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Journal of Neurosurgery. Pediatrics Feb 2024Postoperative cerebellar mutism syndrome (CMS) develops in up to 40% of children with medulloblastoma. The Rotterdam model (RM) has been reported to predict a 66% risk...
OBJECTIVE
Postoperative cerebellar mutism syndrome (CMS) develops in up to 40% of children with medulloblastoma. The Rotterdam model (RM) has been reported to predict a 66% risk of CMS in patients with a score of ≥ 100. The aim of this study was to retrospectively apply the RM to an independent cohort of patients with newly diagnosed medulloblastoma and study the applicability of the RM in predicting postoperative CMS.
METHODS
Participants had to have their first tumor resection at the authors' institution and be enrolled in the SJMB12 protocol (NCT01878617). All participants underwent structured serial neurological evaluations before and then periodically after completing radiation therapy. Imaging was reviewed by the study neurologist who was blinded to CMS status when reviewing the scans and retrospectively applied RM score to each participant.
RESULTS
Forty participants were included (14 females and 26 males). Four (10%) patients had CMS. The median age at tumor resection was 11.7 years (range 3.5-17.8 years). Tumor location was midline in 30 (75%), right lateral in 6 (15%), and left lateral in 4 (10%). The median Evans index was 0.3 (range 0.2-0.4), and 34 (85%) patients had an Evans index ≥ 0.3. Five participants required a ventricular shunt. The median tumor volume was 51.97 cm3 (range 20.13-180.58 cm3). Gross-total resection was achieved in 35 (87.5%) patients, near-total resection in 4 (10%), and subtotal in 1. The median RM score was 90 (range 25-145). Eighteen participants had an RM score of ≥ 100, and of these 16.7% (n = 3) had CMS. Of the 22 patients with an RM score < 100, 1 child developed CMS (4.5%, CI 0.1%-22.8%); 3 of the 18 patients with an RM score ≥ 100 developed CMS (16.7%, CI 3.6%-41.4%). The observed rate of CMS in the cohort of children with an RM score ≥ 100 was significantly lower than the observed rate in the original RM cohort (66.7%, CI 51%-80.0%, p < 0.001). A greater risk of CMS in patients with an RM score ≥ 100 could not be confirmed (p = 0.31).
CONCLUSIONS
At the authors' institution, the incidence of CMS in patients who had an RM ≥ 100 was significantly lower than the RM cohort. These findings raise questions regarding generalizability of RM; however, fewer cases of CMS and a relatively small cohort limit this conclusion.
Topics: Child; Male; Female; Humans; Child, Preschool; Adolescent; Medulloblastoma; Retrospective Studies; Mutism; Cerebellar Diseases; Cerebellar Neoplasms; Postoperative Complications
PubMed: 38000061
DOI: 10.3171/2023.9.PEDS23160 -
Pharmacopsychiatry Jan 2024Electroconvulsive therapy (ECT) is known to be effective in the treatment of catatonia, reaching response rates of about 80 to 100%. It is indicated in cases of...
INTRODUCTION
Electroconvulsive therapy (ECT) is known to be effective in the treatment of catatonia, reaching response rates of about 80 to 100%. It is indicated in cases of treatment resistance to benzodiazepines and in life-threatening conditions such as malignant catatonia. Beneficial effects on specific symptoms or predictors of response are less clear. The objective of this retrospective study is to examine the ECT effect on specific catatonia symptoms in the acute phase of the illness and to identify predictors of response.
METHODS
A retrospective study examined data from 20 patients with catatonia, 18 associated with schizophrenia and 2 with bipolar disorder, who underwent ECT from 2008 to 2021. Ten subjects had more than one ECT-series, resulting in a total of 31 ECT-series. Catatonia symptom severity was assessed with the Bush Francis Catatonia Rating Scale (BFCRS).
RESULTS
ECT yielded excellent response. Nineteen of 20 patients and 30 of 31 ECT-series achieved response. The mean number of ECT sessions to response was 4.2. Response to ECT was more pronounced for motor inhibition symptoms such as stupor and mutism, while echophenomena, dyskinesia, stereotypy and perseveration responded less well. A predictor of late response was the presence of grasp reflex.
DISCUSSION
The present study corroborates the high and rapid effectiveness of ECT in the treatment of catatonia. Focus on single catatonia signs may help to identify those who are most likely to achieve remission quickly, as well as those who might need longer ECT-series.
Topics: Humans; Catatonia; Electroconvulsive Therapy; Retrospective Studies; Schizophrenia; Bipolar Disorder
PubMed: 37995719
DOI: 10.1055/a-2195-1499 -
Journal of Communication Disorders 2024Selective mutism (SM) is an anxiety disorder categorized by a persistent failure to speak in specific situations. In an attempt to facilitate interaction with...
INTRODUCTION
Selective mutism (SM) is an anxiety disorder categorized by a persistent failure to speak in specific situations. In an attempt to facilitate interaction with individuals with SM, other forms of communication (e.g. computer-mediated communication; CMC) are often tried. However, CMC is understudied in individuals with SM, while, especially since the COVID-19 pandemic, the importance of CMC for education and social purposes only increased.
METHODS
In this study, we explored CMC in 79 adolescents with either selective mutism (n = 34), or typical development (n = 45). All participants completed a survey concerning verbal and written CMC in three contexts (friends, family, and school).
RESULTS
Results showed that adolescents with SM used not only verbal but also written CMC less frequently than the comparison group across contexts. While the comparison group preferred Face-to-Face communication over CMC, adolescents with SM were divided, especially in the school context. With family and friends, the majority of the SM group preferred Face-to-Face communication, even though this provoked more feelings of tension than CMC for part of the group.
CONCLUSION
These findings support anecdotal reports that SM affects not only speech but extends to other communicative venues and includes written communication in many situations. This underlines the importance of addressing not just speaking behavior but also writing and CMC in the diagnostic evaluation and treatment plans for adolescents with SM.
Topics: Humans; Adolescent; Mutism; Pandemics; Anxiety Disorders; Communication; Computers
PubMed: 37988827
DOI: 10.1016/j.jcomdis.2023.106389 -
Dementia & Neuropsychologia 2023Locked-in syndrome is a neurological condition characterized by tetraplegia, mutism, preservation of vertical eye movement, superior eyelid movement, and intact...
Locked-in syndrome is a neurological condition characterized by tetraplegia, mutism, preservation of vertical eye movement, superior eyelid movement, and intact consciousness, making it impossible for the patient to communicate properly. We herein describe a case to analyze the practice of developing a method of communication for a patient with locked-in syndrome. Two communication boards were created, adapted to the Portuguese language, as well as a shortcut to inquire about the physical and emotional patient's well-being. We had difficulty with the initial communication board, due to the patient's low education level, so we adapted a new one to the patient's social context, including a shortcut to inquire about physical and emotional well-being. The communication board had a positive impact on treatment development and the patient's life.
PubMed: 37965482
DOI: 10.1590/1980-5764-DN-2023-0041 -
Behavioural Brain Research Feb 2024Over the preceding years, music therapy has gained tremendous attention due to new findings of music in management of various conditions like Alzheimer's, depression,... (Review)
Review
Over the preceding years, music therapy has gained tremendous attention due to new findings of music in management of various conditions like Alzheimer's, depression, anxiety, insomnia, etc. Music is a non-invasive, patient-friendly and pleasant form of therapy with minimal or no side effects. It activates the reward pathway of brain by influencing several processes such as dopamine release, reduction in cortisol levels, increase in estrogen and testosterone levels. This review article focuses on advantages and disadvantages of music therapy, mechanism of action of music in brain and its effective applications in the management of different diseases. The article covers history of music therapy in America, Egypt, and India with practice of music therapy. The advanced effects of music therapy in autism, cancer, post-operative pain, Parkinson's disease, selective mutism, stroke, heart problems, pregnancy, eating disorders, bone fractures and obsessive compulsive disorders are discussed. Also the effect of music therapy on the quality of sleep and brain waves has been discussed. This is an established profession in western countries like America, UK, Australia, and Canada, but not in low-income countries like India where it needs to be standardized.
Topics: Pregnancy; Female; Humans; Music Therapy; Anxiety; Emotions; Music; Obsessive-Compulsive Disorder
PubMed: 37944563
DOI: 10.1016/j.bbr.2023.114750 -
BMC Psychiatry Oct 2023Selective mutism (SM) is a childhood onset anxiety disorder, and the main symptom is not speaking in certain social situations. Knowledge about the duration and...
BACKGROUND
Selective mutism (SM) is a childhood onset anxiety disorder, and the main symptom is not speaking in certain social situations. Knowledge about the duration and long-term outcomes of SM have been lacking and the aim of this systematic literature review was to address this gap in the literature. We investigated how long SM symptoms persisted as well as other psychiatric outcomes associated with SM in later life.
METHODS
The PubMed, PsycInfo, Web of Science, Cochrane Library and Embase databases were initially searched from inception to 11 September 2023. Studies were included if they were published in English and had followed up subjects with clinically diagnosed SM for at least two years. The review followed the Preferred Reporting Items of Systematic Reviews and Meta-analyses guidelines and the protocol was registered with the Open Science Framework. The papers were assessed using the Quality Assessment with Diverse Studies tool.
RESULTS
This review screened 2,432 papers and assessed 18 studies. Seven case series studies were excluded from discussion because of the low number of subjects and the fact that their findings could not be generalized to wider populations. In the end, nine clinical cohorts and two case control studies were reviewed. These provided a total of 292 subjects and the sample sizes ranged from 11-49. The overall quality of the studies was moderate. The review found that 190 of the 243 subjects in the studies that reported recovery rates showed moderate or total improvement from SM during follow up. Other anxiety disorders were the most common psychiatric disorders later in life, although these results should be interpreted with caution. Older age at baseline and parental psychopathology might predict greater impairment, but further studies are needed to confirm these results.
CONCLUSIONS
Most subjects with SM recovered from this disorder during adolescence, but anxiety disorders were common in later life. Early detection and treatment are needed to prevent symptoms from persisting and other psychiatric disorders from developing.
Topics: Adolescent; Child; Humans; Anxiety Disorders; Case-Control Studies; Mutism; Psychopathology; Systematic Reviews as Topic
PubMed: 37875905
DOI: 10.1186/s12888-023-05279-6 -
Pediatric Reports Oct 2023Selective mutism (SM) is a rare childhood anxiety disorder which may be markedly detrimental to a child's academic and social functioning if left untreated....
Selective mutism (SM) is a rare childhood anxiety disorder which may be markedly detrimental to a child's academic and social functioning if left untreated. Cognitive-behavioral treatments for social anxiety disorders have been found to be effective for SM, yet a paucity of published studies have explored manualized treatment approaches carried out by novice clinicians. The purpose of the present study was to examine the adherence, effectiveness, and acceptability of a condensed, 16-session version of Integrated Behavior Therapy for Selective Mutism (IBTSM; Bergman, 2013), the first manualized treatment for SM. A nonconcurrent multiple-baseline single-case design was used across five children diagnosed with SM, exclusively anxious subtype. IBTSM was implemented with excellent adherence (M = 98%) over an average of 19 weeks (range = 16-22 weeks). Visual analyses of weekly caregiver ratings of social anxiety and speaking behaviors did not demonstrate a replicated intervention effect; however, Tau-U effect sizes and Reliable Change Index (RCI) calculations demonstrated significant individual improvements in social anxiety and speaking behaviors over time on several measures. Three children (60%) no longer met diagnostic criteria for SM following treatment. All caregivers rated IBTSM as acceptable, with specific endorsements of acceptability in the areas of time required and treatment quality.
PubMed: 37873803
DOI: 10.3390/pediatric15040057 -
Transcultural Psychiatry Feb 2024Although the diagnosis of selective mutism (SM) is more prevalent among immigrant children, the link between the disorder and an immigration background has been elusive....
Although the diagnosis of selective mutism (SM) is more prevalent among immigrant children, the link between the disorder and an immigration background has been elusive. Guided by ecocultural models of development, the current study aimed to construct a theory-based description of SM while considering individual, family, and contextual risk factors. Participants were 78 children with SM (38.4% with an immigration background), and 247 typically developed children (18.2% with an immigration background). Consistent with previous studies, our results suggest that anxiety was the most important predictor of SM symptoms, above and beyond immigration background. Immigration, especially if coupled with bilingual status and low family income, predicted increased levels of SM symptoms. Identifying multi-level predictors of SM may help researchers and clinicians to improve early identification and treatment of SM in culturally and linguistically diverse children.
Topics: Child; Humans; Mutism; Anxiety Disorders; Anxiety; Emigration and Immigration; Emigrants and Immigrants
PubMed: 37814531
DOI: 10.1177/13634615231202095 -
Rivista Di Psichiatria 2023We hereby report a case of a young Ukrainian woman refugee who immigrated in Italy after the war outbreak in February 2022. The researcher arrived in Italy in March...
We hereby report a case of a young Ukrainian woman refugee who immigrated in Italy after the war outbreak in February 2022. The researcher arrived in Italy in March 2022, thanks to a scholarship of the University of L'Aquila. Shortly after settling in L'Aquila, she started to manifest depressive symptoms, which eventually led her to seek psychological and pharmacological help in the local psychiatric unit. In April 2022, she accessed twice in a week to the emergency department of the "San Salvatore" Hospital of L'Aquila. The second time she presented an acute anxiety attack accompanied by psychomotor disturbances (negativism, mutism) that eventually required admission to the local psychiatric ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC) with the aim of managing the clinical presentation from a pharmacological and psychotherapeutic perspective. The patient submitted a series of validated scales in her own language. After 13 days of hospitalization, the patient was discharged with a diagnosis of "Acute Depressive Disorder, mild severity", according to PHQ-9, and referred to psychiatric services with a dedicated program. The present report aims to underline the need to take into consideration the possibility of developing depressive symptoms and reactions among Ukrainian war refugees and, in light of this evidence, the importance of a cross-country shared program when addressing the mental health of all refugees.
Topics: Female; Humans; Earthquakes; Refugees; Italy; Hospitalization; Mental Health
PubMed: 37807869
DOI: 10.1708/4113.41073 -
BMC Neurology Oct 2023Creutzfeldt-Jakob disease (CJD) is a rapidly progressive and ultimately fatal neurodegenerative condition caused by prions. The clinical symptoms of CJD vary with its...
BACKGROUND
Creutzfeldt-Jakob disease (CJD) is a rapidly progressive and ultimately fatal neurodegenerative condition caused by prions. The clinical symptoms of CJD vary with its subtype, and may include dementia, visual hallucinations, myoclonus, ataxia, (extra)pyramidal signs and akinetic mutism. In the early course of disease however, several clinical symptoms of CJD may mimic those of co-existing morbidities.
CASE PRESENTATION
We report a male in his 60s with a history of situs inversus totalis and Churg Strauss syndrome, who presented with speech fluency disturbances, neuropsychiatric symptoms and allodynia, a few months after becoming a widower. Initially presumed a bereavement disorder along with a flare-up of Churg Strauss, his symptoms gradually worsened with apraxia, myoclonic jerks and eventually, akinetic mutism. MRI revealed hyperintensities at the caudate nucleus and thalami, while the cerebrospinal fluid was positive for the 14-3-3 protein and the real-time quick test, making the diagnosis of CJD highly probable. This case illustrates the complexities that may arise in diagnosing CJD when pre-existing multimorbidity may cloud the clinical presentation. We also discuss the potential mechanisms underlying the co-occurrence of three rare conditions (situs inversus totalis, Churg Strauss syndrome, CJD) in one patient, taking into consideration the possibility of coincidence as well as common underlying factors.
CONCLUSIONS
The diagnosis of CJD may be easily missed when its clinical symptoms are obscured by those of pre-existing (rare) multimorbidity. This case highlights that when the multimorbidity has neurological manifestations, an extensive evaluation remains crucial to establish the diagnosis, minimize the risk of prion-transmission and provide appropriate guidance to patients and their caregivers.
Topics: Humans; Male; Creutzfeldt-Jakob Syndrome; Akinetic Mutism; Churg-Strauss Syndrome; Multimorbidity; Myoclonus; Situs Inversus
PubMed: 37784069
DOI: 10.1186/s12883-023-03401-5