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Child's Nervous System : ChNS :... Sep 2021Cerebellar mutism syndrome (CMS) represents a major complication affecting many children that undergo surgery for posterior fossa lesions. Etiology and pathophysiology... (Review)
Review
PURPOSE
Cerebellar mutism syndrome (CMS) represents a major complication affecting many children that undergo surgery for posterior fossa lesions. Etiology and pathophysiology are still not fully understood. CMS deeply influences quality of life and recovery of these patients. An effective treatment has not been defined yet. This case-based review aims at analyzing the available evidence and knowledge to better delineate this phenomenon and to determine whether CMS can be successfully treated with pharmacological therapy.
METHODS
Systematic research and retrieval of databases were conducted analyzing all papers where medical treatment of CMS was reported. A summary of the latest understanding and reports regarding definition, clinical manifestations, pathophysiology, management, and outcome of CMS has been conducted.
RESULTS
Consensus on definition of this syndrome is lacking. CMS is the term accepted by the Posterior Fossa Society in 2016. Pathophysiology is still poorly understood but the most likely mechanism is injury along proximal components of the efferent cerebellar pathway. Nine papers describing positive effects of pharmacological therapy for CMS have been identified. Fluoxetine, zolpidem, bromocriptine, and midazolam are the drugs that seem to alleviate symptoms of CMS and improve recovery. To date, cognitive rehabilitation and physiotherapy are the only treatment options available.
CONCLUSION
CMS has deep impact on affected children and their families. Despite attempts to identify preventive measures and treatment, cases still occur on a regular basis. Pharmacological treatments have been proposed to help reduce the symptoms of CMS with some promising results, but reports are limited; therefore, further studies are needed.
Topics: Cerebellar Diseases; Cerebellar Neoplasms; Cerebellum; Child; Humans; Mutism; Postoperative Complications; Quality of Life
PubMed: 34128119
DOI: 10.1007/s00381-021-05233-5 -
Acta Neurologica Aug 1993Four patients aged from 20 to 48 years with transient mutism are presented: 3 patients underwent surgery for midline tumours of the mesencephalic-cerebellar region... (Review)
Review
Four patients aged from 20 to 48 years with transient mutism are presented: 3 patients underwent surgery for midline tumours of the mesencephalic-cerebellar region (medulloblastoma in two cases and pinealoblastoma in one), at times attached to one or both lateral recesses of the IV ventricle. One patient was hospitalized and treated for brain-stem ischemia. All patients developed mutism 48 to 72 hours after surgery; in the patient with brain-stem softening mutism appeared 72 hours after admission. All the patients had unimpaired consciousness and no deficits of lower cranial nerves. Speech, always normal in the first hours after surgery, was regained after a period of 6-16 weeks. Various hypotheses for this speech disorder are analyzed.
Topics: Adult; Brain; Cerebellum; Female; Humans; Magnetic Resonance Imaging; Male; Mesencephalon; Middle Aged; Mutism; Postoperative Complications; Time Factors; Tomography, X-Ray Computed
PubMed: 8249672
DOI: No ID Found -
Journal of Anxiety Disorders 2007Selective mutism (SM) is a rare and interesting condition that has been associated with a wide variety of childhood psychiatric conditions. Historically viewed as more... (Review)
Review
Selective mutism (SM) is a rare and interesting condition that has been associated with a wide variety of childhood psychiatric conditions. Historically viewed as more of an oddity than a distinct diagnostic entity, early conceptualizations of the condition were based largely on case studies that tended to link SM with oppositional behavior. More recently, controlled studies have enhanced our understanding of SM. This review summarizes the current conceptualization of SM, highlighting evidence supporting the notion that SM is an anxiety-related condition.
Topics: Anxiety; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Humans; Models, Psychological; Mutism; Phobic Disorders
PubMed: 16949249
DOI: 10.1016/j.janxdis.2006.07.002 -
Journal of Anxiety Disorders 1999The relationship between selective mutism (SM) and childhood anxiety disorders is illustrated through an examination of their temperamental, environmental, and... (Review)
Review
The relationship between selective mutism (SM) and childhood anxiety disorders is illustrated through an examination of their temperamental, environmental, and biological etiologies. SM is also explored as a symptom of the specific anxiety disorders of social phobia, separation anxiety, and posttraumatic stress disorder. The etiology and symptom overlap demonstrates SM as being an anxiety disorder or a variant of a specific anxiety disorder. The conceptualization of SM as an anxiety disorder is helpful in effectively treating afflicted children. There is enough evidence in the current literature to challenge the current classification, from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders of SM as an Other Disorder of Infancy, Childhood, and Adolescence.
Topics: Anxiety Disorders; Anxiety, Separation; Child; Child Development; Female; Humans; Male; Mutism; Phobic Disorders; Sex Factors; Shyness; Stress Disorders, Post-Traumatic
PubMed: 10504110
DOI: 10.1016/s0887-6185(99)00012-2 -
Child's Nervous System : ChNS :... Oct 2022Children undergoing surgical removal of tumors in the posterior cranial fossa can encounter a varied and complex constellation of neurological symptoms, called...
Children undergoing surgical removal of tumors in the posterior cranial fossa can encounter a varied and complex constellation of neurological symptoms, called cerebellar mutism, defined as a disturbance in the planning and programming of motor language with preserved understanding, behavioral disorders such as inattention, visual-spatial disorganization, personality change, as well as ataxia and dysmetria. In the last years, several groups have been trying to establish risk factors or even predictive scores in order to be able at least in part to predict the appearance of speech disorders before surgery. We report on a child with pilocytic astrocytoma of the cerebellar vermis who had already been diagnosed with developmental linguistic delay two years earlier. This disorder initially worsened after surgery and later improved in the following 12 months. The aim of this paper is to emphasize the importance of preoperative neuropsychological evaluation. The present case, along with those reported in the literature, suggests that the risk of long-term cerebellar mutism is higher in children with preoperative speech disorders. In these patients a thorough assessment of cognitive and linguistic functions is therefore necessary to better evaluate the risk of cerebellar mutism after surgery.
Topics: Cerebellar Diseases; Cerebellar Neoplasms; Child; Humans; Language; Medulloblastoma; Mutism; Postoperative Complications; Speech Disorders; Syndrome
PubMed: 35338372
DOI: 10.1007/s00381-022-05497-5 -
Journal of the American Academy of... Jul 1995To provide practical guidelines for the assessment and treatment of children with selective mutism, in light of the recent hypothesis that selective mutism might be best... (Review)
Review
OBJECTIVE
To provide practical guidelines for the assessment and treatment of children with selective mutism, in light of the recent hypothesis that selective mutism might be best conceptualized as a childhood anxiety disorder.
METHOD
An extensive literature review was completed on the phenomenology, evaluation, and treatment of children with selective mutism. Additional recommendations were based on clinical experience from the authors' selective mutism clinic.
RESULTS
No systematic studies of the phenomenology of children with selective mutism were found. Reports described diverse and primarily noncontrolled treatment approaches with minimal follow-up information. Assessment and treatment options for selective mutism are presented, based on new hypotheses that focus on the anxiety component of this disorder. Ongoing research suggests a role for behavior modification and pharmacotherapy similar to the approaches used for adults with social phobia.
CONCLUSION
Selectively mute children deserve a comprehensive evaluation to identify primary and comorbid problems that might require treatment. A school-based multidisciplinary individualized treatment plan is recommended, involving the combined effort of teachers, clinicians, and parents with home- and clinic-based interventions (individual and family psychotherapy, pharmacotherapy) as required.
Topics: Anxiety Disorders; Child; Combined Modality Therapy; Diagnosis, Differential; Female; Humans; Male; Mutism; Patient Care Team; Personality Assessment; Phobic Disorders; Social Environment
PubMed: 7649953
DOI: 10.1097/00004583-199507000-00006 -
Archives of Disease in Childhood Oct 2008Selective mutism (SM) now acknowledged as an anxiety condition, tends to be a poorly understood, highly complex and vastly under-recognised clinical entity. Children... (Review)
Review
BACKGROUND
Selective mutism (SM) now acknowledged as an anxiety condition, tends to be a poorly understood, highly complex and vastly under-recognised clinical entity. Children with SM are a vulnerable group as the condition is not the remit of any one professional group. This inevitably leads to delay in formal diagnosis and management. There is a lack of systematic research on which to base guidelines for management.
AIM
To develop, agree and validate key principles underlying the management of SM through a consensus process involving international experts, in order to create a local care pathway.
METHODS
A local multi-agency consultation process developed 11 statements, which were felt to be the key principles underpinning a potential care pathway for managing SM. Thirteen recognised experts from North America, Europe and Australia participated in a modified Delphi process involving two rounds using a Likert-scale and free commentary. Both quantitative and qualitative analyses were used in the validation or revision of the statements at each stage.
RESULTS
Response rates were 100% for Round 1 and 84.6% for Round 2. Despite the differing professional backgrounds and service contexts, by successive revision and/or revalidation of statements, it was possible to arrive at a consensus about key principles relating to early recognition, assessment and intervention. The agreed key principles are presented together with the resulting local care pathway.
CONCLUSION
Through a Delphi process, agreement was reached by a multidisciplinary group of professionals, on key principles that underpin the timely identification, assessment and management of children with SM. These include the potential for staff in school/preschool settings to identify SM and that intervention programmes should generally be based in these settings. Children with SM should receive assessment for possible coexisting disorders, whether developmental, emotional or behavioural and additional specific intervention given for these. Agreement was reached as to what constitutes clinical progress, intervals for monitoring progress, criteria for referral onwards for multidisciplinary specialist assessment and the role of selective serotonin reuptake inhibitor (SSRI) medication. A consensus methodology has been successfully used to compensate for the lack of evidence base and harness the expertise of a relatively small number of experienced professionals in order to provide a basis for the future development of services.
Topics: Child; Child Health Services; Critical Pathways; Delivery of Health Care; Delphi Technique; Diagnostic and Statistical Manual of Mental Disorders; Evidence-Based Medicine; Humans; Mutism; Professional Practice
PubMed: 18456696
DOI: 10.1136/adc.2007.129437 -
Journal of Neurosurgery. Pediatrics Oct 2010
Topics: Cerebellar Neoplasms; Child; Humans; Medulloblastoma; Mutism; Postoperative Complications
PubMed: 20887118
DOI: 10.3171/2010.5.PEDS10187 -
Psychiatria Polska Apr 2018The position of selective mutism disorder - SM - has been modified in the last edition of the classification of mental disorders DSM-5. It was removed from "Disorders of... (Review)
Review
The position of selective mutism disorder - SM - has been modified in the last edition of the classification of mental disorders DSM-5. It was removed from "Disorders of childhood and adolescence" and placed in "Anxiety disorders". This caused two important changes in the interpretation of the symptoms of selective mutism. It highlighted anxious etiology of the disorder and also open the possibility to diagnose selective mutism in adults as a special category of anxiety disorders. The aim of this study was to present three different cases concerning the diagnostic difficulties of selective mutism (the child, the teenager and the persons who became adult during our observation) regarding current views on SM. In this study we presented the current view on the etiology, course and available therapies for selective mutism. Owing to updating the clinical knowledge about SM and describing three cases, we highlighted the controversies around the diagnosis and treatment of this disorder. Selective mutism might be a preliminary diagnosis, often leading to the diagnosis of other disorders of diverse etiology and course. Among the psychiatric aspects of the disorder, the 'anxiety component' of SM is crucial. In individuals with selective mutism, developmental disorders, social cognition and neurocognition deficits or dysfunctions of auditory processing often coexist. The severity and the type of comorbidities may determine the future course of the illness and the final effects of the therapy.
Topics: Adolescent; Adult; Anxiety Disorders; Child; Child Behavior Disorders; Female; Humans; Male; Mutism; Phobic Disorders; Risk Assessment; Severity of Illness Index
PubMed: 29975370
DOI: 10.12740/PP/76088 -
Neurology Jan 1997
Topics: Cyclosporine; Demyelinating Diseases; Humans; Liver Transplantation; Mutism; Postoperative Complications; Postoperative Period
PubMed: 9008554
DOI: 10.1212/wnl.48.1.296-a