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Crowley TB, Campbell I, Arulselvan A, Friedman D, Zackai EH, Geoffrion TR, Witmer C, Gaynor JW, McDonald-McGinn DM, Lambert MP. A case-control study of bleeding risk in children with 22q11.2 deletion syndrome undergoing cardiac surgery. Platelets 2024; 35:2290108. [PMID: 38099325 DOI: 10.1080/09537104.2023.2290108] [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: 08/21/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023]
Abstract
Previous research suggests that individuals with 22q11.2 deletion syndrome (DS) have an increased risk of bleeding following cardiac surgery. However, current guidelines for management of patients with 22q11.2DS do not provide specific recommendations for perioperative management. This study sought to identify specific risk factors for bleeding in this patient population. Examine the factors determining bleeding and transfusion requirements in patients with 22q11.2DS undergoing cardiac surgery. This was a single center review of patients who underwent cardiac surgery at the Children's Hospital of Philadelphia from 2000 to 2016. Data was extracted from the medical record. Frequency of bleeding events, laboratory values, and transfusion requirements were compared. We included 226 patients with 22q11.2DS and 506 controls. Bleeding events were identified in 13 patients with 22q11.2DS (5.8%) and 27 controls (5.3%). Platelet counts were lower among patients with 22q11.2DS than in control patients, but not statistically different comparing bleeding to not bleeding. Patients with 22q11.2DS received more transfusions (regardless of bleeding status). However, multivariate analysis showed only procedure type was associated with increased risk of bleeding (p = .012). The overall risk of bleeding when undergoing cardiac surgery is not different in patients with 22q11.2DS compared to non-deleted patients. Though platelet counts were lower in patients with 22q11.2DS, only procedure type was significantly associated with an increased risk of bleeding.
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Affiliation(s)
- T Blaine Crowley
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ian Campbell
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abinaya Arulselvan
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David Friedman
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Tracy R Geoffrion
- Department of Surgery, Children's Wisconsin, Milwaukee, WI, USA
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Char Witmer
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Donna M McDonald-McGinn
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Sapienza University, Rome, Italy
| | - Michele P Lambert
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Tanham M, Chen R, Warren N, Heussler H, Scott JG. The effectiveness and tolerability of pharmacotherapy for psychosis in 22q11.2 Deletion Syndrome: A systematic review. Aust N Z J Psychiatry 2024; 58:393-403. [PMID: 38383990 DOI: 10.1177/00048674241233118] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVE The 22q11.2 Deletion Syndrome (22q11.2DS) is the most common microdeletion in humans with over 180 phenotypic expressions. Approximately 30-40% of affected individuals will develop psychosis and 25% meet the criteria for schizophrenia. Despite this, pharmacotherapy for managing psychosis in 22q11.2DS is poorly understood and 22q11.2DS psychosis is frequently labelled as treatment resistant. The objectives of this paper are to evaluate the effectiveness and tolerability of pharmacotherapy for 22q11.2DS psychosis and evaluate the evidence for treatment resistance. METHOD A systematic search was performed using CINAHL, The Cochrane Library (Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials and Cochrane Clinical Answers), EMBASE, PsycINFO, PubMed, Scopus and Web of Science Core Collection from inception to December 2022. It yielded 39 case reports, 6 case series and 1 retrospective study which met the inclusion criteria. RESULTS Based on the current literature, individuals with 22q11.2DS psychosis experience a greater rate of medical co-morbidities such as cardiac arrhythmias, seizures and movement disorders, which complicate pharmacotherapy. Poor tolerability rather than poor clinical response motivates the switching of antipsychotics, which may explain the labelling of treatment resistance in the literature. CONCLUSION There are insufficient data to recommend a single antipsychotic for 22q11.2DS psychosis. Nonetheless, with proactive management of co-morbidities, antipsychotic medication in 22q11.2DS psychosis is an effective treatment commonly resulting in improvement in quality of life.
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Affiliation(s)
- Maya Tanham
- Child and Youth Mental Health Service, Children's Health Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Renee Chen
- Child and Youth Mental Health Service, Children's Health Queensland, Brisbane, QLD, Australia
| | - Nicola Warren
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Metro South Addictions and Mental Health Service, Woolloongabba, QLD, Australia
| | - Helen Heussler
- Child Development Program, Children's Health Queensland, Brisbane, QLD, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - James G Scott
- Child and Youth Mental Health Service, Children's Health Queensland, Brisbane, QLD, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
- Child and Youth Mental Health, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
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White LK, Hillman N, Ruparel K, Moore TM, Gallagher RS, McClellan EJ, Roalf DR, Scott JC, Calkins ME, McGinn DE, Giunta V, Tran O, Crowley TB, Zackai EH, Emanuel BS, McDonald-McGinn DM, Gur RE, Gur RC. Remote assessment of the Penn computerised neurocognitive battery in individuals with 22q11.2 deletion syndrome. J Intellect Disabil Res 2024; 68:369-376. [PMID: 38229473 DOI: 10.1111/jir.13115] [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] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Neurocognitive functioning is an integral phenotype of 22q11.2 deletion syndrome relating to severity of psychopathology and outcomes. A neurocognitive battery that could be administered remotely to assess multiple cognitive domains would be especially beneficial to research on rare genetic variants, where in-person assessment can be unavailable or burdensome. The current study compares in-person and remote assessments of the Penn computerised neurocognitive battery (CNB). METHODS Participants (mean age = 17.82, SD = 6.94 years; 48% female) completed the CNB either in-person at a laboratory (n = 222) or remotely (n = 162). RESULTS Results show that accuracy of CNB performance was equivalent across the two testing locations, while slight differences in speed were detected in 3 of the 11 tasks. CONCLUSIONS These findings suggest that the CNB can be used in remote settings to assess multiple neurocognitive domains.
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Affiliation(s)
- L K White
- Lifespan Brain Institute (LiBI) of, Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - N Hillman
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - K Ruparel
- Lifespan Brain Institute (LiBI) of, Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - T M Moore
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - R S Gallagher
- Lifespan Brain Institute (LiBI) of, Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - E J McClellan
- Lifespan Brain Institute (LiBI) of, Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - D R Roalf
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - J C Scott
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - M E Calkins
- Lifespan Brain Institute (LiBI) of, Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - D E McGinn
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - V Giunta
- 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - O Tran
- 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - T B Crowley
- 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - E H Zackai
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - B S Emanuel
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - D M McDonald-McGinn
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Human Biology and Medical Genetics, Sapienza University, Rome, Italy
| | - R E Gur
- Lifespan Brain Institute (LiBI) of, Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - R C Gur
- Lifespan Brain Institute (LiBI) of, Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
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Esmailzade Moghimi S, Rezaei P, Sadeghi S, Feizi A, Derakhshandeh F. Outcomes of primary repair of cleft palate using sommerled intravelar veloplasty associated with velocardiofacial syndrome. Int J Pediatr Otorhinolaryngol 2024; 179:111940. [PMID: 38588634 DOI: 10.1016/j.ijporl.2024.111940] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/23/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES Velocardiofacial syndrome, a prevalent microdeletion syndrome occurring in 1 in 2000-4000 live births, is marked by speech and language disorders, notably velopharyngeal dysfunction. This study investigates speech outcomes, nasometric and videofluoroscopic results before and after primary repair of cleft palate using the Sommerlad intravelar veloplasty (SIVV) technique within the Isfahan cleft care team for patients with velocardiofacial syndrome. METHODS Employing a quasi-experimental design, 19 participants with velocardiofacial syndrome, who underwent primary cleft palate repair by the Isfahan cleft care team, were included through convenience sampling. Perceptual and instrumental outcomes were assessed pre-and post-operatively. Statistical analysis encompassed paired t-tests and the non-parametric Wilcoxon signed-rank test (p < 0.05). RESULTS The study identified no statistically significant differences between pre-and post-surgical speech outcome parameters and nasalance scores. Nonetheless, a significant distinction emerged in the velopharyngeal closure ratio based on fluoroscopic evaluation (p = 0.038). CONCLUSION The efficacy of the SIVV technique in treating velopharyngeal dysfunction in velocardiofacial syndrome patients is inconclusive, demanding further research. Post-surgical speech outcomes are influenced by surgical technique, hypotonia, apraxia of speech, and surgery timing. Notably, an elevated velopharyngeal valve closure ratio, though anatomically indicative, does not exclusively predict surgical success.
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Affiliation(s)
- Sarah Esmailzade Moghimi
- Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran; Faculty of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Rezaei
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Sadeghi
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Awat Feizi
- Department of Biostatistics, Faculty of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Derakhshandeh
- Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Feller C, Ilen L, Eliez S, Schneider M. Social skills in neurodevelopmental disorders: a study using role-plays to assess adolescents and young adults with 22q11.2 deletion syndrome and autism spectrum disorders. J Neurodev Disord 2024; 16:11. [PMID: 38500028 DOI: 10.1186/s11689-024-09527-y] [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: 02/28/2022] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUNDS Social skills are frequently impaired in neurodevelopmental disorders and genetic conditions, including 22q11.2 deletion syndrome (22q11DS) and autism spectrum disorders (ASD). Although often assessed with questionnaires, direct assessment provides a more valid estimate of the constructs. Role-plays (i.e., simulates situational settings) therefore appear to be an appropriate indicator of social skills in daily life. METHODS This co-registered study involved 53 individuals with 22q11DS, 34 individuals with ASD, and 64 typically developing (TD) peers aged 12-30 years. All participants were assessed with role-plays as well as parent-reported questionnaires and clinical interviews focusing on social skills, functioning and anxiety. RESULTS Both clinical groups showed impaired social skills compared to TD, but distinct social profiles emerged between the groups. Individuals with 22q11DS displayed higher social appropriateness and clarity of speech but weaker general argumentation and negotiation skills, with the opposite pattern observed in participants with ASD. No association was found between social skills measured by direct observation and caregiver reports. Social anxiety, although higher in clinical groups than in TD, was not associated with role-plays. CONCLUSIONS This study highlights the need to train social skills through tailored interventions to target the specific difficulties of each clinical population. It also highlights the importance of combining measures as they do not necessarily provide the same outcome.
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Affiliation(s)
- Clémence Feller
- Department of Psychology and Educational Sciences, Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, 40, Boulevard du Pont-d'Arve, 1205, Geneva, Switzerland.
| | - Laura Ilen
- Department of Psychology and Educational Sciences, Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, 40, Boulevard du Pont-d'Arve, 1205, Geneva, Switzerland
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Lab Research Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Maude Schneider
- Department of Psychology and Educational Sciences, Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, 40, Boulevard du Pont-d'Arve, 1205, Geneva, Switzerland
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von Scheibler ENMM, Widdershoven JCC, van Barneveld DCPBM, Schröder N, van Eeghen AM, van Amelsvoort TAMJ, Boot E. Hearing loss and history of otolaryngological conditions in adults with microdeletion 22q11.2. Am J Med Genet A 2024; 194:e63456. [PMID: 37916923 DOI: 10.1002/ajmg.a.63456] [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: 07/28/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023]
Abstract
Previous studies have shown that the 22q11.2 microdeletion, associated with 22q11.2 deletion syndrome (22q11.2DS), conveys an increased risk of chronic otitis media, and hearing loss at young age. This study reports on hearing loss and history of otolaryngological conditions in adults with 22q11.2DS. We conducted a retrospective study of 60 adults with 22q11.2DS (41.7% male) at median age 25 (range 16-74) years who had visited an otolaryngologist and audiologist for routine assessment at a 22q11.2 expert center. Demographic, genetic, audiometric, and otolaryngological data were systematically extracted from the medical files. Regression analysis was used to evaluate the effect of age, sex, full-scale intelligence quotient, and history of chronic otitis media on the severity of hearing loss. Hearing loss, mostly high-frequency sensorineural, was found in 78.3% of adults. Higher age and history of chronic otitis media were associated with more severe hearing loss. Otolaryngological conditions with possible treatment implications included chronic otitis media (56.7%), globus pharyngeus (18.3%), balance problems (16.7%), and obstructive sleep apnea (8.3%). The results suggest that in 22q11.2DS, high-frequency hearing loss appears to be common from a young adult age, and often unrecognized. Therefore, we recommend periodic audiometric screening in all adults, including high-frequency ranges.
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Affiliation(s)
- Emma N M M von Scheibler
- Advisium, 's Heeren Loo Zorggroep, Amersfoort, The Netherlands
- Department of Psychiatry and Neuropsychology, MHeNs, Maastricht University, Maastricht, The Netherlands
| | - Josine C C Widdershoven
- Department of Otorhinolaryngology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Nina Schröder
- Department of Psychiatry and Neuropsychology, MHeNs, Maastricht University, Maastricht, The Netherlands
| | - Agnies M van Eeghen
- Advisium, 's Heeren Loo Zorggroep, Amersfoort, The Netherlands
- Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Erik Boot
- Advisium, 's Heeren Loo Zorggroep, Amersfoort, The Netherlands
- Department of Psychiatry and Neuropsychology, MHeNs, Maastricht University, Maastricht, The Netherlands
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
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Zafarullah M, Angkustsiri K, Quach A, Yeo S, Durbin-Johnson BP, Bowling H, Tassone F. Untargeted metabolomic, and proteomic analysis identifies metabolic biomarkers and pathway alterations in individuals with 22q11.2 deletion syndrome. Metabolomics 2024; 20:31. [PMID: 38418685 PMCID: PMC10901937 DOI: 10.1007/s11306-024-02088-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/05/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION The chromosome 22q11.2 deletion syndrome (22q11.2DS) is characterized by a well-defined microdeletion and is associated with a wide range of brain-related phenotypes including schizophrenia spectrum disorders (SCZ), autism spectrum disorders (ASD), anxiety disorders and attention deficit disorders (ADHD). The typically deleted region in 22q11.2DS contains multiple genes which haploinsufficiency has the potential of altering the protein and the metabolic profiles. OBJECTIVES Alteration in metabolic processes and downstream protein pathways during the early brain development may help to explain the increased prevalence of the observed neurodevelopmental phenotypes in 22q11.2DS. However, relatively little is known about the correlation of dysregulated protein/metabolite expression and neurobehavioral impairments in individuals who developed them over time. METHODS In this study, we performed untargeted metabolic and proteomic analysis in plasma samples derived from 30 subjects including 16 participants with 22q11.2DS and 14 healthy controls (TD) enrolled in a longitudinal study, aiming to identify a metabolic and protein signature informing about the underlying mechanisms involved in disease development and progression. The metabolic and proteomic profiles were also compared between the participants with 22q11.2DS with and without various comorbidities, such as medical involvement, psychiatric conditions, and autism spectrum disorder (ASD) to detect potential changes among multiple specimens, collected overtime, with the aim to understand the basic underlying mechanisms involved in disease development and progression. RESULTS We observed a large number of statistically significant differences in metabolites between the two groups. Among them, the levels of taurine and arachidonic acid were significantly lower in 22q11.2DS compared to the TD group. In addition, we identified 16 proteins that showed significant changes in expression levels (adjusted P < 0.05) in 22q11.2DS as compared to TD, including those involved in 70 pathways such as gene expression, the PI3K-Akt signaling pathway and the complement system. Within participants with 22q11.2DS, no significant changes in those with and without medical or psychiatric conditions were observed. CONCLUSION To our knowledge, this is the first report on plasma metabolic and proteomic profiling and on the identification of unique biomarkers in 22q11.2DS. These findings may suggest the potential role of the identified metabolites and proteins as biomarkers for the onset of comorbid conditions in 22q11.2DS. Ultimately, the altered protein pathways in 22q11.2DS may provide insights of the biological mechanisms underlying the neurodevelopmental phenotype and may provide missing molecular outcome measures in future clinical trials to assess early-diagnosis treatment and the efficacy of response to targeted treatment.
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Affiliation(s)
- Marwa Zafarullah
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA, 95817, USA
| | - Kathleen Angkustsiri
- Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA, 95817, USA
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, 95817, USA
| | | | | | | | | | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA, 95817, USA.
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, 95817, USA.
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Shitara Y, Toyofuku E, Doi H, Mukai T, Kashima K, Kakiuchi S, Kato M, Takahashi N. Congenital cytomegalovirus infection in a preterm infant with 22q11.2 deletion syndrome and immunological abnormalities. Nagoya J Med Sci 2024; 86:149-154. [PMID: 38505727 PMCID: PMC10945221 DOI: 10.18999/nagjms.86.1.149] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/24/2023] [Indexed: 03/21/2024]
Abstract
The 22q11.2 deletion syndrome has many complications; one of them is immunodeficiency. However, the time of onset and the degree of immunodeficiency can vary. We report a case of a preterm infant with congenital cytomegalovirus infection complicated with 22q11.2 deletion syndrome and immunological abnormalities. Ultrasonography revealed pulmonary atresia, ventricular septal defect, major aortopulmonary collateral artery, and thymic hypoplasia. His serum chemistry tests on admission revealed immunoglobulin G, A, and M levels of 1,547 mg/dL, 70 mg/dL, and 274 mg/dL, respectively. A surface antigen analysis of the peripheral lymphocytes using flow cytometry revealed the following: relatively low CD4-positive T-cell levels (18.1%; 1,767/μL), very high CD8-positive T-cell levels (58.9%; 5,751/μL), and CD4/CD8 ratio of 0.31. The level of T-cell receptor excision circles was relatively low at 17.5 copies/μL. After birth, the CD8-positive T-cell level began to gradually decrease, whereas the CD4/CD8 ratio began to increase. Thrombocytopenia, neutropenia, and skin petechiae were observed on admission. However, the condition improved. Treatment for congenital cytomegalovirus infection was not provided due to the absence of viremia. Unfortunately, the patient died suddenly on the 158th day of life, and the cause of death was unknown. To the best of our knowledge, no association between 22q11 deletion syndrome and cCMV has been described in the recent medical literature. According to the calculation, around one newborn infant who have both 22q11 deletion syndrome and cCMV infection will be born each year in Japan. Healthcare providers should pay more attention to this medical situation in the future.
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Affiliation(s)
- Yoshihiko Shitara
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Etsushi Toyofuku
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideki Doi
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Takeo Mukai
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Kohei Kashima
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Satsuki Kakiuchi
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Motohiro Kato
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
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Kloosterman N, Freeman MH, Belcher RH. Assessing Complication Risk of Pressure Equalizing Tube Placement in Children With Velocardiofacial Syndrome (22q11.2 Deletion Syndrome/DiGeorge Syndrome). Ann Otol Rhinol Laryngol 2024; 133:224-228. [PMID: 37776283 DOI: 10.1177/00034894231202063] [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] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Persistent tympanic membrane perforation is a known complication of pressure-equalizing (PE) tube insertion. Conductive hearing loss and otorrhea can necessitate surgical repair of these perforations. Long-term tympanostomy tube placement can increase the risk of these complications. Patients with velocardiofacial syndrome (VCFS) typically require prolonged PE tube placement and are thought to have higher risk of requiring additional otologic interventions after PE tube placement. To date, no work has established rates of post-PE tube complications requiring myringoplasty or tympanoplasty in patients with VCFS. METHODS A retrospective case review including all patients with VCFS at a single large children's hospital between the years 2000 and 2020 was performed. Number of PE tube insertions required and additional otologic interventions performed were the primary endpoints assessed. RESULTS Of 212 total patients with VCFS, 66 (31%) underwent PE tube placement. Of these children, 46 (70%) required 2 or more sets of PE tubes. A total of 53 patients (80.3%) required no otologic interventions apart from PE tube insertions. Of the 13 patients (19.7%) requiring additional otologic surgery, 6 (9.5%) underwent myringoplasty, and 9 patients (13.6%) required tympanoplasty. There was no significant difference in tympanoplasty (P > 1), myringoplasty (P > 1), or other surgical intervention rates (P = .7464) between VCFS patients with any type of cleft palate versus those with anatomically normal palates. CONCLUSION This work suggests that most VCFS patients that require tubes, require at least 2 sets of PE tubes, and that the rate of post-PE tube complications requiring further otologic surgery is an order of magnitude higher than the rate established at this institution. Counseling for PE tube placement in VCFS patients may require specific dialogue regarding the substantially increased risk of complications and effort to build appropriate expectations for surgical outcomes regardless of palatal status.
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Affiliation(s)
- Nicole Kloosterman
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Michael H Freeman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ryan H Belcher
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Vanderbilt Children's Hospital, Nashville, TN, USA
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Habibagahi R, Fallahi HR, Neghabian N, Hoghoughi MA, Babanouri N. Evaluation of the effect of palatoplasty on the quality of life and speech outcomes in patients with velocardiofacial syndrome. Dent Med Probl 2024; 61:29-34. [PMID: 38376354 DOI: 10.17219/dmp/130094] [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: 06/15/2020] [Accepted: 11/04/2020] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Children diagnosed with velocardiofacial syndrome (VCFS) suffer from various disabilities. Palatal abnormalities, as well as speech and language impairment, adversely affect a child's quality of life (QoL) and are some of the most distressing aspects for the parents of these children. OBJECTIVES The present study aimed to explore the effect of palatoplasty on the health-related quality of life (HRQoL) and speech outcomes in children with VCFS. MATERIAL AND METHODS The study recruited 20 patients (N = 20) with VCFS and connected speech, aged 3 years or older, having either undiagnosed submucous cleft palate (SMCP) or velopharyngeal insufficiency (VPI), and requiring primary cleft palate surgery or revision surgery. Speech assessment was conducted prior to palatoplasty and 6 months after the surgery. Intelligibility and hypernasality were evaluated using the Cleft Audit Protocol for Speech - Augmented (CAPS-A). The parent proxy-report form of the Pediatric Quality of Life Inventory (PedsQL™) was used to evaluate and compare the HRQoL of the VCFS patients before and after palatoplasty. RESULTS Significant improvement in the HRQoL scores was achieved after the surgery across all domains (physical, emotional, social, and school functioning), especially in the emotional and social dimensions (p < 0.000). The post-operative speech assessment based on CAPS-A demonstrated improvement in speech intelligibility and hypernasality in the majority of patients. CONCLUSIONS Given that children with VCFS face various medical and social problems, suitable palatal interventions are beneficial, improving both the speech ability and QoL of these children.
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Affiliation(s)
- Raha Habibagahi
- Orthodontic Research Center, School of Dentistry, Shiraz University of Medical Sciences, Iran
| | - Hamid Reza Fallahi
- School of Advanced Medical Sciences and Technologies, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Ali Hoghoughi
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Sciences, Iran
| | - Neda Babanouri
- Orthodontic Research Center, School of Dentistry, Shiraz University of Medical Sciences, Iran
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11
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Doherty JL, Cunningham AC, Chawner SJRA, Moss HM, Dima DC, Linden DEJ, Owen MJ, van den Bree MBM, Singh KD. Atypical cortical networks in children at high-genetic risk of psychiatric and neurodevelopmental disorders. Neuropsychopharmacology 2024; 49:368-376. [PMID: 37402765 PMCID: PMC7615386 DOI: 10.1038/s41386-023-01628-x] [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: 12/20/2022] [Revised: 05/04/2023] [Accepted: 06/01/2023] [Indexed: 07/06/2023]
Abstract
Although many genetic risk factors for psychiatric and neurodevelopmental disorders have been identified, the neurobiological route from genetic risk to neuropsychiatric outcome remains unclear. 22q11.2 deletion syndrome (22q11.2DS) is a copy number variant (CNV) syndrome associated with high rates of neurodevelopmental and psychiatric disorders including autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and schizophrenia. Alterations in neural integration and cortical connectivity have been linked to the spectrum of neuropsychiatric disorders seen in 22q11.2DS and may be a mechanism by which the CNV acts to increase risk. In this study, magnetoencephalography (MEG) was used to investigate electrophysiological markers of local and global network function in 34 children with 22q11.2DS and 25 controls aged 10-17 years old. Resting-state oscillatory activity and functional connectivity across six frequency bands were compared between groups. Regression analyses were used to explore the relationships between these measures, neurodevelopmental symptoms and IQ. Children with 22q11.2DS had altered network activity and connectivity in high and low frequency bands, reflecting modified local and long-range cortical circuitry. Alpha and theta band connectivity were negatively associated with ASD symptoms while frontal high frequency (gamma band) activity was positively associated with ASD symptoms. Alpha band activity was positively associated with cognitive ability. These findings suggest that haploinsufficiency at the 22q11.2 locus impacts short and long-range cortical circuits, which could be a mechanism underlying neurodevelopmental and psychiatric vulnerability in this high-risk group.
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Affiliation(s)
- Joanne L Doherty
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK.
- Cardiff University's Brain Research Imaging Centre (CUBRIC), School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
| | - Adam C Cunningham
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Samuel J R A Chawner
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Hayley M Moss
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Diana C Dima
- Cardiff University's Brain Research Imaging Centre (CUBRIC), School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - David E J Linden
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Cardiff University's Brain Research Imaging Centre (CUBRIC), School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Michael J Owen
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Marianne B M van den Bree
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Krish D Singh
- Cardiff University's Brain Research Imaging Centre (CUBRIC), School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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12
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O’Hora KP, Kushan-Wells L, Schleifer CH, Cruz S, Hoftman GD, Jalbrzikowski M, Gur RE, Gur RC, Bearden CE. Distinct neurocognitive profiles and clinical phenotypes associated with copy number variation at the 22q11.2 locus. Autism Res 2023; 16:2247-2262. [PMID: 37997544 PMCID: PMC10872774 DOI: 10.1002/aur.3049] [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: 03/13/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023]
Abstract
Rare genetic variants that confer large effects on neurodevelopment and behavioral phenotypes can reveal novel gene-brain-behavior relationships relevant to autism. Copy number variation at the 22q11.2 locus offer one compelling example, as both the 22q11.2 deletion (22qDel) and duplication (22qDup) confer increased likelihood of autism spectrum disorders (ASD) and cognitive deficits, but only 22qDel confers increased psychosis risk. Here, we used the Penn Computerized Neurocognitive Battery (Penn-CNB) to characterized neurocognitive profiles of 126 individuals: 55 22qDel carriers (MAge = 19.2 years, 49.1% male), 30 22qDup carriers (MAge = 17.3 years, 53.3% male), and 41 typically developing (TD) subjects (MAge = 17.3 years, 39.0% male). We performed linear mixed models to assess group differences in overall neurocognitive profiles, domain scores, and individual test scores. We found all three groups exhibited distinct overall neurocognitive profiles. 22qDel and 22qDup carriers showed significant accuracy deficits across all domains relative to controls (episodic memory, executive function, complex cognition, social cognition, and sensorimotor speed), with 22qDel carriers exhibiting more severe accuracy deficits, particularly in episodic memory. However, 22qDup carriers generally showed greater slowing than 22qDel carriers. Notably, slower social cognition speed was uniquely associated with increased global psychopathology and poorer psychosocial functioning in 22qDup. Compared to TD, 22q11.2 copy number variants (CNV) carriers failed to show age-associated improvements in multiple cognitive domains. Exploratory analyses revealed 22q11.2 CNV carriers with ASD exhibited differential neurocognitive profiles, based on 22q11.2 copy number. These results suggest that there are distinct neurocognitive profiles associated with either a loss or gain of genomic material at the 22q11.2 locus.
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Affiliation(s)
- Kathleen P. O’Hora
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Leila Kushan-Wells
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Charles H. Schleifer
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Shayne Cruz
- College of Natural and Agricultural Science, University of California, Riverside, CA, USA
| | - Gil D. Hoftman
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Maria Jalbrzikowski
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA, USA
| | - Raquel E. Gur
- Department of Psychiatry, University of Pennsylvania and the Penn-CHOP Lifespan and Brain Institute, Philadelphia, PA, USA
| | - Ruben C. Gur
- Department of Psychiatry, University of Pennsylvania and the Penn-CHOP Lifespan and Brain Institute, Philadelphia, PA, USA
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
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13
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Modasi J, Khachadourian V, O'Hora K, Kushan L, Slavich GM, Shields GS, Velthorst E, Bearden CE. Associations between acute and chronic lifetime stressors and psychosis-risk symptoms in individuals with 22q11.2 copy number variants. Psychol Med 2023; 53:7222-7231. [PMID: 37078394 PMCID: PMC10719673 DOI: 10.1017/s0033291723000740] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND The 22q11.2 deletion (22q11Del) is among the strongest known genetic risk factors for psychosis. Stress, a known risk factor for psychosis in the general population, has seldom been studied in 22q11Del. We investigated how lifetime stressors related to symptomatic outcomes in patients with 22q11Del. We also explored this association in individuals with 22q11.2 duplications (22q11Dup), which may be potentially protective against psychosis. METHOD One hundred individuals (46 with 22q11Del, 30 with 22q11Dup, and 24 healthy controls; Mage = 17.30 years±10.15) were included. Logistic models were used to examine cross-sectional associations between lifetime acute and chronic stressors (severity and count) and the presence (score ⩾3) of positive, negative, and general symptoms, assessed via the Structured Interview for Psychosis-risk Syndromes (SIPS). RESULTS The 22q11Dup group reported the greatest number and severity of acute lifetime stressors, but did not differ from 22q11Del in chronic stressor count or severity. Lifetime chronic and acute stressors were uniquely associated with positive symptoms in 22q11Del (chronic count: odds ratio [OR] = 2.35, p = 0.02; chronic severity: OR = 1.88, p = 0.03; acute count: OR = 1.78, p = 0.03), but not with negative or general symptoms (ps > 0.05). CONCLUSION Findings suggest that stress may play a role in psychotic symptoms in 22q1Del, while the 22q11Dup CNV appears protective against psychotic symptoms despite higher rates of stressors. Interventions that mitigate effects of stressors in 22qDel may reduce the odds of psychosis in this group. Prospective longitudinal research is needed to replicate these findings.
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Affiliation(s)
- Jasmine Modasi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathleen O'Hora
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Interdepartmental Program for Neuroscience, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Leila Kushan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Grant S. Shields
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
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14
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Pizer JH, Myers MA, Hill BD. PGR - 2 Demons In The Mirrors: A Childhood Case Report of 22q11.2 Deletion Syndrome First Addressed By Tele-Neuropsychological Evaluation During The COVID-19 Lockdown. Arch Clin Neuropsychol 2023; 38:1137-1140. [PMID: 37807134 DOI: 10.1093/arclin/acad067.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE 22q11.2 Deletion Syndrome (22q11DS) results in physical, cognitive, and behavioral issues. Although it is the most common microdeletion syndrome, there remains a high prevalence of delayed diagnosis. Its heterogeneous phenotypic presentation lead to differing considerations for early diagnostic identification. If initial symptomatology includes behavioral and cognitive disturbance, it is likely for such individuals to be referred first for neuropsychological testing before genetic testing. This case will expand upon diagnostic identification of 22q11DS. METHOD A 12-year-old, 5-years educated, white female was seen for tele-neuropsychological evaluation due to COVID-19 restrictions in December 2020. Patient's mother reported concern regarding sudden and worsening behavioral changes including hallucinations, unusual affects, odd beliefs, academic decline, illegible handwriting, attention and memory issues, and behavioral problems in school to the point of removal. RESULTS Overall performance on the Meyers Neuropsychological Battery was severely impaired. See uploaded image file for specific test findings. Speech, affect, and behavior were notable during examination. Diagnoses included schizophrenia (provisional) and specific learning disorder with reading impairment (historical). Immediate neurology consultation was recommended. Later EEG, brain MRI, and CSF were unremarkable. Acute metabolic etiology was ruled out. Subsequent genetic testing revealed 22q11DS. CONCLUSIONS Diagnostic identification of 22q11DS and resulting access to care management heavily depends on initial symptom presentation. In this specific case, the COVID-19 lockdown created barrier to sufficient services. This case expands upon knowledge of the cognitive profile of 22q11DS and calls upon increased awareness. Targeted improvement of neurocognition potentially protects against cognitive decline related to psychotic symptoms, and thus neuropsychologists play a vital role in referral to such resources.
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15
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Vlădăreanu R, Maier C, Tocariu R, Șerban M, Brătilă E. Perinatal Diagnosis and Management of a Case with Interrupted Aortic Arch, Pulmonary Valve Dysplasia and 22q11.2 Deletion: A Case Report. Medicina (Kaunas) 2023; 59:1838. [PMID: 37893556 PMCID: PMC10608239 DOI: 10.3390/medicina59101838] [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: 10/02/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023]
Abstract
The 22q11.2 deletion syndrome (22q11.2DS) is the most common chromosomal microdeletion disorder caused by hemizygous microdeletion of the long arm of chromosome 22. It is now known to have a heterogenous presentation that includes multiple additional congenital anomalies and later-onset conditions, such as gastrointestinal and renal abnormalities, autoimmune disease, variable cognitive delays, behavioral phenotypes and psychiatric illness. The purpose of our paper is to present the case of a fetus diagnosed with a complex association of cardiac anomalies: interrupted aortic arch type B, large malalignment-type ventricular septal defect, pulmonary valve dysplasia, and aberrant right subclavian artery for whom the result of genetic testing revealed 22q11.2 deletion. The pregnancy was regularly followed until delivery which took place in Germany so that neonatal cardiac surgery could be performed in an experienced center for cardiac malformations. The distinctivness of our report resides in the fact that it offers a complete image of a case of 22q11.2 deletion syndrome starting from the prenatal diagnosis (and emphasizing on the most relevant sonographic features) and, with parents not opting for termination of pregnancy, ending with the newborn surviving major cardiac surgery, offering thus the possibility to bring into focus postnatal outcome and future expectations in similar cases.
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Affiliation(s)
- Radu Vlădăreanu
- Department of Obstetrics And Gynecology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
- Department of Obstetrics And Gynecology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
| | - Călina Maier
- Department of Obstetrics And Gynecology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
- Department of Obstetrics And Gynecology, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sîrbu”, 060251 Bucharest, Romania; (R.T.); (M.Ș.)
| | - Raluca Tocariu
- Department of Obstetrics And Gynecology, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sîrbu”, 060251 Bucharest, Romania; (R.T.); (M.Ș.)
| | - Marcela Șerban
- Department of Obstetrics And Gynecology, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sîrbu”, 060251 Bucharest, Romania; (R.T.); (M.Ș.)
| | - Elvira Brătilă
- Department of Obstetrics And Gynecology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
- Department of Obstetrics And Gynecology, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sîrbu”, 060251 Bucharest, Romania; (R.T.); (M.Ș.)
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16
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Rogdaki M. From Gene to Brain and Behavior: Excitatory and Inhibitory Imbalance and Psychosis in Individuals With 22q11.2 Deletion Syndrome. Biol Psychiatry 2023; 94:526-527. [PMID: 37673515 DOI: 10.1016/j.biopsych.2023.07.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Maria Rogdaki
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
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17
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Lu N, Kacin AJ, Shaffer AD, Stapleton AL. Otorhinologic Disorders in 22q11.2 Deletion Syndrome. Otolaryngol Head Neck Surg 2023; 169:1012-1019. [PMID: 36950877 DOI: 10.1002/ohn.331] [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: 10/24/2022] [Revised: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE Investigate incidence and natural history of otologic and sinonasal disease associated with 22q11.2 deletion syndrome. STUDY DESIGN Case series. SETTING Tertiary care children's hospital. METHODS Charts from consecutive children born 2000 to 2018 with a diagnosis of 22q11.2 deletion, DiGeorge, or velocardiofacial syndrome based on the International Classification of Diseases (ICD)-9 and ICD-10 codes were reviewed. Otologic and rhinologic diagnoses and surgeries and immune and microbiologic laboratory findings were collected from the medical record. RESULTS After the exclusion of patients with no 22q11.2 deletion (n = 101), otologic care at an outside hospital (n = 59), and loss to follow-up prior to 3 years of age (n = 22), 128 were included. Males comprised 80 (62.5%) patients, 115 (89.8%) were white, and the median age at genetic confirmation of 22q11.2 deletion was 119 days (range 0 days to 14.6 years). Recurrent acute otitis media (RAOM), chronic otitis media with effusion, chronic rhinosinusitis, and recurrent acute sinusitis were diagnosed in 54 (42.2%), 37 (28.9%), 10 (7.8%), and 8 (6.3%), respectively. Tympanostomy tubes were placed in 49 (38.3%). Adenoidectomy and sinus surgery were performed in 38 (29.7%) and 4 (3.1%), respectively. Neither immunoglobulin nor cluster of differentiation deficiency increased the odds of RAOM diagnosis, tympanostomy tube placement, or chronic/recurrent sinusitis. Methicillin-resistant Staphylococcus aureus was the most common organism in sinus cultures (4/13, 30.8%). Streptococcus pneumonia dominated otorrhea cultures (11/21, 52.4%). CONCLUSION Approximately half of children with 22q11.2 deletion may experience otologic disease that often requires surgical management. Future studies will utilize a larger cohort to examine the role of immunodeficiency in otologic and rhinologic disease in this population.
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Affiliation(s)
- Nathan Lu
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alexa J Kacin
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Amber D Shaffer
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amanda L Stapleton
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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18
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Mancini V, Saleh MG, Delavari F, Bagautdinova J, Eliez S. Excitatory/Inhibitory Imbalance Underlies Hippocampal Atrophy in Individuals With 22q11.2 Deletion Syndrome With Psychotic Symptoms. Biol Psychiatry 2023; 94:569-579. [PMID: 37011759 DOI: 10.1016/j.biopsych.2023.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/10/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Abnormal neurotransmitter levels have been reported in individuals at high risk for schizophrenia, leading to a shift in the excitatory/inhibitory balance. However, it is unclear whether these alterations predate the onset of clinically relevant symptoms. Our aim was to explore in vivo measures of excitatory/inhibitory balance in 22q11.2 deletion carriers, a population at genetic risk for psychosis. METHODS Glx (glutamate+glutamine) and GABA+ (gamma-aminobutyric acid with macromolecules and homocarnosine) concentrations were estimated in the anterior cingulate cortex, superior temporal cortex, and hippocampus using the Mescher-Garwood point-resolved spectroscopy (MEGA-PRESS) sequence and the Gannet toolbox in 52 deletion carriers and 42 control participants. T1-weighted images were acquired longitudinally and processed with FreeSurfer version 6 to extract hippocampal volume. Subgroup analyses were conducted in deletion carriers with psychotic symptoms. RESULTS While no differences were found in the anterior cingulate cortex, deletion carriers had higher levels of Glx in the hippocampus and superior temporal cortex and lower levels of GABA+ in the hippocampus than control participants. We additionally found a higher Glx concentration in the hippocampus of deletion carriers with psychotic symptoms. Finally, more pronounced hippocampal atrophy was significantly associated with increased Glx levels in deletion carriers. CONCLUSIONS We provide evidence for an excitatory/inhibitory imbalance in temporal brain structures of deletion carriers, with a further hippocampal Glx increase in individuals with psychotic symptoms that was associated with hippocampal atrophy. These results are in line with theories proposing abnormally enhanced glutamate levels as a mechanistic explanation for hippocampal atrophy via excitotoxicity. Our results highlight a central role of glutamate in the hippocampus of individuals at genetic risk for schizophrenia.
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Affiliation(s)
- Valentina Mancini
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland.
| | - Muhammad G Saleh
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Farnaz Delavari
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Joëlle Bagautdinova
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland; Department of Genetic Medicine and Development, University of Geneva School of Medicine, Geneva, Switzerland
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19
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Camargo Y, Kellogg B, Kollara L. Pharyngeal Flap Versus Sphincter Pharyngoplasty for the Treatment of Velopharyngeal Insufficiency in 22q11.2 Deletion Syndrome: Preliminary Findings From a Systematic Review. J Craniofac Surg 2023; 34:1994-1998. [PMID: 37431935 DOI: 10.1097/scs.0000000000009531] [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: 07/26/2022] [Accepted: 05/19/2023] [Indexed: 07/12/2023] Open
Abstract
The purpose of this study was to examine and compare surgical and speech outcomes of the posterior pharyngeal flap and sphincter pharyngoplasty following surgical management of velopharyngeal insufficiency in patients with 22q11.2 deletion syndrome (22q11.2DS). This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses checklist and guidelines. Selected studies were chosen using a 3-step screening process. The 2 primary outcomes of interest were speech improvement and surgical complications. Preliminary findings based on included studies suggest a slightly higher rate of postoperative complications with the posterior pharyngeal flap in patients with 22q11.2DS but a lower percentage of patients needing additional surgery compared with the sphincter pharyngoplasty group. The most reported postoperative complication was obstructive sleep apnea. Results from this study provide some insight into speech and surgical outcomes following pharyngeal flap and sphincter pharyngoplasty in patients with 22q11.2DS. However, these results should be interpreted with caution due to inconsistencies in speech methodology and lack of detail regarding surgical technique in the current literature. There is a significant need for standardization of speech assessments and outcomes to help optimize surgical management of velopharyngeal insufficiency in individuals with 22q11.2DS.
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Affiliation(s)
- Yitzella Camargo
- School of Communication Sciences and Disorders, College of Health Professions and Sciences, University of Central Florida
| | - Brian Kellogg
- Division of Plastic & Craniofacial Surgery, Department of Surgery, Nemours Children's Hospital
| | - Lakshmi Kollara
- School of Communication Sciences and Disorders, College of Health Professions and Sciences, University of Central Florida
- Biionix Cluster, College of Medicine, University of Central Florida, Orlando, FL
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20
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Pattisapu P, Kinter S, Bly RA, Dahl JP, Perkins JA, Wang X, Sie KCY. Sphincter Pharyngoplasty for Velopharyngeal Dysfunction: Impact of 22q11.2 Deletion Syndrome. Laryngoscope 2023; 133:2813-2820. [PMID: 36695155 DOI: 10.1002/lary.30579] [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: 06/23/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Patients with 22q11.2 deletion syndrome (22q11DelS) often present with velopharyngeal dysfunction (VPD). VPD in patients with 22q11DelS is multifactorial beyond velopharyngeal insufficiency (VPI) alone, and differences in surgical outcomes are poorly understood. Our objective was to determine whether patients with 22q11DelS have an increased risk for persistent VPI after sphincter pharyngoplasty compared to patients without 22q11DelS. METHODS We completed a retrospective cohort study of patients with 22q11DelS undergoing sphincter pharyngoplasty between 1995 and 2019 using a VPD clinic database. Patients with 22q11DelS were compared to a cohort of 2:1 frequency-matched (age, degree of velopharyngeal closure) patients without 22q11DelS. Variables included patient characteristics, surgical history, perceptual speech evaluation, and degree of closure on nasopharyngoscopic evaluations. Primary outcomes included postoperative VPI severity and hypernasality. Speech and nasopharyngoscopic characteristics were compared using Fisher's exact test. Postoperative VPI severity and hypernasality were compared between groups via relative risks (RR) from mixed effects Poisson regression models, with random effects of age and velopharyngeal closure. RESULTS 134 patients (51 22q11DelS, 83 matched) were included, with mean age of 7.3 years (standard deviation 3.0) and 50% male. Cohorts had similar preoperative speech characteristics and nasopharyngoscopic findings. Patients with 22q11DelS had similar postoperative VP function as patients without 22q11DelS (RR 0.85, CI 0.46-1.57 for VPI severity, RR 0.83, CI 0.45-1.53 for hypernasality). Even after adjusting by preoperative variables, no differences were seen between both groups. CONCLUSION Matched for age and pre-operative velopharyngeal closure, patients with and without 22q11DelS and VPI had similar benefits after sphincter pharyngoplasty. LEVEL OF EVIDENCE Non-randomized controlled cohort study, 3 Laryngoscope, 133:2813-2820, 2023.
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Affiliation(s)
- Prasanth Pattisapu
- Department of Otolaryngology-Head & Neck Surgery, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
- Center for Surgical Outcomes Research and Center for Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sara Kinter
- Childhood Communication Center, Seattle Children's Hospital, Seattle, Washington, USA
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior & Development, Seattle Children's Hospital, Seattle, Washington, USA
| | - Randall A Bly
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - John P Dahl
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jonathan A Perkins
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Xing Wang
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kathleen C Y Sie
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
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21
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O'Hora KP, Schleifer CH, Bearden CE. Sleep in 22q11.2 Deletion Syndrome: Current Findings, Challenges, and Future Directions. Curr Psychiatry Rep 2023; 25:479-491. [PMID: 37721640 PMCID: PMC10627929 DOI: 10.1007/s11920-023-01444-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE OF REVIEW To summarize current literature available on sleep in 22q11.2 Deletion Syndrome (22q11.2DS; Velocardiofacial or DiGeorge Syndrome), a neurogenetic disorder caused by a hemizygous deletion in a genomic region critical for neurodevelopment. Due to the greatly increased risk of developmental psychiatric disorders (e.g., autism and schizophrenia) in 22q11.2DS, this review focuses on clinical correlates of sleep disturbances and potential neurobiological underpinnings of these relationships. RECENT FINDINGS Sleep disturbances are widely prevalent in 22q11.2DS and are associated with worse behavioral, psychiatric, and physical health outcomes. There are reports of sleep architecture and sleep neurophysiology differences, but the literature is limited by logistical challenges posed by objective sleep measures, resulting in small study samples to date. Sleep disturbances in 22q11.2DS are prevalent and have a substantial impact on well-being. Further investigation of sleep in 22q11.2DS utilizing multimodal sleep assessments has the potential to provide new insight into neurobiological mechanisms and a potential trans-diagnostic treatment target in 22q11.2DS.
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Affiliation(s)
- Kathleen P O'Hora
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Charles H Schleifer
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.
- Department of Psychology, University of California, Los Angeles, CA, USA.
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22
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Chan CH, Lam YY, Wong N, Geng L, Zhang J, Ahola V, Zare A, Li RA, Lanner F, Keung W, Cheung YF. Abnormal developmental trajectory and vulnerability to cardiac arrhythmias in tetralogy of Fallot with DiGeorge syndrome. Commun Biol 2023; 6:969. [PMID: 37740059 PMCID: PMC10516936 DOI: 10.1038/s42003-023-05344-6] [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: 05/25/2022] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Ventricular dysfunction and cardiac arrhythmias are well-documented complications in patients with repaired TOF. Whether intrinsic abnormalities exist in TOF cardiomyocytes is unknown. We establish human induced pluripotent stem cells (hiPSCs) from TOF patients with and without DiGeorge (DG) syndrome, the latter being the most commonly associated syndromal association of TOF. TOF-DG hiPSC-derived cardiomyocytes (hiPSC-CMs) show impaired ventricular specification, downregulated cardiac gene expression and upregulated neural gene expression. Transcriptomic profiling of the in vitro cardiac progenitors reveals early bifurcation, as marked by ectopic RGS13 expression, in the trajectory of TOF-DG-hiPSC cardiac differentiation. Functional assessments further reveal increased arrhythmogenicity in TOF-DG-hiPSC-CMs. These findings are found only in the TOF-DG but not TOF-with no DG (ND) patient-derived hiPSC-CMs and cardiac progenitors (CPs), which have implications on the worse clinical outcomes of TOF-DG patients.
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Affiliation(s)
- Chun-Ho Chan
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yin-Yu Lam
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Nicodemus Wong
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lin Geng
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jilin Zhang
- Ming Wai Lau Centre for Reparative Medicine, Hong Kong node, Karolinska Institutet, Units 608-613 Building 15 Science Park, Hong Kong, China
| | - Virpi Ahola
- Ming Wai Lau Centre for Reparative Medicine, Hong Kong node, Karolinska Institutet, Units 608-613 Building 15 Science Park, Hong Kong, China
| | - Aman Zare
- Ming Wai Lau Centre for Reparative Medicine, Hong Kong node, Karolinska Institutet, Units 608-613 Building 15 Science Park, Hong Kong, China
| | - Ronald Adolphus Li
- Ming Wai Lau Centre for Reparative Medicine, Hong Kong node, Karolinska Institutet, Units 608-613 Building 15 Science Park, Hong Kong, China
- Dr. Li Dak-Sum Research Centre, The University of Hong Kong - Karolinska Institutet Collaboration in Regenerative Medicine, The University of Hong Kong, Hong Kong, China
| | - Fredrik Lanner
- Ming Wai Lau Centre for Reparative Medicine, Stockholm node, Karolinska Institutet, Solnavagen 9, 17165, Stockholm, Sweden
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Division of Obstetrics and Gynecology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Wendy Keung
- Dr. Li Dak-Sum Research Centre, The University of Hong Kong - Karolinska Institutet Collaboration in Regenerative Medicine, The University of Hong Kong, Hong Kong, China
| | - Yiu-Fai Cheung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
- Ming Wai Lau Centre for Reparative Medicine, Hong Kong node, Karolinska Institutet, Units 608-613 Building 15 Science Park, Hong Kong, China.
- Dr. Li Dak-Sum Research Centre, The University of Hong Kong - Karolinska Institutet Collaboration in Regenerative Medicine, The University of Hong Kong, Hong Kong, China.
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Denkboy Öngen Y, Özemri Sağ Ş, Temel ŞG, Eren E. An Endocrinological Perspective on 22q11.2 Deletion Syndrome: A Single-center Experience. J Clin Res Pediatr Endocrinol 2023; 15:285-292. [PMID: 37074225 PMCID: PMC10448559 DOI: 10.4274/jcrpe.galenos.2023.2022-11-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/01/2023] [Indexed: 04/20/2023] Open
Abstract
Objective 22q11.2 deletion syndrome (22q11.2 DS) is the most common chromosomal microdeletion disorder. Associated problems in 22q11.2 DS may include cardiac abnormalities, immune dysfunction, facial dysmorphism, with endocrine, genitourinary and gastrointestinal problems, and developmental delay. The aim of this study was to evaluate and present all endocrinological findings of patients with 22q11.2 DS from a single center. Methods All participants had confirmed 22q11.2 DS by fluorescence in situ hybridization with hypoparathyroidism. Data were retrieved by retrospective review of patient records. Results A total of 17 patients were reviewed. On physical examination, all patients had similar dysmorphic features. The median age at diagnosis was 45 days (1 day-13 years). Most cases (64.7%, 11/17) were diagnosed with hypoparathyroidism incidentally after routine tests. At the time of diagnosis, mean calcium was 7.04±0.80 mg/dL, phosphorus was 6.2±1.1 mg/dL, and median parathyroid hormone (PTH) was 11.5 (3.7-47.6) ng/L. Transient hypoparathyroidism was detected in five cases (29.4%). There was no significant difference between patients with permanent or transient hypoparathyroidism regarding gender, age at diagnosis, calcium, phosphorus, and PTH levels. However, vitamin D levels were significantly lower in the transient group (p=0.036). During follow-up, short stature, obesity, and type 2 diabetes mellitus were absent. Thyroid autoantibodies were detected in two patients with normal thyroid function tests. Despite there being no pathological short stature, final stature was shorter than the general population (mean height standard deviation score: -0.94±0.83). Conclusion Hypocalcemia may be detected during acute illness in some cases where hypocalcemia appears at later ages. There was no significant difference between permanent and transient hypoparathyroidism cases in terms of PTH level. Recognition of the more specific facial findings is important to trigger investigation of genetic variants, additional anomalies, and for follow-up.
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Affiliation(s)
- Yasemin Denkboy Öngen
- Bursa Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Şebnem Özemri Sağ
- Bursa Uludağ University Faculty of Medicine, Department of Medical Genetics, Bursa, Turkey
| | - Şehime Gülsün Temel
- Bursa Uludağ University Faculty of Medicine, Department of Medical Genetics, Bursa, Turkey
| | - Erdal Eren
- Bursa Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
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Sarli WM, Ricci S, Lodi L, Cavone F, Pacillo L, Giancotta C, Ubertini G, Baroncelli G, Cancrini C, Azzari C, Stagi S. Risk of thyroid neoplasms in patients with 22q11.2 deletion and DiGeorge-like syndromes: an insight for follow-up. Front Endocrinol (Lausanne) 2023; 14:1209577. [PMID: 37635986 PMCID: PMC10450035 DOI: 10.3389/fendo.2023.1209577] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/14/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction The chromosome 22q11.2 deletion syndrome comprises phenotypically similar diseases characterized by abnormal development of the third and fourth branchial arches, resulting in variable combinations of congenital heart defects, dysmorphisms, hypocalcemia, palatal dysfunction, developmental or neuropsychiatric disorders, and impairment of the immune system due to thymic dysfunction. Other genetic syndromes, often called DiGeorge-like, share clinical and immunological features with 22q11.2 deletion syndrome. This syndrome has been rarely associated with malignancies, mainly hematological but also hepatic, renal, and cerebral. Rarely, malignancies in the head and neck region have been described, although no aggregate of data on the development of thyroid neoplasms in patients with this clinical phenotype has been conducted so far. Materials and methods To characterize this possible association, a multicenter survey was made. Thus, we present a case series of five pediatric patients with 22q11.2 deletion syndrome or DiGeorge-like syndrome who were occasionally found with confirmed or highly suspected neoplasms of the thyroid gland during their follow-up. In three cases, malignancies were histologically confirmed, but their outcome was good due to an early recognition of suspicious nodules and precocious surgery. Conclusions This study underlines for clinicians the higher risk of neoplasms in the head and neck district for patients affected by these syndromes. It also emphasizes the importance of a prolonged clinical and ultrasound follow-up for patients with this clinical and immunological phenotype.
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Affiliation(s)
- Walter Maria Sarli
- Department of Health Sciences, University of Florence, Florence, Italy
- Paediatric Immunology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Silvia Ricci
- Department of Health Sciences, University of Florence, Florence, Italy
- Paediatric Immunology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Lorenzo Lodi
- Department of Health Sciences, University of Florence, Florence, Italy
- Paediatric Immunology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Federica Cavone
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lucia Pacillo
- Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Research Unit of Primary Immunodeficiency, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Carmela Giancotta
- Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Graziamaria Ubertini
- Unit of Endocrinology and Diabetology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Giampiero Baroncelli
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Caterina Cancrini
- Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Research Unit of Primary Immunodeficiency, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Chiara Azzari
- Department of Health Sciences, University of Florence, Florence, Italy
- Paediatric Immunology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Stefano Stagi
- Department of Health Sciences, University of Florence, Florence, Italy
- Auxoendocrinology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
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Latrèche C, Maeder J, Mancini V, Bortolin K, Schneider M, Eliez S. Altered developmental trajectories of verbal learning skills in 22q11.2DS: associations with hippocampal development and psychosis. Psychol Med 2023; 53:4923-4932. [PMID: 35775360 PMCID: PMC10476015 DOI: 10.1017/s0033291722001842] [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: 10/12/2021] [Revised: 03/02/2022] [Accepted: 05/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The cognitive profile in 22q11.2 deletion syndrome (22q11.2DS) is often characterized by a discrepancy between nonverbal vs. verbal reasoning skills, in favor of the latter skills. This dissociation has also been observed in memory, with verbal learning skills described as a relative strength. Yet the development of these skills is still to be investigated. We thus aimed to explore verbal learning longitudinally. Furthermore, we explored verbal learning and its respective associations with hippocampal alterations and psychosis, which remain largely unknown despite their high prevalence in 22q11.2DS. METHODS In total, 332 individuals (173 with 22q11.2DS) aged 5-30 years completed a verbal-paired associates task. Mixed-models regression analyses were conducted to explore developmental trajectories with threefold objectives. First, verbal learning and retention trajectories were compared between 22q11.2DS vs. HC. Second, we examined hippocampal volume development in 22q11.2DS participants with lower vs. higher verbal learning performance. Third, we explored verbal learning trajectories in 22q11.2DS participants with vs. without positive psychotic symptoms and with vs. without a psychotic spectrum disorder (PSD). RESULTS Our findings first reveal lower verbal learning performance in 22q11.2DS, with a developmental plateau emerging from adolescence. Second, participants with lower verbal learning scores displayed a reduced left hippocampal tail volume. Third, participants with PSD showed a deterioration of verbal learning performance, independently of verbal reasoning skills. CONCLUSION Our study challenges the current view of preserved verbal learning skills in 22q11.2DS and highlights associations with specific hippocampal alterations. We further identify verbal learning as a novel cognitive marker for psychosis in 22q11.2DS.
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Affiliation(s)
- Caren Latrèche
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Johanna Maeder
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Valentina Mancini
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Karin Bortolin
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
- Medical Image Processing Lab, Institute of Bioengineering, EPFL, Lausanne, Switzerland
| | - Maude Schneider
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Department of Neurosciences, KU Leuven, Center for Contextual Psychiatry, Leuven, Belgium
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
- Department of Genetic Medicine and Development, University of Geneva School of Medicine, Geneva, Switzerland
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Galazka MA, Wallin L, Thorsson M, Gillberg C, Billstedt E, Hadjikhani N, Åsberg Johnels J. Self-reported eye contact sensitivity and face processing in chromosome 22q11.2 deletion syndrome. J Clin Exp Neuropsychol 2023; 45:570-578. [PMID: 37732542 DOI: 10.1080/13803395.2023.2259043] [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: 02/07/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION 22q11.2 deletion syndrome (22qDS) has been associated with varying levels of social impairments, and with atypical visual scanning of faces. The present study explored whether self-reported sensitivity to eye contact might be related to these phenomena. METHOD Individuals with confirmed 22qDS were interviewed about their experience and possible discomfort with eye contact. In cases where individuals expresesed discomfort, they were subsequently asked about coping mechanisms used to deal with this discomfort. In addition to self-reported eye contact discomfort, gaze to emotional faces was examined using eye tracking. RESULTS In the subgroup of individuals who reported discomfort during eye contact, eye tracking results revealed a lower amount of gaze in the eyes of neutral faces, as well as the absence of the typical left visual field (LVF) bias, indicative of alterations in hemispheric lateralization. This subgroup also scored lower on a measure of everyday functioning. CONCLUSIONS Our results show that, by simply asking individuals with this social and communicative disorder about eye gaze discomfort, we may better understand the specific challenges that they experience. Moreover, information gained from such first-person reports together with eye-tracking measures further informs about the integrity of their face processing system, as well as about the nature and degree of impairment in this population.
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Affiliation(s)
- Martyna A Galazka
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Division of Cognition and Communication, Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Lena Wallin
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Cognition and Old Age Psychiatric Clinic, Sahlgrenska University Hospital, Psychiatry, Gothenburg, Sweden
| | - Max Thorsson
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Child Neuropsychiatric Clinic, Queen Silvia Children's Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Child Neuropsychiatric Clinic, Queen Silvia Children's Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Nouchine Hadjikhani
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jakob Åsberg Johnels
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Child Neuropsychiatric Clinic, Queen Silvia Children's Hospital, Västra Götalandsregionen, Gothenburg, Sweden
- Section of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Leader G, Curtin A, Shprintzen RJ, Whelan S, Coyne R, Mannion A. Adaptive living skills, sleep problems, and mental health disorders in adults with 22q11.21 deletion syndrome. Res Dev Disabil 2023; 136:104491. [PMID: 36965410 DOI: 10.1016/j.ridd.2023.104491] [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: 04/12/2022] [Revised: 02/24/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND 22q11.21 deletion syndrome (22q11DS) is a neurodevelopmental syndrome caused by a microdeletion of genes at the 22q11.21 locus. It has a prevalence of 1:2000. This study investigated the prevalence of adaptive living skills, sleep problems, and mental health disorders in adults with 22q11DS and examined the relationship between these factors. METHODS Parents with an adult son or daughter with 22q11DS completed the following: A bespoke Demographic Information Questionnaire, Sleep Questionnaire (SQ-SP), Psychopathology in Autism Checklist (PAC), and Activities of Daily Living (ADL) scale. Descriptive statistics, correlations, and one-way between groups analysis of variance (ANOVA) were conducted. RESULTS Mental health difficulties, sleep problems, and low levels of adaptive living skills are prevalent in adults with 22q11DS. Strong positive correlations were identified between sleep problems, depression, and anxiety subscale scores and moderate negative correlations between depression, psychosis, and activities of daily living skills. CONCLUSION Adults with 22q11DS need screening and treatment for mental health and sleep problems.
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Affiliation(s)
- Geraldine Leader
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National, University of Ireland, Galway, Ireland.
| | - Andrea Curtin
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National, University of Ireland, Galway, Ireland
| | | | - Sally Whelan
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National, University of Ireland, Galway, Ireland
| | - Rory Coyne
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National, University of Ireland, Galway, Ireland
| | - Arlene Mannion
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National, University of Ireland, Galway, Ireland
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Şeker E, Yıldız GA. A case of DiGeorge syndrome presenting with a cervical aortic arch. Arch Gynecol Obstet 2023; 307:1185-1186. [PMID: 36656434 DOI: 10.1007/s00404-022-06849-x] [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: 10/10/2022] [Accepted: 11/06/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Erdal Şeker
- Perinatology Unit, Department of Obstetrics and Gynecology, Ankara University, Ankara, Turkey.
| | - Gülşah Aynaoğlu Yıldız
- Perinatology Unit, Department of Obstetrics and Gynecology, Ankara University, Ankara, Turkey
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29
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Tanaka W, Oyama N, Makimura M, Miyako K. Hypocalcemia and Graves' disease associated with 22q11.2 deletion syndrome. Pediatr Int 2023; 65:e15709. [PMID: 37968902 DOI: 10.1111/ped.15709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 10/03/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Wataru Tanaka
- Department of Endocrinology and Metabolism, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Noriko Oyama
- Department of Endocrinology and Metabolism, Fukuoka Children's Hospital, Fukuoka, Japan
- Department of Pediatrics, Oita Prefectural Hospital, Oita, Japan
| | - Mika Makimura
- Department of Endocrinology and Metabolism, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Kenichi Miyako
- Department of Endocrinology and Metabolism, Fukuoka Children's Hospital, Fukuoka, Japan
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Schmitt JE, DeBevits JJ, Roalf DR, Ruparel K, Gallagher RS, Gur RC, Alexander-Bloch A, Eom TY, Alam S, Steinberg J, Akers W, Khairy K, Crowley TB, Emanuel B, Zakharenko SS, McDonald-McGinn DM, Gur RE. A Comprehensive Analysis of Cerebellar Volumes in the 22q11.2 Deletion Syndrome. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:79-90. [PMID: 34848384 PMCID: PMC9162086 DOI: 10.1016/j.bpsc.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/12/2021] [Accepted: 11/08/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The presence of a 22q11.2 microdeletion (22q11.2 deletion syndrome [22q11DS]) ranks among the greatest known genetic risk factors for the development of psychotic disorders. There is emerging evidence that the cerebellum is important in the pathophysiology of psychosis. However, there is currently limited information on cerebellar neuroanatomy in 22q11DS specifically. METHODS High-resolution 3T magnetic resonance imaging was acquired in 79 individuals with 22q11DS and 70 typically developing control subjects (N = 149). Lobar and lobule-level cerebellar volumes were estimated using validated automated segmentation algorithms, and subsequently group differences were compared. Hierarchical clustering, principal component analysis, and graph theoretical models were used to explore intercerebellar relationships. Cerebrocerebellar structural connectivity with cortical thickness was examined via linear regression models. RESULTS Individuals with 22q11DS had, on average, 17.3% smaller total cerebellar volumes relative to typically developing subjects (p < .0001). The lobules of the superior posterior cerebellum (e.g., VII and VIII) were particularly affected in 22q11DS. However, all cerebellar lobules were significantly smaller, even after adjusting for total brain volumes (all cerebellar lobules p < .0002). The superior posterior lobule was disproportionately associated with cortical thickness in the frontal lobes and cingulate cortex, brain regions known be affected in 22q11DS. Exploratory analyses suggested that the superior posterior lobule, particularly Crus I, may be associated with psychotic symptoms in 22q11DS. CONCLUSIONS The cerebellum is a critical but understudied component of the 22q11DS neuroendophenotype.
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Affiliation(s)
- J Eric Schmitt
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania; Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - John J DeBevits
- Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David R Roalf
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Kosha Ruparel
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - R Sean Gallagher
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Ruben C Gur
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Aaron Alexander-Bloch
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Tae-Yeon Eom
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Shahinur Alam
- Center for Bioimage Informatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jeffrey Steinberg
- Center for Bioimage Informatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Walter Akers
- Center for Bioimage Informatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Khaled Khairy
- Center for In Vivo Imaging and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - T Blaine Crowley
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beverly Emanuel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stanislav S Zakharenko
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Donna M McDonald-McGinn
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Raquel E Gur
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania; Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Wylazłowska AJ, Grabarczyk M, Gorczyca M, Matusik P. Late diagnosis of DiGeorge syndrome in a 13-year-old male with subclinical course of the disease - case report and literature review. Pediatr Endocrinol Diabetes Metab 2023; 29:259-266. [PMID: 38282495 PMCID: PMC10826693 DOI: 10.5114/pedm.2023.132030] [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: 04/16/2023] [Accepted: 08/20/2023] [Indexed: 01/30/2024]
Abstract
DiGeorge syndrome is associated with microdeletion of chromosome 22q11. Hypoplasia of the thymus, hypoparathyroidism, facial malformations and cardiac defects as well as learning difficulties are typical features of the disease. On the other hand hypocalcemia related to hypoparathyroidism is not present in every patient and can develop later and be persistent or transient and is often masked by the other signs or symptoms. We described a 13-year-old boy diagnosed with DiGeorge syndrome, after a few years of nonspecific signs and symptoms, and a microarray examination performed because myopathy was suspected on the basis of elevated creatine kinase activity. Only after molecular confirmation of DiGeorge syndrome the patient was referred to a pediatric endocrinologist and proper therapy started. Looking back to his medical history, low calcium levels were at least 2 times reported in the medical records, the child had learning difficulties, speech disturbances, and submucosal cleft palate suspicion. In conclusion it is important to educate general practitioners and pediatricians to check the serum calcium levels in patients presenting with nonspecific, muscular signs and symptoms.
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Affiliation(s)
| | - Małgorzata Grabarczyk
- Department of Pathophysiology, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, Health Promotion and Obesity Management Unit, Poland
| | - Marta Gorczyca
- Department of Anatomy, Institute of Medical Sciences, University of Opole, Poland
- Institute of Nursing, Faculty of Medical Sciences, University of Applied Sciences, Poland
| | - Paweł Matusik
- Department of Pediatrics, Pediatric Obesity and Metabolic Bone Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Hankey PB, Ghulmiyyah J, Yeh HW, Tracy M, Arganbright J. Airway anomalies in patients with 22q11.2 deletion syndrome: A scoping review. Int J Pediatr Otorhinolaryngol 2022; 163:111373. [PMID: 36335759 DOI: 10.1016/j.ijporl.2022.111373] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/22/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE People with 22q11.2 deletion syndrome (22q11DS) can present with a wide variety of findings. Various airway anomalies have been described intermittently within this syndrome, but this feature has not been extensively investigated. Increased provider awareness of these findings may help guide clinical decision-making and improve overall patient outcomes. The objectives of this review are to identify the types of airway anomalies in 22q11DS and the prevalence of airway anomalies within symptomatic individuals. METHODS PubMed/MEDLINE, Cochrane Library, and EMBASE databases were searched in February 2022 for all available articles. Search terms included those that described 22q11DS or one of its synonymous conditions AND those that described airway anatomy and anomalies. The term airway anomaly was defined as any structural aberration in the conductive airway from the oral or nasal vestibule region to the mainstem bronchus. Studies were screened by two authors. A review of references was conducted. Eligible manuscripts underwent full-text review for quality appraisal and data extraction. RESULTS From a total of 909 unique manuscripts, 58 studies were selected, describing 328 people. The prevalence of airway anomaly diagnosis within symptomatic individuals ranged from 14% to 74%. Twenty-two unique airway anomalies were described. Laryngeal web was the most frequently described anomaly, followed by airway malacia and subglottic stenosis. Laryngeal web was 40% sensitive for suggesting a diagnosis of 22q11DS. Among affected individuals, as many as 46% had multiple concomitant airway anomalies. Aside from respiratory symptoms, other features that prompted airway evaluation included difficult intubation or failed extubation. CONCLUSION The findings within this review support the notion that a wide variety of airway anomalies may be seen in people with 22q11DS and that these findings have been discovered frequently in those with airway symptoms. Providers should maintain a low threshold to perform an airway examination in those with 22q11DS, especially when airway symptoms are present.
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Affiliation(s)
- Paul Bryan Hankey
- Kansas City University College of Osteopathic Medicine, 1750 Independence Ave, Kansas City, MO, 64106, USA; Children's Mercy Hospital, Division of Otolaryngology, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Jana Ghulmiyyah
- Children's Mercy Hospital, Division of Otolaryngology, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Hung-Wen Yeh
- Children's Mercy Hospital, Division of Otolaryngology, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Meghan Tracy
- Children's Mercy Hospital, Division of Otolaryngology, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Jill Arganbright
- Children's Mercy Hospital, Division of Otolaryngology, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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Chen X, Yang L, Li J, Tan H. Hypoparathyroidism and late-onset hypogonadism in an adult male with familial 22q11.2 deletion syndrome: a case report with 3-year follow-up and review of the literature. BMC Endocr Disord 2022; 22:278. [PMID: 36371175 PMCID: PMC9652942 DOI: 10.1186/s12902-022-01150-z] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 09/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND 22q11.2 deletion syndrome (DiGeorge syndrome) is associated with multiple organ dysfunctions such as cardiac defects, immunodeficiency, and hypoplasia of parathyroid glands. Moreover, the phenotype of 22q11.2 DS has clinical variability and heterogeneity. CASE PRESENTATION In this report, we present the case of a 35-year-old patient with a past medical history that included recurrent infections, mild learning difficulties in childhood, pediatric obesity, and cataract. He was admitted to the endocrinology department for the management of hypogonadism and hypocalcemia. During the 3-year follow-up, the patient gradually developed primary hypoparathyroidism, hypogonadism, chronic renal failure, and heart failure, and his medical condition deteriorated. Meanwhile, in order to improve clinicians' awareness of the endocrine manifestations of adult 22q11.2 DS and reduce missed diagnoses, we reviewed 28 case reports of adult 22q11.2 DS to analyze the clinical characteristics. DISCUSSION Here, we report the case of a young man diagnosed with 22q11.2 DS presented a rare combination of multiple endocrine disorders. This is the first time that a patient with 22q11.2DS had late-onset hypogonadism caused by primary testicular failure combined with decreased pituitary gonadotropin reserve in a patient with 22q11.2DS.
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Affiliation(s)
- Xuelian Chen
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lichuan Yang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jianwei Li
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Huiwen Tan
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
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Kotcher RE, Chait DB, Heckert JM, Crowley TB, Forde KA, Ahuja NK, Mascarenhas MR, Emanuel BS, Zackai EH, McDonald-McGinn DM, Reynolds JC. Gastrointestinal Features of 22q11.2 Deletion Syndrome Include Chronic Motility Problems From Childhood to Adulthood. J Pediatr Gastroenterol Nutr 2022; 75:e8-e14. [PMID: 35641891 PMCID: PMC9329196 DOI: 10.1097/mpg.0000000000003491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 01/21/2023]
Abstract
OBJECTIVES 22q11.2 deletion syndrome (22q11.2DS) is the most common chromosomal microdeletion syndrome and has a multisystemic presentation including gastrointestinal features that have not yet been fully described. Our aim was to examine lifetime gastrointestinal problems in a large cohort of patients with 22q11.2DS. METHODS All patients followed in the 22q and You Center at the Children's Hospital of Philadelphia (n = 1421) were retrospectively screened for: 1) age ≥ 17 years, 2) documented chromosomal microdeletion within the 22q11.2 LCR22A-LCR22D region, and 3) sufficient clinical data to characterize the adult gastrointestinal phenotype. Gastrointestinal problems in childhood, adolescence, and adulthood were summarized. Statistical association testing of symptoms against other patient characteristics was performed. RESULTS Included patients (n = 206; 46% female; mean age, 27 years; median follow-up, 21 years) had similar clinical characteristics to the overall cohort. Genetic distribution was also similar, with 96% having deletions including the critical LCR22A-LCR22B segment (95% in the overall cohort). Most patients experienced chronic gastrointestinal symptoms in their lifetime (91%), but congenital gastrointestinal malformations (3.5%) and gastrointestinal autoimmune diseases (1.5%) were uncommon. Chronic symptoms without anatomic or pathologic abnormalities represented the vast burden of illness. Chronic symptoms in adulthood are associated with other chronic gastrointestinal symptoms and psychiatric comorbidities ( P < 0.01) but not with deletion size or physiologic comorbidities ( P > 0.05). One exception was increased nausea/vomiting in hypothyroidism ( P = 0.002). CONCLUSIONS Functional gastrointestinal disorders (FGIDs) are a common cause of ill health in children and adults with 22q11.2DS. Providers should consider screening for the deletion in patients presenting with FGIDs and associated comorbidities such as neuropsychiatric illness, congenital heart disease, and palatal abnormalities.
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Affiliation(s)
| | | | | | | | - Kimberly A. Forde
- Perelman School of Medicine, University of Pennsylvania
- Division of Gastroenterology, University of Pennsylvania
| | - Nitin K. Ahuja
- Perelman School of Medicine, University of Pennsylvania
- Division of Gastroenterology, University of Pennsylvania
| | - Maria R. Mascarenhas
- Perelman School of Medicine, University of Pennsylvania
- 22q and You Center, Children’s Hospital of Philadelphia
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia
| | - Beverly S. Emanuel
- Perelman School of Medicine, University of Pennsylvania
- 22q and You Center, Children’s Hospital of Philadelphia
- Division of Human Genetics, Children’s Hospital of Philadelphia
| | - Elaine H. Zackai
- Perelman School of Medicine, University of Pennsylvania
- 22q and You Center, Children’s Hospital of Philadelphia
- Division of Human Genetics, Children’s Hospital of Philadelphia
| | - Donna M. McDonald-McGinn
- Perelman School of Medicine, University of Pennsylvania
- 22q and You Center, Children’s Hospital of Philadelphia
- Division of Human Genetics, Children’s Hospital of Philadelphia
| | - James C. Reynolds
- Perelman School of Medicine, University of Pennsylvania
- Division of Gastroenterology, University of Pennsylvania
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McGovern PE, Crowley TB, Zackai EH, Burrows E, McDonald-McGinn DM, Nance ML. Surgical insights and management in patients with the 22q11.2 deletion syndrome. Pediatr Surg Int 2022; 38:899-905. [PMID: 35411495 DOI: 10.1007/s00383-022-05123-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE 22q11.2 deletion syndrome (22q11.2DS) can present with a variety challenges to patients and their caregivers, many of which require surgical evaluation and intervention. Surgical needs can also extend long into adulthood, prompting evaluation and intervention throughout development and beyond. Here, we identify common concerns and patient needs associated with the 22q11.2DS from a general surgery perspective, their management, and typical management based on our institution's experience with 1263 patients. METHODS 1263 patients evaluated and treated at the 22q And You Center at the Children's Hospital of Philadelphia were enrolled and included in the study, from January 1992 to May 2017 Co-morbidities, procedures, and imaging studies performed were quantified and assessed via descriptive analysis. RESULTS Gastroesophageal reflux disease (GERD) and feeding difficulties were the most common surgical issues identified, while gastrostomy tube placement, anorectal procedures, and hernia repairs were the most common surgical interventions performed by general surgeons. CONCLUSIONS General surgical procedures are commonly needed in this population and are part of the complex needs these patients and their surgeons may encounter in the setting of a 22q11.2DS diagnosis. These findings will help to inform a well-coordinated, multidisciplinary approach to care.
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Affiliation(s)
- Patrick E McGovern
- Division of General, Thoracic, and Fetal Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - T Blaine Crowley
- Division of Human Genetics - 22q and You Center, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Elaine H Zackai
- Division of Human Genetics - 22q and You Center, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Evanette Burrows
- Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, 2716 South St, Philadelphia, PA, 19146, USA
| | - Donna M McDonald-McGinn
- Division of Human Genetics - 22q and You Center, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Michael L Nance
- Division of General, Thoracic, and Fetal Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St # 4, Philadelphia, PA, 19104, USA
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Adams JW, Malicki D, Levy M, Crawford JR. Coincident pineocytoma and probable brainstem glioma in a child with 22q11.2 deletion syndrome. BMJ Case Rep 2022; 15:e249232. [PMID: 35272994 PMCID: PMC8915316 DOI: 10.1136/bcr-2022-249232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jason W Adams
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Denise Malicki
- Department of Pathology, Rady Children's Hospital, University of California, San Diego, California, USA
| | - Michael Levy
- Department of Neurosurgery, University of California San Diego, San Diego, California, USA
| | - John Ross Crawford
- Department of Neurosciences and Pediatrics, University of California San Diego, La Jolla, California, USA
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Sanchez Mejia AA, Cambronero N, Dongarwar D, Salihu HM, Vigil-Mallette MA, Garcia BY, Morris SA. Hospital Outcomes Among Infants With Interrupted Aortic Arch With Simple and Complex Associated Heart Defects. Am J Cardiol 2022; 166:97-106. [PMID: 34973687 DOI: 10.1016/j.amjcard.2021.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
There is a lack of current, multi-institutional data regarding hospital outcomes of infants with interrupted aortic arch (IAA). We analyzed the Pediatric Health Information System database to identify infants with IAA who underwent repair during 2004 to 2019. We classified patients as simple or complex based on associated heart defects. We evaluated factors associated with hospital mortality and complications related to 22q11.2 deletion syndrome (22q11.2del) using mixed logistic regression, accounting for hospital clustering. In 1,283 infants included (904 simple, 379 complex), mortality was higher in the complex group (11.7% vs 4.4%, p <0.001). Factors associated with mortality in the simple group were low birth weight (adjusted risk ratio [aRR] 3.77, 95% confidence interval [95% CI] 1.83 to 7.77), non-22q11.2del genetic conditions (aRR 6.44, 95% CI 1.73 to 23.96), and gastrointestinal anomalies (aRR 8.47, 95% CI 3.12 to 22.95), whereas surgery between 2012 and 2015 (aRR 0.36, 95% CI 0.13 to 0.99) was protective. In the complex group, factors associated with mortality were male (aRR 2.32, 95% CI 1.10 to 4.24) and central nervous system anomalies (aRR 3.73, 95% CI 1.62 to 8.59). Compared with their nonsyndromic counterparts, infants with simple IAA and 22q11.2del were at higher risk of sepsis (aRR 1.63, 95% CI 1.02 to 2.39) and gastrostomy tube placement (aRR 3.18, 95% CI 2.13 to 4.74), and infants with complex IAA and 22q11.2del were at higher risk of gastrostomy tube placement (aRR 2.42, 95% CI 1.20 to 4.88). In conclusion, presence of complex cardiac lesions is associated with increased mortality after IAA repair. The co-occurrence of extracardiac congenital anomalies and non-22q11.2del genetic conditions elevates mortality risk. Presence of 22q11.2del is associated with hospital complications.
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Affiliation(s)
- Aura Andrea Sanchez Mejia
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine Houston, Texas.
| | - Neil Cambronero
- Department of Cardiovascular Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine Houston, Texas
| | - Hamisu Mohammed Salihu
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine Houston, Texas
| | | | - Brisa Yran Garcia
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine Houston, Texas
| | - Shaine Alaine Morris
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Sithra R, Sheila GK, Safwan N, Siah WP, Fadilah WI, Zurina Z. Early-onset neonatal hypocalcaemia secondary to maternal vitamin D deficiency in an infant with DiGeorge syndrome: A first case report in Malaysia. Med J Malaysia 2022; 77:271-273. [PMID: 35338644] [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: 06/14/2023]
Abstract
DiGeorge syndrome is a genetic disorder that is related to a wide range of defects affecting various parts of the body. The clinical expression shows marked variability making the diagnosis often missed or underdiagnosed. Here, we describe a neonate who presented with loud inspiratory stridor secondary to hypocalcaemia at birth. Physical examination revealed no abnormality other than evidence of congenital cardiac defect. Laboratory evaluations confirmed the diagnosis of maternal vitamin D deficiency that led to symptomatic hypocalcaemia in the newborn infant. The presence of hypocalcaemia coupled with episodes of recurrent infections led to the clinical suspicion of DiGeorge, which was later confirmed by fluorescence in situ hybridisation test.
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Affiliation(s)
- R Sithra
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Paediatrics, Serdang, Selangor, Malaysia.
| | - G K Sheila
- Hospital Seri Manjung, Department of Paediatrics, Manjung, Perak, Malaysia
| | - N Safwan
- Hospital Seri Manjung, Department of Paediatrics, Manjung, Perak, Malaysia
| | - W P Siah
- Hospital Seri Manjung, Department of Paediatrics, Manjung, Perak, Malaysia
| | - W I Fadilah
- Hospital Seri Manjung, Department of Paediatrics, Manjung, Perak, Malaysia
| | - Z Zurina
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Paediatrics, Serdang, Selangor, Malaysia
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Lin HY, Tsai WY, Tung YC, Liu SY, Lee NC, Chien YH, Hwu WL, Lee CT. Endocrine and Growth Disorders in Taiwanese Children With 22q11.2 Deletion Syndrome. Front Endocrinol (Lausanne) 2022; 13:771100. [PMID: 35432203 PMCID: PMC9008307 DOI: 10.3389/fendo.2022.771100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Endocrine disorders are common in patients with 22q11.2 deletion syndrome (22q11.2DS). This study aimed to elucidate the clinical manifestations of endocrine disorders, including parathyroid, thyroid and growth disorders, in Taiwanese patients with 22q11.2DS. METHODS From 1994 to 2020, the medical records of 138 patients with 22q11.2DS diagnosed at a tertiary referral medical center in Taiwan were thoroughly reviewed retrospectively. RESULTS Hypocalcemia was detected in 57 of 135 patients (42%); 33 of 104 patients (32%) had hypoparathyroidism, and in 87% of them, hypocalcemia was detected before the age of one. Most patients had precipitating stressors during symptomatic hypocalcemic episodes. Eighteen of 29 patients had overt hypoparathyroidism at the last visit: 11 had persistent hypoparathyroidism and the other seven had recurrent hypoparathyroidism. Four of 84 patients had thyroid disorders, including thyroid developmental anomalies in two, dyshormonogenesis in one and Graves' disease in one. Fifty of 126 patients (40%) had short stature. Age (odds ratio (OR) 0.91; 95% confidence interval (CI) 0.86-0.96; P<0.001) and airway anomalies (OR 2.75; 95% CI 1.04-7.31; P<0.05) were significant risk factors for short stature in multivariate logistic regression model. Twenty-eight of the 30 patients with airway anomalies were associated with severe congenital heart disease. Adult height standard deviation score (SDS) in 19 patients was significantly lower than target height SDS (-1.15 ± 0.90 vs -0.08 ± 0.65, P<0.001). CONCLUSIONS Hypoparathyroidism is a common endocrine disorder in patients with 22q11.2DS. It is prudent to assess parathyroid function at diagnosis and during follow-up, especially in the presence of stress, to prevent symptomatic hypocalcemia. Although thyroid disorders are not so common as hypoparathyroidism, screening of thyroid dysfunction is justified in these patients. Patients with 22q11.2DS demonstrate a retarded growth pattern with a tendency of catch-up and regular monitoring of growth is indicated.
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Affiliation(s)
- Han-Yi Lin
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Yu Tsai
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Tung
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shih-Yao Liu
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ni-Chung Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Hsiu Chien
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wuh-Liang Hwu
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Ting Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- *Correspondence: Cheng-Ting Lee,
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Selten I, Boerma T, Everaert E, Vansteensel MJ, Vorstman J, Wijnen F. Narrative comprehension and production abilities of children with 22q11.2 deletion syndrome. Res Dev Disabil 2021; 119:104109. [PMID: 34655956 DOI: 10.1016/j.ridd.2021.104109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/13/2020] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The 22q11.2 Deletion Syndrome (22q11DS) is associated with language deficits and weak intellectual functioning. In other clinical groups, linguistic and cognitive difficulties have been associated with impaired acquisition of narrative abilities. However, little is known about the narrative abilities of children with 22q11DS. AIMS To describe the ability of children with 22q11DS to produce and comprehend narrative macrostructure. Additionally, to examine the role of intellectual functioning in explaining their narrative difficulties. METHODS AND PROCEDURES Narrative skills of 14 school-aged children with 22q11DS were compared to those of younger typically developing (TD) children matched on mental age and same-aged peers with Developmental Language Disorder (DLD). OUTCOMES AND RESULTS Children with 22q11DS had significantly lower scores on narrative comprehension than younger TD children. No significant differences emerged on narrative production. Children with 22q11DS and children with DLD did not differ significantly on any of the narrative measures. CONCLUSIONS AND IMPLICATIONS Narrative comprehension in children with 22q11DS seems more affected than production. Narrative comprehension difficulties cannot be entirely explained by a low level of intellectual functioning. Narrative comprehension and production abilities in 22q11DS require further consideration.
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Affiliation(s)
- Iris Selten
- Utrecht Institute of Linguistics OTS, Utrecht University, Trans 10, 3512 JK, Utrecht, The Netherlands; Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
| | - Tessel Boerma
- Utrecht Institute of Linguistics OTS, Utrecht University, Trans 10, 3512 JK, Utrecht, The Netherlands; Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
| | - Emma Everaert
- Utrecht Institute of Linguistics OTS, Utrecht University, Trans 10, 3512 JK, Utrecht, The Netherlands; Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
| | - Mariska J Vansteensel
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, P.O. Box 85060, 3508 AB, Utrecht, The Netherlands.
| | - Jacob Vorstman
- Program in Genetics and Genome Biology, Research Institute, and Department of Psychiatry, Hospital for Sick Children, 686 Bay St, 14th Floor, Toronto, M5G 0A4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario, M5T 1R8, Canada.
| | - Frank Wijnen
- Utrecht Institute of Linguistics OTS, Utrecht University, Trans 10, 3512 JK, Utrecht, The Netherlands.
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Chandramohan A, Sears CM, Huang LC, Beres S, Fredrick D, Kossler AL. Microphthalmia and orbital cysts in DiGeorge syndrome. J AAPOS 2021; 25:358-360. [PMID: 34597781 PMCID: PMC10838402 DOI: 10.1016/j.jaapos.2021.06.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 10/20/2022]
Abstract
We report the case of a 4-month-old boy diagnosed with DiGeorge syndrome with novel ocular features. The patient was diagnosed through genetic testing, with a noted 22q11.2 deletion, and had the additional clinical findings of cardiac anomalies, Hirschsprung's disease, and intracranial microhemorrhages. Eye findings included bilateral microphthalmia, persistent fetal vasculature, chorioretinal coloboma, and a unilateral orbital cyst. Given no known additional inciting exposures, a dysgenic mechanism resulting in failed closure of developmental fissures associated with the chromosomal deletion likely gave rise to these combined pathologies.
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Affiliation(s)
- Arthika Chandramohan
- Division of Pediatric Ophthalmology & Strabismus, Department of Ophthalmology, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Connie Martin Sears
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Byers Eye Institute, Stanford University, Stanford, California
| | - Laura C Huang
- Division of Pediatric Ophthalmology & Strabismus, Department of Ophthalmology, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Shannon Beres
- Division of Pediatric Ophthalmology & Strabismus, Department of Ophthalmology, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Douglas Fredrick
- Division of Pediatric Ophthalmology and Adult Strabismus, Department of Ophthalmology, Oregon Health Sciences University, Portland, Oregon
| | - Andrea Lora Kossler
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Byers Eye Institute, Stanford University, Stanford, California.
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Linton SR, Popa AM, Luck SJ, Bolden K, Angkustsiri K, Carter CS, Niendam TA, Simon TJ. Atypical attentional filtering of visual information in youth with chromosome 22q11.2 deletion syndrome as indexed by event-related potentials. Neuroimage Clin 2021; 32:102877. [PMID: 34773799 PMCID: PMC8592928 DOI: 10.1016/j.nicl.2021.102877] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022]
Abstract
Attentional control measured in 22q youth and typically developing control group. Differences in attentional control indexed by N2pc and PD event-related potentials. 22q youth exhibited sustained focus on distractor cues and reduced suppression. No relationships between attentional control and psychosis-proneness in 22q youth.
Background Youth with chromosome 22q11.2 deletion syndrome (22q) face one of the highest genetic risk factors for the development of schizophrenia. Previous research suggests impairments in attentional control and potential interactions with elevated anxiety and reduced adaptive functioning may increase the risk for developing psychosis in this population. Here, we examined how variations in attentional control relate to the presence or severity of psychosis-proneness symptoms in these individuals. Methods To achieve this, we measured attentional control in youth (12–18 years) with 22q (N = 35) compared to a typically developing group (N = 45), using a flanker task (the Distractor Target task) while measuring neural activity with event-related potentials. Results Similar to previous findings observed in people with schizophrenia, greater attentional capture by, and reduced suppression of, non-target flanker stimuli characterized participants with 22q and was indexed by the N2pc (N2-posterior-contralateral) and PD (distractor positivity) components. Although we observed no relationships between these components and measures of psychosis-proneness in youth with 22q, these individuals endorsed a relatively low incidence of positive symptoms overall. Conclusions Our results provide neural evidence of an attentional control impairment in youth with 22q that suggests these individuals experience sustained attentional focus on irrelevant information and reduced suppression of distracting stimuli in their environment. Impairments in attentional control might be a valid biomarker of the potential to develop attenuated positive symptoms or frank psychosis in high-risk individuals long before the age at which such symptoms typically arise. The evaluation of such a hypothesis, and the preventive potential for the putative biomarker, should be the focus of future studies.
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Affiliation(s)
- S R Linton
- Department of Psychiatry and Behavioral Sciences, UC Davis, 2230 Stockton Blvd, Sacramento, CA 95817, USA; MIND Institute, UC Davis, 2825 50(th) Street, Sacramento, CA 95817, USA.
| | - A M Popa
- Department of Psychiatry and Behavioral Sciences, UC Davis, 2230 Stockton Blvd, Sacramento, CA 95817, USA; MIND Institute, UC Davis, 2825 50(th) Street, Sacramento, CA 95817, USA
| | - S J Luck
- Center for Mind and Brain and Department of Psychology, UC Davis, 267 Cousteau Place, Davis, CA 95618, USA
| | - K Bolden
- Department of Psychiatry and Behavioral Sciences, UC Davis, 2230 Stockton Blvd, Sacramento, CA 95817, USA; Imaging Research Center, UC Davis, 4701 X Street, Sacramento, CA 95817, USA
| | - K Angkustsiri
- Department of Psychiatry and Behavioral Sciences, UC Davis, 2230 Stockton Blvd, Sacramento, CA 95817, USA; Department of Pediatrics, UC Davis, 2516 Stockton Blvd, Sacramento, CA 95817, USA
| | - C S Carter
- Department of Psychiatry and Behavioral Sciences, UC Davis, 2230 Stockton Blvd, Sacramento, CA 95817, USA; Imaging Research Center, UC Davis, 4701 X Street, Sacramento, CA 95817, USA
| | - T A Niendam
- Department of Psychiatry and Behavioral Sciences, UC Davis, 2230 Stockton Blvd, Sacramento, CA 95817, USA; Imaging Research Center, UC Davis, 4701 X Street, Sacramento, CA 95817, USA
| | - T J Simon
- Department of Psychiatry and Behavioral Sciences, UC Davis, 2230 Stockton Blvd, Sacramento, CA 95817, USA; MIND Institute, UC Davis, 2825 50(th) Street, Sacramento, CA 95817, USA
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Neuhaus E, Hattingen E, Breuer S, Steidl E, Polomac N, Rosenow F, Rüber T, Herrmann E, Ecker C, Kushan L, Lin A, Vajdi A, Bearden CE, Jurcoane A. Heterotopia in Individuals with 22q11.2 Deletion Syndrome. AJNR Am J Neuroradiol 2021; 42:2070-2076. [PMID: 34620586 PMCID: PMC8583271 DOI: 10.3174/ajnr.a7283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 04/09/2021] [Accepted: 07/19/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging studies and neuropathologic findings in individuals with 22q11.2 deletion syndrome show anomalous early brain development. We aimed to retrospectively evaluate cerebral abnormalities, focusing on gray matter heterotopia, and to correlate these with subjects' neuropsychiatric impairments. MATERIALS AND METHODS Three raters assessed gray matter heterotopia and other morphologic brain abnormalities on 3D T1WI and T2*WI in 75 individuals with 22q11.2 deletion syndrome (27 females, 15.5 [SD, 7.4] years of age) and 53 controls (24 females, 12.6 [SD, 4.7] years of age). We examined the association among the groups' most frequent morphologic findings, general cognitive performance, and comorbid neuropsychiatric conditions. RESULTS Heterotopia in the white matter were the most frequent finding in individuals with 22q11.2 deletion syndrome (n = 29; controls, n = 0; between-group difference, P < .001), followed by cavum septi pellucidi and/or vergae (n = 20; controls, n = 0; P < .001), periventricular cysts (n = 10; controls, n = 0; P = .007), periventricular nodular heterotopia (n = 10; controls, n = 0; P = .007), and polymicrogyria (n = 3; controls, n = 0; P = .3). However, individuals with these morphologic brain abnormalities did not differ significantly from those without them in terms of general cognitive functioning and psychiatric comorbidities. CONCLUSIONS Taken together, our findings, periventricular nodular heterotopia or heterotopia in the white matter (possibly related to interrupted Arc cells migration), persistent cavum septi pellucidi and/or vergae, and formation of periventricular cysts, give clues to the brain development disorder induced by the 22q11.2 deletion syndrome. There was no evidence that these morphologic findings were associated with differences in psychiatric or cognitive presentation of the 22q11.2 deletion syndrome.
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Affiliation(s)
- E Neuhaus
- From the Institute of Neuroradiology (E.N., E. Hattingen, S.B., E.S., N.P., A.J.)
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main (E.N., F.R., T.R.)
- LOEWE Center for Personalized Translational Epilepsy Research (E.N., F.R., T.R.)
| | - E Hattingen
- From the Institute of Neuroradiology (E.N., E. Hattingen, S.B., E.S., N.P., A.J.)
| | - S Breuer
- From the Institute of Neuroradiology (E.N., E. Hattingen, S.B., E.S., N.P., A.J.)
| | - E Steidl
- From the Institute of Neuroradiology (E.N., E. Hattingen, S.B., E.S., N.P., A.J.)
| | - N Polomac
- From the Institute of Neuroradiology (E.N., E. Hattingen, S.B., E.S., N.P., A.J.)
| | - F Rosenow
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main (E.N., F.R., T.R.)
- LOEWE Center for Personalized Translational Epilepsy Research (E.N., F.R., T.R.)
| | - T Rüber
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main (E.N., F.R., T.R.)
- LOEWE Center for Personalized Translational Epilepsy Research (E.N., F.R., T.R.)
- Department of Epileptology (T.R.), University Hospital Bonn, Bonn, Germany
| | - E Herrmann
- Institute of Biostatistics and Mathematical Modelling (E. Herrmann)
| | - C Ecker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (C.E.), Goethe University Frankfurt, Frankfurt am Main, Germany
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience (C.E.), King's College, London, UK
| | - L Kushan
- Department of Psychiatry and Biobehavioral Sciences (L.K., A.L., A.V., C.E.B.), Semel Institute for Neuroscience and Human Behavior
| | - A Lin
- Department of Psychiatry and Biobehavioral Sciences (L.K., A.L., A.V., C.E.B.), Semel Institute for Neuroscience and Human Behavior
| | - A Vajdi
- Department of Psychiatry and Biobehavioral Sciences (L.K., A.L., A.V., C.E.B.), Semel Institute for Neuroscience and Human Behavior
| | - C E Bearden
- Department of Psychiatry and Biobehavioral Sciences (L.K., A.L., A.V., C.E.B.), Semel Institute for Neuroscience and Human Behavior
- Department of Psychology (C.E.B.), University of California, Los Angeles, Los Angeles, California
| | - A Jurcoane
- From the Institute of Neuroradiology (E.N., E. Hattingen, S.B., E.S., N.P., A.J.)
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Oluwafemi OO, Musfee FI, Mitchell LE, Goldmuntz E, Xie HM, Hakonarson H, Morrow BE, Guo T, Taylor DM, McDonald-McGinn DM, Emanuel BS, Agopian AJ. Genome-Wide Association Studies of Conotruncal Heart Defects with Normally Related Great Vessels in the United States. Genes (Basel) 2021; 12:genes12071030. [PMID: 34356046 PMCID: PMC8306129 DOI: 10.3390/genes12071030] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/22/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022] Open
Abstract
Conotruncal defects with normally related great vessels (CTD-NRGVs) occur in both patients with and without 22q11.2 deletion syndrome (22q11.2DS), but it is unclear to what extent the genetically complex etiologies of these heart defects may overlap across these two groups, potentially involving variation within and/or outside of the 22q11.2 region. To explore this potential overlap, we conducted genome-wide SNP-level, gene-level, and gene set analyses using common variants, separately in each of five cohorts, including two with 22q11.2DS (N = 1472 total cases) and three without 22q11.2DS (N = 935 total cases). Results from the SNP-level analyses were combined in meta-analyses, and summary statistics from these analyses were also used in gene and gene set analyses. Across all these analyses, no association was significant after correction for multiple comparisons. However, several SNPs, genes, and gene sets with suggestive evidence of association were identified. For common inherited variants, we did not identify strong evidence for shared genomic mechanisms for CTD-NRGVs across individuals with and without 22q11.2 deletions. Nevertheless, several of our top gene-level and gene set results have been linked to cardiogenesis and may represent candidates for future work.
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Affiliation(s)
- Omobola O. Oluwafemi
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77030, USA; (O.O.O.); (F.I.M.); (L.E.M.)
| | - Fadi I. Musfee
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77030, USA; (O.O.O.); (F.I.M.); (L.E.M.)
| | - Laura E. Mitchell
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77030, USA; (O.O.O.); (F.I.M.); (L.E.M.)
| | - Elizabeth Goldmuntz
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; (H.H.); (D.M.T.); (B.S.E.)
| | - Hongbo M. Xie
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Hakon Hakonarson
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; (H.H.); (D.M.T.); (B.S.E.)
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Bernice E. Morrow
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (B.E.M.); (T.G.); (D.M.M.-M.)
| | - Tingwei Guo
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (B.E.M.); (T.G.); (D.M.M.-M.)
| | - Deanne M. Taylor
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; (H.H.); (D.M.T.); (B.S.E.)
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Donna M. McDonald-McGinn
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (B.E.M.); (T.G.); (D.M.M.-M.)
- Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Beverly S. Emanuel
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; (H.H.); (D.M.T.); (B.S.E.)
- Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - A. J. Agopian
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77030, USA; (O.O.O.); (F.I.M.); (L.E.M.)
- Correspondence:
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Mancini V, Maeder J, Bortolin K, Schneider M, Schaer M, Eliez S. Long-term effects of early treatment with SSRIs on cognition and brain development in individuals with 22q11.2 deletion syndrome. Transl Psychiatry 2021; 11:336. [PMID: 34052829 PMCID: PMC8164636 DOI: 10.1038/s41398-021-01456-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022] Open
Abstract
Cognitive deficits in individuals at risk of psychosis represent a significant challenge for research, as current strategies for symptomatic treatment are often ineffective. Recent studies showed that atypical cognitive development predicts the occurrence of psychotic symptoms. Additionally, abnormal brain development is known to predate clinical manifestations of psychosis. Therefore, critical developmental stages may be the best period for early interventions expected to prevent cognitive decline and protect brain maturation. However, it is challenging to identify and treat individuals at risk of psychosis in the general population before the onset of the first psychotic symptoms. 22q11.2 deletion syndrome (22q11DS), the neurogenetic disorder with the highest genetic risk for schizophrenia, provides the opportunity to prospectively study the development of subjects at risk for psychosis. In this retrospective cohort study, we aimed to establish if early treatment with SSRIs in children and adolescents with 22q11DS was associated with long-term effects on cognition and brain development. We included 98 participants with a confirmed diagnosis of 22q11DS followed up 2-4 times (age range: 10-32). Thirty subjects without psychiatric disorders never received psychotropic medications, thirty had psychotic symptoms but were not treated with SSRIs, and 38 received SSRIs treatment. An increase in IQ scores characterized the developmental trajectories of participants receiving treatment with SSRIs, even those with psychotic symptoms. The thickness of frontal regions and hippocampal volume were also relatively increased. The magnitude of the outcomes was inversely correlated to the age at the onset of the treatment. We provide preliminary evidence that early long-term treatment with SSRIs may attenuate the cognitive decline associated with psychosis in 22q11DS and developmental brain abnormalities.
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Affiliation(s)
- Valentina Mancini
- Developmental Imaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland.
| | - Johanna Maeder
- Developmental Imaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Karin Bortolin
- Developmental Imaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
- Medical Image Processing Lab, Institute of Bioengineering, EPFL, Lausanne, Switzerland
| | - Maude Schneider
- Developmental Imaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
- Clinical Psychology Unit for Developmental and Intellectual Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Department of Neuroscience, Center for Contextual Psychiatry, Research Group Psychiatry, KU Leuven, Leuven, Belgium
| | - Marie Schaer
- Developmental Imaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
- Department of Genetic Medicine and Development, University of Geneva School of Medicine, Geneva, Switzerland
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Vansteensel MJ, Selten IS, Charbonnier L, Berezutskaya J, Raemaekers MAH, Ramsey NF, Wijnen F. Reduced brain activation during spoken language processing in children with developmental language disorder and children with 22q11.2 deletion syndrome. Neuropsychologia 2021; 158:107907. [PMID: 34058175 DOI: 10.1016/j.neuropsychologia.2021.107907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 01/03/2023]
Abstract
Language difficulties of children with Developmental Language Disorder (DLD) have been associated with multiple underlying factors and are still poorly understood. One way of investigating the mechanisms of DLD language problems is to compare language-related brain activation patterns of children with DLD to those of a population with similar language difficulties and a uniform etiology. Children with 22q11.2 deletion syndrome (22q11DS) constitute such a population. Here, we conducted an fMRI study, in which children (6-10yo) with DLD and 22q11DS listened to speech alternated with reversed speech. We compared language laterality and language-related brain activation levels with those of typically developing (TD) children who performed the same task. The data revealed no significant differences between groups in language lateralization, but task-related activation levels were lower in children with language impairment than in TD children in several nodes of the language network. We conclude that language impairment in children with DLD and in children with 22q11DS may involve (partially) overlapping cortical areas.
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Affiliation(s)
- Mariska J Vansteensel
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Iris S Selten
- Utrecht Institute of Linguistics (UIL-OTS), Utrecht University, Utrecht, the Netherlands
| | - Lisette Charbonnier
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Julia Berezutskaya
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mathijs A H Raemaekers
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nick F Ramsey
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank Wijnen
- Utrecht Institute of Linguistics (UIL-OTS), Utrecht University, Utrecht, the Netherlands
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Milic B, Feller C, Schneider M, Debbané M, Loeffler-Stastka H. Social cognition in individuals with 22q11.2 deletion syndrome and its link with psychopathology and social outcomes: a review. BMC Psychiatry 2021; 21:130. [PMID: 33676445 PMCID: PMC7936464 DOI: 10.1186/s12888-020-02975-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/21/2019] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The 22q11.2 deletion syndrome (22q11DS) is a genetic syndrome that results in a highly variable profile of affected individuals of which impairments in the social domain and increased psychopathology are the most prominent. Notably, 25-30% of affected individuals eventually develop schizophrenia/psychosis, predisposing persons with the syndrome to increased risk for this disorder. Because social cognition is considered to underlie social behavior and to be related to psychopathology, this systematic review investigated social cognition in individuals with 22q11DS and examined reported links across its domains with psychopathology and social outcomes. This can provide the basis for a closer understanding of the path from risk to disorder and will inform on the specific domains that can be targeted with preventive intervention strategies. METHOD Systematic literature review of studies that reported the links between social cognitive domains and psychopathology and/or social outcomes in individuals with 22q11DS. Electronic databases searched were PubMed and PsycINFO. RESULTS Defined eligibility criteria identified a total of ten studies to be included in the present review. Selected studies investigated links between two domains of social cognition (emotion processing and theory of mind (ToM)) and psychopathology and/or social outcomes. With respect to the links to psychopathology, two aspects of social cognition were related primarily to negative symptoms. Results regarding the associations to positive and emotional symptoms (anxiety/depression) are limited and require further investigation. Even though both aspects of social cognition were associated with social outcomes, several studies also found no links between these two domains. Both reports invite for an additional examination of reported results and specific considerations regarding chosen constructs. CONCLUSION Although equivocal, results of the present review provide sufficient evidence that social cognition is a useful domain for the closer elucidation of clinical outcomes and social difficulties in this population. At the same time, longitudinal studies and consideration of other variables are also necessary for a timely understanding of affected persons in this respect.
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Affiliation(s)
- Branka Milic
- Clinic for Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| | - Clémence Feller
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Maude Schneider
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Martin Debbané
- Developmental Clinical Psychology Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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48
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Coutinho F, Ramos B, Brandão I, Osório E. [First Psychotic Episode in a Patient with DiGeorge Syndrome and Selective Mutism]. ACTA MEDICA PORT 2020; 33:764-766. [PMID: 33160434 DOI: 10.20344/amp.11393] [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: 10/08/2018] [Accepted: 04/16/2019] [Indexed: 11/20/2022]
Abstract
DiGeorge Syndrome is a group of diseases caused by a microdeletion, and some of its most frequent symptoms are those related with development and behavior. We present the case of a female patient with DiGeorge Syndrome and selective mutism since childhood, evaluated for the first time in a psychiatry consultation at the age of 18 for inaugural psychotic symptomatology. We describe the psychopathology, the diagnostic investigation, the treatment, and the clinical evolution. In the future, it will be important to better characterize patients with this syndrome who present psychiatric disease.
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Affiliation(s)
- Francisco Coutinho
- Clínica de Psiquiatria e Saúde Mental. Centro Hospitalar de São João. Porto; Departamento de Neurociências Clínicas e Saúde Mental. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Berta Ramos
- Clínica de Psiquiatria e Saúde Mental. Centro Hospitalar de São João. Porto. Portugal
| | - Isabel Brandão
- Clínica de Psiquiatria e Saúde Mental. Centro Hospitalar de São João. Porto. Departamento de Neurociências Clínicas e Saúde Mental. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Eva Osório
- Clínica de Psiquiatria e Saúde Mental. Centro Hospitalar de São João. Porto. Departamento de Neurociências Clínicas e Saúde Mental. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
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49
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Gudbrandsen M, Mann C, Bletsch A, Daly E, Murphy CM, Stoencheva V, Blackmore CE, Rogdaki M, Kushan L, Bearden CE, Murphy DGM, Craig MC, Ecker C. Patterns of Cortical Folding Associated with Autistic Symptoms in Carriers and Noncarriers of the 22q11.2 Microdeletion. Cereb Cortex 2020; 30:5281-5292. [PMID: 32420595 PMCID: PMC7566689 DOI: 10.1093/cercor/bhaa108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/05/2019] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022] Open
Abstract
22q11.2 deletion syndrome (22q11.2DS) is a genetic condition accompanied by a range of psychiatric manifestations, including autism spectrum disorder (ASD). It remains unknown, however, whether these symptoms are mediated by the same or distinct neural mechanisms as in idiopathic ASD. Here, we examined differences in lGI associated with ASD in 50 individuals with 22q11.2DS (n = 25 with ASD, n = 25 without ASD) and 81 individuals without 22q11.2DS (n = 40 with ASD, n = 41 typically developing controls). We initially utilized a factorial design to identify the set of brain regions where lGI is associated with the main effect of 22q11.2DS, ASD, and with the 22q11.2DS-by-ASD interaction term. Subsequently, we employed canonical correlation analysis (CCA) to compare the multivariate association between variability in lGI and the complex clinical phenotype of ASD between 22q11.2DS carriers and noncarriers. Across approaches, we established that even though there is a high degree of clinical similarity across groups, the associated patterns of lGI significantly differed between carriers and noncarriers of the 22q11.2 microdeletion. Our results suggest that ASD symptomatology recruits different neuroanatomical underpinnings across disorders and that 22q11.2DS individuals with ASD represent a neuroanatomically distinct subgroup that differs from 22q11.2DS individuals without ASD and from individuals with idiopathic ASD.
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Affiliation(s)
- Maria Gudbrandsen
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Caroline Mann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
- Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Anke Bletsch
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
- Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Eileen Daly
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Clodagh M Murphy
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
- Behavioural Genetics Clinic, Adult Autism and ADHD Services, Behavioural and Developmental Clinical Academic Group, South London and Maudsley Foundation, NHS, UK
| | - Vladimira Stoencheva
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
- Behavioural Genetics Clinic, Adult Autism and ADHD Services, Behavioural and Developmental Clinical Academic Group, South London and Maudsley Foundation, NHS, UK
| | - Charlotte E Blackmore
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
- Behavioural Genetics Clinic, Adult Autism and ADHD Services, Behavioural and Developmental Clinical Academic Group, South London and Maudsley Foundation, NHS, UK
| | - Maria Rogdaki
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Imperial College, London, UK
| | - Leila Kushan
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Declan G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
- Behavioural Genetics Clinic, Adult Autism and ADHD Services, Behavioural and Developmental Clinical Academic Group, South London and Maudsley Foundation, NHS, UK
| | - Michael C Craig
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
- National Autism Unit, Bethlem Royal Hospital, London, UK
| | - Christine Ecker
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
- Brain Imaging Center, Goethe University, Frankfurt, Germany
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50
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Mosheva M, Korotkin L, Gur RE, Weizman A, Gothelf D. Effectiveness and side effects of psychopharmacotherapy in individuals with 22q11.2 deletion syndrome with comorbid psychiatric disorders: a systematic review. Eur Child Adolesc Psychiatry 2020; 29:1035-1048. [PMID: 30949827 DOI: 10.1007/s00787-019-01326-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/26/2019] [Indexed: 12/14/2022]
Abstract
22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion in humans and is associated with high rates of attention deficit/hyperactivity disorder (ADHD), psychotic spectrum disorders and mood and anxiety disorders. The objective of the study was to systematically review studies regarding pharmacological treatments for psychiatric disorders in individuals with 22q11.2DS and to provide practical guidelines for the psychiatric management and side effect monitoring in 22q11.2DS. A literature search was conducted using the databases PubMed, PsycINFO and Embase. Information regarding study population, drug treatment, side effect profile and efficacy for each trial was extracted. Data collection was completed on May 2018. The search identified 705 studies. A total of seven studies, describing 182 individuals, were included. Pharmacological interventions included three studies for antipsychotic treatment, two studies for stimulants, one study for selective serotonin reuptake inhibitors (SSRIs), one study for S-adenosyl-L-methionine (SAMe), and one case series for metyrosine. The presented data support the clinical impression that individuals with 22q11.2DS and comorbid psychiatric disorders are treated in a manner comparable to non-22q11.2DS individuals. However, distinct medical comorbidities common in individuals with 22q11.2DS may complicate the administration of pharmacotherapy. Further trials with RCT design, larger sample sizes and more syndrome-specific pharmacological agents are needed to improve evidence-based psychiatric care of 22q11.2DS individuals with comorbid mental disorders.
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Affiliation(s)
- Mariela Mosheva
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashomer, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Liran Korotkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raquel E Gur
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA
- Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Geha Mental Health Center and Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Doron Gothelf
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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