FMR1 Carriers Report Executive Function Changes Prior to Fragile X-Associated Tremor/Ataxia Syndrome: A Longitudinal Study.

BACKGROUND: Men with fragile X-associated tremor/ataxia syndrome (FXTAS) often develop executive dysfunction, characterized by disinhibition, frontal dyscontrol of movement, and working memory and attention changes. Although cross-sectional studies have suggested that earlier executive function changes may precede FXTAS, the lack of longitudinal studies has made it difficult to address this hypothesis. OBJECTIVE: To determine whether executive function deterioration experienced by premutation carriers (PC) in daily life precedes and predicts FXTAS. METHODS: This study included 66 FMR1 PC ranging from 40 to 78 years (mean, 59.5) and 31 well-matched healthy controls (HC) ages 40 to 75 (mean, 57.7) at baseline. Eighty-four participants returned for 2 to 5 follow up visits over a duration of 1 to 9 years (mean, 4.6); 28 of the PC developed FXTAS. The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) was completed by participants and their spouses/partners at each visit. RESULTS: Longitudinal mixed model regression analyses showed a greater decline with age in PC compared to HC on the Metacognition Index (MI; self-initiation, working memory, organization, task monitoring). Conversion to FXTAS was associated with worsening MI and Behavioral Regulation Index (BRI; inhibition, flexibility, emotion modulation). For spouse/partner report, FXTAS conversion was associated with worsening MI. Finally, increased self-report executive function problems at baseline significantly predicted later development of FXTAS. CONCLUSIONS: Executive function changes experienced by male PC represent a prodrome of the later movement disorder. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Reversible encephalitis-like episodes in fragile X-associated tremor/ataxia syndrome: a case report.

BACKGROUND: Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder caused by CGG repeat expansion of FMR1 gene. Both FXTAS and neuronal intranuclear inclusion disease (NIID) belong to polyglycine diseases and present similar clinical, radiological, and pathological features, making it difficult to distinguish these diseases. Reversible encephalitis-like attacks are often observed in NIID. It is unclear whether they are presented in FXTAS and can be used for differential diagnosis of NIID and FXTAS. CASE PRESENTATION: A 63-year-old Chinese male with late-onset gait disturbance, cognitive decline, and reversible attacks of fever, consciousness impairment, dizziness, vomiting, and urinary incontinence underwent neurological assessment and examinations, including laboratory tests, electroencephalogram test, imaging, skin biopsy, and genetic test. Brain MRI showed T2 hyperintensities in middle cerebellar peduncle and cerebrum, in addition to cerebellar atrophy and DWI hyperintensities along the corticomedullary junction. Lesions in the brainstem were observed. Skin biopsy showed p62-positive intranuclear inclusions. The possibilities of hypoglycemia, lactic acidosis, epileptic seizures, and cerebrovascular attacks were excluded. Genetic analysis revealed CGG repeat expansion in FMR1 gene, and the number of repeats was 111. The patient was finally diagnosed as FXTAS. He received supportive treatment as well as symptomatic treatment during hospitalization. His encephalitic symptoms were completely relieved within one week. CONCLUSIONS: This is a detailed report of a case of FXTAS with reversible encephalitis-like episodes. This report provides new information for the possible and rare features of FXTAS, highlighting that encephalitis-like episodes are common in polyglycine diseases and unable to be used for differential diagnosis.

Cannabidiol (Epidyolex®) for severe behavioral manifestations in patients with tuberous sclerosis complex, mucopolysaccharidosis type III and fragile X syndrome: protocol for a series of randomized, placebo-controlled N-of-1 trials.

BACKGROUND: Many rare genetic neurodevelopmental disorders (RGNDs) are characterized by intellectual disability (ID), severe cognitive and behavioral impairments, potentially diagnosed as a comorbid autism spectrum disorder or attention-deficit hyperactivity disorder. Quality of life is often impaired due to irritability, aggression and self-injurious behavior, generally refractory to standard therapies. There are indications from previous (case) studies and patient reporting that cannabidiol (CBD) may be an effective treatment for severe behavioral manifestations in RGNDs. However, clear evidence is lacking and interventional research is challenging due to the rarity as well as the heterogeneity within and between disease groups and interindividual differences in treatment response. Our objective is to examine the effectiveness of CBD on severe behavioral manifestations in three RGNDs, including Tuberous Sclerosis Complex (TSC), mucopolysaccharidosis type III (MPS III), and Fragile X syndrome (FXS), using an innovative trial design. METHODS: We aim to conduct placebo-controlled, double-blind, block-randomized, multiple crossover N-of-1 studies with oral CBD (twice daily) in 30 patients (aged ≥ 6 years) with confirmed TSC, MPS III or FXS and severe behavioral manifestations. The treatment is oral CBD up to a maximum of 25 mg/kg/day, twice daily. The primary outcome measure is the subscale irritability of the Aberrant Behavior Checklist. Secondary outcome measures include (personalized) patient-reported outcome measures with regard to behavioral and psychiatric outcomes, disease-specific outcome measures, parental stress, seizure frequency, and adverse effects of CBD. Questionnaires will be completed and study medication will be taken at the participants' natural setting. Individual treatment effects will be determined based on summary statistics. A mixed model analysis will be applied for analyzing the effectiveness of the intervention per disorder and across disorders combining data from the individual N-of-1 trials. DISCUSSION: These N-of-1 trials address an unmet medical need and will provide information on the effectiveness of CBD for severe behavioral manifestations in RGNDs, potentially generating generalizable knowledge at an individual-, disorder- and RGND population level. TRIAL REGISTRATION: EudraCT: 2021-003250-23, registered 25 August 2022, https://www.clinicaltrialsregister.eu/ctr-search/trial/2021-003250-23/NL .

Characterising the social interaction style of autism in young adult males with fragile X syndrome.

BACKGROUND: The characterisation of autism in fragile X syndrome (FXS) has been a source of controversy due to the complexity of disentangling autism traits from common features of the FXS phenotype. Autism in FXS is significantly underdiagnosed in the community, which may be partly due to insufficient clinical description of the social interaction profile of autism within the FXS phenotype. In this study, we applied a classic framework for characterising social interaction styles in autism to a sample of young adult males with FXS and co-occurring autism to enhance understanding of how the social challenges associated with autism manifest within FXS. METHODS: Participants were 41 males (M age = 18 years) with FXS and co-occurring autism. Interaction samples were coded for expression of predominately 'active' (characterised by a desire to make social approaches) or 'passive' (characterised by lack of initiation of social approach towards others) interaction profiles. Differences in the expression of phenotypic features of FXS, including anxiety, attention-deficit/hyperactivity disorder, cognitive, adaptive and language impairments and autism symptom severity, were examined across those with passive and active interaction styles. RESULTS: Approximately half of the sample was classified as active and half as passive, demonstrating diversity in the social phenotype of autism associated with FXS. The two subtypes did not differ in autism severity, anxiety or attention-deficit/hyperactivity disorder symptoms or in cognitive, adaptive or language abilities. CONCLUSIONS: This study enhances understanding of FXS-associated autism by documenting phenotypic variability in the social interaction profile in this group, with active and passive social interaction styles represented. The two social interaction styles were not associated with differential expression of common phenotypic features of FXS, suggesting similar support needs.

Language Skills Influence Transition Planning in Adolescents With Fragile X Syndrome.

Individuals with fragile X syndrome (FXS) and their parents have a range of experiences navigating the crucial transition period between adolescence and adulthood. Semistructured interviews of 47 mothers of adolescents with FXS (mean child age = 15.89 years) were analyzed to identify mothers' changing expectations during the adolescent period and parent goals related to work and postsecondary education. Mothers' work and education goals were explored in relation to child factors such as language skills and autism characteristics. Lower language skills were associated with lower likelihood of reporting vocational goals. Results suggest that adolescents with FXS with lower language ability are less likely to have vocational plans for adulthood during this critical period and may need greater transition planning assistance.

Unmethylated Mosaic Full Mutation Males without Fragile X Syndrome.

Fragile X syndrome (FXS) is the leading inherited cause of intellectual disability (ID) and single gene cause of autism. Although most patients with FXS and the full mutation (FM) have complete methylation of the fragile X messenger ribonucleoprotein 1 (FMR1) gene, some have mosaicism in methylation and/or CGG repeat size, and few have completely unmethylated FM alleles. Those with a complete lack of methylation are rare, with little literature about the cognitive and behavioral phenotypes of these individuals. A review of past literature was conducted regarding individuals with unmethylated and mosaic FMR1 FM. We report three patients with an unmethylated FM FMR1 alleles without any behavioral or cognitive deficits. This is an unusual presentation for men with FM as most patients with an unmethylated FM and no behavioral phenotypes do not receive fragile X DNA testing or a diagnosis of FXS. Our cases showed that mosaic males with unmethylated FMR1 FM alleles may lack behavioral phenotypes due to the presence of smaller alleles producing the FMR1 protein (FMRP). However, these individuals could be at a higher risk of developing fragile X-associated tremor/ataxia syndrome (FXTAS) due to the increased expression of mRNA, similar to those who only have a premutation.

Differential cognitive and behavioral development from 6 to 24 months in autism and fragile X syndrome.

BACKGROUND: Specifying early developmental differences among neurodevelopmental disorders with distinct etiologies is critical to improving early identification and tailored intervention during the first years of life. Recent studies have uncovered important differences between infants with fragile X syndrome (FXS) and infants with familial history of autism spectrum disorder who go on to develop autism themselves (FH-ASD), including differences in brain development and behavior. Thus far, there have been no studies longitudinally investigating differential developmental skill profiles in FXS and FH-ASD infants. METHODS: The current study contrasted longitudinal trajectories of verbal (expressive and receptive language) and nonverbal (gross and fine motor, visual reception) skills in FXS and FH-ASD infants, compared to FH infants who did not develop ASD (FH-nonASD) and typically developing controls. RESULTS: Infants with FXS showed delays on a nonverbal composite compared to FH-ASD (as well as FH-nonASD and control) infants as early as 6 months of age. By 12 months an ordinal pattern of scores was established between groups on all domains tested, such that controls > FH-nonASD > FH-ASD > FXS. This pattern persisted through 24 months. Cognitive level differentially influenced developmental trajectories for FXS and FH-ASD. CONCLUSIONS: Our results demonstrate detectable group differences by 6 months between FXS and FH-ASD as well as differential trajectories on each domain throughout infancy. This work further highlights an earlier onset of global cognitive delays in FXS and, conversely, a protracted period of more slowly emerging delays in FH-ASD. Divergent neural and cognitive development in infancy between FXS and FH-ASD contributes to our understanding of important distinctions in the development and behavioral phenotype of these two groups.

Hypnotic treatment improves sleep architecture and EEG disruptions and rescues memory deficits in a mouse model of fragile X syndrome.

Fragile X syndrome (FXS) is associated with disrupted cognition and sleep abnormalities. Sleep loss negatively impacts cognitive function, and one untested possibility is that disrupted cognition in FXS is exacerbated by abnormal sleep. We tested whether ML297, a hypnotic acting on G-protein-activated inward-rectifying potassium (GIRK) channels, could reverse sleep phenotypes and disrupted memory in Fmr1-/y mice. Fmr1-/y mice exhibit reduced non-rapid eye movement (NREM) sleep and fragmented NREM architecture, altered sleep electroencephalogram (EEG) oscillations, and reduced EEG coherence between cortical areas; these are partially reversed following ML297 administration. Treatment following contextual fear or spatial learning restores disrupted memory consolidation in Fmr1-/y mice. During memory recall, Fmr1-/y mice show an altered balance of activity among hippocampal principal neurons vs. parvalbumin-expressing interneurons; this is partially reversed by ML297. Because sleep disruption could impact neurophysiological phenotypes in FXS, augmenting sleep may improve disrupted cognition in this disorder.

Síndrome X frágil: presentación clínica, patología y tratamiento / Fragile X syndrome: clinical presentation, pathology and treatment

Resumen El síndrome X frágil es la condición monogenética que produce más casos de autismo y de discapacidad intelectual. La repetición de tripletes CGG (> 200) y su metilación conllevan el silenciamiento del gen FMR1. La proteína FMRP (producto del gen FMR1) interacciona con los ribosomas, controlando la traducción de mensajeros específicos y su pérdida produce alteraciones de la conectividad sináptica. El tamizaje de síndrome X frágil se realiza por reacción en cadena de la polimerasa. La recomendación actual de la Academia Americana de Pediatría es realizar pruebas a quienes presenten discapacidad intelectual, retraso global del desarrollo o antecedentes familiares de afección por la mutación o premutación. Países hispanos como Colombia, Chile y España reportan altas prevalencias de síndrome X frágil y han creado asociaciones o corporaciones nacionales de X frágil que buscan acercar a los pacientes a redes disponibles de diagnóstico y tratamiento.

Abstract Fragile X syndrome is the monogenetic condition that produces more cases of autism and intellectual disability. The repetition of CGG triplets (> 200) and their methylation entail the silencing of the FMR1 gene. The FMRP protein (product of the FMR1 gene) interacts with ribosomes by controlling the translation of specific messengers, and its loss causes alterations in synaptic connectivity. Screening for fragile X syndrome is performed by polymerase chain reaction. Current recommendation of the American Academy of Pediatrics is to test individuals with intellectual disability, global developmental retardation or with a family history of presence of the mutation or premutation. Hispanic countries such as Colombia, Chile and Spain report high prevalence of fragile X syndrome and have created fragile X national associations or corporations that seek to bring patients closer to available diagnostic and treatment networks.

Caries experience and salivary aspects in individuals with fragile X syndrome

Abstract Fragile X syndrome (FXS) is the most common cause of hereditary mental retardation, but studies on the oral health condition of these patients are rare. The aim of this study was to determine the experience of dental caries in individuals with FXS, by examining the saliva profile, oral hygiene, socioeconomic characteristics and use of controlled drugs in these patients. Dental health was estimated using the decayed, missing and filled teeth index (DMF-T) and sialometry, and the pH value and buffering capacity of the saliva, colony forming units of S. mutans (CFU/mL), visible biofilm index, and socioeconomic status were all examined. The sample, comprising 23 individuals, had an average age of 17.3 ± 5.6 years, a DMF-T index of 5.5, a diminished salivary flow (78.3%), and a low (73.9%) saliva buffering capacity. Most (52.2%) individuals presented with a high abundance (CFU/mL) of S. mutans. The experience of caries was correlated with salivary parameters, poor oral hygiene, lower socioeconomic status and an increased count of S. mutans in saliva.

Síndrome do X Frágil com variante de Dandy-Walker: estudo clínico das manifestações comunicativas orais e escritas / Fragile X syndrome with Dandy-Walker variant: a clinical study of oral and written communicative manifestations

A síndrome do X Frágil é a causa mais frequente de deficiência intelectual hereditária. A variante de Dandy-Walker trata-se de uma constelação específica de achados neurorradiológicos. Este estudo relata achados da comunicação oral e escrita de um menino de 15 anos com diagnóstico clínico e molecular da síndrome do X-Frágil e achados de neuroimagem do encéfalo compatíveis com variante de Dandy-Walker. A avaliação fonoaudiológica foi realizada por meio da Observação do Comportamento Comunicativo, aplicação do ABFW - Teste de Linguagem Infantil - Fonologia, Perfil de Habilidades Fonológicas, Teste de Desempenho Escolar, Teste Illinois de Habilidades Psicolinguísticas, avaliação do sistema estomatognático e avaliação audiológica. Observou-se: alteração de linguagem oral quanto às habilidades fonológicas, semânticas, pragmáticas e morfossintáticas; déficits nas habilidades psicolinguísticas (recepção auditiva, expressão verbal, combinação de sons, memória sequencial auditiva e visual, closura auditiva, associação auditiva e visual); e alterações morfológicas e funcionais do sistema estomatognático. Na leitura verificou-se dificuldades na decodificação dos símbolos gráficos e na escrita havia omissões, aglutinações e representações múltiplas com o uso predominante de vogais e dificuldades na organização viso-espacial. Em matemática, apesar do reconhecimento numérico, não realizou operações aritméticas. Não foram observadas alterações na avaliação audiológica periférica. A constelação de sintomas comportamentais, cognitivos, linguísticos e perceptivos, previstos na síndrome do X-Frágil, somada às alterações estruturais do sistema nervoso central, pertencentes à variante de Dandy-Walker, trouxeram interferências marcantes no desenvolvimento das habilidades comunicativas, no aprendizado da leitura e escrita e na integração social do indivíduo.

The Fragile X syndrome is the most frequent cause of inherited intellectual disability. The Dandy-Walker variant is a specific constellation of neuroradiological findings. The present study reports oral and written communication findings in a 15-year-old boy with clinical and molecular diagnosis of Fragile X syndrome and neuroimaging findings consistent with Dandy-Walker variant. The speech-language pathology and audiology evaluation was carried out using the Communicative Behavior Observation, the Phonology assessment of the ABFW - Child Language Test, the Phonological Abilities Profile, the Test of School Performance, and the Illinois Test of Psycholinguistic Abilities. Stomatognathic system and hearing assessments were also performed. It was observed: phonological, semantic, pragmatic and morphosyntactic deficits in oral language; deficits in psycholinguistic abilities (auditory reception, verbal expression, combination of sounds, auditory and visual sequential memory, auditory closure, auditory and visual association); and morphological and functional alterations in the stomatognathic system. Difficulties in decoding the graphical symbols were observed in reading. In writing, the subject presented omissions, agglutinations and multiple representations with the predominant use of vowels, besides difficulties in visuo-spatial organization. In mathematics, in spite of the numeric recognition, the participant didn't accomplish arithmetic operations. No alterations were observed in the peripheral hearing evaluation. The constellation of behavioral, cognitive, linguistic and perceptual symptoms described for Fragile X syndrome, in addition to the structural central nervous alterations observed in the Dandy-Walker variant, caused outstanding interferences in the development of communicative abilities, in reading and writing learning, and in the individual's social integration.

Sintomas de linguagem e Síndrome de X Frágil: estudo de caso / Language symptoms and Fragile X Syndrome: case study

Esta pesquisa aborda um estudo de caso de um menino com sintomas de linguagem e com diagnóstico médico de Síndrome de X Frágil e acompanha seu processo terapêutico fonoaudiológico dos quatro aos seis anos de idade, visando identificar, de forma mais específica, como as leis da estrutura da linguagem se manifestam na fala da criança. O foco escolhido privilegia o olhar sobre a entrada ou a recusa do falante no funcionamento relativamente autônomo da língua, afastando-se da noção de causalidade linear entre a síndrome genética e os sintomas na linguagem. Elegeu-se, para análise, episódios clínicos extraídos de gravações de sessões fonoaudiológicas que foram considerados enigmáticos. Fundamentando-se na Clínica Fonoaudiológica que se sustenta na dialogia, ou seja, na relação do falante e Outro, buscou-se uma prática clínica assentada sobre a subjetividade e a intersubjetividade. As análises permitiram hipotetizar o percurso da criança no enlaçamento singular de sua fala ao modo de funcionamento da língua, pontuando interpretações e escansões, isto é, cortes marcados pelos gradientes de entonação, ritmo e melodia da fala. Concluiu-se que tanto os atos interpretativos sobre as ecolalias e estereotipias como o silenciamento do terapeuta podem deslocar a criança para a posição de falante, identificando-se neste manejo terapêutico, caminhos promissores para a instância terapêutica da Clínica Fonoaudiológica que atua com sujeitos com falas ditas patológicas.

he present research approaches a case study of a boy with language symptoms and medical diagnosis of Fragile X Syndrome following on the Speech-Language therapeutic process from the age of four up to six years old, with the purpose of identifying, in a more specific way, how the language structure laws emerge in the child's speech. The elected focus aims to privilege a view on the speaker entrance or refusal on the relative autonomy of language, moving away from the notion of lineal causality of the genetic syndrome and the language symptoms. Were elected, for analysis, clinical episodes that were considered enigmatic extracted from the therapeutic Speech-Language sessions. Based on the Speech-Language Therapy Clinics that is supported on the dialogy, or, in the relationship between the speaker and the Other, clinical practice was approached based on subjectivity and inter-subjectivity. The analyses allowed to outline the child's trajectory in the singular interlacement of his speech to the language way of functioning, pointing out the language therapist's interpretations and scansions, which are cuts marked by speech variations of intonation, rhythm and melody. It was concluded that interpretative actions resting on the verbal stereotypeand echolalia as well as on the therapist's silence can generate changes in the child's position, identifying in this therapeutic approach, promising ways to the therapeutic instance of Speech-Language Clinics that deals with speaker with the so-called pathological speech.

Esta investigación analiza un estudio de caso de un niño con síntomas de lenguaje con diagnóstico de Síndrome X Frágil y sigue su proceso terapéutico fonoaudiológico de cuatro a seis años de edad, para identificar, más específicamente, cómo las leyes de la estructura del lenguaje se manifiestan en el habla del niño. El enfoque elegido privilegia la atención sobre la entrada o la denegación del hablante en el funcionamiento autónomo de la lengua, alejándose de la noción de causalidad lineal entre el síndrome genético y los síntomas en el lenguaje. Fueron elegidos para el análisis, episodios clínicos que consideramos enigmáticos extraídos de grabaciones de sesiones fonoaudiológicas. Basándose en la Clínica Fonoaudiológica que se sustenta en el proceso dialógico, es decir, en la relación del hablante y Otro, intentase una práctica clínica asentada en la subjetividad y ínter subjetividad. Los análisis permitieron plantear la hipótesis de la ruta del niño en el entrelazamiento singular de su habla al funcionamiento de la lengua, puntuando interpretaciones y escansiones, es decir, cortes marcados por los gradientes de entonación, ritmo y melodía del habla. Se concluyó que tanto los actos interpretativos sobre las ecolalias y estereotipias como el silenciamiento del terapeuta pueden mover al niño a la posición de hablante, identificándose en este manejo terapéutico, posibilidades prometedoras para la instancia terapéutica de la Clínica Fonoaudiológica que trabaja con sujetos con habla entendida como patológica.

Síndrome de Turner, a propósito de un caso / Turner síndrome, a case report

El Síndrome de Turner es una alteración cromosómica producida por una pérdida parcial o total de un cromosoma X durante el desarrollo sexual. Se presenta con una frecuencia de 1 en 2.500 a 5.000 recién nacidos de sexo femenino, cerca del 1 % de las concepciones presentan una monosomía X, de las cuales la mayoría terminanen abortos espontáneos generalmente durante el primer trimestre del embarazo.

Laboratorial diagnosis of fragile-X syndrome: experience in a sample of individuals with pervasive developmental disorders

A síndrome do cromossomo X frágil (SXF) é uma doença genética freqüente associada a distúrbios do desenvolvimento neurológico, incluindo dificuldades de aprendizagem, retardo mental, problemas comportamentais e distúrbios invasivos do desenvolvimento (autismo e correlatos). Estudamos uma amostra de 82 indivíduos (69 homens e 13 mulheres) apresentando distúrbios invasivos do desenvolvimento, utilizando três técnicas para o diagnóstico da SXF. A análise citogenética detectou a presença do sítio frágil em quatro homens, porém apenas um deles com percentagem consistente. O estudo molecular baseado na técnica da PCR foi inconclusivo para a maioria das mulheres (92,3%), as quais foram posteriormente submetidas a análise por Southern blotting, e para um homem (1,4%), excluindo a mutação FRAXA nos demais homens (98,6%). O teste molecular usando a técnica de Southern blotting confirmou apenas um caso positivo (1,2%) em um indivíduo do sexo masculino. Tais resultados mostraram que a técnica de Southern blotting para análise da mutação FRAXA apresenta a melhor sensibilidade e especificidade para o diagnóstico da SXF, mas também valida a técnica da PCR como um teste confiável para seu rastreamento.

Investigação molecular por PCR da síndrome do cromossomo X frágil em homens com transtornos invasivos do desenvolvimento / Molecular investigation by PCR of fragile X syndrome in men with pervasive development disorders

Os transtornos invasivos do desenvolvimento afetam cerca de 2-5 a cada 1.000 crianças, interferem no desenvolvimento emocional e cognitivo e caracterizam-se por prejuízo severo do desenvolvimento, comportamento esteriotipado, interesses e atividades restritas. Incluem cinco diagnósticos: Transtornos desintegrativo da infância> Transtornos invasivos do desenvolvimento sem outra especificação, Síndrome de Rett e de Asperger e Autismo. Tais transtornos têm sido associados a várias doenças genéticas, com destaque para a Síndrome do Cromossomo X Frágil, que resulta de mutações no gene FMR-1 e é a maior causa de retardo mental em meninos. Este trabalho teve como objetivo investigar a presença da mutação completa do gene FMR-1, com a utilização da técnica de Reação em Cadeia da Polimerase (PCR), em homens poratdores de Transtornos Invasivos do Desenvolvimento. Entre os 25 indivíduos estudados, um apresentou a mutação completa. A frequência de 4 por cento da síndrome corrobora os dados da literatura e reforça o conceito de que esta doença representa um fator etiológico importante e deve ser investigada em todo indivíduo com estes distúrbios comportamentais, inclusive por suas implicações no processo de Aconselhamento Genético das famílias

Relevância da genética na etiologia do autismo / Relevance of genetics in autism etiology

O autismo constitui uma das orincipais patologias integrantes dos transtornos invasivos do desenvolvimento. É caracterizado por atraso e desvio do desenvolvimento social, de comunicaçäo e cognitivo e se manifesta precocemente. Atualmente, é reconhecida a participaçäo de fatores genéticos em sua etiologia. Esse distúrbio näo segue padröes clássicos de herança mendeliana e apresenta grande heterogeneidade genética. Entre as síndromes gênicas observa-se forte associaçäo com a síndrome do cromossomo X frágil (gene FMR-1) com a esclerose tuberosa. Um número crescente de trabalhos têm relatado a ocorrência de anomalias cromossômicas em autismo, incluindo cromossomos extranumerários derivados do 15, envolvendo a regiäo 15q11-q13 e o cromossomo 7. Na regiäo 15q11-q13 encontram-se genes cujo produtos atuam no sistema nervoso central e que säo subunidades de recptores de neurotransmissores ou de canais de íons (UBE3A, GABRA5, GABRG3, CHRNA7, I ITO). Algumas regiöes do cromossomo 7 também contêm genes (EN-2 e HOXA) importantes para o desenvolvimento (homeogenes), com atuaçäo na formaçäo do sistema nervoso central. Os cromossomos 7, 15 e X, portanto, parecem conter genes relacionados com a etiologia do autismo, cuja avaliaçäo genética pode gerar conhecimentos sobre os mecanismos biológicos envolvidos neste grave distúrbio

Prevalencia del Sìndrome de fragilidad en adultos mayores del consultorio externo del hospital Buongermini en noviembre 2009 / Prevalence of frailty syndrome in older adults hospital`s outpatient clinic in november 2009 Buongermini

El estado de fragilidad es un sìndrome clìnico,biològico y psicosocial;y se puede dar definiciòn poniendo ènfasis en cualquiera de los antes mencionados puntos o en todos y se encuentran mas o menos estandarizados.