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Santoro JD, Jafarpour S, Khoshnood MM, Boyd NK, Vogel BN, Nguyen L, Saucier LE, Partridge R, Tiongson E, Ramos-Platt L, Nagesh D, Ho E, Rosser T, Ahsan N, Mitchell WG, Rafii MS. Safety and tolerability of intravenous immunoglobulin infusion in Down syndrome regression disorder. Am J Med Genet A 2024; 194:e63524. [PMID: 38169137 DOI: 10.1002/ajmg.a.63524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/06/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Abstract
Three large multi-center studies have identified the clinical utility of intravenous immunoglobulin (IVIg) in the treatment of Down syndrome regression disorder (DSRD). Yet the tolerability of infusions in individuals with DS and the safety of IVIg remains unknown in this population. This study sought to evaluate the safety and tolerability of IVIg in individuals with DSRD compared to a real-world cohort of individuals with pediatric onset neuroimmunologic disorders. A single-center, retrospective chart review evaluating clinically documented infusion reactions was performed for individuals meeting international consensus criteria for DSRD and having IVIg infusions between 2019 and 2023. Infusion reactions were evaluated for severity and need for alterations in infusion plan. This cohort was compared against an age and sex matched cohort of children with neuroimmunologic conditions who had also received IVIg infusions. In total, 127 individuals with DSRD and 186 individuals with other neuroimmunologic disorders were enrolled. There was no difference in the overall rate of adverse reactions (AEs) between the DSRD and general neuroimmunology cohorts (p = 0.31, 95% CI: 0.80-2.00), but cardiac-related AEs specifically were more common among the DSRD group (p = 0.02, 95% CI: 1.23-17.54). When AEs did occur, there was no difference in frequency of pharmacologic intervention (p = 0.12, 95% CI: 0.34-1.13) or discontinuation of therapy (p = 0.74, 95% CI: 0.06-7.44). There was a higher incidence of lab abnormalities on IVIG among the general neuroimmunology cohort (p = 0.03, 95% CI: 0.24-0.94) compared to the DSRD cohort. Transaminitis was the most common laboratory abnormality in the DSRD group. In a large cohort of individuals with DSRD, there were no significant differences in the safety and tolerability of IVIg compared to a cohort of children and young adults with neuroimmunologic conditions.
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Affiliation(s)
- Jonathan D Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Saba Jafarpour
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Mellad M Khoshnood
- Department of Pediatrics, Los Angeles General Hospital, Los Angeles, California, USA
| | - Natalie K Boyd
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Benjamin N Vogel
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Lina Nguyen
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Laura E Saucier
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | | | - Emmanuelle Tiongson
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Leigh Ramos-Platt
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Deepti Nagesh
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Eugenia Ho
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Tena Rosser
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Nusrat Ahsan
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Wendy G Mitchell
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Michael S Rafii
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, California, USA
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Santoro JD, Khoshnood MM, Jafarpour S, Nguyen L, Boyd NK, Vogel BN, Kammeyer R, Patel L, Manning MA, Rachubinski AL, Filipink RA, Baumer NT, Santoro SL, Franklin C, Tamrazi B, Yeom KW, Worley G, Espinosa JM, Rafii MS. Neuroimaging abnormalities associated with immunotherapy responsiveness in Down syndrome regression disorder. Ann Clin Transl Neurol 2024; 11:1034-1045. [PMID: 38375538 PMCID: PMC11021615 DOI: 10.1002/acn3.52023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE To determine the prevalence of neuroimaging abnormalities in individuals with Down syndrome regression disorder (DSRD) and evaluate if neuroimaging abnormalities were predictive of therapeutic responses. METHODS A multicenter, retrospective, case-control study which reviewed neuroimaging studies of individuals with DSRD and compared them to a control cohort of individuals with Down syndrome (DS) alone was performed. Individuals aged 10-30 years and meeting international consensus criteria for DSRD were included. The presence of T1, T2/FLAIR, and SWI signal abnormalities was reviewed. Response rates to various therapies, including immunotherapy, were evaluated in the presence of neuroimaging abnormalities. RESULTS In total, 74 individuals (35%) had either T2/FLAIR and/or SWI signal abnormality compared to 14 individuals (12%) without DSRD (p < 0.001, 95%CI: 2.18-7.63). T2/FLAIR signal abnormalities were not appreciated more frequently in individuals with DSRD (14%, 30/210) than in the control cohort (9%, 11/119) (p = 0.18, OR: 1.63, 95%CI: 0.79-3.40). SWI signal abnormalities were appreciated at a higher frequency in individuals with DSRD (24%, 51/210) compared to the control cohort (4%, 5/119) (p < 0.001, OR: 7.31, 95%CI: 2.83-18.90). T2/FLAIR signal abnormalities were localized to the frontal (40%, 12/30) and parietal lobes (37%, 11/30). SWI signal abnormalities were predominantly in the bilateral basal ganglia (94%, 49/52). Individuals with DSRD and the presence of T2/FLAIR and/or SWI signal abnormalities were much more likely to respond to immunotherapy (p < 0.001, OR: 8.42. 95%CI: 3.78-18.76) and less likely to respond to benzodiazepines (p = 0.01, OR: 0.45, 95%CI: 0.25-0.83), antipsychotics (p < 0.001, OR: 0.28, 95%CI: 0.11-0.55), or electroconvulsive therapy (p < 0.001, OR: 0.12; 95%CI: 0.02-0.78) compared to individuals without these neuroimaging abnormalities. INTERPRETATION This study indicates that in individuals diagnosed with DSRD, T2/FLAIR, and SWI signal abnormalities are more common than previously thought and predict response to immunotherapy.
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Affiliation(s)
- Jonathan D. Santoro
- Division of Neuroimmunology, Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
- Department of NeurologyKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mellad M. Khoshnood
- Division of Neuroimmunology, Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Saba Jafarpour
- Division of Neuroimmunology, Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Lina Nguyen
- Division of Neuroimmunology, Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Natalie K. Boyd
- Division of Neuroimmunology, Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Benjamin N. Vogel
- Division of Neuroimmunology, Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Ryan Kammeyer
- Department of NeurologyChildren's Hospital ColoradoAuroraColoradoUSA
| | - Lina Patel
- Department of NeurologyChildren's Hospital ColoradoAuroraColoradoUSA
- Department of Pharmacology, Linda Crnic Institute for Down SyndromeUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Melanie A. Manning
- Department of GeneticsStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Angela L. Rachubinski
- Department of Pharmacology, Linda Crnic Institute for Down SyndromeUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Robyn A. Filipink
- Division of Child Neurology, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Nicole T. Baumer
- Division of Developmental Medicine, Department of PediatricsBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Stephanie L. Santoro
- Genetics and Metabolism DivisionMassachusetts General Hospital for ChildrenBostonMassachusettsUSA
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
| | - Catherine Franklin
- Mater Research Institute‐UQThe University of QueenslandBrisbaneQueenslandAustralia
| | - Benita Tamrazi
- Department of RadiologyChildren's Hospital Los Angeles and Keck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kristen W. Yeom
- Department of RadiologyStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Gordon Worley
- Department of PediatricsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Joaquin M. Espinosa
- Department of Pharmacology, Linda Crnic Institute for Down SyndromeUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Michael S. Rafii
- Department of NeurologyKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
- Alzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
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Vancura J, Boyd NK, Vogel BN, Nagesh D, Ho E, Santoro JD. Rapidly progressive moyamoya vasculopathy stabilized with immunotherapy in aicardi-goutières syndrome. J Neurol 2024; 271:1019-1022. [PMID: 37855872 DOI: 10.1007/s00415-023-12040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/07/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Jenae Vancura
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Natalie K Boyd
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Benjamin N Vogel
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Deepti Nagesh
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Neurology, Keck School of Medicine of the, University of Southern California, Los Angeles, CA, USA
| | - Eugenia Ho
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Neurology, Keck School of Medicine of the, University of Southern California, Los Angeles, CA, USA
| | - Jonathan D Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.
- Department of Neurology, Keck School of Medicine of the, University of Southern California, Los Angeles, CA, USA.
- Division of Neuroimmunology, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS 82, Los Angeles, CA, 90027, USA.
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Abe J, Jafarpour S, Vu MH, O'Brien D, Boyd NK, Vogel BN, Nguyen L, Paulsen KC, Saucier LE, Ahsan N, Mitchell WG, Santoro JD. Impact of endocrine dysregulation on disability and non-motor symptoms in pediatric onset multiple sclerosis. Front Neurol 2023; 14:1304610. [PMID: 38130835 PMCID: PMC10733457 DOI: 10.3389/fneur.2023.1304610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background Pediatric onset multiple sclerosis (POMS) commonly occurs at the time of various endocrine changes. Evaluation of the impact of endocrine status on disease severity in POMS has not been previously explored. Objective This study sought to evaluate if sex and stress hormones in children with POMS impact motor and non-motor diseases severity. Methods A single-center case control study was performed. Individuals with POMS were compared to individuals without neurologic disease. Each individual had three blood draws assessing stress and sex hormones between 07:00 and 09:00. Measures of fatigue (Epworth sleepiness scale), depression (PHQ-9), and quality of life (PedsQL) assessed at each visit. Results Forty individuals with POMS and 40 controls were enrolled. Individuals with POMS had lower free testosterone (p = 0.003), cortisol (p < 0.001), and ACTH (p < 0.001) and had higher progesterone (p = 0.025) levels than controls. Relapses and EDSS were not impacted by endocrine variables. The POMS cohort had a significantly higher Epworth score (p < 0.001), PHQ-9 score (p < 0.001), and lower PQL score (p < 0.001) than controls. Non-motor measures were not associated with endocrine status. Conclusion Free testosterone, cortisol, ACTH, and progesterone were abnormal in children with POMS although there was no association between endocrine status and markers of disease severity or non-motor symptoms of MS.
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Affiliation(s)
- Justin Abe
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
| | - Saba Jafarpour
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - My H. Vu
- Biostatistics and Data Management Core, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Devon O'Brien
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Natalie K. Boyd
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Benjamin N. Vogel
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lina Nguyen
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Kelli C. Paulsen
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Laura E. Saucier
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Nusrat Ahsan
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Wendy G. Mitchell
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Jonathan D. Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, United States
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Jain A, Boyd NK, Paulsen KC, Vogel BN, Nguyen L, Santoro JD. Ophthalmologic and neuro-ophthalmologic findings in children with Down syndrome. Am J Med Genet C Semin Med Genet 2023; 193:e32068. [PMID: 37794641 DOI: 10.1002/ajmg.c.32068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
Down syndrome, also known as Trisomy 21, is a genetic disorder associated with mild-to-moderate intellectual disability, delays in growth, and characteristic facial features. A wide range of ocular complications are seen in children with Down syndrome, including strabismus, nystagmus, refractive errors, congenital cataracts, the presence of keratoconus, and decreased visual acuity. Early ophthalmic examination is needed for early diagnosis and treatment in patients. This narrative review examines ocular manifestations in children with Down syndrome and the importance of prompt ophthalmic interventions for treatment.
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Affiliation(s)
| | - Natalie K Boyd
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Kelli C Paulsen
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Benjamin N Vogel
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Lina Nguyen
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jonathan D Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA
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Santoro JD, Khoshnood MM, Nguyen L, Vogel BN, Boyd NK, Paulsen KC, Rafii MS. Alternative Diagnoses in the Work Up of Down Syndrome Regression Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-06057-9. [PMID: 37584771 DOI: 10.1007/s10803-023-06057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Down Syndrome Regression Disorder (DSRD) is a diagnosis of exclusion. Psychiatric and neuroimmunologic etiologies have been proposed although the exact etiology remains unknown. This study sought to review non-DSRD diagnoses at a large quaternary medical center specializing in the diagnosis of DSRD and compare clinical characteristics between those diagnosed with DSRD and those with non-DSRD diagnoses. METHODS The authors performed a single-center retrospective, chart-based, review of referrals for developmental regression in individuals with Down syndrome. RESULTS Two hundred and sixty-six individuals were evaluated for DSRD and of these, 54 (20%) ultimately had alternative diagnoses. Individuals with DSRD were more likely to have shorter nadir to clinical symptoms (p = 0.01, 95% CI: 0.36-0.47) and have preceding triggers (p < 0.001, 95% CI: 1.13-1.43) compared to those with alternative diagnoses. Individuals with non-DSRD diagnoses were more likely to be born premature (p = 0.01, 95% CI: 0.51-0.87) and have a history of epilepsy (p = 0.01, 95% CI: 0.23-0.77) but were also less likely to have a history of cytokine abnormalities on bloodwork (p < 0.001, 95% CI: 1.19-1.43) and have catatonia (p < 0.001, 95% CI: 1.54-2.17). The majority of alternative diagnoses (41/54, 76%) were autism spectrum disorder. In these cases, symptoms were more likely to be longstanding (symptoms > 12 months) and earlier onset (median 8 years, IQR: 6-11). Other diagnoses included epilepsy (5/54, 9%), Celiac disease (5/54, 9%), cerebrovascular disease (3/54, 6%). CONCLUSIONS This study identifies that 20% of individuals referred with concerns for DSRD have alternative diagnoses. The majority of these diagnoses were autism, but rare treatable conditions were also identified, highlighting the importance of a thorough neurodiagnostic assessment.
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Affiliation(s)
- Jonathan D Santoro
- Division of Neuroimmunology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
- Division of Neurology, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS 82, Los Angeles, CA, 90027, USA.
| | - Mellad M Khoshnood
- Division of Neuroimmunology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Lina Nguyen
- Division of Neuroimmunology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Benjamin N Vogel
- Division of Neuroimmunology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Natalie K Boyd
- Division of Neuroimmunology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kelli C Paulsen
- Division of Neuroimmunology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Michael S Rafii
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Department of Neurology, Alzheimer's Therapeutic Research Institute (ATRI), Keck School of Medicine, University of Southern California, San Diego, CA, USA
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Santoro JD, Patel L, Kammeyer R, Filipink RA, Gombolay GY, Cardinale KM, Real de Asua D, Zaman S, Santoro SL, Marzouk SM, Khoshnood M, Vogel BN, Tanna R, Pagarkar D, Dhanani S, Ortega MDC, Partridge R, Stanley MA, Sanders JS, Christy A, Sannar EM, Brown R, McCormick AA, Van Mater H, Franklin C, Worley G, Quinn EA, Capone GT, Chicoine B, Skotko BG, Rafii MS. Assessment and Diagnosis of Down Syndrome Regression Disorder: International Expert Consensus. Front Neurol 2022; 13:940175. [PMID: 35911905 PMCID: PMC9335003 DOI: 10.3389/fneur.2022.940175] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo develop standardization for nomenclature, diagnostic work up and diagnostic criteria for cases of neurocognitive regression in Down syndrome.BackgroundThere are no consensus criteria for the evaluation or diagnosis of neurocognitive regression in persons with Down syndrome. As such, previously published data on this condition is relegated to smaller case series with heterogenous data sets. Lack of standardized assessment tools has slowed research in this clinical area.MethodsThe authors performed a two-round traditional Delphi method survey of an international group of clinicians with experience in treating Down syndrome to develop a standardized approach to clinical care and research in this area. Thirty-eight potential panelists who had either previously published on neurocognitive regression in Down syndrome or were involved in national or international working groups on this condition were invited to participate. In total, 27 panelists (71%) represented nine medical specialties and six different countries reached agreement on preliminary standards in this disease area. Moderators developed a proposed nomenclature, diagnostic work up and diagnostic criteria based on previously published reports of regression in persons with Down syndrome.ResultsDuring the first round of survey, agreement on nomenclature for the condition was reached with 78% of panelists agreeing to use the term Down Syndrome Regression Disorder (DSRD). Agreement on diagnostic work up and diagnostic criteria was not reach on the first round due to low agreement amongst panelists with regards to the need for neurodiagnostic testing. Following incorporation of panelist feedback, diagnostic criteria were agreed upon (96% agreement on neuroimaging, 100% agreement on bloodwork, 88% agreement on lumbar puncture, 100% agreement on urine studies, and 96% agreement on “other” studies) as were diagnostic criteria (96% agreement).ConclusionsThe authors present international consensus agreement on the nomenclature, diagnostic work up, and diagnostic criteria for DSRD, providing an initial practical framework that can advance both research and clinical practices for this condition.
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Affiliation(s)
- Jonathan D. Santoro
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine at USC, Los Angeles, CA, United States
- *Correspondence: Jonathan D. Santoro
| | - Lina Patel
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States
| | - Ryan Kammeyer
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Robyn A. Filipink
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Grace Y. Gombolay
- Department of Pediatrics, Division of Neurology, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Kathleen M. Cardinale
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Diego Real de Asua
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Fundación de Investigación Biomédica, Hospital Universitario de La Princesa, Madrid, Spain
| | - Shahid Zaman
- Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Stephanie L. Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Sammer M. Marzouk
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Mellad Khoshnood
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Benjamin N. Vogel
- Department of Neurology, Keck School of Medicine at USC, Los Angeles, CA, United States
| | - Runi Tanna
- Department of Neurology, Keck School of Medicine at USC, Los Angeles, CA, United States
| | - Dania Pagarkar
- Department of Neurology, Keck School of Medicine at USC, Los Angeles, CA, United States
| | - Sofia Dhanani
- Department of Neurology, Keck School of Medicine at USC, Los Angeles, CA, United States
| | | | | | - Maria A. Stanley
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Jessica S. Sanders
- Sie Center for Down Syndrome at the University of Colorado, Aurora, CO, United States
| | | | - Elise M. Sannar
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States
- Division of Psychiatry and Behavioral Sciences, Children's Hospital Colorado, Aurora, CO, United States
| | - Ruth Brown
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Andrew A. McCormick
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Heather Van Mater
- Division of Rheumatology, Department of Pediatrics, Duke University, Durham, NC, United States
| | - Cathy Franklin
- Queensland Center for Intellectual and Developmental Disability, Mater Research Institute, The University of Queensland, South Brisbane, QLD, Australia
| | - Gordon Worley
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Eileen A. Quinn
- Department of Pediatrics, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States
| | - George T. Capone
- Department of Pediatrics, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Brian Chicoine
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL, United States
| | - Brian G. Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Michael S. Rafii
- Department of Neurology, Keck School of Medicine at USC, Los Angeles, CA, United States
- Department of Neurology, Alzheimer's Therapeutic Research Institute (ATRI), Keck School of Medicine at the University of Southern California, San Diego, CA, United States
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