THE ANTICIPATION OF
WALKING IN DRUG TREATED DOWN INFANTS:
A CONTROLLED
STUDY
Renato COCCHI MD,
neurologist and medical psychologist
Summary
Forty home reared Down syndrome children
(24 F and 16 M; 39 pure trisomy 21 +2 translocations; average age at first
consultation: 10.70 months) were given an individually adjusted pharmacotherapy
for at least six months beíore they were 24 months old.
The tine they reached autonomous walking
was compared to that of a control group of 103 non-institutionalized Down
children (59 M and 44 F; sex ratio = 134; the year of birth of the older one
was the same of the older child in the index group; distribution of chromosomal
anomalies: pure trysomy 21 = 96 Ss (93.20 %), transiocations = 4 Ss (3.89 %),
mosaicisms = 3 Ss (2.91 %); nationwide provenance; average age at first consultation:
44.44 months), all seen after they bad begun autonomous walking. Resulted times
oí autonomous walking were as follows: index group: range: 16 - 35 months,
average 22.55; control group:
range: 13 - 56 months: average 26.16 ("t" = 2.45, with 142 df; p .01.
For each subject drugs used and daily doses are detailed.
Key words: syndrome of Down; walking;
stress, drug therapy.
Down's syndrome
Drug modulation of stress reactions
Mental retardation
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One of the effects most frequently observed
in Down children to whom I have applied drug therapy has been an improveinent
in their motor abilities.
This improvement is evident in both gross
motor activity (demodulation, running, going up and down stairs, kicking a
ball, bicycle riding), and fine movement (the handling of cutlery; cutting with
scissors; buttoning and unbuttoning clothes; tying up shoelaces; pretension,
direction and control in handwriting).
This improvement has been observed and
commented on, from a clinical point of view, by parents, teachers and
professionals involved in motor and psychomotor rehabilitation.
During the course of 9 year practice I have
seen that drugs can affect various components of the Down child motor activity.
In particular I have noted:
- an increased in strength;
- a reduction in articular laxity;
- an improved sense of balance;
- co-ordination and movement precision;
- the acquisition of complex motor sequences;
- a reduction in motor awkwardness.
In attempting to evaluate in a scientific
way all these clinical impressions, I started by investigating whether home
reared Down children treated with drugs for at least 6 months, under the age
all two years old, reached walking any earlier.
I compared the same children to a control
group of home reared Down children who had begun undertaking drug therapy (or
who were only brought for examination once) after already having learned to
walk.
Far both these groups I gathered, amongst
other data, the month in which they began to walk unaided and in a stable
manner.
Subjects and methods
The index group was made up of children of
both genders, examined before the age of 18 months and treated for at least 6
months with an individualized drug therapy (Table 1), based on criteria
outlined elsewhere (Cocchi, 1987).
The following data about these subjects were
recorded: - sex;
- age on first examination;
- chromosomal diagnosis;
- the age, in months, at which autonomous
deambulation appeared;
- the time period, in months of drug therapy
undertaken up to the moment in which the
child began to walk unaided;
- drugs used and daily dosages;
I excluded from this group:
- children (on the contrary enrolled in the
control group) who had begun to walk before having undergone drug therapy for
at least 6 months, in order to eliminate subjects who, even without the use of
drugs, would have started walking early on their own;
- one child who, even without the use of
drugs, would have started walking early on their own:
- one child who, even though undergoing
treatment from the age of 9 months, had very serious neurological brain trouble
(Dandy Walker's syndrome) and who underwent neurosurgery.
The control group was made up of Down Ss of
both genders, born no earlier then 1979, the year in which the oldest child in
the index group was born and children who had begun to walk before having been
treated by drugs less than 6 months.
Apart from the few latter, these were
brought for examination after already having acquired autonomous walking.
The same information was gathered about
these as with the index group with the exclusion of what pertained to drug
therapy.
The absence of the chromosomal diagnosis, or
the uncertainty on the part of the parents as to the exact month in which their
son or daughter began walking unaided were reasons for excluding 1 + 3 subjects
from this control group.
In the sane way 3 other subjects were
excluded due to being affected by CP. This is because the condition in itself
has a decisive effect on the acquisition of the deambulation.
Statistics: Student 't' test for 2 independent samples.
Results.
|
INDEX GROUP |
|
|
Subjects |
40 (24 F + 16 M); |
|
age an first visit: |
4-19 months; mean: 10.70; |
|
chromosomal diagnoses: |
pure trisomy 21 = 38 Ss; |
|
|
translocations = 2 Ss |
|
drugs used and daily doses |
(see Table 1); |
|
length of drug therapy: |
:range: 6 - 29 months; mean: 12; |
|
autonomous walking was achieved at an average |
22.55 months; range: 16 - 35; |
|
|
|
|
CONTROL GROUP |
|
|
subjects: |
103 (44 F + 59 M); |
|
M/F ratio: |
134; |
|
provenance: from all parts of Italy. |
|
|
age on first visit |
Average 44.44 months, with SD = 10.70; |
|
chromosomal diagnoses: |
pure trisomy 21 = 96 Ss = 93.20 %; |
|
|
translocations = 4 Ss = 3.88 %; |
|
|
mosaicisms = 3 Ss = 9.91 %; |
|
age of the appearance of autonomous deambulation: |
range: 13 - 56 months; average: 26.14 |
|
|
|
|
Statistics (only for autonomous walking): |
"t" = 2,45; df = 142 and p < .01. |
Table 1: drugs used and daily doses. Keys : G = glutamine 125 - 375 mg; GP = glutamine + pemoline 90 + 10 mq; D - diazepam 1 - 2 mg; O = oxazepam 4 - 7 mg; CD = chIordemethyldiazepam 0.2 - 0.3 mq; Bl = thiamine 125 - 150 mg; B6 = pyridoxine 125-150 mg; B12 = cyanocobalamine 500 mcg; T = 5-hydroxitryptophan 25 - 50 mg; CB = carbamazepine 25 - 75 mg; E alpha-tocopherol 50 mq; CR = carnitine 500 mg; F = tetrahydrofolate 7.5 mg; P pantotenate 150 mg; H = biotin 50 mg. X+ or X- = increased or decreased dosage of the drugs within the range; -X = drug off. All drugs were administered by oral via.
|
Ss No. PRESCRIBED DRUGS - (in check-ups only changes have been listed) |
||||||
|
|
1st visit |
3 months |
6 months |
12 months |
18 mnts |
24 mnts |
|
1 |
G B1 B6 D |
CB |
CB+ |
G+ CB+ |
|
|
|
2 |
GP B1 B6 CB D |
GP+ CB+ |
CB+ D+ |
|
|
|
|
3 |
G B1 B6 D |
|
G+ B12 CB |
G+ CR |
|
|
|
4 |
GP B6 D |
B1 CB |
B12 CB+ CR |
CB+ D+ E |
|
|
|
5 |
G B6 CR D |
|
B1 F |
G+ B12 P |
|
|
|
6 |
G B6 O |
G+ B6+ |
B1 E |
G+ B 12 F |
CB |
|
|
7 |
GP B6 O |
B1 T |
B12 CB F |
-O CB D E |
CB+ H |
|
|
8 |
G B6 O |
G+ B6+ |
B1 B12 O+ |
CB E P |
|
|
|
9 |
G B6 D |
B1 T D+ |
G+ B12 F |
|
|
|
|
10 |
G CB CR B6 D |
B1 CB+ |
G+ B12 CB+ |
G+ T |
|
|
|
11 |
G B6 D |
B1 CR |
B12 CR+ |
-CR G+ D+ |
|
|
|
12 |
G B6 O |
G+ B6+ |
B1 B12 |
-O D E T |
T+ |
|
|
13 |
G B1 B6 O |
CB |
CB+ CR |
G+ B12 CB+ |
|
|
|
14 |
G B1 B6 D |
G+ D+ |
T |
-D CD T CR |
|
|
|
15 |
GP B6 D |
B1 CR |
B12 |
D+ F |
|
|
|
16 |
G B1 B6 D |
CR |
G+ CB |
B12 T |
E CB+ |
G- |
|
17 |
GP B1 B6 O |
-O D CB |
GP+ B12 |
CB+ D+ |
|
|
|
18 |
G B1 B6 T D |
CR T+ |
G+ CB |
B12 CB+ G+ |
|
|
|
19 |
GP B6 CB D |
B1 CB+ T |
B1 T+ CB+ |
GP+ CB+ T- |
D+ |
|
|
20 |
G B1 B6 0 |
|
-O D G+ |
|
|
|
|
21 |
G B1 B6 D |
G+ CR |
CR+ B12 |
|
|
|
|
22 |
G B1 B6 CB D |
CR T |
G+ CR+ |
|
|
|
|
23 |
G B1 B6 CR O |
G+ B12 |
-O D T |
CB |
|
|
|
24 |
GP B1 B6 CB D |
T CB+ |
GP+ B12 CB- |
|
|
|
|
25 |
G B1 B6 D |
CB |
|
|
|
|
|
26 |
GP B1 B6 O |
-O CB D |
GP+ CP+ |
|
|
|
|
27 |
G B1 B6 D |
G+ B1 T |
G+ E |
D+ T+ |
|
|
|
28 |
GP B6 D T |
B1 CB D+ |
D+ CB+ |
|
|
|
|
29 |
G B6 D |
B1 |
G+ CR |
B12 CB |
CB+ E |
|
|
30 |
GP B6 CB O |
B1 CB+ |
GP+ CB+ CR |
|
|
|
|
31 |
G B1 B6 B12 D |
|
T CR |
|
|
|
|
32 |
G B1 B6 O |
-0 G+ D |
T |
T+ CR+ |
|
|
|
33 |
GP B6 D |
B12 B1 T |
GP+ D+ F H |
|
|
|
|
34 |
G B6 D |
G+ B6+ B1 |
B12 T |
G+ T+ E |
|
|
|
35 |
G B6 D |
G+ B1 E |
|
|
|
|
|
36 |
GP B6 CD |
B1 E |
GP+ CD+ |
|
|
|
|
37 |
G B6 D |
|
|
|
|
|
|
38 |
G B6 D |
G+ B6+ B1 |
B12 D+ T |
|
|
|
|
39 |
G B6 CD |
|
G+ B1 E |
B12 CB |
|
|
|
40 |
GP B6 O |
GP+ B1 T |
GP+ B12 H E |
|
|
|
Discussion.
The M / F ratio of the control group which
varies little from 132 found in 1984 by Camera and Mastroiacavo, referring to
an Italian sample of newborn Down babies, the nationwide provenance, and the
distribution of the chromosomal anomalies paralleling the standard limits of
both Italian and International findings, lead to consider the control group as
being suitable for the task and representative of the Italian population of
Down children under 9 years.
The age at which autonomous deambulation
took place also corresponds to what reported in various International
literature (Fishler, Share and Koch, 1964; Melyn and White, 1973; Rynders and
Horrobin, 1975; Haley, 1983).
The acquisition of autonomous walking in the
control group is spread over a wide time scale, from children who learned to
walk unaided at an early age to those really quite late.
The index group showed an advance of roughly
three and a half months in the achievement of walking.
The time scale for acquisition is less
ranging. Possible reasons of it are two:
i. The fact of having undergone drug therapy
for at least 6 months on its own tends to raise the minimum age limit far the
beginning of autonomous walking;
ii. For 4 years
up to now I have not started drug therapies in infants under 12 months, to
avoid that one may attribute to drug therapy the very rare, but possible
superimposition of the syndrome o+ West, which, when it happens, has been seen
to account far 97 % incidence in the first year of life.
References
Camera G., Mastroiacovo
P.: Epideziologia della sindrome di Down. In: Ce. Pi. M. (ed): Aspetti
epidemialogici, genetici, clinici, riabilitativi e sociali della sindrome di
Down. Ce.Pi.M., Genova 1984: 225-230.
Cocchi R.: Terapia farmacologica
nella sindrome di Down: inquadramento teorico. In: Cocchi R., Belacchi C.,
Cercolani P. (eds): Risultati di 8 anni di terapia farmacologica nella sindrome
di Down. GISSTIMMAI, Pesaro 1987: 19-41.
Fishler K., Share-J.,
Koch R.: Adaptation of Gesell developmental scales to evaluation of development
in children with Down's syndrome (mongolism). Am. J. Ment. Defic. 1964, 68:
642-646.
Haley S.M.: Relationship
between postural reactions and motor milestones in infants with Down syndrome.
PhD Dissertation, University of Washington, 1983.
Melyn M.A., White D.T.:
Mental and developmental milestones of noninstitutionalized Down's syndrome
children. Pediatrics 1973, 72: 542-545.
Rynders G.E., Horrobin
J.M.: Project EDGE:Tthe University of Minnesota's Communication Stimulation
Program for Down's syndrome infants. In: Friedlander D., Sterill G., Kirk G.
(eds): The exceptional infant. Vo1.3 : Assessment and intervention.
Brunner-Mazel, New York 1975.
Presented
at the 8th Congress of IASSMD, Dublin 1989.
Printed on lt.. J. lntellect. Impair. 1989, 2: 15-19
Author's address: Renato COCCHI MD, via Rabbeno, 3
42100 Reggio Emilia
(Italy)
renatococchi@libero.it
Down's syndrome
Drug modulation of stress reactions
Mental retardation
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