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Tost A, Bachiller A, Medina-Rivera I, Romero S, Serna LY, Rojas-Martínez M, García-Cazorla Á, Mañanas MÁ. Repetitive active and passive cognitive stimulations induce EEG changes in patients with Rett syndrome. Pediatr Res 2024:10.1038/s41390-024-03254-9. [PMID: 39014240 DOI: 10.1038/s41390-024-03254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Despite being considered a rare disease, Rett syndrome is a leading cause of profound cognitive impairment in females. This study explores game-based cognitive stimulation to enhance attention during learning tasks, offering an alternative treatment perspective. METHODS Fifteen diagnosed Rett syndrome girls participated in four 24-minute sessions, including a 5-minute initial resting state recording. Primary indicators for analysis included relative power and spectral entropy. RESULTS Significant findings indicated variations among conditions (resting state, active task, passive task) in response to stimulation. Notably, over four days, evolution occurred, characterized by decreasing delta power and increasing theta and beta power. Topographic maps confirmed these shifts, highlighting affected brain areas. Linear regression emphasized the most significant impact on the first day, with subsequent shifts towards higher frequencies, particularly during the resting state. By the fourth day, resting-state patterns resembled those during cognitive activities. CONCLUSION Findings suggest cognitive stimulation induces substantial EEG spectral changes, potentially linked to cognitive enhancements in Rett syndrome. The shift towards higher frequency bands and increased spectral entropy align with enhanced brain activation during cognitive sessions, underscoring the potential of cognitive stimulation therapies and calling for further research to optimize abilities in individuals with Rett syndrome. IMPACT Game-based cognitive stimulation induces substantial EEG changes in individuals with Rett syndrome, enhancing cognitive functions, notably attention during learning. This study conducts a distinctive examination, assessing the habituation paradigm through the combination of game-based cognitive stimulation and learning, providing valuable insights into enhancing attention in Rett syndrome. Impacting understanding of cognitive processes in Rett syndrome, this research reveals significant EEG variations during tasks, emphasizing the potential of cognitive stimulation for attention enhancement and the need for further research in tailored interventions.
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Affiliation(s)
- Ana Tost
- Department of Automatic Control (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain.
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
| | - Alejandro Bachiller
- Department of Automatic Control (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | | | - Sergio Romero
- Department of Automatic Control (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Leidy-Yanet Serna
- Department of Automatic Control (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Monica Rojas-Martínez
- Department of Automatic Control (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Ángeles García-Cazorla
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Neurology Department, Neurometabolic Unit and Synaptic Metabolism Lab, Institut Pediàtric de Recerca, Hospital Sant Joan de Déu, metabERN and CIBERER-ISCIII, Barcelona, Spain
| | - Miguel Ángel Mañanas
- Department of Automatic Control (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
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Abo Zeid M, Elrosasy A, Mohamed RG, Ghazou A, Goufa E, Hassan N, Abuzaid Y. A meta-analysis of the efficacy and safety of trofinetide in patients with rett syndrome. Neurol Sci 2024:10.1007/s10072-024-07584-8. [PMID: 38771525 DOI: 10.1007/s10072-024-07584-8] [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: 02/14/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Rett syndrome (RTT) is an uncommon inherited neurodevelopmental disorder that affects brain development, mostly in females. It results from mutation in MECP2 gene in the long arm (q) of the X chromosome. OBJECTIVE Trofinetide is a recently developed drug that has a neuroprotective effect on neurons, and it is our aim in this meta-analysis to evaluate its efficacy and safety in treating Rett syndrome patients. METHODS We searched 5 databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases) to identify randomized controlled trials (RCTs) comparing Trofinetide and placebo in patients with Rett syndrome until August 13, 2023.Our primary outcomes were the Clinical Global Impression-Improvement (CGI) and the Rett syndrome Behavior Questionnaire (RSBQ). We used Risk of Bias Assessment tool-2 (ROB2) to assess the methodological quality of the included randomized controlled trials. RESULTS Three RCTs with a total of 325 patients were included with a follow-up duration ranging from one month to three months. 186 patients received the intervention drug (Trofinetide) and 138 received the placebo. Trofinetide was found to reduce CGI and RSBQ significantly more than placebo (MD = -0.35, 95% CI [-0.52 to -0.18], P 0.0001), (MD = -3.40, 95% CI [-3.69 to -3.12], P 0.00001) respectively. Most adverse events did not show any statistical difference between Trofinetide and the placebo. CONCLUSION Trofinetide offers promise as a potential effective and safe therapeutic opportunity for a population without many available treatments, with improvements seen on both CGI and RSBQ assessments and no severe adverse effects reported.
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Affiliation(s)
| | - Amr Elrosasy
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rashad G Mohamed
- Mansoura Manchester Program for Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alina Ghazou
- Faculty of Medicine, Jordan University of Science and Technology, Ar-Ramtha, Jordan
| | - Elarbi Goufa
- Faculty of Medicine, University of Oran 1 - Ahmed Ben Bella, Es Senia, Algeria
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Caprì T, Dovigo L, Semino M, Lotan M, Mohammadhasani N, Zamarra G, Fabio RA. Use of a low-tech tool in the improvement of social interaction of patients with Rett Syndrome: an observational study. Front Public Health 2024; 12:1353099. [PMID: 38645452 PMCID: PMC11027742 DOI: 10.3389/fpubh.2024.1353099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction The main aim of the present study was to examine whether the use of a low-tech tool, called click4all, inserted into cognitive and motor training can increase social interaction of patients with Rett Syndrome (RTT) with classmates in a school setting. Methods Twenty-seven participants with RTT were randomly assigned to two groups: the experimental group received treatment with click4all, and the control group received traditional treatment without click4all. Parameters were measured before treatment (T1), 6 months after treatment (T2), 6 months after the second treatment phase (T3) and at the end of the third treatment phase (T4). Results The results demonstrated an increase in levels of social interaction among classmates and patients with RTT in the experimental group, over time, compared to the control group, 95% CI [5.20-15.30]. Classmates also showed a higher level of knowledge related to participants of the experimental group, and this increased over time, 95% CI [24.98-63.52]. The level of knowledge related to the control group was stable over time and lower than the experimental group. Discussion This study demonstrated that the use of a low-tech tool can increase social interactions of patients with RTT in a school setting. This is important, as patients with RTT are often restricted in an isolation condition.
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Affiliation(s)
- Tindara Caprì
- Department of Life and Health Sciences, and Health Professions, Link Campus University, Rome, Italy
| | - Lucia Dovigo
- Airett Innovation and Research Center, Verona, Italy
| | | | - Meir Lotan
- Department of Physical Therapy, Ariel University, Ariel, Israel
| | - Nasrin Mohammadhasani
- Department of Educational Technology, Faculty of Educational Sciences and Psychology, Kharazmi University, Tehran, Iran
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Romano A, Lotan M, Fabio RA. A Severity Comparison between Italian and Israeli Rett Syndrome Cohorts. Diagnostics (Basel) 2023; 13:3390. [PMID: 37958286 PMCID: PMC10648171 DOI: 10.3390/diagnostics13213390] [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: 08/18/2023] [Revised: 10/08/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Rett syndrome (RTT) is a neurodevelopmental disorder marked by profound cognitive, communication, and motor impairments. Despite identified genotype/phenotype connections, the extent of clinical severity varies even among individuals sharing the same genetic mutation. Diverse sociocultural environments, such as the level of inclusivity of the scholar system, the time spent with family, and the intensity of the rehabilitative intervention provided, might influence their development diversely. This study examines the severity of RTT in people in Italy and Israel, countries with distinct contradictory approaches to caring for those with intricate disabilities, across two age groups. Data from 136 Italian and 59 Israeli girls and women with RTT were assessed and divided into two age categories: above and below 12 years. The RARS, a standardized RTT-specific clinical severity tool, was administered. Despite no differences in age and genetic characteristics, the Italian group showed better scores in the RARS motor and disease-related characteristics areas in both age groups. Moreover, the young Italian participants gathered better total RARS scores and emotional and behavioral characteristics area scores. Furthermore, the young group showed significantly less scoliosis, foot problems, and epilepsy than the older group. These findings endorse the inclusion of girls with RTT in the regular schooling system for a limited daily period, investing in high activity levels within the home and community environments, and suggest continuously providing the person with daily occasions of physical activity and socialization.
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Affiliation(s)
- Alberto Romano
- Department of Health System Management, Ariel University, Ariel 4070000, Israel
| | - Meir Lotan
- Department of Physiotherapy, Ariel University, Ariel 4070000, Israel
- Israeli Rett Syndrome National Evaluation Team, Ramat Gan 5200100, Israel
| | - Rosa Angela Fabio
- Department of Economics, University of Messina, 98122 Messina, Italy
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Malar DS, Thitilertdecha P, Ruckvongacheep KS, Brimson S, Tencomnao T, Brimson JM. Targeting Sigma Receptors for the Treatment of Neurodegenerative and Neurodevelopmental Disorders. CNS Drugs 2023; 37:399-440. [PMID: 37166702 PMCID: PMC10173947 DOI: 10.1007/s40263-023-01007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/12/2023]
Abstract
The sigma-1 receptor is a 223 amino acid-long protein with a recently identified structure. The sigma-2 receptor is a genetically unrelated protein with a similarly shaped binding pocket and acts to influence cellular activities similar to the sigma-1 receptor. Both proteins are highly expressed in neuronal tissues. As such, they have become targets for treating neurological diseases, including Alzheimer's disease (AD), Huntington's disease (HD), Parkinson's disease (PD), multiple sclerosis (MS), Rett syndrome (RS), developmental and epileptic encephalopathies (DEE), and motor neuron disease/amyotrophic lateral sclerosis (MND/ALS). In recent years, there have been many pre-clinical and clinical studies of sigma receptor (1 and 2) ligands for treating neurological disease. Drugs such as blarcamesine, dextromethorphan and pridopidine, which have sigma-1 receptor activity as part of their pharmacological profile, are effective in treating multiple aspects of several neurological diseases. Furthermore, several sigma-2 receptor ligands are under investigation, including CT1812, rivastigmine and SAS0132. This review aims to provide a current and up-to-date analysis of the current clinical and pre-clinical data of drugs with sigma receptor activities for treating neurological disease.
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Affiliation(s)
- Dicson S Malar
- Natural Products for Neuroprotection and Anti-ageing Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Premrutai Thitilertdecha
- Siriraj Research Group in Immunobiology and Therapeutic Sciences, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokphorn S Ruckvongacheep
- Department of Clinical Microscopy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Sirikalaya Brimson
- Department of Clinical Microscopy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Tewin Tencomnao
- Natural Products for Neuroprotection and Anti-ageing Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - James M Brimson
- Natural Products for Neuroprotection and Anti-ageing Research Unit, Chulalongkorn University, Bangkok, Thailand.
- Research, Innovation and International Affairs, Faculty of Allied Health Sciences, Chulalongkorn University, Room 409, ChulaPat-1 Building, 154 Rama 1 Road, Bangkok, 10330, Thailand.
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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.
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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
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Abstract
Early childhood affords rapid brain development and advancement of the motor system. In High-Risk Infant Follow-Up programs, watchful waiting and monitoring of infants at high risk is shifting toward active surveillance and early diagnosis, followed by immediate targeted very early interventions. Infants with delayed motor skills benefit from developmental care, NIDCAP, and generic or specific motor training. Infants with cerebral palsy benefit from enrichment, targeted skills interventions, and task-specific motor training at high intensity. Infants with degenerative conditions benefit from enrichment but also require accommodations such as powered mobility.
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Affiliation(s)
- Lynda McNamara
- The Children's Hospital Westmead Clinical School, The University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW 2145, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, PO Box 171, Forestville, Sydney, NSW 2006, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, PO Box 171, Forestville, Sydney, NSW 2006, Australia.
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de Alvarenga KAF, de Alcântara WL, de Miranda DM. What has been done to improve learning for intellectual disability? An umbrella review of published meta-analyses and systematic reviews. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:413-428. [PMID: 36760221 DOI: 10.1111/jar.13072] [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: 05/16/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Intellectual disability (ID) affects 1%-3% of the paediatric population. Currently, there is no consensus as to the most effective strategies for improving the learning skills of children and adolescents with ID. This review aims to systematically gather information regarding interventions to promote and improve learning skills in children/adolescents with ID from previously published systematic reviews and meta-analyses. METHODS Systematic search strategies, including appropriate descriptors, were employed on Medline, Cochrane, Scopus, Web of Science, Lilacs, SciELO, ERIC, and PsycINFO databases. Quality assessment was conducted via the AMSTAR-2. RESULTS Fifty-nine studies were selected, subdivided by outcome domains and by the type of intervention. Interventions were related to caregiving, education, pharmaco-dietary, physical, and technology approaches. The overall low quality of the studies limited our recommendations.
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Affiliation(s)
- Kevin Augusto Farias de Alvarenga
- Laboratório de Neurociências, Faculdade de Medicina-Centro de Tecnologia em Medicina Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Wagner Lima de Alcântara
- Laboratório de Neurociências, Faculdade de Medicina-Centro de Tecnologia em Medicina Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Débora Marques de Miranda
- Laboratório de Neurociências, Faculdade de Medicina-Centro de Tecnologia em Medicina Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Departamento de Pediatria, Faculdade de Medicina, Centro de Tecnologia em Medicina Molecular-Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Romero-Galisteo RP, González-Sánchez M, Costa L, Brandão R, Ramalhete C, Leão C, Jacobsohn L. Outcome measurement instruments in Rett syndrome: A systematic review. Eur J Paediatr Neurol 2022; 39:79-87. [PMID: 35717810 DOI: 10.1016/j.ejpn.2022.06.003] [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: 11/26/2021] [Revised: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to identify and characterize outcome measures for objective and subjective assessment in persons with Rett syndrome (RS). METHODS A systematic review was conducted consulting the EBSCO, Cochrane, Web of Science, Scielo, MEDLINE and PsycINFO databases for published studies describing the use of patient-reported outcome measures (PROMs) and other outcome measures in persons with RS. Validation studies and observational studies were included. The PROMs were first described, and then the measurement properties were evaluated using predefined criteria according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN). The outcome measures were then grouped according to the International Classification of Functioning, Disability and Health (ICF) to establish a relationship between outcome measures and ICF domains. RESULTS Twenty out of 2327 articles were appraised, and seventeen different outcome measures were identified and described. Ten outcome measures corresponded to evaluation questionnaires, while the remaining seven assessed functional outcomes: walking distance, physical activity level and ability to interact visually. A relation between these outcome measures that assess RS and the ICF allows understanding that most of the instruments (fifteen) include the assessment of activity limitations. CONCLUSIONS The findings of this study seem to be promising for their use by clinicians and researchers, although they have methodological limitations. The accuracy and quality of these individual outcome measures should continue to be assessed in an attempt to gather a consensus on the best tools used in RS.
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Affiliation(s)
- R P Romero-Galisteo
- Department of Physiotherapy, Faculty of Health Science, University of Málaga, Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - M González-Sánchez
- Department of Physiotherapy, Faculty of Health Science, University of Málaga, Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain.
| | - L Costa
- Escola Superior de Saúde Atlantica, Oeiras, Portugal
| | - R Brandão
- Escola Superior de Saúde Atlantica, Oeiras, Portugal
| | - C Ramalhete
- Atlântica- Instituto Universitário, Oeiras, Portugal; Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal
| | - C Leão
- Escola Superior de Saúde Atlantica, Oeiras, Portugal
| | - L Jacobsohn
- Escola Superior de Saúde Atlantica, Oeiras, Portugal
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Effect of Two Different Rehabilitation Approaches on Pulmonary Functional Tests, Neuromuscular Functions and Quality of Life in Juvenile Myasthenia Gravis: A Randomized Controlled Trial Study. Medicina (B Aires) 2022; 58:medicina58030374. [PMID: 35334548 PMCID: PMC8955821 DOI: 10.3390/medicina58030374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Children with juvenile myasthenia gravis have a variety of symptoms, ranging from isolated intermittent ocular complaints to overall muscle weakness with or without respiratory insufficiency. This study aimed to investigate the efficacy of a specialized physical therapy with or without partial body weight supported treadmill training on pulmonary functional tests, neuromuscular functions, and quality of life. Materials and Methods: Thirty children, ranging in age from 13 to 16 years, were distributed randomly into two study groups (A or B). Both groups underwent a designed physical therapy program. In addition, group A underwent the partial body weight supported treadmill training. The treatment was conducted three times a week for 12 weeks successively. Pulmonary functional tests (FVC, FEV1, PEFR, and MVV), neuromuscular function tests (compound motor action potential, isometric muscle force of biceps brachii and rectus femoris, balance, walking endurance, and fatigue), and quality of life were measured before and after 12 successive weeks. Results: A significant improvement in all investigated variables were recorded in both groups in favor of group A. Conclusions: Both a specialized physical therapy and partial body weight supported treadmill training are effective in terms of enhancing pulmonary functional tests, neuromuscular functions, and quality of life. Partial body weight supported treadmill training is an excellent adjunctive to the physical therapy program.
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11
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Roidi MLR, Toshimori K, Colletti A, Ripamonti E, Olivieri I. A semi-standardized music therapy intervention for girls with Rett syndrome: A descriptive essay. J Pediatr Rehabil Med 2022; 15:323-334. [PMID: 35001899 DOI: 10.3233/prm-200736] [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: 11/15/2022] Open
Abstract
Rett syndrome (RTT) is a severe neurodevelopmental disorder resulting in a wide range of functional impairments and therefore greatly impacts the lives of both patients and their families. While genetic and medical aspects have been studied for several decades, rehabilitation intervention research is still in its infancy. In this study, the investigating researchers have presented a rehabilitative framework by using music therapy for girls with RTT. This model is founded upon the use of music therapy in light of Stern's proposal of subjective experience and affect attunement; it also refers to Rosenbaum's family-centered rehabilitation medicine perspective. This study both describes the theory behind this intervention and presents a newly developed outcome measure. This novel tool may have future clinical and research applications. Music therapy for patients with RTT has not been well researched yet, and, as a result, is not universally recommended. However this study's findings suggest that music therapy is an important component of multidisciplinary therapy. Further collaborative research should be encouraged in order to study and implement the use of music therapy in the treatment of severe disabilities. Projects such as the Enablin+ program with the support from the European Commission constitute fundamental tools in promoting integrative medical research and international networks.
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Affiliation(s)
| | | | | | - Enrico Ripamonti
- Milan Center for Neuroscience, University of Milan-Bicocca, Milan, Italy.,Department of Economics and Management, University of Brescia, Brescia, Italy
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12
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Singh J, Lanzarini E, Nardocci N, Santosh P. Movement disorders in patients with Rett syndrome: A systematic review of evidence and associated clinical considerations. Psychiatry Clin Neurosci 2021; 75:369-393. [PMID: 34472659 PMCID: PMC9298304 DOI: 10.1111/pcn.13299] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/28/2021] [Accepted: 08/20/2021] [Indexed: 12/18/2022]
Abstract
AIM This systematic review identified and thematically appraised clinical evidence of movement disorders in patients with Rett syndrome (RTT). METHOD Using PRISMA criteria, six electronic databases were searched from inception to April 2021. A thematic analysis was then undertaken on the extracted data to identify potential themes. RESULTS Following the thematic analysis, six themes emerged: (i) clinical features of abnormal movement behaviors; (ii) mutational profile and its impact on movement disorders; (iii) symptoms and stressors that impact on movement disorders; (iv) possible underlying neurobiological mechanisms; (v) quality of life and movement disorders; and (vi) treatment of movement disorders. Current guidelines for managing movement disorders in general were then reviewed to provide possible treatment recommendations for RTT. CONCLUSION Our study offers an enriched data set for clinical investigations and treatment of fine and gross motor issues in RTT. A detailed understanding of genotype-phenotype relationships of movement disorders allows for more robust genetic counseling for families but can also assist healthcare professionals in terms of monitoring disease progression in RTT. The synthesis also showed that environmental enrichment would be beneficial for improving some aspects of movement disorders. The cerebellum, basal ganglia, alongside dysregulation of the cortico-basal ganglia-thalamo-cortical loop, are likely anatomical targets. A review of treatments for movement disorders also helped to provide recommendations for treating and managing movement disorders in patients with RTT.
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Affiliation(s)
- Jatinder Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK.,Centre for Personalised Medicine in Rett Syndrome, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Evamaria Lanzarini
- Child and Adolescent Neuropsychiatry Unit, Infermi Hospital, Rimini, Italy
| | - Nardo Nardocci
- Department of Paediatric Neurology, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK.,Centre for Personalised Medicine in Rett Syndrome, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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13
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Low-intensity extracorporeal shock wave therapy promotes recovery of sciatic nerve injury and the role of mechanical sensitive YAP/TAZ signaling pathway for nerve regeneration. Chin Med J (Engl) 2021; 134:2710-2720. [PMID: 34845995 PMCID: PMC8631414 DOI: 10.1097/cm9.0000000000001431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Histological and functional recovery after peripheral nerve injury (PNI) is of significant clinical value as delayed surgical repair and longer distances to innervate terminal organs may account for poor outcomes. Low-intensity extracorporeal shock wave therapy (LiESWT) has already been proven to be beneficial for injured tissue recovery on various pathological conditions. The objective of this study was to explore the potential effect and mechanism of LiESWT on PNI recovery. Methods: In this project, we explored LiESWT's role using an animal model of sciatic nerve injury (SNI). Shockwave was delivered to the region of the SNI site with a special probe at 3 Hz, 500 shocks each time, and 3 times a week for 3 weeks. Rat Schwann cells (SCs) and rat perineurial fibroblasts (PNFs) cells, the two main compositional cell types in peripheral nerve tissue, were cultured in vitro, and LiESWT was applied through the cultured dish to the adherent cells. Tissues and cell cultures were harvested at corresponding time points for a reverse transcription-polymerase chain reaction, Western blotting, and immunofluorescence staining. Multiple groups were compared by using one-way analysis of variance followed by the Tukey-Kramer test for post hoc comparisons. Results: LiESWT treatment promoted the functional recovery of lower extremities with SNI. More nerve fibers and myelin sheath were found after LiESWT treatment associated with local upregulation of mechanical sensitive yes-associated protein (YAP)/transcriptional co-activator with a PDZ-binding domain (TAZ) signaling pathway. In vitro results showed that SCs were more sensitive to LiESWT than PNFs. LiESWT promoted SCs activation with more expression of p75 (a SCs dedifferentiation marker) and Ki67 (a SCs proliferation marker). The SCs activation process was dependent on the intact YAP/TAZ signaling pathway as knockdown of TAZ by TAZ small interfering RNA significantly attenuated this process. Conclusion: The LiESWT mechanical signal perception and YAP/TAZ upregulation in SCs might be one of the underlying mechanisms for SCs activation and injured nerve axon regeneration.
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14
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Pool D, Elliott C. Kindy Moves: a protocol for establishing the feasibility of an activity-based intervention on goal attainment and motor capacity delivered within an interdisciplinary framework for preschool aged children with cerebral palsy. BMJ Open 2021; 11:e046831. [PMID: 34389566 PMCID: PMC8365782 DOI: 10.1136/bmjopen-2020-046831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 08/03/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Preschool aged children with cerebral palsy (CP) and like conditions are at risk of performing below their peers in key skill areas of school readiness. Kindy Moves was developed to support school readiness in preschool aged children with CP and like conditions that are dependent on physical assistance and equipment throughout the day. The primary aims are to determine the feasibility of motor-based interventions that are functional and goal directed, adequately dosed and embedded into a play environment with interdisciplinary support to optimise goal-driven outcomes. METHODS AND ANALYSIS Forty children with CP and like conditions aged between 2 and 5 years with a Gross Motor Function Classification System (GMFCS) level of III-V or equivalent, that is, dependent on physical assistance and equipment will be recruited in Western Australia. Participants will undertake a 4-week programme, comprised three, 2-hour sessions a week consisting of floor time, gross motor movement and play (30 min), locomotor treadmill training (30 min), overground walking in gait trainers (30 min) and table-top activities (30 min). The programme is group based with 3-4 children of similar GMFCS levels in each group. However, each child will be supported by their own therapist providing an interdisciplinary and goal directed approach. Primary outcomes of this feasibility study will be goal attainment (Goal Attainment Scale) and secondary outcomes will include Canadian Occupational Performance Measure, 10 metre walk test, Children's Functional Independence Measure, Sleep Disturbance Scale, Infant and Toddler Quality of Life Questionnaire, Peabody Developmental Motor Scale and Gross Motor Function Measure. Outcomes will be assessed at baseline, post intervention (4 weeks) and retention at the 4-week follow-up. ETHICS AND DISSEMINATION Ethical approval was obtained from Curtin University Human Ethics Committee (HRE2019-0073). Results will be disseminated through published manuscripts in peer-reviewed journals, conference presentations and public seminars for stakeholder groups. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12619000064101p).
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Affiliation(s)
- Dayna Pool
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- The Healthy Strides Foundation, Perth, Western Australia, Australia
| | - Catherine Elliott
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Telethon Institute for Child Health Research, Nedlands, Western Australia, Australia
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15
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Sommese M, Corrado B. A Comprehensive Approach to Rehabilitation Interventions in Patients with Angelman Syndrome: A Systematic Review of the Literature. Neurol Int 2021; 13:359-370. [PMID: 34449677 PMCID: PMC8395863 DOI: 10.3390/neurolint13030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022] Open
Abstract
Angelman syndrome is a rare genetic disease affecting the central nervous system and neurobehavioral development causing severe mental, linguistic, and physical disabilities. The purpose of this review was to analyze the most recent evidence regarding the rehabilitation of subjects affected by this syndrome. The review was carried out in accordance with the preferred reporting items for systematic reviews and meta-analyses. A total of 3661 studies were identified in the databases. Once the inclusion/exclusion criteria were applied, 15 studies were considered for the paper's preparation. The level of evidence of the studies was established according to the criteria of the Oxford Center for Evidence-Based Medicine-Levels of Evidence. From the selected studies, five rehabilitative approaches emerged: physiotherapy, applied behavioral analysis, toilet training, microswitch-cluster technology, and augmentative and alternative communication. Although the studies did not have a high level of evidence, the reported results appear to be encouraging and pave the way for further studies. It seems that individualized and multidisciplinary rehabilitation interventions help to improve patients' autonomy and quality of life. In some studies, the caregivers' role was fundamental to identify preferences and long-term improvements. Further studies on larger populations and with better methodological quality are needed to confirm the results.
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Affiliation(s)
| | - Bruno Corrado
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
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16
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Tolentino-Castro JW, Raab M. Intellectual Disabilities Behavior Under the Lens of Embodied Cognition Approaches. Front Psychol 2021; 12:620083. [PMID: 34322048 PMCID: PMC8311120 DOI: 10.3389/fpsyg.2021.620083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Walter Tolentino-Castro
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany.,School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
| | - Markus Raab
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany.,School of Applied Sciences, London South Bank University, London, United Kingdom
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17
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Pecorelli A, Cordone V, Schiavone ML, Caffarelli C, Cervellati C, Cerbone G, Gonnelli S, Hayek J, Valacchi G. Altered Bone Status in Rett Syndrome. Life (Basel) 2021; 11:life11060521. [PMID: 34205017 PMCID: PMC8230033 DOI: 10.3390/life11060521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
Rett syndrome (RTT) is a monogenic neurodevelopmental disorder primarily caused by mutations in X-linked MECP2 gene, encoding for methyl-CpG binding protein 2 (MeCP2), a multifaceted modulator of gene expression and chromatin organization. Based on the type of mutation, RTT patients exhibit a broad spectrum of clinical phenotypes with various degrees of severity. In addition, as a complex multisystem disease, RTT shows several clinical manifestations ranging from neurological to non-neurological symptoms. The most common non-neurological comorbidities include, among others, orthopedic complications, mainly scoliosis but also early osteopenia/osteoporosis and a high frequency of fractures. A characteristic low bone mineral density dependent on a slow rate of bone formation due to dysfunctional osteoblast activity rather than an increase in bone resorption is at the root of these complications. Evidence from human and animal studies supports the idea that MECP2 mutation could be associated with altered epigenetic regulation of bone-related factors and signaling pathways, including SFRP4/WNT/β-catenin axis and RANKL/RANK/OPG system. More research is needed to better understand the role of MeCP2 in bone homeostasis. Indeed, uncovering the molecular mechanisms underlying RTT bone problems could reveal new potential pharmacological targets for the treatment of these complications that adversely affect the quality of life of RTT patients for whom the only therapeutic approaches currently available include bisphosphonates, dietary supplements, and physical activity.
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Affiliation(s)
- Alessandra Pecorelli
- Animal Science Department, Plants for Human Health Institute, North Carolina State University, Kannapolis, NC 28081, USA;
- Correspondence: (A.P.); (G.V.)
| | - Valeria Cordone
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy;
| | - Maria Lucia Schiavone
- Animal Science Department, Plants for Human Health Institute, North Carolina State University, Kannapolis, NC 28081, USA;
| | - Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy; (C.C.); (S.G.)
| | - Carlo Cervellati
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy;
| | - Gaetana Cerbone
- Division of Medical Genetics, “S.G. Moscati” Hospital, 74100 Avellino, Italy;
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy; (C.C.); (S.G.)
| | - Joussef Hayek
- Toscana Life Sciences Foundation, 53100 Siena, Italy;
| | - Giuseppe Valacchi
- Animal Science Department, Plants for Human Health Institute, North Carolina State University, Kannapolis, NC 28081, USA;
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy;
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea
- Correspondence: (A.P.); (G.V.)
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18
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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.
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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
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19
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Supervised Physical Therapy and Polymyositis/Dermatomyositis-A Systematic Review of the Literature. Neurol Int 2020; 12:77-88. [PMID: 33255200 PMCID: PMC7768488 DOI: 10.3390/neurolint12030015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Abstract
Objective: to find the most up-to-date evidence of the effectiveness and safety of supervised physical therapy in polymyositis/dermatomyositis patients. Methods: a systematic review of the literature in the main scientific databases was carried out. We searched for randomized controlled trials concerning supervised physical therapy and polymyositis/dermatomyositis. The PICOS method was used for the formulation of the clinical query. Methodological quality and the level of evidence of the included studies were assessed using the modified Jadad scale and the Oxford Centre for Evidence-Based Medicine Levels of Evidence guide, respectively. Results: a total of 2591 articles were found. By applying the inclusion/exclusion criteria, six randomized controlled clinical trials were admitted to the final phase of the review. The compared approaches concerned supervised exercise programs based on strategies of muscle strengthening or aerobic work. Following these exercises, an increase in the maximum rate of oxygen consumption, a decrease in creatine phosphokinase levels, an enhancement in the patient’s aerobic performance and an improvement in the quality of life indexes were registered. The methodological quality of the included studies ranged from 3 to 4.5. All the studies were classified as presenting an evidence level of 2b. Conclusions: supervised physical therapy in polymyositis/dermatomyositis is an effective, safe and free-of-contraindications tool to be used both in the acute and in the established phases of the pathology. However, further and higher-quality studies are necessary to confirm those findings, to clarify the timing of exercise delivery and to guide the choice towards different types of muscle contraction exercises.
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20
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Corrado B, Giardulli B, Costa M. Evidence-Based Practice in Rehabilitation of Myasthenia Gravis. A Systematic Review of the Literature. J Funct Morphol Kinesiol 2020; 5:jfmk5040071. [PMID: 33467286 PMCID: PMC7739309 DOI: 10.3390/jfmk5040071] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 12/28/2022] Open
Abstract
Myasthenia gravis is a rare neuromuscular disorder characterized by muscle weakness and fatigue. This review analyzes the most recent evidence regarding the effectiveness and safety of different rehabilitative approaches to the disease. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 365 articles were found in the main scientific databases. Applying the inclusion/exclusion criteria, 11 studies were admitted to the final phase of the review. Three different rehabilitative approaches were identified: physical training, respiratory training, and balance training. All rehabilitative modalities contributed to enhancing functional outcomes, reducing fatigue, and improving quality of life, but currently none can be recommended over another for the lack of cross-comparative studies. The included studies showed methodological quality from low to fair. Despite the range of rehabilitative interventions available, there is a lack of high-quality evidence. However, this review suggests that a multidisciplinary rehabilitation approach should be recommended to people with myasthenia gravis, and above all, for those with mild to moderate symptomatology.
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Affiliation(s)
- Bruno Corrado
- Department of Public Health, University Federico II of Naples, Via S. Pansini n.5, 80131 Naples, Italy;
- Correspondence: ; Tel.: +39-0817462796; Fax: +39-0817462881
| | - Benedetto Giardulli
- Department of Public Health, University Federico II of Naples, Via S. Pansini n.5, 80131 Naples, Italy;
| | - Massimo Costa
- Department of Polyspecialistic Medicine, Cardarelli Hospital, Via A. Cardarelli, 80131 Naples, Italy;
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