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Rett syndrome is a disorder of the nervous system that leads to developmental reversals, especially in the areas of expressive language and hand use.
Causes, incidence, and risk factors
Rett syndrome occurs almost always in girls. It may be misdiagnosed as autism or cerebral palsy.
Studies have linked many Rett syndrome cases to a defect in a gene called methl-CpG-binding protein 2 (MeCP2). This gene is on the X chromosome. Females have two X chromosomes. Even when one chromosome has this defect, the other X chromosome is normal enough for the child to survive.
The condition affects about 1 out of 10,000 children. Groups of the disease have appeared within families and certain areas of the world, including Norway, Sweden, and northern Italy.
An infant with Rett syndrome usually has normal development for the first 6 - 18 months. Symptoms range from mild to severe.
Symptoms may include:
Problems in breathing pattern may be the most upsetting and difficult symptom for parents to watch. Why they happen and what to do about them is not well understood. Most experts in Rett syndrome recommend that parents remain calm through an episode of irregular breathing like breath holding. It may help to remind yourself that normal breathing always returns and that your child will become used to the abnormal breathing pattern.
Signs and tests
Genetic testing may be done to look for the gene defect associated with the syndrome. However, since the defect is not identified in everyone with the disease, the diagnosis of Rett syndrome is based on symptoms.
There are several different types of Rett syndrome:
Rett syndrome is classified as atypical if:
Treatment may include:
Supplemental feedings can help those with slowed growth. A feeding tube may be needed if the child breathes in (aspirates) food. Diets high in calories and fat combined with feeding tubes can help increase weight and height. Weight gain may improve alertness and social interactions.
Medications such as carbamazepine may be used to treat seizures. Other medications or supplements that have been used or studied include:
Stem cell therapy, alone or in combination with gene therapy, is another hopeful treatment.
International Rett Syndrome Association - www.rettsyndrome.org
The disease slowly gets worse until the teenage years. Then, symptoms may improve. For example, seizures or breathing problems tend to lessen in late adolescence.
Developmental regression or delays vary. Usually, a child with Rett syndrome sits up properly but may not crawl. For those who do crawl, many do so by scooting on their tummy without using their hands.
Similarly, some children walk independently within the normal age range, while others are delayed, don't learn to walk independently at all, or don't learn to walk until late childhood or early adolescence. For those children who do learn to walk at the normal time, some keep that ability for their lifetime, while other children lose the skill.
Life expectancies are not well studied, although survival at least until the mid-20s is likely. The average life expectancy of a girl with Rett syndrome may be mid-40s. Death is often related to seizure, aspiration pneumonia, malnutrition, and accidents.
Calling your health care provider
Call your health care provider if you:
The likelihood of having another child with Rett syndrome is less than 1%.
Kwon JM. Miscellaneous Disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 592.5.
Reviewed by:Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.
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