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Rett syndrome

Definition

Rett syndrome is a disorder of the nervous system that leads to developmental problems in children, especially in the areas of language and hand use.

Causes

Rett syndrome occurs almost always in girls. It may be diagnosed as autism or cerebral palsy.

Most Rett syndrome cases are due to a problem in the gene called MECP2. This gene is on the X chromosome. Females have 2 X chromosomes. Even when 1 chromosome has this defect, the other X chromosome is normal enough for the child to survive.

Males born with this defective gene do not have a second X chromosome to make up for the problem. Therefore, the defect usually results in miscarriage, stillbirth, or very early death.

Symptoms

An infant with Rett syndrome usually has normal development for the first 6 to 18 months. Symptoms range from mild to severe.

Symptoms may include:

  • Breathing problems, which may get worse with stress. Breathing is usually normal during sleep and abnormal while awake
  • Change in development
  • Excessive saliva and drooling
  • Floppy arms and legs, which is frequently the first sign
  • Intellectual disabilities and learning difficulties
  • Scoliosis
  • Shaky, unsteady, stiff gait or toe walking
  • Seizures
  • Slowing head growth beginning at 5 to 6 months of age
  • Loss of normal sleep patterns
  • Loss of purposeful hand movements: for example, the grasp used to pick up small objects is replaced by repetitive hand motions like hand wringing or constant placement of hands in mouth
  • Loss of social engagement
  • Ongoing, severe constipation and gastroesophageal reflux (GERD)
  • Poor circulation that can lead to cold and bluish arms and legs
  • Severe language development problems

NOTE:

Problems with breathing patterns may be the most upsetting and difficult symptom for parents to watch. Why they happen and what to do about them is not well understood. Most experts in Rett syndrome recommend that parents remain calm through an episode of irregular breathing like breath holding. It may help to remind yourself that normal breathing always returns and that your child will become used to the abnormal breathing pattern.

Exams and Tests

Genetic testing may be done to look for the gene defect. But, since the defect is not identified in everyone with the disease, the diagnosis of Rett syndrome is based on symptoms.

There are several different types of Rett syndrome:

  • Atypical
  • Classical (meets the diagnostic criteria)
  • Provisional (some symptoms appear between ages 1 and 3)

Rett syndrome is classified as atypical if:

  • It begins early (soon after birth) or late (beyond 18 months of age, sometimes as late as 3 or 4 years old)
  • Speech and hand skill problems are mild
  • If it appears in a boy (very rare)

Treatment

Treatment may include:

  • Help with feeding and diapering
  • Methods to treat constipation and GERD
  • Physical therapy to help prevent hand problems
  • Weight bearing exercises with scoliosis

Supplemental feedings can help with slowed growth. A feeding tube may be needed if the child breathes in (aspirates) food. Diets high in calories and fat combined with feeding tubes can help increase weight and height. Weight gain may improve alertness and social interaction.

Medicines may be used to treat seizures. Supplements may be tried for other problems such as constipation, alertness, or rigid muscles.

Stem cell therapy, alone or in combination with gene therapy, is another hopeful treatment.

Support Groups

International Rett Syndrome Foundation -- www.rettsyndrome.org

Outlook (Prognosis)

The disease slowly gets worse until the teen years. Then, symptoms may improve. For example, seizures or breathing problems tend to lessen in the late teens.

Developmental regression or delays vary. Usually, a child with Rett syndrome sits up properly but may not crawl. For those who do crawl, many do so by scooting on their tummy without using their hands.

Similarly, some children walk independently within the normal age range, while others:

  • Are delayed
  • Do not learn to walk independently at all
  • Do not learn to walk until late childhood or early adolescence

For those children who do learn to walk at the normal time, some keep that ability for their lifetime, while other children lose the skill.

Life expectancies are not well studied, although survival at least until the mid-20s is likely. The average life expectancy of a girl with Rett syndrome may be mid-40s. Death is often related to seizure, aspiration pneumonia, malnutrition, and accidents.

When to Contact a Medical Professional

Call your health care provider if you:

  • Have any concerns about your child's development
  • Notice a lack of normal development with motor or language skills in your child
  • Think your child has a health problem that needs treatment

References

Liyanage VR, Rastegar M. Rett syndrome and MeCP2. Neuromolecular Med. 2014;16:231-64. PMID 24615633 www.ncbi.nlm.nih.gov/pubmed/24615633.

Raviola G, Gosselin GJ, Walter HJ, DeMaso DR. Pervasive developmental disorders and childhood psychosis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 28.


Review Date: 11/5/2014
Reviewed By: Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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