THE DIFFICULTY OR REFUSAL TO HAVE THE HAIR COMBED IN DOWNS. RESULTS IN 33 SUBJECTS AFTER ANTISTRESS DRUG THERAPY

THE DIFFICULTY OR REFUSAL TO HAVE THE HAIR COMBED IN DOWNS. RESULTS IN 33 SUBJECTS AFTER ANTISTRESS DRUG THERAPY.

Renato COCCHI, neurologist and medical psychologist.

Summary

Thirty-three Down subjects who showed the symptom "difficulty or the refusal to have the hair combed" (14 M and 19 F, all with standard trisomy 21; average age at first consultation 69.70 months, range 11-204) had follow-ups of such a symptom during an antistress drug therapy. Thirty-one (93.94%) had the disappearance of it after, at average, 10.97 months of treatment. It is confirmed the female prevalence, and ex [adjuvantibus], the relationship of the symptom with the stress.

Key words: Down syndrome,hair combing,difficulty,refusal,stress,antistress drug therapy.

Testo in Italiano

Modulation of stress reactions by drugs.

Mental retardation

Stress symptoms

Down syndrome

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In a previous investigation (Cocchi, 2003) it was noting the prevalence, in Downs, of a curious symptom, the difficulty or the refusal to have his/her hair combed, mainly the hairs of the nape.

The child involves as if to having the hairs combed produced him/her pain. Every mother confirming me the presence of this symptom, has always considered this one as a specific feature of his/her child, ignoring that instead it is a frequent fact.

Victor Bishop of the Riverbend Down Syndrome Support Group, USA, wrote me this personal comment after reading the first paper of mine on this topic. "I have heard that this is a common problem with Downs going to the barber shop and having a haircut."

Then this me conscious that this symptom is not only a pure curiosity, but that it creates bothers in the usual management of the Down child.

The difficulty or the refusal to have the hair combed does not appear to get ever systematic investigations (Check on Medline 1960-2003) but it was reported anecdotally in two autistic Down children, as I find on Google.

The previous epidemiological investigation on 213 subjects found its presence in 83 of them. I concluded that this symptom doesn't have any relationship with the chromosomal diagnosis, it has female prevalence and disappear with the age.

Already then, however, I wrote "Unfortunately this symptom, as not essential to evaluate the current stress and the possible brain biochemical balance, did not have punctual attention and investigation in all subjects, even if this happened in a random way."

The same mostly occurred in following its evolution during a drug therapy, which never had such a symptom as its target.

Materials and methods.

This research has been carried out on the 83 clinical cards where, in the preceding investigation, I found the symptom "difficulty or refusal to have the hair combed" as noted during the first visit. From them I selected the cards where the symptom had a specific follow-up during the drug therapy.

No card refers to autistic Down children as otherwise reported there (Cocchi, 2003).

From these records I collected:

- sex; -

- chromosomal diagnosis; -

- age at 1st consultation;

- length (in months) of the drug therapy until the symptom disappeared or, if else, until the last checkup.

I processed data with plain statistics according to sex, chromosomal anomalies and age bands. When fitting, I applied the ANOVA test.

Results.

Data of the 33 subjects belonging the selected clinical cards had a summarizing into the following 1-5 tables.

The average age to the first visit resulted 69.70 months, with range 11-204 months.

Unfortunately this symptom, as judged of poor relevance, had even poor follow-up during the drug therapy.

In 31 Ss out of 33, this symptom disappeared, and in two, at the end of available checkups - respectively after 25 and 38 months of drug treatment -, this symptom was still present.

Tab. 1. Gender distribution of the symptom prevalence, the total amount and Ss treated with drugs.

Presence of the symptom	83	100.00%
Males	39	46.99
Females	44	53.01
M/F ratio	88.63%
Drug treated Ss	33	39.76%

Drug treated Ss	33	100.00%
Males	14	42.42%
Females	19	57.58%
M/F ratio	73.78%

Months of treatment, average
Total	10.97
Males	11.72
Females	10.42

How we can see, only in the 33% of the subjects owning the symptom according to the first visit had a specific follow-up during drug therapy.

In this sub-sample also there is clear female prevalence, even more marked. There it does not stand any gender difference as for the length of the drug therapy till the disappearance of the symptom, or at the end checkup.

Tab.2. Distribution of chromosomal diagnoses of the prevalence of the symptom "having difficulty or refusal to have the hair combed ".

Presenzsence of the symptom	83	100.00%
Standard trisomy 21	78	93.98%
Translocations	2	2.41%
Mosaicisms	3	3.61%

Ss treated by drugs	33	100%
Standard trisomy 21	33	100%

The only presence of subjects with trisomy 21, has very high probability of being simply an artifact due to the reduced total of the sub-sample of drug treated Ss.

Tab. 3: Distribution of the symptom according to the age, for bands of two years.

Years age bands,	Symptom present / investigated Ssi		Symptom present / treated Ss		Ss with the symptom off after drug therapy
Years age bands,	Ss nr.	%	Ss nr.	%	Ss nr.	%
1-2	9	10.84	5	15.16	4	12.12
3-4	28	33.74	8	24.25	7	21.22
5-6	18	21.69	6	18.18	6	18.18
7-8	13	15.67	7	21.21	7	21.21
9-10	5	6.02	1	3.03	1	3.03
11-12	8	9.64	4	12.12	4	12.12
13-14	2	2.40	2	6.06	2	6.06
Totals	83	100.00	33	100.00	31	93.94

Investigated vs treated Ssi: ANOVA: F = 7.91 with 13 df and p = .031.

The distribution of treated Ss is significantly different from that of the subjects owning the symptom at the first visit. At a first blink, it occurred like a selection of sub-sample subjects, although without any intention to do it.

Over 93% had the disappearance of the symptom during an antistress drug therapy.

Tab. 4: Main used drugs, in mg/die, by the oral via, if not otherwise specified

Drug	Mg/die, by the oral via	Ss nr.	%
Pyridoxine	75-150	33	100.00
Glutamine	125-250	22 + ( 11 ^)	66.67
Glutamine + pemoline	(45+5) -(90+10)	11	33.33
Diazepam	1-3	25	75.76
Bromazepan	0.75-1.5	5	15,15
Oxazepam (*)	5-10	5	15.15
Delorazepam	0.2-0.5	3	9.09
Thiamine + pyridoxine + cyanocobalamine (**)	125mg+125mg+250gam-ma	33	100.00
Metiltetrahydrofolates (***)	7.5	27	81.81
Carbamazepine	50-100	9	27.27
Amantadine (****)	50-100	11	33.33
5-hydroxytriptophan	25-50	9	27.27
S-adenosil-l-methionine	100-200	12	36.36

^ When the glutamine + pemoline has been marketed out, it has been substituted with glutamine and amantadine. (*) In infants, then substituted with another benzodiazepine. (**) The following substitute of the pyridoxine; (****) Used when the diet doesn't introduce folates or it was very poor of them. (****) Substitute of the pemoline in hyperactive Downs.

As for the average, it is about five drugs for subject.

Tab. 5: Length of the drug therapy, in months, till disappearance of the symptom (31 subjects).

Years age bands	1-2	3-4	5-6	7-8	9-10	11-12	13-14
Average length, months	10.5	11.29	10.67	7.57	8*	6.75	9**
Months range	4-14	4-27	6-18	4-10	8*	3-8	8-18**

* One S; ** Two Ss.

The drug therapy length, according to band age has not an indicative course, perhaps even for the amount difference of the components of the various bands of age. As average, within 11.29 and 6.75 months, the parents reported disappearance of the symptom. The range is 3-27 months.

Discussion.

This second investigation, althougn carried out in a modest sample, brings some new information, with the limits due to only 33 cases.

The first one comes from the different distribution of the chromosomal anomalies. Subjects with mosaicisms and translocations do not have a share in this sample. It is much probable that it is creditable to the poor numerical consistence of the sample, but this is not a sure thing, and to the moment I am unable to decide with safety.

Although this symptom affects both sexes, it has a clear female prevalence, that here comes confirmed and reinforced.

In over 93% of the cases, the difficulty or the refusal to have the hair is combed is missing following an antistress drug therapy, not specifically targeted to this symptom. This is a datum that confirms its relationship with the stress.

The fact that in two children, belonging to the first two age bands, this symptom was still present after respectively 25 and 38 months of drug therapy, strongly suggests that every individual has own features of answering to the stress. An antistress drug therapy can only be made more effective in the long time. Even more the extra chromosome 21 stands in every cell and it will stay there. (Cocchi, 1993)

In fact in both cases the therapy stopped, perhaps because the parents not have seen in a hurry the results they hoped, or perhaps for other reasons (Cocchi, 1987: Cocchi, 2001, Unidown 1985).

Conclusions.

Thirty-three Down subjects who showed the symptom "difficulty or the refusal to have the hair combed", had follow-ups of such a symptom during an antistress drug therapy. Thirty-one (93.94%) had the disappearance of it after, at average, 10.97 months of treatment. It is confirmed the female prevalence, and, ex adjuvantibus, the relationship of the symptom with the stress.

References.

Cocchi R. The difficulty of being combed as a curious symptom in Downs. An epidemiological investigation on 510 subjects. August 2003, <www.stress-cocchi.org/Down32.htm> .

Cocchi R. Drug therapy in Down's syndrome:A theoretical context. It. J. Intellect. Impair. 1993, 6: 143-154. <www.stress-cocchi.org/Down14.htm> .

Cocchi R. (Letter of complaint). Sindrome di Down 1987, 4 / no.7: 26.

Cocchi R. Mitigation of facial features in Downs undergoing drug therapy: 23 years later. 2001<www.stress-cocchi.org/Down22.htm> .

Unidown Scientific Committee (Giorgio Albertini, neurologo; Massimo Badas, pedagogista; Paolo Berruti, neurologo; Franco Chiappe, neonatologo, Franca Dagna Bricarelli, genetista; Bruno Dallapiccola, genetista; Ennio Del Giudice, pediatra; Franca Felicioli, psicopedagogista; Angiolina Garau, pediatra genetista; Maria Luisa Giovannucci Uzielli, pediatra genetista; Liliana Minoja Zani, neuropsichiatra infantile; Aldo Moretti, psicopedagogista; Alberto Rasore Quartino, pediatra genetista; Vincenzo Reale, pediatra; Valerio Ventruto, genetista): Perche' no alle terapie farmacologiche nella sindrome di Down. Sindrome di Down 1985, 2 / no. 4, 1-3.

Author's address: dr Renato Cocchi, via Mercalli 10,

42100 Reggio Emilia (Italy)

renatococchi@libero.it

Testo in Italiano

Modulation of stress answers by drugs.

Mental retardation

Stress symptoms

Down syndrome

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