Hypotonia

Although Darus has not been formally diagnosed with hypotonia, AKA low muscle tone, I believe he has it, even if just mildly.  It was not noted at birth, nor was it noted by his developmental pediatrician upon our first visit in November 2012, nor was it noted by the geneticist in March 2013.  However, I have always wondered why his colds would last so long and why he was always chesty, especially as a toddler.  I now know.  Because his diaphragm isn't as strong as it should be.  I believe the hypotonia is also the reason why he drooled constantly the first 3 years of his life ... and intermittently since then.  Thankfully he's been quite healthy, physically.  And thankfully we've been taught how to perform Beckman stretches on his face, that have greatly helped to reduce if not extinct his drooling.

 

 

Receiving a Prenatal Downs Syndrome dx - What One Couple Did

I read this touching article last night.  It's tough to say what any of us would do, until we find ourselves in the shoes.  According to the article, though, 90% of expecting parents terminate upon receiving this diagnosis.  The other statistic mentioned in the article that I found particularly awesome ::

". . . 99% of people who have Down syndrome report that they are happy with their lives. Only 76% of Americans reported the same overall life satisfaction . . ."

Enjoy the read!

AAC Evaluation

Since receiving a PMs dx, we've been faced with the decision of finding the right AAC device for Darus.  I'm trying hard not to reinvent the wheel.  I spoke w/ Vivian Hsu of Pediatric Minds who has referred me to Deborah Lim, an AAC specialist.  I've subsequently found this lovely mom's blog, all about AAC.  She's done a terrific job explaining the ins and outs of AAC and everything she went through to find the right device/system for her daughter.  I'm looking forward to helping Darus find his words via AAC!

Nighttime Waking

UPDATE - I'm excited to be able to post this update.  Darus had the same behavior pattern the very next day.  I was able to videotape it and brought it to his neurologist who assured me that this was not seizure activity, as I had feared, instead, it's stimming. 

3:35 AM - I went into Darus' dark room after waking from hearing him kick the wall (I think?)  He didn't seem upset.  He was a bit warmer than usual and was a little bit sweaty, not too bad.  He seemed to somewhat acknowledge my presence.  I laid down with him.  In a 5-10 minute span, his left leg seemed to flex/lock up and he would concurrently grunt and had a different than normal breathing pattern ... it would last for about 5 - 10 seconds.  I couldn't see his eyes or face, but from feeling them, I do not think his face was locked up ... after this happened a few times he farted ... so, not sure if this was just gas?  I tried to hug him a few times and attempted to bring him out of his room, but when I did, he got upset and seemed like he wanted to stay in his bed.  I laid with him another 10 minutes or so and he went back to sleep.

Ever since receiving his dx, I have been on heightened alert for seizures.  Per Wikipedia, approximately 27% of PMS kids have epilepsy.  I talked to the neurologist this morning.  She didn't seem too concerned, but we're both glad to be having a sleep study/24 hour EEG next week at UCLA.

Pull-Ups

One of the characteristics/symptoms of PMS is delayed or unreliable toileting.  While we are definitely in the delayed category at this point, I am hopeful someday to be in the reliable category.  Until then, however, pull-ups are expensive.  I contacted our lovely (private) insurance only to be denied.  Apparently our (self-funded) ppo plan does not provide for incontinence care.  I then turned to my beloved caseworker at the Regional Center.  She had to 'staff the request'.  She seemed reasonably sure that the RC will either reimburse us or provide pull-ups for him until he turns five.  If he still needs them then, MediCal will provide them.

Phelan-McD​ermid Syndrome part of the NIH-Funded Rare Diseases Consortium

The information below was released this morning.  I am hopeful that perhaps Darus will be able to participate in the study.  Regardless of his participation, I'm thrilled that PMS is going to be studied and hopeful that additional research will open doors for all of us affected by rare conditions.

 

CONTACT:

Meghan Weber, Boston Children’s Hospital

617-919-3110 | meghan.weber@childrens.harvard.edu

Boston Children’s Hospital to lead NIH-funded Rare Diseases Consortium studying autism and intellectual disability

10-institution study will seek to pilot new treatment approaches

BOSTON (Oct. 8, 2014)— Under a five-year, $6 million grant announced today by the National Institutes of Health, Boston Children’s Hospital will lead 10 medical centers in studying three rare genetic syndromes that often cause autism spectrum disorder (ASD) and intellectual disability (ID). The study’s ultimate goal is to launch clinical trials of new treatments and develop "biomarkers" that can be used to monitor treatment effectiveness—for the three rare syndromes and possibly for broader groups of ASD/ID patients.

Through the grant, from NIH’s Rare Diseases Clinical Research Network (RDCRN), the 10 centers have formed the Developmental Synaptopathies Consortium (U54 NS092090). In addition to the NIH and Boston Children’s, the Consortium includes Cincinnati Children’s Hospital Medical Center, Cleveland Clinic, Icahn School of Medicine at Mount Sinai, Rush University Medical Center, Stanford University, University of Alabama at Birmingham, University of California at Los Angeles and University of Texas at Houston. (See below for a list of leading investigators.) Enrollment is projected to begin in the spring of 2015.

While both ASD and ID have a variety of known genetic causes, some of them have been shown to impair similar cellular pathways in the brain. The three conditions to be studied by the Consortium—tuberous sclerosis complex (caused by mutations in the TSC1 and TSC2 genes), Phelan-McDermid syndrome (caused by SHANK3 mutations) and PTEN Hamartoma Tumor Syndrome (caused by PTEN mutations)—seem to affect certain shared pathways influencing the development of brain connections, or synapses.

"To date, genetic studies indicate that there are about 500 to 1,000 genes that make people susceptible to ASD and ID," says Mustafa Sahin, MD, PhD, a pediatric neurologist at Boston Children’s Hospital and the Consortium Director. "While it’s very unlikely that a single therapy could treat disorders with so many distinct causes, we may be able to find certain groups of patients who share defects in similar biochemical pathways and may respond to treatment with the same agents."

For example, the finding that tuberous sclerosis complex results from disruption of the mTOR pathway have led Sahin and colleagues to test whether mTOR inhibitors can improve patients’ neurocognition. The Consortium investigators now plan to begin testing mTOR inhibitors in PTEN patients, since mTOR has also been implicated in their disease.

Together, the sites will seek to enroll 100 patients with tuberous sclerosis, 90 with Phelan-McDermid syndrome and 140 with PTEN mutations, ages 3 to 21, and follow them for three to five years with physical examinations, neuropsychological testing and advanced brain imaging. Advocacy groups for each condition, including the Tuberous Sclerosis Alliance, Phelan McDermid Syndrome Foundation, PTEN World, PTEN Life and The Beatrice and

Samuel A. Seaver Foundation, helped design the studies and are providing additional funding. Each group will notify its patient community when enrollment opens.

"Through comparative analysis of pathology caused by multiple genes, we may find that treatments developed for one disorder might be applicable to others," says Sahin, who also founded and directs the Multidisciplinary Tuberous Sclerosis Program at Boston Children’s. "A deeper understanding of this shared biology may also be a gateway to understanding the broader mechanisms of ASD and ID."

The RDCRN is an initiative of NIH’s Office of Rare Disease Research (ORDR) and National Center for Advancing Translational Sciences. The Developmental Synaptopathies Consortium is funded through collaboration between NCATS, NIMH, NINDS and NICHD. Its lead investigators are:

 Mustafa Sahin, MD, PhD, Principal Investigator, Boston Children’s Hospital

 Audrey Thurm, PhD, Principal Investigator, NIH

 Darcy Krueger, MD, PhD, Principal Investigator, Cincinnati Children’s Hospital Medical Center

 Charis Eng, MD, PhD, Principal Investigator, and Thomas Frazier, PhD, co-investigator, Cleveland Clinic)

 Joseph Buxbaum, PhD, Administrative Director, and Alexander Kolevzon, MD, Principal Investigator, Icahn School of Medicine at Mount Sinai

 Elizabeth Berry-Kravis, MD, PhD, Co-Investigator, and Latha Soorya, PhD, Co- Investigator, Rush University Medical Center

 Antonio Hardan, MD, Principal Investigator, Stanford University

 Martina Bebin, MD, Principal Investigator, University of Alabama at Birmingham

 Joyce Wu, MD, Principal Investigator, and Julian Martinez, MD, Co-Investigator, University of California at Los Angeles

 Hope Northrup, MD, Principal Investigator, and Deborah Pearson, PhD, Co-investigator, University of Texas at Houston

About Boston Children’s Hospital

Boston Children’s Hospital is home to the world’s largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including seven members of the National Academy of Sciences, 14 members of the Institute of Medicine and 14 members of the Howard Hughes Medical Institute comprise Boston Children’s research community. Founded as a 20-bed hospital for children, Boston Children’s today is a 395-bed comprehensive center for pediatric and adolescent health care. Boston Children’s is also the primary pediatric teaching affiliate of Harvard Medical School.

Welcome to Holland

The outgoing speech therapist at Vista del Mar, Carol, told me about this poem.  It stuck with me and it's a lovely introduction to the life I had never imagined but now find myself living.

I am often asked to describe the experience of raising a child with a disability - to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It's like this......

When you're going to have a baby, it's like planning a fabulous vacation trip - to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It's all very exciting.

After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The stewardess comes in and says, "Welcome to Holland."

"Holland?!?" you say. "What do you mean Holland?? I signed up for Italy! I'm supposed to be in Italy. All my life I've dreamed of going to Italy."

But there's been a change in the flight plan. They've landed in Holland and there you must stay.

The important thing is that they haven't taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It's just a different place.

So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met.

It's just a different place. It's slower-paced than Italy, less flashy than Italy. But after you've been there for a while and you catch your breath, you look around.... and you begin to notice that Holland has windmills....and Holland has tulips. Holland even has Rembrandts.

But everyone you know is busy coming and going from Italy... and they're all bragging about what a wonderful time they had there. And for the rest of your life, you will say "Yes, that's where I was supposed to go. That's what I had planned."

And the pain of that will never, ever, ever, ever go away... because the loss of that dream is a very very significant loss.

But... if you spend your life mourning the fact that you didn't get to Italy, you may never be free to enjoy the very special, the very lovely things ... about Holland.

c1987 by Emily Perl Kingsley. All rights reserved

The Day of the Diagnosis

Email below was sent to our friends and family.  I fully realize that it's a lot of information - but this is the condensed version of what I went through the morning the doctor informed us of our son's syndrome.

Everyone and their mother has asked me, "if there's anything I can do to help, don't hesitate to let me know".  Well, read the email below.  That will help.  When you read something you don't understand, Google it.  That's what I had to do.  You can help me by helping yourself to understand my child's condition.

Dear Friends & Family,

Darus has been diagnosed with Phelan McDermid Syndrome (22q13).  Jonas and I met with our UCLA geneticist, Dr. Barbara Crandall, this morning and learned the following:

Darus’ case is rare and different than the majority cases of PMS because of a change/mutation (not deletion) in the base of the SHANK3 gene on the 22nd chromosome.  It is heterozygous.  It is de novo – Jonas nor I are carriers.  The geneticist believes that this happened in either the egg or the sperm – preconception.  This would not have been detected w/ an amnio nor a Maternit21 test because there was no chromosomal change.  The chromosome microarray that was performed in March 2013 did not pick this up for that same reason.  We learned of this variant mutation via WES (whole exome sequencing) trio.

“The c.4065_4066delTG variant represents a deletion of two nucleotides resulting in a frame-shift and premature termination of the SHANK3 gene.  This variant has not been previously observed in the general population.  Phelan-McDermid syndrome is typically associated with terminal deletions of 22q13.3 encompassing the SHANK3 gene.”

Dr. Crandall seemed eager to point out that Darus does not present with many of the characteristics that typically accompany PMS.  She, however, could not confirm our hope that perhaps his case is/will be more mild than a more typical PMS case.

The SHANK3 gene has gotten a lot of attention recently, as scientists believe it could be connected to autism.  Given all of the autism research currently underway, this is encouraging to me.

There is an exploratory clinical trial that involves using intranasal insulin that has been proven to help typical PMS kids (those w/ the deletion not mutation).  There is a child right now, that has the same dx as Darus (mutation not deletion), that is going to start this trial.  We’ve asked to be connected to his/her parents.  I’m hopeful they will be open to speaking with us about their experience(s).

I’ve registered Darus w/ the Phelan McDermid Syndrome Foundation.  I’ve also connected with a few groups online that I hope will be able to guide us down this new path.  Last, but not least, there is a conference in Washington DC in November that is going to address the SHANK3 gene, and I hope to attend.

Overall, we're doing okay.  It's a lot to take in/absorb/process, but it's nice to finally have answers and a better understanding of our sweet boy.

If you have any questions/advice/words of wisdom, please don't hesitate to send them my way.  This has been and will continue to be a learning curve for us.

Thank you all very much for your support,

With love & gratitude,
Abby