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Breu M, Sandesjö F, Milos RI, Svoboda J, Salzer J, Schneider L, Reichelt JB, Bertolini A, Blaschek A, Fink K, Höftberger R, Lycke J, Rostásy K, Seidl R, Siegert S, Wickström R, Kornek B. Rituximab treatment in pediatric-onset multiple sclerosis. Eur J Neurol 2024; 31:e16228. [PMID: 38375947 DOI: 10.1111/ene.16228] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/05/2023] [Accepted: 01/15/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND PURPOSE Rituximab (RTX) is frequently used off-label in multiple sclerosis. However, studies on the risk-benefit profile of RTX in pediatric-onset multiple sclerosis are scarce. METHODS In this multicenter retrospective cohort study, patients with pediatric-onset multiple sclerosis from Sweden, Austria and Germany, who received RTX treatment were identified by chart review. Annualized relapse rates, Expanded Disability Status Scale scores and magnetic resonance imaging parameters (new T2 lesions and contrast-enhancing lesions) were assessed before and during RTX treatment. The proportion of patients who remained free from clinical and disease activity (NEDA-3) during RTX treatment was calculated. Side effects such as infusion-related reactions, infections and laboratory abnormalities were assessed. RESULTS Sixty-one patients received RTX during a median (interquartile range) follow-up period of 20.9 (35.6) months. The annualized relapse rate decreased from 0.6 (95% confidence interval [CI] 0.38-0.92) to 0.03 (95% CI 0.02-0.14). The annual rate of new T2 lesions decreased from 1.25 (95% CI 0.70-2.48) to 0.08 (95% CI 0.03-0.25) and annual rates of new contrast-enhancing lesions decreased from 0.86 (95% CI 0.30-3.96) to 0. Overall, 70% of patients displayed no evidence of disease activity (NEDA-3). Adverse events were observed in 67% of patients. Six patients discontinued treatment due to ongoing disease activity or adverse events. CONCLUSION Our study provides class IV evidence that RTX reduces clinical and radiological activity in pediatric-onset multiple sclerosis.
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Affiliation(s)
- Markus Breu
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Fredrik Sandesjö
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ruxandra-Iulia Milos
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Jan Svoboda
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonatan Salzer
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Lisa Schneider
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Julian Benedikt Reichelt
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Annikki Bertolini
- Department of Pediatric Neurology, University Witten/Herdecke, Children's Hospital Datteln, Datteln, Germany
| | - Astrid Blaschek
- Paediatric Neurology and Developmental Medicine, Ludwig Maximilian University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Katharina Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kevin Rostásy
- Department of Pediatric Neurology, University Witten/Herdecke, Children's Hospital Datteln, Datteln, Germany
| | - Rainer Seidl
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Sandy Siegert
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ronny Wickström
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Barbara Kornek
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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Viktorsson C, Portugal AM, Taylor MJ, Ronald A, Falck-Ytter T. Sustained looking at faces at 5 months of age is associated with socio-communicative skills in the second year of life. Infancy 2024; 29:459-478. [PMID: 38358338 DOI: 10.1111/infa.12586] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Efficiently processing information from faces in infancy is foundational for nonverbal communication. We studied individual differences in 5-month-old infants' (N = 517) sustained attention to faces and preference for emotional faces. We assessed the contribution of genetic and environmental influences to individual differences in these gaze behaviors, and the association between these traits and other concurrent and later phenotypes. We found an association between the mean duration of looking at a face (before looking away from it) at 5 months and socio-communicative abilities at 14 months (β = 0.17, 95% CI: 0.08; 0.26, p < 0.001). Sustained attention to faces predicted socio-communicative abilities over and above variance captured by mean fixation duration. We also found a statistically significant but weak tendency to prefer looking at smiling faces (relative to neutral faces), but no indication that variability in this behavior was explained by genetic effects. Moderate heritability was found for sustained attention to faces (A = 0.23, CI: 0.06; 0.38), while shared environmental influences were non-significant for both phenotypes. These findings suggest that sustained looking at individual faces before looking away is a developmentally significant 'social attention' phenotype in infancy, characterized by moderate heritability and a specific relation to later socio-communicative abilities.
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Affiliation(s)
- Charlotte Viktorsson
- Development and Neurodiversity Lab, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Ana Maria Portugal
- Development and Neurodiversity Lab, Department of Psychology, Uppsala University, Uppsala, Sweden
- Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Mark J Taylor
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Ronald
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
| | - Terje Falck-Ytter
- Development and Neurodiversity Lab, Department of Psychology, Uppsala University, Uppsala, Sweden
- Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Swedish Collegium for Advanced Study, Uppsala, Sweden
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Viktorsson C, Portugal AM, Falck-Ytter T. Genetic and environmental contributions to gaze lateralization across social and non-social stimuli in human infants. Sci Rep 2024; 14:3668. [PMID: 38351309 PMCID: PMC10864339 DOI: 10.1038/s41598-024-54373-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/12/2024] [Indexed: 02/16/2024] Open
Abstract
A tendency to look at the left side of faces from the observer's point of view has been found in older children and adults, but it is not known when this face-specific left gaze bias develops and what factors may influence individual differences in gaze lateralization. Therefore, the aims of this study were to estimate gaze lateralization during face observation and to more broadly estimate lateralization tendencies across a wider set of social and non-social stimuli, in early infancy. In addition, we aimed to estimate the influence of genetic and environmental factors on lateralization of gaze. We studied gaze lateralization in 592 5-month-old twins (282 females, 330 monozygotic twins) by recording their gaze while viewing faces and two other types of stimuli that consisted of either collections of dots (non-social stimuli) or faces interspersed with objects (mixed stimuli). A right gaze bias was found when viewing faces, and this measure was moderately heritable (A = 0.38, 95% CI 0.24; 0.50). A left gaze bias was observed in the non-social condition, while a right gaze bias was found in the mixed condition, suggesting that there is no general left gaze bias at this age. Genetic influence on individual differences in gaze lateralization was only found for the tendency to look at the right versus left side of faces, suggesting genetic specificity of lateralized gaze when viewing faces.
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Affiliation(s)
- Charlotte Viktorsson
- Development and Neurodiversity Lab, Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Ana Maria Portugal
- Development and Neurodiversity Lab, Department of Psychology, Uppsala University, Uppsala, Sweden
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
| | - Terje Falck-Ytter
- Development and Neurodiversity Lab, Department of Psychology, Uppsala University, Uppsala, Sweden
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
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Bölte S, Alehagen L, Black MH, Hasslinger J, Wessman E, Remnélius KL, Marschik PB, D'arcy E, Seidel A, Girdler S, Zander E. Assessment of functioning in ADHD according to World Health Organization standards: First revision of the International Classification of Functioning, Disability and Health Core Sets. Dev Med Child Neurol 2024. [PMID: 38308443 DOI: 10.1111/dmcn.15865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/27/2023] [Accepted: 12/27/2023] [Indexed: 02/04/2024]
Abstract
AIM To conduct the first revision of the World Health Organization International Classification of Functioning, Disability and Health (ICF) Core Sets for attention-deficit/hyperactivity disorder (ADHD). METHOD A Delphi-like method was used, integrating evidence from stakeholder feedback and developing and piloting the ADHD ICF Core Set platform to inform revisions to the ADHD Core Sets. RESULTS A total of 27 second-level ICF codes were added to the comprehensive ADHD Core Set: body functions of temperament and personality, and basic sensory functions; activities and participation in terms of learning to read and write, spoken communication, community life, religion and spirituality, education, economy, and human rights; environmental factors for domestic animals; and several societal services. The revised comprehensive Core Set contains 98 ICF codes: 18 body function codes; 47 activities and participation codes; and 33 environmental factor codes. Extensive changes were also made to the age-appropriate brief Core Sets to allow their independent use in research and clinical practice. INTERPRETATION Although substantially expanded, the revised ICF Core Sets better reflect the lived experience of individuals with ADHD and clinical implementation preferences than the initial sets. We recommend further feasibility and validation studies of these Core Sets with the goal of optimizing their acceptance and practicability, and strengthening their evidence base.
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Affiliation(s)
- Sven Bölte
- Center of Neurodevelopmental Disorders, Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Lovisa Alehagen
- Center of Neurodevelopmental Disorders, Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
| | - Melissa H Black
- Center of Neurodevelopmental Disorders, Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
| | - John Hasslinger
- Center of Neurodevelopmental Disorders, Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Elina Wessman
- Center of Neurodevelopmental Disorders, Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Karl Lundin Remnélius
- Center of Neurodevelopmental Disorders, Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
| | - Peter B Marschik
- Center of Neurodevelopmental Disorders, Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen and Leibniz Science Campus Primate Cognition, Göttingen, Germany
- Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Austria
| | - Emily D'arcy
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Andreas Seidel
- Department of Economics and Social Sciences, University of Applied Sciences Nordhausen, Nordhausen, Germany
| | - Sonya Girdler
- Center of Neurodevelopmental Disorders, Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Eric Zander
- Center of Neurodevelopmental Disorders, Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
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Lidbeck C, Bartonek Å, Ferrari A, Alboresi S, Örtqvist M. Signs of perceptual disorder during movement were reliably assessed in children with cerebral palsy in Sweden. Acta Paediatr 2024; 113:344-352. [PMID: 37874018 DOI: 10.1111/apa.17012] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
AIM The aim of this Swedish study was to evaluate the assessment of clinical signs of perceptual disorder in children with cerebral palsy (CP). METHODS Three experienced raters assessed 56 videos of 19 children from 1 to 18 years of age with bilateral spastic CP, which were recorded by colleagues at an Italian hospital. Six signs were evaluated for inter-rater reliability and criterion validity. Clinical applicability was evaluated by assessing inter-rater reliability between 47 Swedish clinicians, who examined 15 of the videos during face-to-face and online education seminars. There were 41 physiotherapists, two occupational therapists and four doctors, with 1-37 years of clinical experience and a median of 10 years. RESULTS The experienced raters demonstrated moderate to almost perfect inter-rater reliability (kappa 0.54-0.81) and criterion validity (0.54-0.87) for startle reaction, upper limbs in startle position, averted eye gaze and eye blinking. The clinicians recognised these signs with at least moderate reliability (0.56-0.88). Grimacing and posture freezing were less reliable (0.22-0.35) and valid (0.09-0.50). CONCLUSION Four of the six signs of perceptual disorder were reliably recognised by experienced raters and by clinicians after education seminars. Extended education and larger study samples are needed to recognise all the signs.
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Affiliation(s)
- Cecilia Lidbeck
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Bartonek
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Adriano Ferrari
- Department of Neuroscience, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Alboresi
- Children Rehabilitation Unit of S. M. Nuova Hospital, AUSL-IRCCS, Reggio Emilia, Italy
| | - Maria Örtqvist
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Kruse A, Imery I, Corell L, Hjalmarsson E, Fernandez-Gonzalo R, Von Walden F, Reitzner SM. Circulating immune cell populations at rest and in response to acute endurance exercise in young adults with cerebral palsy. Dev Med Child Neurol 2023. [PMID: 38111130 DOI: 10.1111/dmcn.15835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023]
Abstract
AIM The aim of this observational study was to determine the immune status and function in young adults with cerebral palsy (CP) in comparison to typically developing individuals. METHOD Blood samples from 12 individuals with CP (five males, seven females; mean age: 25 years 1 month (5 years 9 months); age range: 19-38 years) and 17 typically developing individuals (eight males, nine females; mean age: 31 years 4 months (6 years 2 months); age range: 20-40 years) were collected before, immediately after, and 1 hour after 45 minutes of frame running or running respectively. Independent t-tests were used to compare heart rate, level of exertion, and baseline cell proportions between groups. Mixed model analysis of variance was utilized to investigate immune cell responses to exercise across groups. RESULTS Baseline levels of gamma delta (TCRγδ+) T-cells were significantly higher (absolute percentage: +2.65, p = 0.028) in the individuals with CP. Several cell populations showed similar significant changes after exercise in both CP and typically developing groups. Cytotoxic (CD8+) T-cells were only significantly elevated immediately after exercise in the typically developing participants (p < 0.01). Individuals with CP exhibited significantly lower heart rates (-11.1%, p < 0.01), despite similar ratings of perceived exertion. INTERPRETATION Elevated baseline TCRγδ+ T-cells may indicate low-grade inflammation in adults with CP. Although most of the cell populations showed typical responses to endurance exercise, the absence of response in CD8+ T-cells in individuals with CP may indicate the need for higher intensity during exercise.
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Affiliation(s)
- Annika Kruse
- Department of Women's and Children's Health, Division of Neurology/Pediatric Orthopedics, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Institute of Human Movement Science, Sport and Health, University of Graz, Austria
| | - Ian Imery
- Department of Women's and Children's Health, Division of Neurology/Pediatric Orthopedics, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Linnéa Corell
- Department of Women's and Children's Health, Division of Neurology/Pediatric Orthopedics, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Emma Hjalmarsson
- Department of Women's and Children's Health, Division of Neurology/Pediatric Orthopedics, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Functional Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Rodrigo Fernandez-Gonzalo
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
- Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ferdinand Von Walden
- Department of Women's and Children's Health, Division of Neurology/Pediatric Orthopedics, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan M Reitzner
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Hedenius M, Hardiansyah I, Falck-Ytter T. Visual Global Processing and Subsequent Verbal and Non-Verbal Development: An EEG Study of Infants at Elevated versus Low Likelihood for Autism Spectrum Disorder. J Autism Dev Disord 2023; 53:3700-3709. [PMID: 35353335 PMCID: PMC10465659 DOI: 10.1007/s10803-022-05470-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Martina Hedenius
- Department of Public Health and Caring Sciences, Speech-Language Pathology, Uppsala University, P.O. Box 564, 752 37, Uppsala, Sweden.
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, CAP Research Centre, Gävlegatan 22, 113 30, Stockholm, Sweden.
| | - Irzam Hardiansyah
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, CAP Research Centre, Gävlegatan 22, 113 30, Stockholm, Sweden
| | - Terje Falck-Ytter
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, CAP Research Centre, Gävlegatan 22, 113 30, Stockholm, Sweden
- Development and Neurodiversity Lab (DIVE), Department of Psychology, Uppsala University, Uppsala, Sweden
- The Swedish Collegium for Advanced Study (SCAS), Uppsala, Sweden
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Astenvald R, Frick MA, Neufeld J, Bölte S, Isaksson J. Emotion dysregulation in ADHD and other neurodevelopmental conditions: a co-twin control study. Child Adolesc Psychiatry Ment Health 2022; 16:92. [PMID: 36443776 PMCID: PMC9706824 DOI: 10.1186/s13034-022-00528-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Emotion dysregulation (ED) is common in attention-deficit/hyperactivity disorder (ADHD) and often results in adverse outcomes. However, ED has been suggested as a transdiagnostic construct, why the specific association between ADHD and ED when adjusting for other mental health conditions needs further investigation. It is also important to determine the aetiological basis of the association between ADHD and ED to inform the theoretical conceptualization of ADHD. METHOD This study used a co-twin control design, including a sample of dizygotic (DZ) and monozygotic (MZ) twins (N = 389; 45.8% females, age = 8-31 years, MZ twin pairs 57.6%). ED was assessed using the dysregulation profile from the parent-rated Child Behaviour Checklist and its adult version. Regression analyses were used across individuals and within the pairs, while adjusting for diagnoses of autism, intellectual disability, other neurodevelopmental conditions and affective conditions. RESULTS ADHD was significantly associated with ED, even when adjusting for age, sex, attention problems and other mental health conditions, and was the diagnosis most strongly associated with ED. Within-pair analyses revealed that twins with ADHD had higher levels of ED compared to their co-twin without ADHD. This association remained within DZ twins and was non-significant in the MZ subsample, with non-overlapping confidence intervals between the DZ and MZ estimates. CONCLUSION ADHD is strongly and in part independently linked to ED, stressing the importance of early detection and treatment of emotional difficulties within this group. The findings from the within-pair analyses indicate a genetic influence on the association between ADHD and ED.
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Affiliation(s)
- Rebecka Astenvald
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - Matilda A Frick
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
- Department of Psychology, Division of Emotion Psychology, Uppsala University, Uppsala, Sweden
| | - Janina Neufeld
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
- Swedish Collegium for Advanced Study (SCAS), Uppsala, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden
| | - Johan Isaksson
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden.
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.
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Malmgren B, Thesleff I, Dahllöf G, Åström E, Tsilingaridis G. Abnormalities in Tooth Formation after Early Bisphosphonate Treatment in Children with Osteogenesis Imperfecta. Calcif Tissue Int 2021; 109:121-131. [PMID: 33743023 PMCID: PMC8273054 DOI: 10.1007/s00223-021-00835-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/03/2021] [Indexed: 01/20/2023]
Abstract
Treatment with intravenous bisphosphonate (BP) in children and adolescents with osteogenesis imperfecta (OI) started in Sweden in 1991. No human studies on the role of BP therapy in development of disturbances in tooth mineralization or tooth morphology have been published. The study cohort comprised 219 individuals who were divided into four groups: group 1, BP treatment onset before 2 years of age (n = 22); group 2, BP treatment onset between 2 and 6 years of age (n = 20); group 3, BP treatment onset between 6 and 10 years of age (n = 13); and a control group of patients with OI who had not received BP therapy (n = 164). The chi-square test was used in between-group comparisons of the prevalence of tooth agenesis. The prevalence of tooth agenesis was significantly higher in children who began BP treatment before the age of 2 years (group 1; 59%,) compared to the controls (10%; p < 0.001) and to children who had begun BP therapy between ages 2 and 6 years (group 2; 10%; p = 0.009) or between ages 6 and 10 years (group 3; 8%; p = 0.003). Different types of disturbances in the enamel formation were seen in 52 premolars, where 51 were seen in those who began BP treatment before the age of 2 years. To conclude, starting BP treatment before the age of 2 years increases the risk of abnormalities in tooth formation manifesting as morphological aberrations, tooth agenesis, and enamel defects.
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Affiliation(s)
- Barbro Malmgren
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, POB 4046, 141 04, Huddinge, Sweden.
| | - Irma Thesleff
- Developmental Biology Program, Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Göran Dahllöf
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, POB 4046, 141 04, Huddinge, Sweden
- Center for Pediatric Oral Health Research, Stockholm, Sweden
- TkMidt - Center for Oral Health Services and Research, Mid-Norway, Trondheim, Norway
| | - Eva Åström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Neurology, Astrid Lindgren Children's Hospital at Karolinska University Hospital, Stockholm, Sweden
| | - Georgios Tsilingaridis
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, POB 4046, 141 04, Huddinge, Sweden
- Center for Pediatric Oral Health Research, Stockholm, Sweden
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Malmgren B, Tsilingaridis G, Monsef-Johansson N, Qahtani ZHA, Dahllöf G, Åström E. Bisphosphonate Therapy and Tooth Development in Children and Adolescents with Osteogenesis Imperfecta. Calcif Tissue Int 2020; 107:143-150. [PMID: 32451573 PMCID: PMC7343730 DOI: 10.1007/s00223-020-00707-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/13/2020] [Indexed: 10/30/2022]
Abstract
Osteogenesis imperfecta (OI) is a heterogeneous connective tissue disorder characterized by repeated fractures and skeletal disorders. At present, bisphosphonate (BP) therapy is the gold standard for OI treatment. The present retrospective study evaluated the effect of BP therapy on tooth development and eruption of permanent teeth in a cohort of children receiving pamidronate. Three groups were studied: patients with OI who were treated with BPs (n = 45), patients with OI who were not treated with BPs (n = 117), and age- and gender-matched healthy controls (n = 121). Dental age, dental maturity, and tooth eruption were assessed on panoramic radiographs using the methods of Demirjian et al. (Hum Biol 45(2):211-227, 1973) and Haavikko (Suom Hammaslaak Toim 66(3):103-170, 1970) and were evaluated using the t-test, Chi-square test, and the Mann-Whitney U test. Dental age in the study group was significantly (p < 0.05) lower than chronological age compared with both control groups. Dental maturity and the eruption of permanent teeth were also significantly (p < 0.05) delayed in the study group in relation to the two control groups. The dental age was significantly lower (p < 0.001) in patients with OI type III treated with BPs compared with healthy controls and the dental maturation was significantly delayed in patients with OI type IV treated with BPs compared with those not treated. In conclusion, BP therapy in OI patients seems to lower the dental age, delay the dental maturity, and tooth eruption. BP administration before 2 years of age might be a contributing factor.
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Affiliation(s)
- Barbro Malmgren
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, Huddinge, Sweden.
- Center for Pediatric Oral Health Research, Stockholm, Sweden.
| | - Georgios Tsilingaridis
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, Huddinge, Sweden
- Center for Pediatric Oral Health Research, Stockholm, Sweden
| | - Nina Monsef-Johansson
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, Huddinge, Sweden
- Center for Pediatric Oral Health Research, Stockholm, Sweden
| | - Zaina Haif Al Qahtani
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, Huddinge, Sweden
- Center for Pediatric Oral Health Research, Stockholm, Sweden
| | - Göran Dahllöf
- Department of Dental Medicine, Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, Huddinge, Sweden
- Center for Pediatric Oral Health Research, Stockholm, Sweden
| | - Eva Åström
- Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Neurology, Astrid Lindgren Children's Hospital at Karolinska University Hospital, Stockholm, Sweden
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