and the yield for finding a diagnosis based on neuroradiological studies only was 1.3% (no data available on value of negative findings). A very high yield was found for dysmorphologic examination (variation 39-81%). The data from this review allow conclusions for most types of diagnostic investigations in MR patients. Recommendations for further studies are provided.
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Affiliation(s)
- Clara D M van Karnebeek
- Department of Paediatrics/Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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Fombonne E, Simmons H, Ford T, Meltzer H, Goodman R. Prevalence of pervasive developmental disorders in the British nationwide survey of child mental health. J Am Acad Child Adolesc Psychiatry 2001; 40:820-7. [PMID: 11437021 DOI: 10.1097/00004583-200107000-00017] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The prevalence of pervasive developmental disorders (PDD) is not well established and needs monitoring. The prevalence of PDD in the 1999 nationwide British survey of child and adolescent mental health was investigated. METHOD A randomized, stratified sample of children (N= 12,529) aged 5 to 15 years was generated from the Child Benefit Register. Trained interviewers interviewed parents and youths aged 11 or older with a standardized diagnostic interview (Development and Well-Being Assessment), and questionnaire data (Strengths and Difficulties Questionnaire) were obtained from teachers and parents, who also completed self-report measures of psychological distress. Final diagnostic determination was achieved by a team of experienced clinicians using all data sources. RESULTS A total of 10,438 (83%) interviews were conducted. There were 2 girls with Rett syndrome (weighted prevalence: 3.8/10,000 girls) and 27 children with other PDD (weighted prevalence: 26.1/10,000). Compared with children with a psychiatric disorder other than PDD, social but not behavioral problems were more frequent in the PDD group. Parents of children with PDD had higher rates of psychological distress than those from the two comparison groups. CONCLUSIONS Consistent with other recent surveys, PDD rates are higher than those reported 30 years ago. The burden associated with PDD is very high.
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Affiliation(s)
- E Fombonne
- Institute of Psychiatry, Department of Child and Adolescent Psychiatry, King's College London, England.
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Yeargin-Allsopp M, Murphy CC, Cordero JF, Decouflé P, Hollowell JG. Reported biomedical causes and associated medical conditions for mental retardation among 10-year-old children, metropolitan Atlanta, 1985 to 1987. Dev Med Child Neurol 1997; 39:142-9. [PMID: 9112961 DOI: 10.1111/j.1469-8749.1997.tb07401.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This report describes biomedical causes of mental retardation (MR) among school-age children and associated medical conditions in children for whom no cause was reported. This study involved 715, 10-year-old children with MR (intelligence quotient [IQ] 70 or less) born between 1975 and 1977. We determined biomedical causes of MR using a hierarchical approach based on the timing of the event (i.e. prenatal, perinatal, or postneonatal). Among children with no identified biomedical cause the occurrence of associated medical conditions was examined. No reported biomedical cause could be found in 78% of children with MR (87% mild, IQ 50 to 70; 57% severe, IQ < 50). Prenatal causes were present in 12%, perinatal causes in 6%, and postneonatal causes in 4%. On the basis of these findings it was concluded that intensive use of public health prevention strategies can reduce the number of children who receive a diagnosis of MR.
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Affiliation(s)
- M Yeargin-Allsopp
- Division of Birth Defects and Developmental Disabilities, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30333, USA
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Murray J, Cuckle H, Taylor G, Hewison J. Screening for fragile X syndrome: information needs for health planners. J Med Screen 1997; 4:60-94. [PMID: 9275266 DOI: 10.1177/096914139700400204] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- J Murray
- Centre for Reproduction, Growth & Development, Research School of Medicine, University of Leeds, United Kingdom
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Demaerel P, Kingsley DP, Kendall BE. Isolated neurodevelopmental delay in childhood: clinicoradiological correlation in 170 patients. Pediatr Radiol 1993; 23:29-33. [PMID: 7682322 DOI: 10.1007/bf02020217] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
CT findings on 170 patients presenting with isolated moderate to severe neurodevelopmental delay have been compared with the final diagnosis. MRI was undertaken in 29 patients. Eighty per cent of the patients remained undiagnosed, and although the MRI findings were abnormal in 65.5% compared with only 30% of the CT examinations, imaging uncommonly suggested a specific diagnosis. Biochemical and chromosomal investigations were significantly more diagnostic. The results of these studies should restrict the number of non-contributory neuroradiological examinations. The superior intrinsic contrast of MRI will detect more lesions, particularly in white matter, but these are rarely diagnostic and where access to MRI is limited, CT is usually adequate.
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Affiliation(s)
- P Demaerel
- Department of Neuroradiology, Hospital for Sick Children, London, UK
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