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Rosen CL, Aurora RN, Kapur VK, Ramos AR, Rowley JA, Troester MM, Zak RS. Supporting American Academy of Neurology's new clinical practice guideline on evaluation and management of insomnia in children with autism. J Clin Sleep Med 2020; 16:989-990. [PMID: 32125270 DOI: 10.5664/jcsm.8426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals-Cleveland Medical Center, Cleveland, Ohio
| | - R Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Vishesh K Kapur
- Division of Pulmonary Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Alberto R Ramos
- Department of Neurology, University of Miami, Miami, Florida
| | | | | | - Rochelle S Zak
- Sleep Disorders Center, University of California, San Francisco, California
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Boerwinkle VL, Mirea L, Gaillard WD, Sussman BL, Larocque D, Bonnell A, Ronecker JS, Troester MM, Kerrigan JF, Foldes ST, Appavu B, Jarrar R, Williams K, Wilfong AA, Adelson PD. Resting-state functional MRI connectivity impact on epilepsy surgery plan and surgical candidacy: prospective clinical work. J Neurosurg Pediatr 2020; 25:574-581. [PMID: 32197251 DOI: 10.3171/2020.1.peds19695] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' goal was to prospectively quantify the impact of resting-state functional MRI (rs-fMRI) on pediatric epilepsy surgery planning. METHODS Fifty-one consecutive patients (3 months to 20 years old) with intractable epilepsy underwent rs-fMRI for presurgical evaluation. The team reviewed the following available diagnostic data: video-electroencephalography (n = 51), structural MRI (n = 51), FDG-PET (n = 42), magnetoencephalography (n = 5), and neuropsychological testing (n = 51) results to formulate an initial surgery plan blinded to the rs-fMRI findings. Subsequent to this discussion, the connectivity results were revealed and final recommendations were established. Changes between pre- and post-rs-fMRI treatment plans were determined, and changes in surgery recommendation were compared using McNemar's test. RESULTS Resting-state fMRI was successfully performed in 50 (98%) of 51 cases and changed the seizure onset zone localization in 44 (88%) of 50 patients. The connectivity results prompted 6 additional studies, eliminated the ordering of 11 further diagnostic studies, and changed the intracranial monitoring plan in 10 cases. The connectivity results significantly altered surgery planning with the addition of 13 surgeries, but it did not eliminate planned surgeries (p = 0.003). Among the 38 epilepsy surgeries performed, the final surgical approach changed due to rs-fMRI findings in 22 cases (58%), including 8 (28%) of 29 in which extraoperative direct electrical stimulation mapping was averted. CONCLUSIONS This study demonstrates the impact of rs-fMRI connectivity results on the decision-making for pediatric epilepsy surgery by providing new information about the location of eloquent cortex and the seizure onset zone. Additionally, connectivity results may increase the proportion of patients considered eligible for surgery while optimizing the need for further testing.
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Affiliation(s)
| | | | - William D Gaillard
- 3Department of Neurology, Children's National Medical Center, Washington, DC
| | | | | | | | - Jennifer S Ronecker
- 5Division of Pediatric Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona; and
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Abstract
PURPOSE OF REVIEW Congenital malformations of the central nervous system may be seen in isolation or in association with syndromes that have multiorgan involvement. Among the potential health challenges these children may face, sleep concerns are frequent and may include chronic insomnia, sleep-related breathing disorders, and circadian rhythm disorders. RECENT FINDINGS In this review, we describe recent research into sleep disorders affecting children with congenital malformations of the CNS including visual impairment, septo-optic dysplasia, agenesis of the corpus callosum, Aicardi syndrome, Chiari malformation, spina bifida, achondroplasia, Joubert syndrome, fetal alcohol spectrum disorders, and congenital Zika syndrome. In many cases, the sleep disturbance can be directly related to observed anatomical differences in the brain (such as in apnea due to Chiari malformation), but in most syndromes, a complete understanding of the underlying pathophysiology connecting the malformation with sleep problem is still being elucidated. Our review provides a synthesis of available evidence for clinicians who treat this patient population, in whom appropriate diagnosis and management of sleep problems may improve the quality of life for both patient and caregiver.
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Affiliation(s)
| | - Matthew M Troester
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - David G Ingram
- Department of Pediatrics, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, USA.
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Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Pediatric Sleep Duration Consensus Statement: A Step Forward. J Clin Sleep Med 2016; 12:1705-1706. [PMID: 27855732 DOI: 10.5664/jcsm.6368] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 11/13/2022]
Affiliation(s)
| | - Lee J Brooks
- Children's Hospital of Philadelphia, Philadelphia, PA.,Liaison for the American Academy of Pediatrics
| | | | - Wendy A Hall
- University of British Columbia School of Nursing, Vancouver, BC
| | | | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | - Merrill S Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN
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Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion. J Clin Sleep Med 2016; 12:1549-1561. [PMID: 27707447 DOI: 10.5664/jcsm.6288] [Citation(s) in RCA: 355] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/12/2016] [Indexed: 12/13/2022]
Abstract
ABSTRACT Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. After review of 864 published articles, the following sleep durations are recommended: Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health. Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health. Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression. Insufficient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts. COMMENTARY A commentary on this article apears in this issue on page 1439.
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Affiliation(s)
| | - Lee J Brooks
- Children's Hospital of Philadelphia, Philadelphia, PA.,Liaison for the American Academy of Pediatrics
| | | | - Wendy A Hall
- University of British Columbia School of Nursing, Vancouver, BC
| | | | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | - Merrill S Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN
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Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016; 12:785-6. [PMID: 27250809 DOI: 10.5664/jcsm.5866] [Citation(s) in RCA: 742] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 11/13/2022]
Abstract
ABSTRACT Sleep is essential for optimal health in children and adolescents. Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. The recommendations are summarized here. A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be published in the Journal of Clinical Sleep Medicine.
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Affiliation(s)
| | - Lee J Brooks
- Children's Hospital of Philadelphia, Philadelphia, PA.,Liaison for the American Academy of Pediatrics, Elk Grove Village, IL
| | | | - Wendy A Hall
- University of British Columbia School of Nursing, Vancouver, BC
| | | | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Carol L Rosen
- Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Matthew M Troester
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Merrill S Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN
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Balestrini S, Milh M, Castiglioni C, Lüthy K, Finelli MJ, Verstreken P, Cardon A, Stražišar BG, Holder JL, Lesca G, Mancardi MM, Poulat AL, Repetto GM, Banka S, Bilo L, Birkeland LE, Bosch F, Brockmann K, Cross JH, Doummar D, Félix TM, Giuliano F, Hori M, Hüning I, Kayserili H, Kini U, Lees MM, Meenakshi G, Mewasingh L, Pagnamenta AT, Peluso S, Mey A, Rice GM, Rosenfeld JA, Taylor JC, Troester MM, Stanley CM, Ville D, Walkiewicz M, Falace A, Fassio A, Lemke JR, Biskup S, Tardif J, Ajeawung NF, Tolun A, Corbett M, Gecz J, Afawi Z, Howell KB, Oliver KL, Berkovic SF, Scheffer IE, de Falco FA, Oliver PL, Striano P, Zara F, Campeau PM, Sisodiya SM. TBC1D24 genotype-phenotype correlation: Epilepsies and other neurologic features. Neurology 2016; 87:77-85. [PMID: 27281533 PMCID: PMC4932231 DOI: 10.1212/wnl.0000000000002807] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/28/2016] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the phenotypic spectrum associated with mutations in TBC1D24. Methods: We acquired new clinical, EEG, and neuroimaging data of 11 previously unreported and 37 published patients. TBC1D24 mutations, identified through various sequencing methods, can be found online (http://lovd.nl/TBC1D24). Results: Forty-eight patients were included (28 men, 20 women, average age 21 years) from 30 independent families. Eighteen patients (38%) had myoclonic epilepsies. The other patients carried diagnoses of focal (25%), multifocal (2%), generalized (4%), and unclassified epilepsy (6%), and early-onset epileptic encephalopathy (25%). Most patients had drug-resistant epilepsy. We detail EEG, neuroimaging, developmental, and cognitive features, treatment responsiveness, and physical examination. In silico evaluation revealed 7 different highly conserved motifs, with the most common pathogenic mutation located in the first. Neuronal outgrowth assays showed that some TBC1D24 mutations, associated with the most severe TBC1D24-associated disorders, are not necessarily the most disruptive to this gene function. Conclusions: TBC1D24-related epilepsy syndromes show marked phenotypic pleiotropy, with multisystem involvement and severity spectrum ranging from isolated deafness (not studied here), benign myoclonic epilepsy restricted to childhood with complete seizure control and normal intellect, to early-onset epileptic encephalopathy with severe developmental delay and early death. There is no distinct correlation with mutation type or location yet, but patterns are emerging. Given the phenotypic breadth observed, TBC1D24 mutation screening is indicated in a wide variety of epilepsies. A TBC1D24 consortium was formed to develop further research on this gene and its associated phenotypes.
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Abstract
"What will you give my child to help him sleep?" is a common question parents ask and some health care providers abhor hearing. Entire families may suffer when one member does not sleep well. Poor sleep may complicate the management of other comorbid conditions. Health care providers may have received only limited education on sleep disorders and are frequently forced to choose between treatment options that are poorly studied in children. Fortunately, when addressed correctly, many children with chronic sleep disorders may improve their sleep and daytime behavior in a relatively short time. This review provides a framework to help understand the causes of poor sleep in children and the potential pharmacologic options.
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Affiliation(s)
- Matthew M Troester
- Department of Neurology, University of Arizona College of Medicine, Phoenix, AZ; Department of Pediatrics, Creighton University College of Medicine, Omaha, NE; Comprehensive Sleep Medicine Program, Phoenix Children's Hospital, Phoenix, AZ.
| | - Rafael Pelayo
- Stanford Sleep Disorders Clinic, Stanford University School of Medicine, Redwood City, CA
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Kothare SV, Rosen CL, Lloyd RM, Paruthi S, Thomas SM, Troester MM, Carden KA. Quality measures for the care of pediatric patients with obstructive sleep apnea. J Clin Sleep Med 2015; 11:385-404. [PMID: 25700879 DOI: 10.5664/jcsm.4558] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 11/13/2022]
Abstract
ABSTRACT The Board of Directors of the American Academy of Sleep Medicine (AASM) commissioned a Task Force to develop quality measures as part of its strategic plan to promote high quality patient-centered care. Among many potential dimensions of quality, the AASM requested Workgroups to develop outcome and process measures to aid in evaluating the quality of care of five common sleep disorders: insomnia, obstructive sleep apnea in adults, obstructive sleep apnea in children, restless legs syndrome, and narcolepsy. This paper describes the rationale, background, general methods development, and considerations in implementation of these quality measures in obstructive sleep apnea (OSA) in children. This document describes measurement methods for five desirable process measures: assessment of symptoms and risk factors of OSA, initiation of an evidence-based action plan, objective evaluation of high-risk children with OSA by obtaining a polysomnogram (PSG), reassessment of signs and symptoms of OSA within 12 months, and documentation of objective assessment of positive airway pressure adherence. When these five process measures are met, clinicians should be able to achieve the two defined outcomes: improve detection of childhood OSA and reduce signs and symptoms of OSA after initiation of a management plan. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with childhood OSA.
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Affiliation(s)
| | - Carol L Rosen
- University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
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Abstract
Klonopin (clonazepam; Genentech Inc, South San Francisco, California) oral wafers are benzodiazepines with anticonvulsive and anxiolytic properties. Our institution has been prescribing clonazepam wafers for acute treatment of prolonged seizures for years. Patients' size determined dosing at 0.25, 0.5, 1, or 2 mg wafers. We proceeded to obtain evidence for efficacy. Hospital Institutional Review Board approval was obtained for anonymous patient survey. All children who had been prescribed clonazepam wafers over a 6-year period at our institution were mailed detailed questionnaires. Three hundred eighty-one questionnaires were mailed with 88 replies but only 56 with meaningful data. Average age was 12.1 years. There were 31 males. Efficacy was defined as stopping seizure within 10 minutes, >50% of the time. Thirty-eight of the 56 (68%) patients met this criterion. From these 38 patients, 19 (50%) had seizures stop within 1 minute. Overall results were comparable to Diastat (rectal diazepam; Valeant Pharmaceuticals International, Aliso Viejo, California). Clonazepam wafers are an effective acute therapy for prolonged seizures.
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Affiliation(s)
- Matthew M Troester
- Division of Pediatric Neurology, Barrow Neurological Institute, Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Chan YM, Fenoglio-Simeone KA, Paraschos S, Muhammad L, Troester MM, Ng YT, Johnsonbaugh RE, Coons SW, Prenger EC, Kerrigan JF, Seminara SB. Central precocious puberty due to hypothalamic hamartomas correlates with anatomic features but not with expression of GnRH, TGFalpha, or KISS1. Horm Res Paediatr 2010; 73:312-9. [PMID: 20389100 PMCID: PMC2868525 DOI: 10.1159/000308162] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 06/17/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Hypothalamic hamartomas are the most common identifiable cause of central precocious puberty (CPP). Hamartoma characteristics proposed to be associated with CPP include specific anatomic features and expression of molecules such as gonadotropin-releasing hormone (GnRH), transforming growth factor alpha (TGFalpha), and GRM1A, which encodes the type 1 metabotropic glutamate receptor alpha isoform. We sought to determine whether hamartomas that cause CPP could be distinguished by anatomic features, expression of these molecules, or expression of KISS1, whose products signal through the receptor GPR54 to stimulate GnRH release. METHODS Clinical records and radiologic images were reviewed for 18 patients who underwent hamartoma resection for intractable seizures; 7 had precocious puberty. Resected tissue was examined for expression of GnRH, GnRH receptor (GnRHR), TGFalpha, KISS1, GPR54, and GRM1A. RESULTS Hypothalamic hamartomas associated with CPP were more likely to contact the infundibulum or tuber cinereum and were larger than hamartomas not associated with CPP. GnRH, TGFalpha, and GnRHR were expressed by all hamartomas studied. Expression of KISS1, GPR54, and GRM1A did not differ significantly between hamartomas associated and not associated with CPP. CONCLUSION Anatomic features rather than expression patterns of candidate molecules distinguish hypothalamic hamartomas that are associated with CPP from those that are not.
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Affiliation(s)
- Yee-Ming Chan
- Harvard Reproductive Sciences Center and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Kristina A. Fenoglio-Simeone
- Divisions of Neurology and Pediatric Neurology, Barrow Neurological Institute and Children's Health Center, St. Joseph's Hospital and Medical Center, Phoenix, Ariz., USA
| | - Sophia Paraschos
- Harvard Reproductive Sciences Center and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital Boston, Boston, Mass., USA
| | - Laura Muhammad
- Divisions of Neurology and Pediatric Neurology, Barrow Neurological Institute and Children's Health Center, St. Joseph's Hospital and Medical Center, Phoenix, Ariz., USA
| | - Matthew M. Troester
- Divisions of Neurology and Pediatric Neurology, Barrow Neurological Institute and Children's Health Center, St. Joseph's Hospital and Medical Center, Phoenix, Ariz., USA
| | - Yu-tze Ng
- Divisions of Neurology and Pediatric Neurology, Barrow Neurological Institute and Children's Health Center, St. Joseph's Hospital and Medical Center, Phoenix, Ariz., USA
| | | | | | - Erin C. Prenger
- Neuroimaging, Barrow Neurological Institute, Phoenix, Ariz., USA
| | - John F. Kerrigan
- Divisions of Neurology and Pediatric Neurology, Barrow Neurological Institute and Children's Health Center, St. Joseph's Hospital and Medical Center, Phoenix, Ariz., USA
| | - Stephanie B. Seminara
- Harvard Reproductive Sciences Center and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital Boston, Boston, Mass., USA
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Troester MM. "She is fine, other than her spinal epidural!". Semin Pediatr Neurol 2010; 17:65-7. [PMID: 20434701 DOI: 10.1016/j.spen.2010.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Matthew M Troester
- Children's Health Centers, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
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Abstract
ARX (Aristaless-related homeobox gene) is located at Xp22. It contains 5 exons and encodes a 562-amino acid protein. The protein contains 4 polyalanine tracts, 3 of which are encoded in exon 2 and 1 in exon 4. Mutations in the ARX gene have been found in X-linked infantile spasms syndrome, Partington syndrome (mental retardation with dystonic movements of the hands), X-linked lissencephaly with abnormal genitalia, X-linked myoclonus epilepsy with spasticity and intellectual disability, and in nonsyndromic X-linked mental retardation. The most common mutation in ARX (seen in X-linked infantile spasms syndrome, Partington syndrome, and X-linked mental retardation) is a 24-bp duplication in exon 2 resulting in expansion of a polyalanine tract. Truncating mutations (deletions, frameshift, non-sense) have been found in X-linked lissencephaly with abnormal genitalia, as well as homeodomain missense mutations in X-linked myoclonus epilepsy with spasticity and intellectual disability. The authors report a novel 24-bp in-frame deletion within exon 2 of the ARX gene in a male child with X-linked mental retardation and review the spectrum of ARX mutations. This mutation results in a contraction of the second polyalanine repeat.
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Affiliation(s)
- Matthew M Troester
- Children's Health Center, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute Phoenix, Arizona, USA
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Bastani JB, Troester MM, Bastani AJ. Serotonin syndrome and fluvoxamine: a case study. Nebr Med J 1996; 81:107-9. [PMID: 8628448] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To report a serotonin syndrome reaction in a patient taking fluvoxamine to replace an earlier SSRI agent. CASE REPORT A female patient with Obsessive Compulsive Disorder on paroxetine after resurgence in her obsessive ruminations was started on fluvoxamine 50 mg daily. One week later she became suicidal and was hospitalized. The fluvoxamine was increased to 50 mg morning and 100 mg bedtime and the paroxetine was discontinued. Over the next few days she began to have trouble with her concentration. A low grade fever set in after she experienced auditory hallucinations. Fluvoxamine was discontinued and she had an uneventful recovery after twenty-four hours. DISCUSSION Fluvoxamine is a recently approved serotonin selective reuptake inhibitor (SSRI) with few side effect profiles. It is effective in the treatment of Depressive Disorder and Obsessive Compulsive Disorder and is used to potentiate or replace other anti-OCD drugs including already available serotonin specific reuptake inhibitors (SSRI). We wish to draw attention to the potential for serotonin syndrome in patients on fluvoxamine who may have previously been on other SSRIs.
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Affiliation(s)
- J B Bastani
- Dept. of Psychiatry, Bryan Memorial Hospital, Lincoln, NE 68506, USA
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