THE BALANCE IN 230 DOWN
SUBJECTS.
AN EVALUATION AFTER
ONE-YEAR ANTISTRESS DRUG THERAPIES.
Renato COCCHI, neurologist and medical
psychologist.
Abstract.
Out of 383 Down Ss
that who had an initial evaluation of their balance skills, 230 ( 122 M and 108
F; normal distribution of the chromosomal anomalies; average age at first
consultation 67.69 +/- 56.03 months with 6-285 months range ), had an
evaluation of the balance one year later, during antistress drug therapies. It
resulted for a clean improvement of the balance that does not seem only due to
the personal experience creditable to the growing age. Even in the Band age
superior to 15 years (181-240 months) most subjects showed a more stable
balance. At first watching, we cannot deny a specific drugs intervention (An
improvement of the cerebellar function?), even if we need better investigate
this result.
Key words: Down syndrome, balance,
stress, age, antistress drug therapy, GABA, glutamate, cerebellum.
Drug modulation of stress reactions.
Home Page / / / Pagina iniziale.
In a preliminary note on the troubles of the
balance in the Down person (Cocchi, 1991) I made a neurophysiological,
neuropathological, clinical and rehabilitative frame of reference where these
troubles can take place and their treatment possibilities.
I mentioned there, at that moment, the
dysfunction state of vestibular, mid-brain and pons, and cerebellar areas as
possible promoters of the balance troubles. Felicioli and Moretti, 1984,
asserted them as treatable..
As for me, the balance troubles in Downs are
not secluded in a specific way from all motor skills of these subjects.
This clumsy and awkward motility, without
any motor lesion, is enough similar to that of the children with mental
retardation of other origin. On the other hand, the aspects of the balance
control in Downs seem to have peculiar features, worthy of a punctual
investigation. (Cocchi, 1991).
After a first epidemiological investigation
on a cohort of 510 subjects (limit of my old data-base) (Cocchi, 2003), with
evaluation after at least 6 months from the attainment of walking, out of the
383 cases reported in the preceding research I examined who had a second
scoring of the balance after one-year antistress drug therapy.
Materials and methods.
This investigation used the clinical cards
referring to 383 home reared and home living Downs as seen in outpatients'
clinic by the present author, and object of the first investigation on the
balance.(Cocchi, 2003). After one-year drug therapies I checked again tha
balance skills, as compared to the preceding evaluation..
From the remaining records I collected:
- sex;
- chromosomal diagnosis;
- age at 1st consultation;
- age of the walking, if attained before the
first examination, or before six months from the drugs taking (Group of
not-pretreated Ss);
- age of the walking when attained after at
least six months of drugs taking (Group of pretreated Ss);
- balance scoring after one year of drugs
taking;
- the gradation of the balance as prevailing
aspects, as it follows. I must remember that a child may anticipate a symptom
of the upgrading condition, (usually the biking without support wheels) or may
maintain a symptom of the downgrading condition (fear to be upon the basis of
the scale to weigh).
(++++) a little uncertain walking; enlarged
maintenance base; going upstairs downstairs by a simple footstep with the
support of the adult or of the handrail; the child doesn't run, nor jumps, and
he/she goes in panic if standing upon the basis of the scale to measure his/her
weigh;
(+++) sure walking; less enlarged
maintenance base; he/she climbs by alternating feet and go downstairs by simple
footstep, without any support; awkward run; he/she doesn't know how to jump;
and he/she goes in panic if standing upon the basis of the scale to measure
his/her weigh;
(++) normal run or just a little awkward,
with wavering of limbs; going upstairs and downstairs with alternating feet;
jumps from at least two steps; he/she is biking with support wheels; no panic
when he/she stands upon the basis of the scale to measure his/her weigh;
(+) like the preceding grade (++) but, as
more, he/she is biking without support wheels. The balance trouble is nearly
absent.
I elaborated the collected data by
statistics for gender, chromosomal anomaly, and I classified them by
12-months-step age bands, and I evaluated them, when possible, with the Chi
Square test.
Results.
The data of 230 subjects to whom pertain the
clinical cards used for this investigation were reported in the following
tables and graphics.
Tab. 1. Distribution for gender, for
chromosomal diagnoses and age of the subjects who had balance scoring or at
first examination, when already walking or walking since at least six months;
Or 6-7 months after walking, when seen before walking at first consultation,
and having a prescribed drug regimen.
|
|
Ss |
Percentage |
|
|
Balance evaluation. |
383 |
100.00 % |
|
|
M |
219 |
57.18 % |
|
|
F |
164 |
42.82 % |
|
|
M/F ratio |
133.54 |
||
|
|
|||
|
Chromosomal diagnoses |
|
||
|
Standard trisomia 21 |
347 |
90.60 % |
|
|
Translocations |
12 |
3.13 % |
|
|
Mosaicisms |
10 |
2.61 % |
|
|
Only clinical diagnosis |
14 |
3.66 % |
|
|
|
|||
|
Age at first consultation. |
|
||
|
Average +/- SD (months) |
83.53 +/- 71.23 |
||
|
Range (months) |
6 - 506 |
||
The scored symptom has the usual male prevalence
nearly overwhelming what found to the birth for Italian Down children (Camera
and Mastroiacovo, 1984).
The distribution of the chromosomal
anomalies does not differ from what known for both Italian and international
Down populations.
Tab. 2: Balance scoring after one-year drugs
therapy: Epidemiological data.
|
First balance evaluation |
383 |
100.00 % |
|
|
Re-evaluation after one-year therapy |
230 |
60.05 % |
|
|
|
|
|
|
|
Re-evaluation |
230 |
100.00% |
|
|
M |
122 |
53.04 % |
|
|
F |
108 |
46.96 % |
|
|
M/F ratio. |
112.96 % |
||
|
|
|||
|
Chromosomal diagnoses |
|
||
|
Standard trisomy 21 |
209 |
90.87 % |
|
|
Translocations |
9 |
3.92 % |
|
|
Mosaicisms |
7 |
3.04 % |
|
|
Only clinical diagnosis |
5 |
2.17 % |
|
|
|
|||
|
Age at first consultation. |
|
||
|
Average +/- SD (months) |
67.79 +/- 56.03 |
||
|
Range (months) |
6 - 295 |
||
How we can see, only 230 Ss = 60.05% of whom
had a first balance evaluation, had second scoring, after one-year drug
therapies.
This subsample shows still a male
prevalence, but it has a M/F ratio different from the usual, because decidedly
reduced.
Even here, the distribution of the
chromosomal anomalies is close to what known for Italian and international Down
populations.
The average age at first consultation is
about 15-months lower, as compared to the whole sample of 383 Ss that had a
first balance scoring. This is a fact easily to understand since the age range
reduced of more than 200 months.
Tab. 3. Distribution for gender of the
symptom "new scoring of balance troubles" according of its severity.
|
Gradation of the symptom |
Ss no. |
% |
|
|
||
|
Severe trouble (++++) |
|
|
|
M |
0 |
0.00 |
|
F |
1 |
0.43 |
|
|
||
|
Moderate trouble (+++) |
|
|
|
M |
50 |
21.74 |
|
F |
52 |
22.61 |
|
|
||
|
Light trouble (++) |
|
|
|
M |
71 |
30.87 |
|
F |
55 |
23.92 |
|
|
||
|
Nearly absent trouble (+) |
|
|
|
M |
1 |
0.43 |
|
F |
0 |
0.00 |
|
|
||
|
Totals |
230 |
100.00 |
Chi Square Test F vs M =
3.231 with three df and p = 0.488 NS.
The symptom distribution according to the
gender after one year does not significantly differ. For what concerns the
trouble ++ (a light trouble) and that + (a nearly absent trouble), we can
observe male prevalence.
Tab. 4. Subjects not previously drug treated
when I made the first scoring. Distribution of the balance trouble by age bands
in months at first consultation and after one year. Scoring in the early age
subjects, at least five months after attaining walking, if the age at first
consultation preceded walking, or followed it until maximum four months
(evaluation at five or more months after the acquisition of walking), and after
12 months, since the beginning of the drug therapy.
|
Total of Ss |
334 Ss = 100.00 %, with first evaluation 183 Ss = 100.00%, with a second evaluation after one year |
||||||||
|
|
|||||||||
|
Age in months |
Grade ++++ Ss No. |
% |
Grade +++ Ss. No. |
% |
Grade ++ Ss No. |
% |
Grade + Ss No. |
% |
|
|
|
|||||||||
|
13-24 (first eval.) |
8 |
3.23 |
1 |
0.40 |
0 |
0.00 |
0 |
0.00 |
|
|
13-24 (final eval.) |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
|
|
|
|||||||||
|
25-36 (first eval.) |
22 |
8.87 |
24 |
9.68 |
2 |
0.81 |
0 |
0.00 |
|
|
25-36 (final eval.) |
0 |
0.00 |
8 |
4.37 |
1 |
0.55 |
0 |
0.00 |
|
|
|
|||||||||
|
37-48 (first eval.) |
9 |
3.63 |
15 |
6.05 |
3 |
1.21 |
0 |
0.00 |
|
|
37-48 (final eval.) |
0 |
0.00 |
16 |
8.74 |
21 |
11.48 |
1 |
0.55 |
|
|
|
|||||||||
|
49-60 (first eval.) |
6 |
2.42 |
25 |
10.08 |
5 |
2.02 |
0 |
0.00 |
|
|
49-60 (final eval.) |
0 |
0.00 |
10 |
5.46 |
7 |
3.83 |
1 |
0.55 |
|
|
|
|||||||||
|
61-72 (first eval.) |
3 |
1.21 |
16 |
6.45 |
2 |
0.81 |
0 |
0.00 |
|
|
61-72 (final eval.) |
1 |
0.55 |
9 |
4.92 |
16 |
8.74 |
1 |
0.55 |
|
|
|
|||||||||
|
73-84 (first eval.) |
1 |
0.40 |
10 |
4.03 |
3 |
1.21 |
0 |
0.00 |
|
|
73-84 (final eval.) |
0 |
0.00 |
0 |
0.00 |
13 |
7.10 |
0 |
0.00 |
|
|
|
|||||||||
|
85-96 (first eval.) |
1 |
0.40 |
7 |
2.82 |
1 |
0.40 |
0 |
0.00 |
|
|
85-96 (final eval.) |
0 |
0.00 |
1 |
0.55 |
11 |
6.01 |
0 |
0.00 |
|
|
|
|||||||||
|
97-108 (first eval.) |
0 |
0.00 |
6 |
2.42 |
4 |
1.61 |
0 |
0.00 |
|
|
97-108 (final eval.) |
0 |
0.00 |
2 |
1.09 |
4 |
2,19 |
0 |
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
109-120 (first eval.) |
2 |
0.81 |
8 |
3.23 |
6 |
2.42 |
0 |
0.00 |
|
|
109-120 (final eval.) |
0 |
0.00 |
2 |
1.09 |
6 |
3.28 |
0 |
0.00 |
|
|
|
|||||||||
|
121-132 (first eval.) |
0 |
0.00 |
5 |
2.02 |
4 |
1.61 |
0 |
0.00 |
|
|
121-132 (final eval.) |
0 |
0.00 |
5 |
2.73 |
12 |
6.56 |
0 |
0.00 |
|
|
|
|||||||||
|
133-144 (first eval.) |
1 |
0.40 |
5 |
2.02 |
7 |
2.82 |
0 |
0.00 |
|
|
133-144 (final eval.) |
0 |
0.00 |
0 |
0.00 |
7 |
3.83 |
0 |
0.00 |
|
|
|
|||||||||
|
145-156 (first eval.) |
0 |
0.00 |
1 |
0.40 |
3 |
1.21 |
0 |
0.00 |
|
|
145-156 (final eval.) |
0 |
0.00 |
1 |
0.55 |
8 |
4.37 |
1 |
0.55 |
|
|
|
|||||||||
|
157-168 (first eval.) |
0 |
0.00 |
3 |
1.21 |
2 |
0.81 |
0 |
0.00 |
|
|
157-168 (final eval.) |
0 |
0.00 |
1 |
0.55 |
3 |
1.64 |
0 |
0.00 |
|
|
|
|||||||||
|
169-180 (first eval.) |
0 |
0.00 |
4 |
1.61 |
3 |
1.21 |
1 |
0.40 |
|
|
169-180 (final eval.) |
0 |
0.00 |
0 |
0.00 |
2 |
1.09 |
0 |
0.00 |
|
|
|
|||||||||
|
181-240 (first eval.) |
0 |
0.00 |
10 |
4.03 |
2 |
0.81 |
0 |
0.00 |
|
|
181-240 (final eval.) |
0 |
0.00 |
3 |
1.64 |
6 |
3.28 |
0 |
0.00 |
|
|
|
|||||||||
|
241-360 (first eval.) |
0 |
0.00 |
3 |
1.21 |
4 |
1.61 |
0 |
0.00 |
|
|
241-360 (final eval.) |
0 |
0.00 |
0 |
0.00 |
3 |
1.64 |
0 |
0.00 |
|
Graph 1.
Now we may see from the graph 1, the more precarious balance condition diminished in an extraordinary way. Now it is represented only by one unique case (0.55%) in the age band between five and six years.
Graph 2.
A more favourable condition, but always with impairment, after one-year drugs therapy, together diminished, even if with not always a coherent time course. The small peak between 10 and 11 years could be a statistical artifact.
Graph 3.
There is a definite increase of the less unfavourable balance condition with a peak in the 2-3 years. The result is always higher than the initial condition.
Graph 4.
As we can see, after a year of drugs therapy four Ss reached the nearly optimal level ( grade +), while there was only one before the therapy.
Even in the age band over 15 years (181-240 months) most Ss moved towards more stable balance condition. The same I could have said for the last age band (241-360 months), but the shortage in persons returned to check does not make it as valuable with a good approximation.
Tab. 5. Pretreated Ss. Distribution of the balance trouble in drug taking Ss, according to age bands, in months till 60 months, evaluated 6-7 months after starting of walking, and 12 months later.
|
Total of Ss --> |
49
Ss = 100.00%, with initial evaluation; 47 Ss of which = 95.92, with evaluation one year later. |
||||||||||
|
No. of Ss and % |
|||||||||||
|
Age, in months |
13-24 |
% |
25-36 |
% |
37-48 |
% |
49-60 |
% |
61-72 |
% |
|
|
++++ initial eval |
2 |
4.08 |
26 |
57.14 |
4 |
8.16 |
1 |
2.04 |
0 |
0.00 |
|
|
++++ final eval. |
0 |
0.00 |
1 |
2.04 |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
|
|
|
|||||||||||
|
+++ initial eval. |
1 |
2.04 |
12 |
24.49 |
1 |
2.04 |
0 |
0.00 |
0 |
0.00 |
|
|
+++ final eval. |
0 |
0.00 |
0 |
0.00 |
30 |
61.22 |
4 |
8.16 |
2 |
4.08 |
|
|
|
|||||||||||
|
++ initial eval. |
0 |
0.00 |
0 |
0.00 |
2 |
4.08 |
0 |
0.00 |
0 |
0.00 |
|
|
++ final eval. |
0 |
0.00 |
1 |
2.04 |
8 |
16.33 |
0 |
0.00 |
0 |
0.00 |
|
|
|
|||||||||||
|
+ initial eval. |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
|
|
+ final eval. |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
1 |
2.04 |
0 |
0.00 |
|
Graph 5
As we may see from the graph 5, the Ss already in treatment at least six months before they reached walking, one year later from the first balance scoring, most of them left this very unfavourable condition.
Graph 6.
The 47 subjects in drugs treatment from at least
6 monthes before they reached walking, moved in a still unfavourable situation,
but with increased balance skills ( grade +++).
Graph 7.
After one year, there is a clear displacement
of the Ss, pretreated for at least 6 months before reaching walking, towards
the balance condition with lighter deficits ( grade ++).
To that it is to add the appearance of a
subject with nearly normal balance (grade +), after a year of drugs treatment.
Discussion.
I recall here that it is not easy to find
literature on specific investigations of balance troubles in Down Ss. Internet
(Google) and Medline from the 1960 to today did not help me about it. For what
I know, it doesn't exist research on results on the balance in Down Ss treated
by drugs therapy.
Felicioli and Moretti , 1984 find again, an altogether modest casuistry, a rate varying from 41.4% to 48.9 % and they thought that the smaller rate, related to Ss born five-years later, as the fruit of a wider and more precocious neuro-psychomotor rehabilitation. From it they deduced that the troubled balance is not stabilized, but "malleable&qu