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Italian Journal of Intellective Impairment 1997 Abstracts
Studied toilet habits in 209 drug-treated patients with Down's syndrome (DS) who went to consultation to the same physician. Ss had an examination for toilet habits at the first visit and at a checkup after starting drug therapy (varying, but always including a benzodiazepine and pyridoxine). Average age at first consultation was 71.21 mo and at the last checkup was 130.16 mo; average drug therapy lasted 59.57 mo. Toilet habits included normal habits, atonic or spastic constipation, diarrhea, celiac disease, and mixed forms. Improvements in toilet habits were related to (1) decreased upper respiratory tract infections and consequent cut-down of antibiotic therapies, (2) amelioration of motor activities, (3) increased intake of dietary fibers following an increased intake of diet vegetables and fruit, and (4) increased emotional threshold. These improvements were effects of drug therapies.
Among 510 Down's syndrome persons, (292 M + 218 F; M/F = 133.94; chromosomal diagnosis: 90.39 standard trisomy 21; 3.14% mosaicisms; 3.14% translocations; 3.33% only clinical diagnosis; average age at 1st visit: 71.37 months ± 69.71), 33.34% of them had hyperkinesis recorded during their first visit. The hyperkinetic Downs does not differ from non-hyperkinetic ones as for the M/F ratio, chromosomal diagnosis spreading, and average age.
As for age, hyperkinesis ranges 25-41% up to 12 years, with a clear fall in 13-14 years, a fact related to the inhibitory action of pubertal sexual hormones.
Although all Downs show also attention problems, we do not think that hyperkinetic Downs have a dual diagnosis, the second being Attention Deficit Disorder with Hyperkinesis. We noted motor hyperactivity as compared to the low motor activity of normal Down children, but we could not match it to hyperkinesis of non-Down children.
From the same unselected consecutive series of Ss with Down's syndrome already surveyed in a previous paper (Cocchi R., Favuto M.: It. J. Intellect. Impair. 1997, 10:19-23) the authors extracted the clinical reports of 442 Ss aged up to 144 mo at first consultation. These reports pertained to 442 children, whose 251 males and 191 females, with M/F ratio = 131.41/100.
The distribution of chromosomal anomalies divided by gender was as usual, and average age at first consultation was about 51 months. 34.03% of the girls and 35.86% of the boys had hyperkinetic DS. Epidemiological features of these hyperkinetic subgroups do not differ, like the age at first consultation. At least for Italian Down children, it is suggested that gender do not influence the presence of hyperkinesis.
Six children (aged 6 yrs 3 mo-9 yrs 4 mo) with Down's syndrome had their cognitive skills evaluated on seriation, computation, classification, and memory using the MS 4-8 test. Ss were then treated daily with the neurotransmitter modulator, a modified transcutaneous electrical nerve stimulation device, together with psychological treatments and school attendance with a support teacher. At retest, all Ss had improved in their cognitive skills, regardless of their CA or MA at the beginning of stimulation with the neurotransmitter modulator. Increased scores were observed in all fields tested with the MS 4-8 test.
An epidemiological investigation on the possible influence of seasonal factors on conceptions of Trisomy 21 subjects was carried out, as the following of a previous paper (Cocchi R., Occhialini O.: It. J. Intellect. Impair. 1989, 2 1-7) The monthly conception's periods of a representative sample of 487 Italian Down Ss born between 1973 and 1992 were compared with the same monthly periods of all Italian live-born babies of the same years, minus 1/700 as the rate of Down births.
The seasonal distribution of conceptions of Down Ss has been found significantly different (.018), having increased rates particularly in spring and in first and second month of autumn and decreased in 3rd autumn and 2nd winter month. Cutting off the sample according to mother's age on giving birth, the conceptions of Down Ss born from less than 36 year old mothers present the same seasonal distribution (.0009), while in more than 35 year old mothers' sons a seasonal influence seems masked by the well-known maternal age effect.
Strong significant correlation exists between the monthly distribution of the whole sample conceptions and the distribution of the children born from less than 36 years mothers, while this does not occurs for children of mothers with 36 or more years at delivery.
The clinical records of two groups of Ss with PDD (PDD DS group: 32 Ss, with 19 M and 13 F; M/F = 146.58; average age at first consultation: 87.25 months ± 39.21; Chromosomal diagnosis: standard trisomy 21: 30 Ss; 1 mosaic and 1 unkn. Non DS PDD group: 55 Ss, with 30 M and 20 F, M/F = 175; average age at fiest consultation: 95.29 months ± 39.90; diagnosis: Kanner's type autism: 47 Ss; late onset PDD: 3 Ss; autism in Tuberous Sclerosis: 2 Ss; Rett's syndrome : 2 Ss; PDD n.o.s.: 1 S; both groups' Ss seen by the present author) were re-examined as for toilet habits reported during 1st consultation. The results showed normal or nearly normal toilet habits in 56.67% DS Ss and in 54.54% non DS Ss. Spastic or prevailing spastic constipation was the more frequent encontered toilet disturb, being found in 28.13% DS Ss and in 23.63% non DS Ss. Atonic or prevailing atonic constipation was reported in 6.25% DS Ss and in 9.09% non DS Ss. Diarrhoea, as prevailing toilet habit had 3.12% rate in DS Ss and 1.82% in non DS Ss. When the two groups were compared eachother, the toilet habits' distribution overlaps as more than a 89% extent. When PDD DS Ss were compared to non PDD DS Ss of the previous investigation (Cocchi, 1996), toilet habits differ in a highly significant way (.0009). In particular spastic constipation becomes more frequent than atonic constipation, as the prevalent toilet disorder seen in non PDD DS Ss. It can be suggested that PDD when act on toilet habits, do so in the direction of spastic constipation. This fact could point out a trend to exceeding parasympathetic outflow in several PDD Ss.
In clinical records taken at first consultation of a consecutive series of 510 Down's syndrome persons not treated by drugs (292 M + 218 F; M/F = 133.94; chromosomal diagnosis: 90.39% standard trisomy 21; 3.14% mosaicisms; 3.33% translocations and 3.14% unknown, only clinical diagnosis; average age 71.37 ± 69.71 months) easiness to Upper Respiratory Tract Infections (URTI) was noted in 504 of them with a severity scale ranging from 0 to 4 . The sample, as a representative one of at least the Italian population of Down subjects, had age stratification by two years' intervals from 2 to 16 years and a cumulative interval for 16+ ages. That people showed maximal easiness to URTI (80% of the Ss) in 2-4 years old children, with a progressive decreasing to 25% in 16+ years ages. The severity of URTI is lowering according to age, with disappearance of more severe forms in the 14-16 years' interval. This easiness is not gender related. This is a preliminary investigation to a next research on drug reduction of URTI in drug treated Downs.
This is a retrospective study of a consecutive series of 328 home reared Down Ss tretad by drug therapy. Sample data: 188 M and 140 F; M/F ratio = 134.29; chromosomal diagnosis: standard trisomy 21 = 90.85%; mosaicisms = 3.66%; translocationa = 3.66%; only clinical diagnosis: 1.83%; Average age at first consultation; 77.70 ± 61.64 months; average age at last checkup; 116.60 ± 67.86 months; average therapy length: 48.04 ± 43.58 months. The reduction of upper respiratory tract infections (URTI) easiness after at least 1-year drug therapy was evaluated by the same 0-4 points scale used for scoring during the first consultation. The sample, as representative of the Italian population of Down Ss, had two age stratifications by two-years subsamples till 16 year inclusive, plus one subsample for the age 16;1 and more years. The first stratification is for scores at first consultation, and the second one for scores at last checkup. This URTI easiness decreases in the 4 subsamples from 2;1 to 10 years of age (.02 - .0009). From 10;1 years this reduction does not reach any significany level due to the superimposed age reduction effect (see: Cocchi, 1997). The more severe URTI forms, which in non-treated Downs Ss disappeared since 14 years, were found non present since 8;1-10 years. Also the subsample of infants up to 2 years inclusive had a statistically significant reduction of that easiness (.047), but scoring was made after average six-months therapy.