COMPARISON ON BALANCE DEVELOPMENT IN DOWNS AGED FROM 13-24 TO 61-72 MONTHS, NOT PRETREATED AND PRETREATED WITH ANTISTRESS DRUG THERAPY

Renato COCCHI, neurologist and medical psychologist.

Summary.

Two groups of Down Ss with age between 13 and 72 months at the first consultation had evaluation for the balance after at least 6 months they reached walking and revalued one year lated, during the antistress drug therapy.

At the first consultation, the group of the subjects not pretreated before they started walking was 120 but 92 one year later, with average age: initial 42.56 months, and 42.13 for who coming to check. There was reduced male prevalence at the first consultation, female prevalence at the checkup, with normal distribution of the chromosomal anomalies.

The group of the pretreated subjects before they started walking was 49 at the first evaluation but 47 at the checkup, with average age 11.98 months and 12.07 for whom coming to check. Female prevalence was the same both in the first examination that to the checkup, with normal distribution of the chromosomal anomalies.

The investigation has suggested that the balance improvement seems different when drug therapy started before walking or after it. In this age range pretreated subjects seem reaching anticipate more stable balance conditions.

Key words: Down syndrome, balance, stress, age, drug therapy.

Testo in italiano

Down Syndrome

Drug modulation of stress reactions

Mental retardation

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In a preliminary note on the balance troubles in Down children (Cocchi, 1991) a neurophysiological, neuropatological, clinical and rehabilitative frame of reference where these troubles take room and their treatment possibilities. In that moment, I pointed up the dysfunctionality of vestibular, midbrain-pontine and cerebellar areas as possible causes inducing balance deficits.

 

Materaials and method.

This investigation used the clinical clinical records 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).

I selected the clinical records of the subjects aged between 13 and 72 months at the first visit, non-being or being treated for a maximum of five months before walking ( the group of not pretreated Ss) and the clinical records of the subjects treated for at least six months before walking ( the group of pretreated Ss ).

Such clinical records had to have the record of the balance checkup after one year during an antistress drug therapy.

From those clinical 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 weighs;

(+++) 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 plain statistics and I compared the two groups by 12-months-step age bands, and I evaluated them, when possible, with the Chi Square test.

 

Results.

In the tables that follow, I reported the data of 120 + 92 subjects not pretreated, and of 49 + 47 subjects pretreated both with initial and final balance scoring, according to the clinical cards used for this investigation.

Table 1. Distribution for gender, chromosomal diagnosis and age of the subjects where the balance had scoring or at the first consultation, if they were already walking since more than six months (not pretreated Ss), or 6-7 months after they started walking, if seen for the first time before walking, and immediately having drug therapy (pretreated Ss).

 

Not pretreated Ss

Pretreated Ss

 

Initial

Final

Initial

Final

Balance scoring

Ss Nu.

%

Ss Nu.

%

Ss Nu.

%

Ss Nu.

%

Males

65

54.17

41

44.57

24

48.98

20

42.55

Females

55

45.83

51

55.43

25

51.02

27

74.07

Ratio M/F.100

118.18

80.39

96.00

74.07

Chromosomal dignoses

 

 

 

 

 

 

 

 

Standard trisomy 21

112

93.33

86

93.48

46

93.88

44

93.62

Translocationsi

4

3.33

3

3.26

2

4.08

2

4.25

Mosaicisms

3

2.51

3

3.26

1

3.26

1

2.13

Only clinical diagnosis

1

0.83

0

0.00

0

0.00

0

0.00

Age at 1st visit.

 

 

 

 

 

 

 

 

Average +/- SD (months)

42.56 +/- 14.86

42.42+/-16.69

11.98 +/- 4.99

12.07 +/- 5.05

Range (months)

12-72

12-72

6-33

6-33

The scored data has the usual male prevalence, although reduced, only in the group of not pretreated Ss at the first consultation. At the final scoring of both groups, and at the initial scoring of the pretreated Ss, there is instead female prevalence, which increased in the final scoring of pretreated Ss.

The distribution of the chromosomal anomalies does not really differ from what known for Italian and international Down population.

The average age difference, at the first and at the final consultation, has scarce relevance for both Ss groups (not pretreated or pretreated Ss).

 

Table 2. Subjects not previously drug treated. Distribution for age bands of the balance trouble at the first consultation, in months and with one year step, as scored at six or more months after walking, and 12 months after, during drug therapy.

Total of Ss -->

120 Ss = 100.00 %, with initial scoring

92 Ss of them = 76.67 with scoring after one year

 

Age, in months

Grade ++++ Nu.of Ss

%

Grade +++ Nu.of Ss

%

Grade ++

Nu.of Ss

%

Grade

+

Nu.of Ss

%

13-24 initial

8

6.67

1

0.83

0

0.00

0

0.00

13-24 final

0

0.00

0

0.00

0

0.00

0

0.00

 

 

 

 

 

 

 

 

 

25-36 initial

22

18.33

11

9.17

2

1.67

0

0.00

25-36 final

0

0.00

8

6.67

1

0.83

0

0.00

 

 

 

 

 

 

 

 

 

37-48 initial

9

7.50

13

10.83

3

2.50

0

0.00

37-48 final

0

0.00

16

13.34

21

17.5

1

0.83

 

 

 

 

 

 

 

 

 

49-60 initial

6

5.00

19

15.83

5

4.17

0

0.00

49-60 final

0

0.00

10

8.33

7

5.83

1

0.83

 

 

 

 

 

 

 

 

 

61-72 initial

3

2.50

18

15.00

2

1.67

0

0.00

61-72 final

1

0.83

9

7.50

16

13.33

1

0.83

 

 

 

 

 

 

 

 

 

Totals of iniz. 120 Ss

40

33.33

68

56.67

12

10.00

0

0.00

Totals of fin. 92 Ss

1

0.83

43

35.83

45

37.5

3

2.50

 

Graph 1

 

How we may see from the graph 1, in not pretreated Ss from 1-2 to 5-6 years, the worst balance condition sinks nearly to 0 at 6 years. It is possible that the rehabilitative treatments put into play have a very important role.

Graph 2

In spite of rehabilitative treatments, at 6 years 7.5% have still remarkable problems, in these not drug pretreated Ss.

 

Graph 3

The condition of reduced balance troubles, at 6 years relates to 13.33% of not drug pretreated Ss.

Table 3. Pretreated Ss. Distribution of the balance troubles for age bands at the first examination, till 60 months, as scored 6-7 months after walking in Ss already in drugs treatment, and 12 months later.

Total of Ss -->

49 Ss = 100.00%, with initial scoring;

47 Ss of them = 95.92% with final scoring, after one year

 

N u. o f S s

Age, in months

13-24

%

25-36

%

37-48

%

49-60

%

61-72

%

++++ initial

2

4.08

26

57.14

4

8.16

1

2.04

0

0.00

++++ final

0

0.00

1

2.04

0

0.00

0

0.00

0

0.00

 

 

 

 

 

 

 

 

 

 

 

+++ initial

1

2.04

12

24.49

1

2.04

0

0.00

0

0.00

+++ final

0

0.00

0

0.00

30

61.22

4

8.16

2

4.08

 

 

 

 

 

 

 

 

 

 

 

++ initial

0

0.00

0

0.00

2

4.08

0

0.00

0

0.00

++ final

0

0.00

1

 

8

16.33

0

0.00

0

0.00

 

 

 

 

 

 

 

 

 

 

 

+ initial

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

+ final

0

0.00

0

0.00

0

0.00

1

2.04

0

0.00

 

 

 

 

 

 

 

 

 

 

 

Totals inizial 49 Ss

3

6.12

38

77.55

7

14.29

1

2.04

0

0.00

Totals final 47 Ss

0

0.00

2

4.08

36

77.55

5

10.20

2

4.08

This table is the same already published previously under the name of Tab. 6 (Cocchi 2003).

After one year, there is a clear displacement of pretreated Ss for at least six months before walking, towards a balance condition with a lighter deficit (degree ++).

To that it has to add one subject with quite normal balance (degree +), after one year of drug treatment.

Graph 4:

At six years age the reduction of the worst balance condition reduced nearly to zero, in subjects treated even with drugs.

Graph 5

At five years, in subject pretreated with drugs, even the condition with remarkable balance problems already reduced to the 8.16%.

Graph 6

At 5 years, in drugs pretreated Ss, even the condition with moderate balance troubles reduced to zero.

Tab. 4: Comparison between not pretreated and pretreated Ss as for the severity of the balance trouble.

Age band (months)

++++

++++

+++

+++

++

++

Not pretreat.

Pretreated

Not pretreat.

Pretreated

Not pretreat.

Pretreated

Scoring. -->

Initial

Final

Initial

Final

Initial

Final

Initial

Fineal

Initial

Final

Initial

Final

 

Rates ----->

13-24

6.67

0.00

4.08

0.00

0.83

0.00

2.04

0.00

0.00

0.00

0.00

0.00

 

25-36

18.33

0.00

57.14

2.04

9.17

6.67

24.49

0.00

1.67

0.83

0.00

2.04

 

37-48

7.50

0.00

8.16

0.00

10.83

13.34

2.04

61.22

2.50

17.50

4.08

16.33

 

49-60

5.00

0.00

2.04

0.00

15.83

8.33

0.00

8.16

4.17

5.83

0.00

0.00

 

61-72

2.50

0.83

0.00

0.00

15.00

7.50

0.00

4.08

1.67

13.33

0.00

0.00

 

Totali

35.00

0.83

71.42

2.04

49.80

35.83

28.57

73.46

10.01

37.49

4.08

18.37

For the Chi Square calculation: 0 = 0.01

++++ Initial vs final treatment of: not pretreated Ss: Chi Square = 9.043 with 4 df and p = 0.060 NS.

++++ Initial vs final treatment of: pretreated Ss: Chi Square = 0.602 with 4 df and p = 0.963 NS.

++++ Initial: Not pretreated vs pretreated: Chi Square = 16.795 with 4 df and p = 0.002;

++++ Final: Not pretreated vs pretreated: Chi Square = 2.782 with 4 df and p = 0.595 NS.

+++ Initial vs final treatment of: not pretreated Ss: Chi Square = 3.545 with 4 df and p = 0.471 NS.

+++ Initial vs final treatment of: pretreated Ss: Chi Square = 91.735 with 4 df and p = 0.0009:

+++ Initial: Not pretreated vs pretreated: Chi Square = 41.014 with 4 df and p = 0.0009;

+++ Final: Not pretreated vs pretreated: Chi Square = 28.867 with 4 df and p = 0.0009;

++ Initial vs final treatment of: not pretreated Ss: Chi Square = 7.483 with 4 df and p = 0.112;

++ Initial vs final treatment of: pretreated Ss: Chi Square = 6.043 with 4 df and p = 0.196 NS.

++ Initial: Not pretreated vs pretreated: Chi Square = 6.463 with 4 df and p = 0.167 NS.

++ Final: Not pretreated vs pretreated: Chi Square = 14.859 with 4 df and p = 0.005.

In spite of the difficulty of calculus for the presence of too much blank values, I found five significantly different comparisons, and at least one of them for every degree of severity.

Although we need to suppose that the group of not previously treated Ss has bias because the first balance scoring happened more than 6-7 months after walking, we may however observe that the following distributions significantly diverged:

- grade ++++, not preteatedi vs. pretreated initial rate;

- grade +++, pretreated, initial and final rate ;

- grade +++, not pretreated vs pretreated initial rate;

- grade +++, not pretreated vs pretreated final rate;

- grade ++, not pretreated vs pretreated final rate.

The +++ degree of severity is undoubtedly that with increasing modifications.

 

Graph 7

Although having a greater rate (2.04% vs 0.83%), after one-year therapy, the pretreated Ss belong to a lower age band.

Graph 8

 

At six years the results are practically overwhelming, with a light prevalence of the diminution of the pretreated subjects ( 4.08% vs 7.50%).

Graph 9

At six years, in the pretreated Ss there is a sound reduction even of the less precarious condition (0.00% vs 13.33%).

 

Tab. 5: Comparison among % variations after therapy in not pretreated and pretreated Ss as for the severity of the symptom.

Age band (months)

++++

++++

+++

+++

++

++

Not preatrat.

Pretreated

Not pretreat.

Pretreated

Not preatrat.

Pretreated

Scoring-->

Initial

Final

Initial

Final

Initial

Final

Initial

Final

Initial

Final

Initial

Fina

 

Rates ----->

Totals

35.00

0.83

71.42

2.04

49.80

35.83

28.57

73.46

10.01

37.49

4.08

18.37

% Variation

- 97.63

- 97.14

- 28.06

+ 257.12

+ 374.52

+ 450.25

Even now, it is not easy to give a clean judgment. We may observe that the not pretreated Ss go on to lower till the +++ degree, the pretreated instead, lower of the same percentage in the ++++ degree, but they increase from the +++ degree. In the ++ degree, both groups are rising, even if with different rates.

It seems however that we can conclude that pretreated Ss more easily arive to a more stable balance development.

Discussion.

I repeat here that it is not easy to find literature on specific investigations of the balance troubles in the Downs. Internet (Google) and Medline from the 1960 to today did not give any help. For what I know, doesn't exist research on balance results in drugs treated Downs.

My previous epidemiological survey was nearly certainly the first wide casuistry, evaluated either for the chronological age at the first examination, either according to walking age (Cocchi, 2003 ).

The second investigation on the effects on the balance of an antistress drug therapy (for the drugs used and their dosages, see: Cocchi, 1993 and Cocchi 2003 ) has pointed on that in both groups under observation (not pretreated and pretreated Down Ss) the course of the positive response does not parallel the normal balance course of same age Ss before the the drug treatment.

I found an acceleration towards conditions of greater stability, a few fact debatable fact, mainly in the non pretreated group at first evaluation (Cocchi, 2003).

In this third research, it is to remember that the group of the not pretreated Ss, to difference of the pretreated Ss, were often scored initially to much more than 6-7 months from the walking acquisition, so with greater acquired experience. In spite of this bias, after one year of drugs therapy, the pretreated's balance seems evolving more easily towards greater stability, as visible in the results of the degree +++.

It is incomprehensible, by now, the fact that at the checkups after one year drug therapy in both groups, and at the initial scoring, in the group of the pretreated Ss, there is a female prevalence.

Conclusion.

The investigation on the balance troubles in Downs aged from 1-2 to 5-6 years treated with an antistress drug therapy, at the checkup after one year, showed that the balance development could be different if drug therapy started before or after walking.

In that age range the pretreated Down Ss seem reaching more stable balance conditions in advance.

 References.

 Cocchi R. Evaluation of balance in Down persons. An epidemiological and clinical investigation on 383 subjects. 2003 <www.stress-cocchi.net/Down35.htm>

Cocchi R. The balance in 230 Down subjects. An evaluation after one-year antistress drug therapies. 2003 <www.stress-cocchi.net/Down36.htm>

 

Posted on Internet on December 2003. Copyright by Renato Cocchi, 2003.

 

Author’s address: Dr Renato COCCHI, via Mercalli 10

42100 Reggio Emilia (Italy)

renatococchi@libero.it


Testo in italiano

Down Syndrome

Drug modulation of stress reactions

Mental retardation

Home Page  / / /  Pagina iniziale