15.11.13 Who are our sister syndromes sharing the same Deletion?

Since we are promoting 15 November 2013 as PWS Awareness Day because of the 15.11.13 date coincidence, I thought it would be good to know who our sister syndromes are.  The deletion may be on the same site, but the three syndromes, PWS, Angelman's Syndrome, and Dup15q, are completely different.  To give you some idea, here's a brief synopsis or the other two.  Some of the symptoms will be familiar and others are quite different.

Dup15q Syndrome (or idic15q)

(See video clip here)

Physical Features

Daniel, who has Dup15q

• Hypotonia: Babies with Dup15q usually have hypotonia (poor muscle tone). They may appear 'floppy' and have difficulty sucking and feeding. Some parents report that their babies with Dup15q have an unusual, weak cry. Motor milestones such as rolling over, sitting up, and walking are significantly delayed. Older children and adults with hypotonia often tire easily. Hypotonia in Dup15q syndrome generally decreases with age and sometimes progresses to hypertonia (tight muscle tone) particularly in the lower legs.

• Physical Features: Many individuals with Dup15q share similar facial characteristics. These include a flat nasal bridge which gives them a 'button' nose. There may be skin folds, called 'epicanthic', at the inner corners of the eyes, and the eyes may be deep set. Ears may be low-set and/or posteriorly rotated. There may also be noticeable unfolding of the edge of the ears. The palate (roof of the mouth) may be unusually high. There are also reports of areas of increased and reduced skin pigmentation.

• Growth: Growth is retarded in about 20 – 30% of individuals with Dup15q. Although puberty appears to be normal in most individuals, pubertal disorders such as central precocious puberty have been observed in some girls.

• Other Abnormalities: Rarely, babies with Dup15q may be born with a cleft lip and/or palate or differences in the way their hearts, kidneys, or other body organs are formed. For this reason, it is important for newly diagnosed children with Dup15q to be carefully evaluated for the possibility of such structural differences. Check with your genetics specialist for specific recommendations.

Developmental Problems in Chromosome 15q Duplication Syndrome

• Gross Motor Delays: Due to the hypotonia experienced by young children with Dup15q, gross motor delays are very common. In a 2005 scientific review article, sitting was reportedly achieved between 10 and 20 months of age, and walking between 2 and 3 years.2 A current study of children with Dup15q found that children with isodicentric duplications achieved independent walking at an average of 25.5 months (range 13-54 months), with 3 kids (out of 47) who were not ambulatory at the time of testing.3 The vast majority of individuals with Dup15q are able to walk independently.

• Fine Motor Delays: Parent report suggests that fine motor delays are widespread among children with Dup15q syndrome. Nonfunctional use of objects with an immature type of exploration has been reported in the scientific literature.4

• Cognitive Delays: Most individuals with Dup15q show some degree of cognitive delay/disability (mental retardation) from very early on. These cognitive disabilities are often associated with behavioral problems as children age.

• Autism Spectrum Disorders: There are now over 20 reports in the literature of individuals with both autism and idic15. Two studies that included a total of 226 patients with autism found Dup15q in approximately 3-5% of the patients.5, 6 Chromosome 15q11–13 duplications are the most frequently identified chromosome problem in individuals with autism.

• Speech/Language Delays: Most children with Dup15q are affected by speech/language delays. Expressive language may be absent or may remain very poor, and is often echolalic with immediate and delayed echolalia and pronoun reversal.7 In her study of Dup15q, Dr. Carolyn Schanen found 26 of 47 children had some language at the time of their participation in the research study, with the first word achieved at an average of 28.7 months (range 7-84 months) and phrase speech beginning by an average of 44.1m (range 9-114). While the majority of children with Dup15q experience speech delays, some children are highly verbal.

• Sensory Processing Disorders: Parent report suggests that sensory processing disorders are widespread in Dup15q. These sensory processing disorders disrupt the affected child’s ability to achieve and maintain an optimal range of arousal and to adapt to challenges in daily life. These disorders are often manifested by an over-responsiveness or under-responsiveness to sensory input or fluctuations in response to sensory input.

• Behavior Challenges: Many individuals with Dup15q have difficulties of behavior and social communication, with a lack of response to social cues frequently observed. In older individuals, there is some suggestion of improving social awareness with age.

Medical problems in chromosome 15q duplication syndrome

• Seizure Disorders: Seizures represent an important medical feature of Dup15q. Over half of all people with idic15 will have at least one seizure. The majority of those will experience their first seizure before age 5 but seizure onset occurs up through puberty and young adulthood in this population. There are many different types of seizures experienced by individuals with Dup15q. Affected individuals can start with one seizure type and other seizure types may emerge as the individual ages. Response to treatment is variable. Some seizures are easily controlled with the first medication, other seizures are controlled for a while and then become more complex and some affected individuals experience intractable seizures that have never been controlled with medication.

• Attention Deficit Disorders: Attention Deficit Disorder/Hyperactivity has been reported in a number of cases of children with Dup15q syndrome.9

• Anxiety Disorders: Parent report of anxiety disorders in children with Dup15q has been noted on the Dup15q Alliance online community. More research in this area is needed.

• Other Medical Problems: Other reported medical problems include recurrent respiratory infections in childhood, middle ear effusions requiring tubes, eczema, precocious puberty, other menstrual irregularities, overeating and weight gain.10, 11 Scoliosis is also reported in adolescence.

Treatments for Chromosome 15q Duplication Syndrome

At the present time there is no specific treatment that can undo the genetic pattern seen in people affected by hromosome 15q duplications. Although the fundamental genetic differences cannot be reversed, therapies are available to help address many of the symptoms associated with Dup15q. Physical, occupational and speech therapy along with special education techniques can stimulate children with Dup15q to develop to their full potential.

In terms of medical management of the symptoms associated with Dup15q, families should be aware that individuals with chromosome 15 duplications may tolerate medications differently and may be more sensitive to side effects for some classes of medications, such at the serotonin reuptake inhibitor type medications (SSRI).12 These medications should be used with caution and any new medication should be instituted in a controlled setting, with slow titration up to the expected therapeutic dose and with a clear endpoint as to what the expected outcome is for the treatment. This includes supplements.

(Information has been taken from the Dup15q website)

Angelman Syndrome

(video clip here)

Angelman syndrome is a severe neurogenetic disorder that shares symptoms and characteristics similar to those associated with other disorders including autism, cerebral palsy, Prader-Willi syndrome.

Due to these similarities, misdiagnosis is a prevalent problem.

Late or misdiagnosis may cause individuals to lose opportunities for early intervention programs, resources, personalized support and life-saving treatments.

That’s why it’s important to increase awareness and understanding of Angelman syndrome, a disorder that occurs in roughly 1 in 15,000 live births.

Symptoms of Angelman syndrome:

• Developmental delays – vary from individual to individual
• Seizures
• A happy demeanor – frequent laughing, smiling and excitability
• In infants 0-24 months:
• Lack of cooing or babbling
• Inability to support one’s head, pull oneself up to stand, and delayed motor skills
• In young children:
• Lack of speech, although some develop the ability to speak a few words
• Delayed ability to walk, unstable gait or balance issues

Diagnosis:

A blood test can detect up to 80-85% of individuals with Angelman syndrome by identifying whether the UBE3A gene is functioning properly.

For the remaining 15-20% of individuals, an experienced clinician who is familiar with Angelman syndrome can provide a clinical diagnosis. To find a clinician in your area, contact the AS Foundation.

Information has been taken from the AS website