Cass Hilary, Reilly Sheena, Owen Lucy, Wisbeach Alison, Weekes Lyn, Slonims Vicky, Wigram Tony, Charman Tony
Wolfson Centre, Great Ormond Street Children's Hospital NHS Trust, Mecklenburgh Square, London WC 1N 2AP, UK.
Dev Med Child Neurol. 2003 May;45(5):325-37. doi: 10.1017/s0012162203000616.
Systematic data from a multidisciplinary clinical assessment of a large series of females with Rett syndrome (RS; n=87) is presented. Participants' ages ranged from 2 years 1 month to 44 years 10 months. Areas assessed included oromotor skills, feeding problems, growth, breathing abnormalities, mobility, postural abnormalities and joint deformities, epilepsy, hand use and stereotypies, self-care, and cognitive and communication skills. Many previously reported trends in the presentation of RS over time were confirmed, notably the increasingly poor growth and near pervasiveness of fixed joint deformities and scoliosis in adulthood. In contrast, there was a slight trend towards improved autonomic function in adulthood, whereas feeding difficulties increased into middle childhood and then reached a plateau. Improvements in mobility into adolescence were followed by a decline in those skills in adulthood. Levels of dependency were high, confirming findings from previous studies. Despite the presence of repetitive hand movements, a range of hand-use skills was seen in individuals of all ages. Cognitive and communication skills were limited, but there was little evidence of deterioration of these abilities with age. These findings confirm that RS is not a degenerative condition and indicate that intervention and support to maintain and increase motor skills, daily living skills, and cognitive and communicative functioning are appropriate targets for individuals with RS.
本文呈现了对大量雷特综合征(RS;n = 87)女性患者进行多学科临床评估得出的系统性数据。参与者年龄范围从2岁1个月至44岁10个月。评估领域包括口面部运动技能、喂养问题、生长发育、呼吸异常、活动能力、姿势异常与关节畸形、癫痫、手部使用与刻板动作、自我护理以及认知和沟通技能。许多先前报道的RS随时间推移的表现趋势得到了证实,尤其是成年后生长发育日益不良以及固定关节畸形和脊柱侧弯几乎普遍存在。相比之下,成年后自主功能有轻微改善趋势,而喂养困难在童年中期增加,然后趋于平稳。进入青春期时活动能力有所改善,但成年后这些技能又有所下降。依赖程度较高,这与先前研究结果一致。尽管存在重复性手部动作,但在各年龄段个体中都观察到了一系列手部使用技能。认知和沟通技能有限,但几乎没有证据表明这些能力会随年龄恶化。这些发现证实RS并非退行性疾病,并表明对RS患者而言,干预和支持以维持和提高运动技能、日常生活技能以及认知和沟通功能是合适的目标。