Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS) has commonly occured in Down syndrome children caused by the abnormalities in upper respiratory tract anatomy and obesity. This study aims to identify the correlation between Mallampati score and obesity and the risk of OSAHS in Down syndrome children. This was an analytical descriptive cross-sectional study. This study was conducted in children with Down syndrome from September until November 2017. All parents filled the Indonesian Pediatric Sleep Questionnaire (PSQ), then all of the children were examined for Mallampati score and BMI. The correlation was analyzed by the Pearson Chi-Square model. Thirty-six subjects were included in this study. The number of male subjects were slightly more (61.1%), the mean age of the subjects was 8.42±4,449 years, with 52.8% (19 subjects) having OSAHS. There were 23 subjects (63.9%) who had Mallampati scores of 3 and 4, with 13 subjects (36.1%) were obese. This study concluded a statistically significant correlation between Mallampati score and obesity and the risk of OSAHS in Down syndrome children (p-value 0.001 and 0.029). Mallampati score and obesity had a significant correlation with the risk of OSAHS in Down syndrome children.
Spinocerebellar ataxia (SCA) is an autosomal dominant hereditary disease with progressive course, and no causal therapy. Diagnostics are still challenging, due to facility and protocols, and so as in Indonesia. As a national referral center, Dr. Hasan Sadikin Central General Hospital has received a lot of patients from all over Indonesia, particularly from Western Java. Study related to SCA (including clinical and genetic profile) is still limited in Indonesia. We identified index patients from three families with ataxia, hence intend to determine their clinical and genetic pattern. The hereditary pattern is autosomal dominant. Scale for the assessment and rating of ataxia (SARA) shows mild and moderate ataxia. Inventory of non-ataxia signs (INAS) scores of the patients were 3, 5 and 6. Montreal cognitive assessment-Indonesian version (MOCA-INA) shows only one patient has mild cognitive impairment, despite young age. Barthel index shows 1 subject has moderate dependency. Mutation in Ataxin3 polyQ repeats shows pathologically long CAG repeats, 72,10; 72,10; and 72,23 respectively in mutant and wild type allele. We diagnosed the index patients with spinocerebellar ataxia type 3. This study is the first case series study in Indonesia. The hereditary pattern is clearly shown as an autosomal dominant ataxia. The clinical and genetic profile was varied, and the symptom is progressive and deteriorates overtime, including wide based gait, speech problem, motor and sensor complaint, and cognitive decline complaint. Despite the same polyQ stretch length, the onset and clinical characteristics of patients are diverse.
IntroductionSpinocerebellar ataxia type-3 (SCA3) is an adult-onset autosomal dominant neurodegenerative disease. It is caused by expanding of CAG repeat in ATXN3 gene that later on would affect brain structures. This brain changes could be evaluated using brain MRI volumetric. However, findings across published brain volumetric studies have been inconsistent. Here, we report MRI brain volumetric analysis in a family of SCA 3 patients, which included pre-symptomatic and symptomatic patients.MethodologyThe study included affected and unaffected members from a large six-generation family of SCA 3, genetically confirmed using PolyQ/CAG repeat expansion analysis, Sanger sequencing, and PCR. Clinical evaluation was performed using Scale for the Assessment and Rating of Ataxia (SARA). Subjects' brains were scanned using 3.0-T MRI with a 3D T1 BRAVO sequence. Evaluations were performed by 2 independent neuroradiologists. An automated volumetric analysis was performed using FreeSurfer and CERES (for the cerebellum).ResultWe evaluated 7 subjects from this SCA3 family, including 3 subjects with SCA3 and 4 unaffected subjects. The volumetric evaluation revealed smaller brain volumes (p < 0.05) in the corpus callosum, cerebellar volume of lobules I-II, lobule IV, lobule VIIB and lobule IX; and in cerebellar gray matter volume of lobule IV, and VIIIA; in the pathologic/expanded CAG repeat group (SCA3).ConclusionBrain MRI volumetry of SCA3 subjects showed smaller brain volumes in multiple brain regions including the corpus callosum and gray matter volumes of several cerebellar lobules.
Spinocerebellar ataxia (SCA) 3 is a neurodegenerative disease which involves cerebellum and extra cerebellum. Neuropathy in SCA3 manifests in various ways, including axonal and demyelination lesions in sensory and motor nerves. There has not been any study that describes the peripheral neuropathy characteristics of SCA3 patients in Indonesia at the time of this publication. This paper reports a case of a 43-year-old male with known spinocerebellar ataxia 3 presented with hereditary ataxia and mild numbness in both palms since two years before. No abnormalities were found during the sensory examination. The NCS showed severe axonal demyelinating sensorimotor peripheral neuropathy. In magnetic resonance imaging (MRI), an atrophy in the cerebellum with cerebral multiple lacunar infarction was identified. Electrophysiological results revealed profound axonal lesion in peripheral nerves. To conclude, peripheral neuropathy in SCA3 represents the dominance of axonal lesions in motor nerves.
Children with cerebral palsy are considered a population at risk for sleep disturbance. Various factors can cause sleep disorders in children with cerebral palsy. This study investigates the relationship between endogenous factors and sleep disorders in children with cerebral palsy. It was a cross-sectional analytical study using randomized sampling on children with cerebral palsy who met the inclusion criteria for the period of May–August 2017. The location of the study was special schools in the Bandung area, Indonesia. All participants were screened with the Sleep Disturbances Scale for Children (SDSC) questionnaire to determine the prevalence of period of sleep disorders. Data analysis was then performed using the unpaired t test to compare the characteristics of two variables with a p value≤0.05 considered statistically significant. Sixty-six subjects aged 8–14 years were recruited. The results showed that the prevalence of sleep disorders was 67% (32 children), with insomnia as the most common type of sleep disorder (39%). There was a significant association between motor disabilities type and sleep disorders (p≤0.05). The most common type of sleep disorder in children with cerebral palsy is insomnia. In conclusion, there is a relationship between motor disability type and sleep disorders in cerebral palsy children.
Rationale: Spinocerebellar ataxia (SCA) 3, also known as Machado-Joseph Disease (MJD), is a neurodegenerative disease which involves cerebellum and its afferent and efferent pathways. Generally, the initial symptoms were gait disturbance, double vision, dysarthria, and vertigo.Patient concerns: a 43-year-old male, with known SCA3, presented hereditary ataxia had mild numbness in his both palms since two years ago. Sensory examination found no abnormality. Nerve Conduction Studies (NCS) showed severe axonal demyelinating sensorimotor peripheral neuropathy. In magnetic resonance imaging atrophy cerebellum with cerebral multiple lacunar infarction were seen. Diagnoses: SCA3 was diagnosed on the basis of clinical features, family pedigree, physical examination, electrophysiology study, neuroimaging, nerve biopsy, and genetic testing results. The electrophysiological manifestations revealed profound axonal demyelinating lesion in peripheral nerves. Genetic analysis was not done yet due to lack of availability of genetic testing in our country at this moment although it is the gold standard for diagnosis.Lessons: SCA3 with peripheral neuropathy represents a specific clinical entity that so far has never been described previously in Indonesia.Abbreviations: SCA3 = Spinocerebellar ataxia, MJD = Machado-Joseph Disease, NCS = Nerve Conduction Studies
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