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Is the early development of girls with Rett disorder really normal?
Christa Einspieler1, Alison M Kerr, Heinz F R Prechtl
1Section Developmental Physiology and Developmental Neurology, Institute of Physiology, Center for Physiological Medecine, Medical University of Graz, A-8010 Graz, Austria. christa.einspieler@meduni-graz.at
Insights
Early signs of Rett syndrome are present within the first six months of life. This study identified specific abnormal movements and behaviors in infants, aiding early diagnosis and intervention for this neurodevelopmental disorder.
Area of Science:
- Neurodevelopmental disorders
- Pediatric neurology
- Movement disorders
Background:
- Classical Rett syndrome diagnosis historically required normal early development.
- Emerging evidence suggested Rett syndrome manifests much earlier in infancy.
- Understanding early signs is crucial for timely intervention.
Purpose of the Study:
- To investigate early motor and behavioral signs in infants with Rett syndrome within the first six months of life.
- To determine if Rett syndrome presents with observable abnormalities shortly after birth.
- To provide evidence supporting early diagnosis of Rett syndrome.
Main Methods:
- Video analysis of 22 infants diagnosed with Rett syndrome.
- Systematic assessment of movements, posture, and behavior during the first six months of life.
- Meticulous recording of deviations from normal developmental standards.
Main Results:
- Abnormal general movements (100%) were universally observed.
- Other common early signs included tongue protrusion (62%) and postural stiffness (58%).
- Asymmetric eye movements (56%), abnormal finger movements (52%), and hand stereotypies (42%) were also frequently noted.
Conclusions:
- Rett syndrome is demonstrably a disorder manifesting within the first months of life.
- Early identification of specific movement and behavioral patterns can alert clinicians to potential diagnosis.
- Early diagnosis facilitates prompt intervention, potentially improving outcomes for affected children.
Abstract:
An apparently normal early development was one of the initial criteria for classical Rett syndrome. However, several investigators considered Rett syndrome to be a developmental disorder manifesting very soon after birth. Videos of 22 Rett cases were assessed carefully for movements, posture, and behavior during the first 6 mo of life. All signs that deviated from the normal standard were recorded meticulously. Special attention was paid to the face, the hands, and body movements. A detailed analysis clearly demonstrated an abnormal quality of general movements (100%), tongue protrusion (62%), postural stiffness (58%), asymmetric eye opening and closing (56%), abnormal finger movements (52%), hand stereotypies (42%), bursts of abnormal facial expressions (42%), bizarre smile (32%), tremor (28%), and stereotyped body movements (15%). Our study is the first to apply specific standardized measures of early spontaneous movements to Rett infants, proving conclusively that the disorder is manifested within the first months of life. Although not necessarily specific, the signs that we have observed will be of value in alerting clinicians to the possibility of the diagnosis at an early stage, when intervention is likely to be most effective.
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