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Rett Syndrome
Rett Syndrome Awareness Month
Mostly females; Normal until the age of 6 to 18 months until their development regresses
Psychomotor regression-Communication dysfunction, loss of learned words, Emerging
social withdrawal, Profound cognitive impairment
Deterioration in developmental milestones, head circumference, overall growth
What is Rett syndrome?
Gait dysfunction -Poor coordination, ataxia
Respiratory irregularity Early seizures Sporadic in 99.5 % cases; Hereditary
factors in 0.5 % >95% of females have MECP2
mutations
What is Rett syndrome?
Stereotypic hand movements
• hand-wringing
•
handwashing/squeezing/clapping/tapping/rubbi
ng
• hand-to-mouth
• Loss of purposeful hand movements
Management
No cure for Rett syndrome Symptomatic — focusing on the
management of symptoms Supportive, requiring a multidisciplinary
approach Dietitians Physiotherapists Occupational, speech, and music
therapists Hydrotherapy/Music therapy/Massage
Psychosocial support
GROWTH
Small stature is typical Deceleration of growth
Head circumference as early as 3 months• Median value at 2nd percentile by age 2 years
Weight as early as 8 months Length as early as 12-14 months
Hands and feet small; feet relatively smaller than hands
Neurologic Abnormalities and Treatment
Occurrence variable; from 20 to 80% in different reports
Seizures in 75%, most severe earlier in life
Abnormal EEG in 100% Truncal ataxia Dystonia may be prominent with age Treatment: Anteconvulsants, ketogenic
diet for seizures
Communicative and Cognitive Concerns and Treatment
Babbling, single words by 10-12 months; lose verbalization by 18 months
More quiet, improved eye contact with time
Happy disposition Treatment: Speech/language
therapy, music therapy
Management of Agitation
Find cause ( reflux, constipation, infections, gall stones, seizures, headache, fractures, change of school or placement, abuse )
Treat cause Use frequent snacks, music,
massage, warm baths Medications
Sleep Disturbances and Treatment
Often disrupted; frequent awakenings
Night waking, screaming, laughing
Increased daytime sleep with age;
delayed onset of sleep at night
Consider infection (otitis media), hunger,
constipation, GE reflux
Treatment: Behavioral modalities, drugs
Breathing Irregularities
Hyperventilation, breath holding, forced air expulsion
Occur while awake Modified by hunger, agitation,
other stress Typically reach maximum in school
years No specific therapy
Gastrointestinal Issues
Chewing and swallowing often poor
May choke on thin liquids
GE reflux typical
Constipation also common; may
require laxative
Good nutrition essential
Osteopenia
Occurs in almost all girls or women
Worse with poor calorie-protein
intake
Fractures
Oral calcium , Good nutrition
Orthopedic Abnormalities, Motor Disturbances, and Treatment
Early truncal ataxia,Legs abducted Hypotonic early; hyperreflexive and rigid
later Scoliosis (64%)-Usually apparent by age
8 years Treatment: Brace/surgery for
scoliosis, orthopedic and intensive physical therapy, special computers and toys
Ambulation
Overall, ~ 60% remain ambulatory Orthotic devices may be needed for
toe walking Great effort should be exerted to
maintain ambulation Standing frames, walkers, or parallel
bars should be used at home and school for those who do not walk
Sexual Maturation
Puberty acquired at ages similar to peers
Menstrual cycles usually predictably regular after puberty well-established
A variety of strategies available to manage menstrual cycles
Cardiac conduction system
Cardiac conduction may be immature
Prolonged QT interval may be observed
ECG At diagnosis (usually normal)
Cardiology consult
AUTONOMIC NERVOUS SYSTEM
Hands and feet tend to be cold
Does not appear to cause discomfort
No specific treatment available
Bruxism or Teeth grinding
Occurs in almost all Varies in frequency and intensity May increase with anxiety or excitement Efforts to reduce generally unrewarding Tend to diminish or disappear after
school age
Genetic Counseling
X-linked dominant inheritance If parent is a carrier, the risk to
sibs of inheriting the mutant MECP2 allele at conception is 50%
If a mutation is not identified in a parent, the risk to sibs is low (Germline mosaicism )
Clinical Trials
Many Clinical trials esp with
Dextromethorphan , Donepzil, IGF 1
Still a definitive treatment is
awaited……www.RettSearch.org
Thanks
Indian Rett Support Foundation
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