Psychiatric Manifestations of Organic Conditions! Focus on NPC!

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Psychiatric Manifestations of Organic Conditions! Focus on NPC!"

Transcription

1 Psychiatric Manifestations of Organic Conditions! Focus on NPC! Olivier Bonnot, MD, PhD! Department of Child and Adolescent Psychiatry! University of Nantes, France! website: COPENHAGEN April, 16 th, 2015

2 Outline! Overview of organic disorders in psychiatry! Focus on treatable IEM and NPC! How to build an accurate and efficient algorithm for differential diagnosis?! Conclusions!

3 General Consideration! Organic disorders are poorly recognised in psychiatric patients! Prevalence is unknown except in few! sub-samples! Cross-discipline diseases are obviously more difficult to diagnose!

4 Main Organic Disorders in Schizophrenia! Nutritional deficiency! Pellagra! (Vitamin B3 deficiency)! Biermer! (Vitamin B12 deficiency) Bushman 1999! Endocrine diseases! Other vitamin deficiency?! Addison s Disease! Cushing's Disease Hirsh 2000! Inborn errors of metabolism! Dysregulation of thyroid and! hyper-parathyroid! Homocysteine metabolism disorders (MTHFR and CBs) Reif 2005! Wilson s Disease Wichovicz 2006! Urea cycle disorders! Porphyria Ellencweig 2006! Infectious diseases! Niemann-Pick disease Type C! Xanthomatosis! Cerebral abscess! Encephalitis (HSV ++)! Neuro-syphilis! Auto-immune diseases! Chorea / Multiple Sclerosis! Lupus / Sarcoidosis! NMDA! Chromosomal abnormalities! Mac Carthy, Nat Genet 2009; Ingason, Mol Psy, 2011; Abdolmaleky, Am J Med Genet 2005, Stefansson, Nature 2009; Levinson, Am J Psy 2011!! 1q21, 2p53, 2q29, 15q11.2, 15q11.3, 17q12, 22q11.2! NRXN1 (Neurexin 1)! 7q36.3, 25q11-13, 16p11.2, 16p13.1! Other CNS diseases! Toxic! Medication! Epilepsy!!!

5 Main Genetic Disorders in ASD Pathology! % in ASD! % with ASD! Genes! Fragile X! 2 5%! 20 40%! FMR1! Tuberous Sclerosis! 3 4%! 43 86%! TSC1-TSC2! Duplication 15q! Angelman / Prader Willi! 22q11 deletion! 16p11 deletion! 1 2%! sup 40%! 1 %! High but unknown! UBE3A! GABAr! SHANK3! PCKB1! 2q37 deletion!?! 50! K1F1A, GBX2! Joubert Syndrome!?! 40%! AH1! Timothy Syndrome!?! 60 70%! CACNA1C! Focal Cortical Epilepsy with dysplasia!?! 70%! CNTNAP2! ASD, autistic spectrum disorder!

6 Main IEM in ASD Diseases! ASD + associated signs! Diagnosis! Treatment! Phenylketonuria! Neonatal onset, seizure, microcephaly, musty and mousy odour! Phenylpyruvic acid in urine! Plasma amino acids analysis! Restricted diet! Amino acids! Adenylosuccinase deficiency! Profound retardation! first year! epilepsy, hypotonia! Succinyl aminoimidazole, carboxamine riboside and succinyl adenosine in urine and CNS! D-Ribose! Creatine deficiency! Mental retardation, hypotonia, epilepsy, dyskinetic movements, regression +++! Blood and urinary creatinine, MRI, Spectroscopy! Oral creatine! Arginine restriction! Ornithine substitution! Smith-Lemli-Opitz! Onset in infancy, mental retardation, sensory hyperactivity, sleep disturbance, hypotonia,! Abnormal sterol pattern (low plasma and tissue cholesterol and increased plasma and tissue! 7-dehydrocholesterol reductase)! Cholesterol replacement therapy! Serotonin deficiency! Various! CNS serotonin level! Serotonin + L-Dopa?! Cerebal folate deficiency! Ataxia, abnormal movement! Controversial! CNS folate! Folic acid! ASD, autistic spectrum disorder; CNS, central nervous system; IEM, inborn error in metabolism; MRI, magnetic resonance

7 Tableau I Principales causes de retard mental : classification, étiopathogénie, et fréquence estimée (d après Szymanski et Bryan, 1999)! Classification! Exemples! Etiopathogénie! Causes prénatales d origine génétique a 32 %! 95 % : trisomie 21 (non transmise) ; 5 % : translocation (peut être Aberrations chromosomiques! Syndrome de Down ou Mongolisme! transmise)! X Fragile! Lié à l X ; répétition CGG > 230! Mutations monogéniques! Phénylcétonurie! Autosomique récessif ; déficit enzymatique! Sclérose tubéreuse! Autosomique dominant! Multifactoriel! Retard mental «familial»! Mixte: génétique, environnementale! Syndrome Vélo-Cardio-Facial! Délétion sur le chromosome 22 (q11)! Syndrome de Prader-Willi! Délétion sur le chromosome 15 (q11-q13) d origine paternelle! Microdélétion! Syndrome d Angelman! Délétion sur le chromosome 15 (q11-q13) d origine maternelle! Syndrome de Williams-Beuren! Microdelétion du chromosome 7 (q11.23)! 82 treatable causes! Metaboliques! 82 causes de pathologies neurométaboliques! enzymatiques! Causes prénatales d origine externe 12 %! Infections maternelles! of Infection VIH! IEM! Encéphalopathie virale! Causes toxiques! Syndrome d alcoolisme fœtal! Exposition in utero à l alcool! Causes obstétricales! in Intellectual Prématurité! Deficiency! Variable, multifactorielle! Malformations d origine inconnue 8 %! Malformations du SNC! Non fermeture du tube neural! Parfois associé à une hydrocéphalie! Syndrome poly-malformatifs! Syndrome de Cornelia de Lange! Inconnue! Causes périnatales 11 %! Infections! Encéphalite! Infection au virus Herpes Simplex 2! Problèmes pendant la délivrance! Anoxie néonatale! Variable, infarctus cérébral! Autres! Hyperbilirubinémie! Incompatibilité rhésus mère enfant! Causes post natales 8 %! Infections! Encéphalite! Infection virale ou bactérienne! Causes toxiques! Saturnisme! Intoxication au plomb! Psychosocial! Pathologie de déprivation! Malnutrition, abus, négligence, dépression anaclitique! Autres! Traumatismes ou tumeurs cérébrales! Variable, atteinte du SNC! Causes inconnues 25 %!

8 Thousands! All inherited! 40 / (Applegarth, Toole 2000, British Columbia) UNDERESTIMATED! Frequently associated with Psychiatric signs! Psychiatric presentations are underestimated particularly when case are sever and with early onset!

9 CLINICAL CASE

10 Brother an Sister, Hanon et al, 2013 Cases 22 years old boy Brief and acute Psycho=c symptoms cannabis 14 hospitaliza=ons in 4 years (same symptoms, same context) Diagnose is Schizophrenia AP are poorly efficient

11 Age 26 Speech and swallow impairments Abnormal movements Blankly stare Cogni=ve decline No change with AP stop or down =tra=on

12 Age 26 Choreo- dystonic movements Cerebellum syndrome Dysmetria / Dysarthria Frontal Syndrome SNGP Niemann Pick Type C Improvement of Psycho=c symptoms with no other treatment than Miglustat

13 Niemann Pick type C

14 Place of Psychiatric Signs in! Niemann-Pick disease Type C! Sévin M, et al. Brain 2007:130;120 33

15 Psychiatric Signs 9 case reports (1) + 5 case series (2) : 30 patients with psychiatric signs 24 ataxia: 80% 24 VSNGP: 80% 18 cognitive impairments: 60% 15 large liver or spleen : 50% (1) (1) Hulette et al 1992; Shulman et al 1995; Campo et al 1998; Battisti et al 2003; Turpin et al 2003; Tyvaert et al 2005; Trendelenburg et al 2006; Sandu et al 2009; Walterfang et al 2006 (2) (2) Imrie et al. 2002; Josephs et al 2003; Walterfang et al 2006; Sevin et al 2007; Walterfang et al 2009;

16 NP-C and Neuropsychological Signs! Intellectual deficiency is not systematic, but when it occurs, it s moderate! Cognitive impairments are common but unspecific: lack of working memory, impairment in logic thought 1! Developmental delay 2! All are very heterogeneous! 1. Klarner B, et al. J Inherit Met Dis 2007;30:60 7;! 2. van de Vlasakker CJ, et al. Clin Neurol Neurosurg 1994;96:

17 NP-C and Psychiatric Signs! Schizophrenia may occur! Cognitive impairment!

18 Main IEM in Schizophrenia! Disorder! Clinical signs! Context! Eye exam! Biological markers! Wilson! Urea cycle! Homocysteinemia (CbS)! Homocysteinemia (MTHFR)! Niemann-Pick! disease Type C! Cerebrotendinous xanthomatosis! Porphyria! Tremor! Dystonia! Dysarthria! Confusion! Abdominal pain! Nausea vomiting! Thromboembolism! Scoliosis! Marfan-like! Cerebellar signs! Early-onset severe disease usually with microcephaly/ apnea / convulsion! Dystonia + ataxia Dysarthria! Splenomegaly! Chronic diarrhoea! Spastic paralysis! Urine black or red! Constipation! Confusion! Abdominal pain! Nausea / vomiting! Protein diet! Post-surgery! Drugs! (valproate / corticoids)! Protein diet! Post-surgery! Neonatal icterus! Slow progression! Periodic! Kayser-Fleischer ring! Severe myopia! Ectopic lens! Supranuclear vertical! Gaze palsy! Juvenile cataract! Coeruloplasmin! Ammoniaemia! Homocysteiniemia! Methioninemia! Homocysteiniemia! Methioninemia! Skin-biopsy! Filipin test! NPC1 and NPC2 gene test! Cholesteanoemia! Porphobilinogens (URINE)!

19 Atypical Psychiatric Features! How to

20 Atypical Psychiatric Signs of Schizophrenia! No! 0! Slightly! 1! Evident! 2! Main clinical feature! 3! Visual hallucinations more important than auditory! 0 Confusion! 0 Catatonia! 0 Progressive cognitive decline! 0 Treatment resistance! 3 Fluctuating schizophrenia core symptoms! 1 Acute onset! 2 Early onset! 0 Intellectual disabilities! 1 Unusual side effects! (level and type)! 1

21 Atypical Psychiatric Features! Suggest the need for a more extensive search! Are probably not accurate for acute (infections, toxic)! Could be a starting point for a large algorithm!

22 Differential Diagnosis Algorithm! A large list of diseases! 61 disorders!!

23 Differential Diagnosis Algorithm! An even larger list of signs and symptoms (293)! Try to make it simple for clinical use! Not an easy task!!! Physical phenotype! Symptom categories! Bone/connective tissue! Cardiovascular! Dermatological! Endocrine! Genitourinary! Haematological! Hearing! Miscellaneous! Neuroimaging! Neurological! Renal! Speech! Visceral! Visual!

24 Differential Diagnosis Algorithm! Physical phenotype! Symptom categories! Bone/connective tissue! Cardiovascular! Dermatological! Endocrine! Genitourinary! Haematological! Hearing! Miscellaneous! Neuroimaging! Neurological! Renal! Speech! Visceral! Visual!

25 Differential Diagnosis Algorithm! Diagnos=c loop 1 Suspicion of psychosis [entry criteria to be defined] Assess/Treat/Refer Yes Obvious cause? No Abnormal MRI Symptom checker Tier 1 No, but more poten4al diagnoses (i.e. move down the ranked list) Diagnos=c loop 2 Assess/addi=onal examina=ons Diagnosis confirmed? Yes Treat/Refer Yes No more poten4al diagnoses Possible to provide short list of high likelihood diagnoses? No Symptom checker Tier 2 No, but more poten4al diagnoses (i.e. move down the ranked list) Diagnos=c loop 3 Assess/addi=onal examina=ons Diagnosis confirmed? Yes Treat/Refer No more poten4al diagnoses Ranked list of poten=al diagnoses No diagnosis possible

26 Differential Diagnosis Algorithm! Still a work in progress! Simple and accurate! IEM and other genetic diseases! Atypical psychosis signs are a good entry point! Few discriminative neurological (and / or other) symptoms must be identified!

27 Conclusion and Take Home Messages! Schizophrenia is present in 1% of the general population! An underestimated proportion may be associated with organic disorders! Not only inborn errors of metabolism! Atypical signs of psychosis are a clear indication! to perform an extensive search of organic causes! Think about NPC!

28 Tak for er opmærksomhed!

Contents : Definition Prevalence Classification Causes Clinical Evaluation Investigation Management

Contents : Definition Prevalence Classification Causes Clinical Evaluation Investigation Management Mental Retardation Contents : Definition Prevalence Classification Causes Clinical Evaluation Investigation Management Definition Mental Retardation is defined statistically as tested cognitive performance

More information

Orphanet Journal of Rare Diseases 2014, 9:65

Orphanet Journal of Rare Diseases 2014, 9:65 Orphanet Journal of Rare Diseases This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. Diagnostic

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Abuse substance. See Substance abuse Acquired disorders presenting as psychosis in children and young adults, 581 608. See also specific

More information

Approach to the Child with Developmental Delay

Approach to the Child with Developmental Delay Approach to the Child with Developmental Delay Arwa Nasir Department of Pediatrics University of Nebraska Medical Center DISCLOSURE DECLARATION Approach to the Child with Developmental Delay Arwa Nasir

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Centre for Clinical Practice SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Centre for Clinical Practice SCOPE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Centre for Clinical Practice 1 Guideline title SCOPE Autism: the management and support of children and young people on the autism spectrum 1.1 Short

More information

The child with hemiplegic cerebral palsy thinking beyond the motor impairment. Dr Paul Eunson Edinburgh

The child with hemiplegic cerebral palsy thinking beyond the motor impairment. Dr Paul Eunson Edinburgh The child with hemiplegic cerebral palsy thinking beyond the motor impairment Dr Paul Eunson Edinburgh Content Coming to a diagnosis The importance of understanding the injury MRI scans Role of epilepsy

More information

Autism Update and Lifetime Care Considerations

Autism Update and Lifetime Care Considerations Autism Update and Lifetime Care Considerations February 2008 By Susan Carpenter MD, FRCPC History of Autism Kanner first introduced the syndrome of autism in 1943. This allowed researchers to differentiate

More information

WHAT IS DEMENTIA? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient

WHAT IS DEMENTIA? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient DEMENTIA WHAT IS DEMENTIA? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient Progressive and disabling Not an inherent aspect of

More information

The Neurology of HIV Infection. Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University

The Neurology of HIV Infection. Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University The Neurology of HIV Infection Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University HIV/AIDS Epidemiology World-wide pandemic, 40 million affected U.S.- Disproportionate

More information

The Amazing Brain Webinar Series: Select Topics in Neuroscience and Child Development for the Clinician

The Amazing Brain Webinar Series: Select Topics in Neuroscience and Child Development for the Clinician The Amazing Brain Webinar Series: Select Topics in Neuroscience and Child Development for the Clinician Part VII Recent Advances in the Genetics of Autism Spectrum Disorders Abha R. Gupta, MD, PhD Jointly

More information

Autism Spectrum Disorder What is it?

Autism Spectrum Disorder What is it? Autism Spectrum Disorder What is it? Robin K. Blitz, MD Resident Autism Diagnostic Clinic Lecture Series #1 Learning Objectives What can we talk about in 20 minutes? What is Autism? What are the Autism

More information

THIAMINE TRANSPORTER TYPE 2 DEFICIENCY

THIAMINE TRANSPORTER TYPE 2 DEFICIENCY THIAMINE TRANSPORTER TYPE 2 DEFICIENCY WHAT IS THE THIAMINE TRANSPORTER TYPE 2 DEFICIENCY (hthtr2)? The thiamine transporter type 2 deficiency (hthtr2) is a inborn error of thiamine metabolism caused by

More information

Childhood epilepsy: the biochemical epilepsies. Dr Colin D Ferrie Consultant Paediatric Neurologist Leeds General Infirmary

Childhood epilepsy: the biochemical epilepsies. Dr Colin D Ferrie Consultant Paediatric Neurologist Leeds General Infirmary Childhood epilepsy: the biochemical epilepsies Dr Colin D Ferrie Consultant Paediatric Neurologist Leeds General Infirmary Definitions Epileptic Seizure Manifestation(s) of epileptic (excessive and/or

More information

AMERICAN BOARD OF MEDICAL GENETICS AND GENOMICS

AMERICAN BOARD OF MEDICAL GENETICS AND GENOMICS AMERICAN BOARD OF MEDICAL GENETICS AND GENOMICS Logbook Guidelines for Certification in Clinical Genetics and Genomics for the 2017 Examination as of 10/5/2015 Purpose: The purpose of the logbook is to

More information

The University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Neurology

The University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Neurology The University of Arizona Pediatric Residency Program Primary Goals for Rotation Neurology 1. GOAL: Understand the role of the pediatrician in preventing neurological diseases, and in counseling and screening

More information

Autism in children and young people

Autism in children and young people nice bulletin Autism in children and young people NICE provided the content for this booklet which is independent of any company or product advertised NIP.63.NICE Bulletin Autism.indd 1 21/11/2011 10:48

More information

Pediatric Genetic Conditions

Pediatric Genetic Conditions Pediatric Genetic Conditions HEIDI M NELSON, PT, DPT, PCS DIRECTOR OF CLINICAL EDUCATION & ASSISTANT PROFESSOR BRIAR CLIFF UNIVERSITY DOCTOR OF PHYSICAL THERAPY* Basics & Characteristics Prader-Willi Syndrome

More information

Smith-Magenis. and Potocki-Lupski. syndromes

Smith-Magenis. and Potocki-Lupski. syndromes and Potocki-Lupski syndromes Pr. Didier LACOMBE Dept. Médical Genetics, National Reference Center for Birth Defects Hopital Pellegrin,, CHU de Bordeaux University of Bordeaux, France Roma, November 20

More information

Autism Spectrum Disorder What is it? Robin K. Blitz, MD Resident Autism Diagnostic Clinic Lecture Series #1

Autism Spectrum Disorder What is it? Robin K. Blitz, MD Resident Autism Diagnostic Clinic Lecture Series #1 Autism Spectrum Disorder What is it? Robin K. Blitz, MD Resident Autism Diagnostic Clinic Lecture Series #1 Learning Objectives What can we talk about in 20 minutes? What is Autism? What are the Autism

More information

Fragile X Syndrome & Recent Advances in Behavioural Phenotype Research Jeremy Turk

Fragile X Syndrome & Recent Advances in Behavioural Phenotype Research Jeremy Turk Fragile X Syndrome & Recent Advances in Behavioural Phenotype Research Jeremy Turk Institute of Psychiatry Psychology & Neurosciences, King s College, University of London Child & Adolescent Mental Health

More information

New Patient History. Name: DOB: Sex: Date: If yes, give the name of the physician who did your evaluation or ordered your tests:

New Patient History. Name: DOB: Sex: Date: If yes, give the name of the physician who did your evaluation or ordered your tests: New Patient History Name: DOB: Sex: Date: Chief Complaint: 1. Give a brief description of the problem you are seeking treatment for today: 2. Have you been evaluated for this problem or had any tests for

More information

Cerebral Palsy: Facts and Fiction-What is CP all about?

Cerebral Palsy: Facts and Fiction-What is CP all about? Cerebral Palsy: Facts and Fiction-What is CP all about? Andrea Paulson MD MPH Assistant Professor Pediatric Rehabilitation Medicine August 9 th 2017 Teresa Flower BSN, RN II, CPN Pediatric Rehabilitation

More information

Delirium & Dementia. Nicholas J. Silvestri, MD

Delirium & Dementia. Nicholas J. Silvestri, MD Delirium & Dementia Nicholas J. Silvestri, MD Outline Delirium vs. Dementia Neural pathways relating to consciousness Encephalopathy Stupor Coma Dementia Delirium vs. Dementia Delirium Abrupt onset Lasts

More information

Cephalic Disorders. Katelyn Anderson. Adapted From: National Institute of Neurological Disorders and Stroke

Cephalic Disorders. Katelyn Anderson. Adapted From: National Institute of Neurological Disorders and Stroke Cephalic Disorders Katelyn Anderson Adapted From: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/disorders/cephalic_disorders/ detail_cephalic_disorders.htm http://magisgroup.com/wp-content/uploads/2011/03/bluebrainfrontnew.jpg

More information

Neurology Goals: Knowledge:

Neurology Goals: Knowledge: Neurology Goals: A solid understanding of normal neurological development, anatomy and neurophysiology is imperative to the treatment of neurological pathology. The goal is to sensitize the family medicine

More information

Intellectual Disability

Intellectual Disability Intellectual Disability Outline Definition Medical investigation Common syndromes Associated comorbidity and management Educational issues Medication Transition to adulthood Definition Terminology differs

More information

Fact Sheet 8. DSM-5 and Autism Spectrum Disorder

Fact Sheet 8. DSM-5 and Autism Spectrum Disorder Fact Sheet 8 DSM-5 and Autism Spectrum Disorder A diagnosis of autism is made on the basis of observed behaviour. There are no blood tests, no single defining symptom and no physical characteristics that

More information

The University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Genetics

The University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Genetics The University of Arizona Pediatric Residency Program Primary Goals for Rotation Genetics 1. GOAL: Understand the role of the pediatrician in preventing genetic disease, and in counseling and screening

More information

A Neurologist s Approach to Altered Mental Status

A Neurologist s Approach to Altered Mental Status A Neurologist s Approach to Altered Mental Status S. Andrew Josephson, MD Department of Neurology University of California San Francisco October 23, 2008 The speaker has no disclosures Case 1 A 71 year-old

More information

Neurology. Access Center 24/7 access for referring physicians (866) 353-KIDS (5437)

Neurology. Access Center 24/7 access for referring physicians (866) 353-KIDS (5437) Neurology The Neurology practice at Valley Children s provides diagnostic services, medical treatment, and followup care to infants, children, and adolescents who have suspected or confirmed neurological

More information

MICROCEPHALY DEVELOPMENTAL IMPLICATIONS IN BIRTH-3 Diana M. Cejas, MD, MPH Child Neurology Fellow The University of Chicago Comer Children s Hospital

MICROCEPHALY DEVELOPMENTAL IMPLICATIONS IN BIRTH-3 Diana M. Cejas, MD, MPH Child Neurology Fellow The University of Chicago Comer Children s Hospital Early Intervention Training Program at the University of Illinois at Urbana Champaign presents Microcephaly: Developmental Implications in Birth-3 The webinar will begin at (1:30 PM CST). There will be

More information

Proximal 18q- Treatment and Surveillance ICD-10 = Q99.9 or Q93.89

Proximal 18q- Treatment and Surveillance ICD-10 = Q99.9 or Q93.89 Proximal 18q- Treatment and Surveillance ICD-10 = Q99.9 or Q93.89 These recommendations are inclusive of the entire population of people with Proximal 18q deletions even though each person has a unique

More information

Epilepsy Mark Doran Consultant Neurologist. February 2018

Epilepsy Mark Doran Consultant Neurologist. February 2018 Epilepsy Mark Doran Consultant Neurologist February 2018 Epilepsy Outline of talk Definition of epilepsy Diagnosis of epilepsy Treatment of epilepsy Complications Problems with management of epilepsy Epilepsy

More information

Exploding Genetic Knowledge in Developmental Disabilities. Disclosures. The Genetic Principle

Exploding Genetic Knowledge in Developmental Disabilities. Disclosures. The Genetic Principle Exploding Genetic Knowledge in Developmental Disabilities How to acquire the data and how to make use of it Elliott H. Sherr MD PhD Professor of Neurology & Pediatrics UCSF Disclosures InVitae: clinical

More information

Autism Spectrum Disorder What is it?

Autism Spectrum Disorder What is it? Autism Spectrum Disorder What is it? Robin K. Blitz, MD Director, Developmental Pediatrics Resident Autism Diagnostic Clinic Lecture Series #1 Learning Objectives What can we talk about in 20 minutes?

More information

M0BCore Safety Profile

M0BCore Safety Profile M0BCore Safety Profile Active substance: Aciclovir Pharmaceutical form(s)/strength: Tablets 200, 400 or 800 mg Dispersible tablets 200, 400 or 800 mg Oral suspensions 200 mg or 400 mg per 5 ml. Freeze

More information

Marchiafava Bignami Disease (MBD) and Diffusion Tensor Image (DTI) Tractography. Priscilla Chukwueke, MD, MPH

Marchiafava Bignami Disease (MBD) and Diffusion Tensor Image (DTI) Tractography. Priscilla Chukwueke, MD, MPH Marchiafava Bignami Disease (MBD) and Diffusion Tensor Image (DTI) Tractography Priscilla Chukwueke, MD, MPH INTRODUCTION Definition: A rare CNS disease characterized by demyelination of the Corpus Callosum.

More information

Evolution of Genetic Testing. Joan Pellegrino MD Associate Professor of Pediatrics SUNY Upstate Medical University

Evolution of Genetic Testing. Joan Pellegrino MD Associate Professor of Pediatrics SUNY Upstate Medical University Evolution of Genetic Testing Joan Pellegrino MD Associate Professor of Pediatrics SUNY Upstate Medical University Genetic Testing Chromosomal analysis Flourescent in situ hybridization (FISH) Chromosome

More information

Schizophrenia. Introduction. Overview and Facts

Schizophrenia. Introduction. Overview and Facts Introduction is a chronic, severe and disabling brain disease that typically shows its first clear symptoms in late adolescence or early adulthood. It is one of several types of Psychotic Disorders. It

More information

Feeding Disorders and Growth in Williams Syndrome

Feeding Disorders and Growth in Williams Syndrome Feeding Disorders and Growth in Williams Syndrome Sharon M. Greis M.A., CCC/SLP BRS-S and Paige Kaplan M.B.B.Ch. Williams Syndrome Clinic The Children s Hospital of Philadelphia Pediatric Feeding & Swallowing

More information

Chapter 2 Classification of Language Abnormalities Based on Etiology and Diagnostic Labels

Chapter 2 Classification of Language Abnormalities Based on Etiology and Diagnostic Labels Chapter 2 Classification of Language Abnormalities Based on Etiology and Diagnostic Labels 9/19/05 COMD 326, Chapter 2 1 1 Cognition Language Develop together Early gestures are communication (symbols)

More information

This fact sheet describes the condition Fragile X and includes a discussion of the symptoms, causes and available testing.

This fact sheet describes the condition Fragile X and includes a discussion of the symptoms, causes and available testing. 11111 Fact Sheet 54 FRAGILE X SYNDROME This fact sheet describes the condition Fragile X and includes a discussion of the symptoms, causes and available testing. In summary Fragile X is a condition caused

More information

Update on the Genetics of Ataxia. Vicki Wheelock MD UC Davis Department of Neurology GHPP Clinic

Update on the Genetics of Ataxia. Vicki Wheelock MD UC Davis Department of Neurology GHPP Clinic Update on the Genetics of Ataxia Vicki Wheelock MD UC Davis Department of Neurology GHPP Clinic Outline Definitions Review of genetics Autosomal Dominant cerebellar ataxias Autosomal Recessive cerebellar

More information

Tuberous Sclerosis Complex. Joanna Wai Ling Ma

Tuberous Sclerosis Complex. Joanna Wai Ling Ma Tuberous Sclerosis Complex Joanna Wai Ling Ma Tuberous sclerosis complex (TSC) Objectives Definition Diagnostic criteria Clinical manifestation Surveillance and management Diagnostic and follow-up Tool

More information

"Current Scientists Perspectives of Autism

Current Scientists Perspectives of Autism "Current Scientists Perspectives of Autism Medical Genetics Children s Hospital of Pittsburgh June 3, 2008 Nancy Minshew, MD Director, NIH Autism Center of Excellence University of Pittsburgh Key Features

More information

R.C.P.U. NEWSLETTER. Hunting for Genes - It isn=t as easy as it looks! Angelman syndrome:

R.C.P.U. NEWSLETTER. Hunting for Genes - It isn=t as easy as it looks! Angelman syndrome: R.C.P.U. NEWSLETTER Editor: Heather J. Stalker, M.Sc. Director: Roberto T. Zori, M.D. R.C. Philips Research and Education Unit Vol. XII No. 1 A statewide commitment to the problems of mental retardation

More information

SWISS SOCIETY OF NEONATOLOGY. Prader-Willi-Labhart syndrome

SWISS SOCIETY OF NEONATOLOGY. Prader-Willi-Labhart syndrome SWISS SOCIETY OF NEONATOLOGY Prader-Willi-Labhart syndrome December 2003 2 Berger D, Och I, Gnehm HPE, Zankl A, Zeilinger G, Children s Hospital of Aarau, Switzerland Title image: Andrea Prader (1919-2001)

More information

PEDIATRIC MEDICAL HISTORY QUESTIONNAIRE

PEDIATRIC MEDICAL HISTORY QUESTIONNAIRE Division of Otolaryngology Main Phone: 847 504-3300 Main Fax: 847 504-3305 Mihir Bhayani, MD Judy L. Chen, MD Mark E. Gerber, MD, FACS, FAAP Joseph Raviv, MD Ilana Seligman, MD, FACS, FAAP Michael J. Shinners,

More information

Objectives. Setting Events. A Biobehavioral Approach to Functional Assessment

Objectives. Setting Events. A Biobehavioral Approach to Functional Assessment A Biobehavioral Approach to Functional Assessment Jennifer Zarcone Strong Center for Developmental Disabilities December 5, 2008 Objectives Three major kinds of setting events: Genetic factors Biological

More information

Memento, Bourne series, The Notebook 50 First Dates etc.

Memento, Bourne series, The Notebook 50 First Dates etc. Dementia / Amnesia Memento, Bourne series, The Notebook 50 First Dates etc. Memory refers to the ability of the brain to store and retrieve information. Memory complaints are common, particularly among

More information

Psychotic Disorders in Children and Adolescents

Psychotic Disorders in Children and Adolescents Psychotic Disorders in Children and Adolescents Dr. Marcelo Rodriguez-Chevres, M.D. Emergence Health Network Learning Objectives Audience will be able to: 1. Distinguish developmentally normal experiences

More information

Epilepsy 101. Russell P. Saneto, DO, PhD. Seattle Children s Hospital/University of Washington November 2011

Epilepsy 101. Russell P. Saneto, DO, PhD. Seattle Children s Hospital/University of Washington November 2011 Epilepsy 101 Russell P. Saneto, DO, PhD Seattle Children s Hospital/University of Washington November 2011 Specific Aims How do we define epilepsy? Do seizures equal epilepsy? What are seizures? Seizure

More information

EAC-AZ Webinar #7 November 18 th & 25 th. Today s Objectives 11/17/2015. Month 4 Related Medical/Behavioral Issues

EAC-AZ Webinar #7 November 18 th & 25 th. Today s Objectives 11/17/2015. Month 4 Related Medical/Behavioral Issues EAC-AZ Webinar #7 November 18 th & 25 th Robin Blitz, MD Sara Bode, MD Amber Wright, CPNP Today s Objectives Month 4 Article Review STAT Reliability Testing ADOS Interpretation AzEIP / School Testing M-CHAT-R

More information

The Cause of Autism: Its Footprint Tells. Autism Symposium-Part II

The Cause of Autism: Its Footprint Tells. Autism Symposium-Part II The Cause of Autism: Its Footprint Tells Autism Symposium-Part II May 22, 2009 Nancy Minshew, MD Professor Psychiatry & Neurology University of Pittsburgh USA Convergence The Top of 10 Clinical of 2007

More information

Prevalence, Conditions Associated with Autistic Spectrum Disorders

Prevalence, Conditions Associated with Autistic Spectrum Disorders CLDDV 168: Autism I Week 3: Prevalence, Conditions Associated with Autistic Spectrum Disorders Prepared by Debbie Laffranchini, Instructor From: The Autistic Spectrum, by Lorna Wing, MD Are the Numbers

More information

It s Always a Stroke; Except For When It s Not..

It s Always a Stroke; Except For When It s Not.. It s Always a Stroke; Except For When It s Not.. TREVOR PHINNEY, D.O. Disclosures No Relevant Disclosures 1 Objectives Discuss variables of differential diagnosis for stroke Review when to TPA and when

More information

Genetic Disorders. Dr Essam AL AGEELI Assistant professor of Medical Genetics DES of Medical Genetics, Paris-France.

Genetic Disorders. Dr Essam AL AGEELI Assistant professor of Medical Genetics DES of Medical Genetics, Paris-France. Genetic Disorders Dr Essam AL AGEELI Assistant professor of Medical Genetics DES of Medical Genetics, Paris-France. Objectives To define the types of congenital anomalies which may occur and their underlying

More information

Case #1. Inter-ictal EEG. Difficult Diagnosis Pediatrics. 15 mos girl with medically refractory infantile spasms 2/13/2010

Case #1. Inter-ictal EEG. Difficult Diagnosis Pediatrics. 15 mos girl with medically refractory infantile spasms 2/13/2010 Difficult Diagnosis Pediatrics Joseph E. Sullivan M.D. Assistant Professor of Clinical Neurology & Pediatrics Director, UCSF Pediatric Epilepsy Center University of California San Francisco Case #1 15

More information

Module : Clinical correlates of disorders of metabolism Block 3, Week 2

Module : Clinical correlates of disorders of metabolism Block 3, Week 2 Module : Clinical correlates of disorders of metabolism Block 3, Week 2 Department of Paediatrics and Child Health University of Pretoria Tutor : Prof DF Wittenberg : dwittenb@medic.up.ac.za Aim of this

More information

Substance and Medication Induced Mood Disorders KELLY GODECKE, MD PSYCHIATRY DEPARTMENT UNIVERSITY OF UTAH

Substance and Medication Induced Mood Disorders KELLY GODECKE, MD PSYCHIATRY DEPARTMENT UNIVERSITY OF UTAH Substance and Medication Induced Mood Disorders KELLY GODECKE, MD PSYCHIATRY DEPARTMENT UNIVERSITY OF UTAH Substance Induced Depressive Disorder A. A prominent and persistent disturbance in mood that predominates

More information

UPDATE: AUTISM SPECTRUM DISORDER IN CHILDREN

UPDATE: AUTISM SPECTRUM DISORDER IN CHILDREN UPDATE: AUTISM SPECTRUM DISORDER IN CHILDREN HISTORY OF AUTISM ABLE TO TRACE THE CHANGING APPROACHES TO AUTISM BY LOOKING AT DSM CRITERIA OVER TIME IN THE BEGINNING, IT WAS PERCEIVED AS A SINGULAR DISORDER

More information

Fragile X One gene, three very different disorders for which Genetic Technology is essential. Significance of Fragile X. Significance of Fragile X

Fragile X One gene, three very different disorders for which Genetic Technology is essential. Significance of Fragile X. Significance of Fragile X Fragile X One gene, three very different disorders for which Genetic Technology is essential Martin H. Israel Margaret E. Israel mhi@wustl.edu meisrael@sbcglobal.net uel L. Israel Association of Genetic

More information

3) Approach to Ataxia - Dr. Zana

3) Approach to Ataxia - Dr. Zana 3) Approach to Ataxia - Dr. Zana Introduction Ataxia is derived from Greek word a -not, taxis -orderly, (not orderly/ not in order) Ataxia is the inability to make smooth, accurate and coordinated movements

More information

Epilepsy CASE 1 Localization Differential Diagnosis

Epilepsy CASE 1 Localization Differential Diagnosis 2 Epilepsy CASE 1 A 32-year-old man was observed to suddenly become unresponsive followed by four episodes of generalized tonic-clonic convulsions of the upper and lower extremities while at work. Each

More information

New Patient Questionnaire Pediatric Orthopaedic Surgery

New Patient Questionnaire Pediatric Orthopaedic Surgery Page 1 of 5 New Patient Questionnaire Pediatric Orthopaedic Surgery First Name: Last Name: Middle: DOB: Height: Weight: Primary Care Physician/Pediatrician Name: Address: Phone Number: Chief Compliant

More information

Autism Spectrum Disorder: A Primer for PCPs

Autism Spectrum Disorder: A Primer for PCPs Autism Spectrum Disorder: A Primer for PCPs Learning Objectives 1. Define current ASD diagnostic criteria 2. Identify ASD screening tools, including the M-CHAT-R/F 3. Describe treatments/interventions

More information

Scope. EEG patterns in Encephalopathy. Diffuse encephalopathy. EEG in adult patients with. EEG in diffuse encephalopathy

Scope. EEG patterns in Encephalopathy. Diffuse encephalopathy. EEG in adult patients with. EEG in diffuse encephalopathy Scope EEG patterns in Encephalopathy Dr.Pasiri Sithinamsuwan Division of Neurology Department of Medicine Phramongkutklao Hospital Diffuse encephalopathy EEG in specific encephalopathies Encephalitides

More information

Clinical evaluation of microarray data

Clinical evaluation of microarray data Clinical evaluation of microarray data David Amor 19 th June 2011 Single base change Microarrays 3-4Mb What is a microarray? Up to 10 6 bits of Information!! Highly multiplexed FISH hybridisations. Microarray

More information

Public Dissemination Effective: January 2018

Public Dissemination Effective: January 2018 Board of Pharmacy Specialties Board Certified Geriatric Pharmacist (BCGP) Detailed Content Outline 1. GENERAL PRINCIPLES OF AGING (20%) A. Apply the knowledge of physiologic changes associated with aging

More information

EEG in the Evaluation of Epilepsy. Douglas R. Nordli, Jr., MD

EEG in the Evaluation of Epilepsy. Douglas R. Nordli, Jr., MD EEG in the Evaluation of Epilepsy Douglas R. Nordli, Jr., MD Contents Epidemiology First seizure Positive predictive value Risk of recurrence Identifying epilepsy Type of epilepsy (background and IEDs)

More information

There are several types of epilepsy. Each of them have different causes, symptoms and treatment.

There are several types of epilepsy. Each of them have different causes, symptoms and treatment. 1 EPILEPSY Epilepsy is a group of neurological diseases where the nerve cell activity in the brain is disrupted, causing seizures of unusual sensations, behavior and sometimes loss of consciousness. Epileptic

More information

From Diagnosis to Intervention: ASD & Seizures-Epilepsy Indications for EEG and MRI. Reet Sidhu, MD Gregory Barnes, MD Nancy Minshew, MD

From Diagnosis to Intervention: ASD & Seizures-Epilepsy Indications for EEG and MRI. Reet Sidhu, MD Gregory Barnes, MD Nancy Minshew, MD From Diagnosis to Intervention: ASD & Seizures-Epilepsy Indications for EEG and MRI Reet Sidhu, MD Gregory Barnes, MD Nancy Minshew, MD Overview Autism Spectrum Disorders (ASD) and the role of the Neurologist

More information

Classes of Neurotransmitters. Neurotransmitters

Classes of Neurotransmitters. Neurotransmitters 1 Drugs Outline 2 Neurotransmitters Agonists and Antagonists Cocaine & other dopamine agonists Alcohol & its effects / Marijuana & its effects Synthetic & Designer Drugs: Ecstasy 1 Classes of Neurotransmitters

More information

The Neurologic Examination. John W. Engstrom, M.D. University of California San Francisco School of Medicine

The Neurologic Examination. John W. Engstrom, M.D. University of California San Francisco School of Medicine The Neurologic Examination John W. Engstrom, M.D. University of California San Francisco School of Medicine Overview The Neurologic Examination Mental status demonstration/questions Cranial nerves demonstration/questions

More information

CHAPTER 6 NERVOUS SYSTEM G00-G99. Presented by Jan Halloran

CHAPTER 6 NERVOUS SYSTEM G00-G99. Presented by Jan Halloran CHAPTER 6 NERVOUS SYSTEM G00-G99 Presented by Jan Halloran 1 LEARNING OUTCOMES After studying this chapter you should be able to: Explain the difference between the central and peripheral nervous systems

More information

Neurotransmitter Disorders.

Neurotransmitter Disorders. Neurotransmitter Disorders Simon.heales@gosh.nhs.uk Chemical Neurotransmission Neurotransmitters Substances that upon release from nerve terminals, act on receptor sites at postsynaptic membranes to produce

More information

Case reports functional imaging in epilepsy

Case reports functional imaging in epilepsy Seizure 2001; 10: 157 161 doi:10.1053/seiz.2001.0552, available online at http://www.idealibrary.com on Case reports functional imaging in epilepsy MARK P. RICHARDSON Medical Research Council Fellow, Institute

More information

Autism. Recognition, referral and diagnosis of children and young people on the autism spectrum

Autism. Recognition, referral and diagnosis of children and young people on the autism spectrum Issue date: September 2011 Autism Recognition, referral and diagnosis of children and young people on the autism spectrum NICE clinical guideline 128 Developed by the National Collaborating Centre for

More information

Genetics of Behavior (Learning Objectives)

Genetics of Behavior (Learning Objectives) Genetics of Behavior (Learning Objectives) Recognize that behavior is multi-factorial with genetic components Understand how multi-factorial traits are studied. Explain the terms: incidence, prevalence,

More information

AUTISM SPECTRUM DISORDER: DSM-5 DIAGNOSTIC CRITERIA. Lisa Joseph, Ph.D.

AUTISM SPECTRUM DISORDER: DSM-5 DIAGNOSTIC CRITERIA. Lisa Joseph, Ph.D. AUTISM SPECTRUM DISORDER: DSM-5 DIAGNOSTIC CRITERIA Lisa Joseph, Ph.D. Autism Spectrum Disorder Neurodevelopmental disorder Reflects understanding of the etiology of disorder as related to alterations

More information

EEG in Epileptic Syndrome

EEG in Epileptic Syndrome EEG in Epileptic Syndrome Surachai Likasitwattanakul, M.D. Division of Neurology, Department of Pediatrics Faculty of Medicine, Siriraj Hospital Mahidol University Epileptic syndrome Electroclinical syndrome

More information

PATIENT INTAKE FORM. Name: Address: Town: State: Zip Code: MMJ Card #: Exp. Date: Drivers License #: Exp. Date: Home Phone: Cell:

PATIENT INTAKE FORM. Name: Address: Town: State: Zip Code: MMJ Card #: Exp. Date: Drivers License #: Exp. Date: Home Phone: Cell: PATIENT INTAKE FORM Name: Last Name First Name Date of Birth: / / Gender: Male Female Address: Town: State: Zip Code: MMJ Card #: Exp. Date: Drivers License #: Exp. Date: Home Phone: Cell: Email: Primary

More information

Understanding the Dental Patient with Self-injurious Behavior

Understanding the Dental Patient with Self-injurious Behavior Understanding the Dental Patient with Self-injurious Behavior Self Injurious Behaviors A class of behaviors, often highly repetitive and rhythmic, that result in physical harm to the individual displaying

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Genetic Testing for FMR1 Mutations Including Fragile X Syndrome File Name: Origination: Last CAP Review Next CAP Review Last Review genetic_testing_for_fmr1_mutations_including_fragile_x_syndrome

More information

HISTORY TAKING ON NERVOUS SYSTEM. Dr. Amitesh Aggarwal

HISTORY TAKING ON NERVOUS SYSTEM. Dr. Amitesh Aggarwal HISTORY TAKING ON NERVOUS SYSTEM Dr. Amitesh Aggarwal General points History of neurological symptoms should also be taken from patient and close relative or friend Memory loss, intoxication, aphasia Patient

More information

Medical History Form

Medical History Form Medical History Form Name: ; Birth date: / / ; Date: / / Person filling out form: ; Relationship: Thank you for taking the time to fill out this valuable information. This allows us to provide the best

More information

Goal: To identify the extent to which different aspects of brain structure and brain processes might offer explanations for different forms of

Goal: To identify the extent to which different aspects of brain structure and brain processes might offer explanations for different forms of Goal: To identify the extent to which different aspects of brain structure and brain processes might offer explanations for different forms of psychopathology The human brain If genetics play a role, it

More information

Neurological Problems

Neurological Problems Neurological Problems Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme Neurological Problems The child s nervous system may be damaged through:

More information

United Council for Neurologic Subspecialties Geriatric Neurology Written Examination Content Outline

United Council for Neurologic Subspecialties Geriatric Neurology Written Examination Content Outline United Council for Neurologic Subspecialties Geriatric Neurology Written Examination Content Outline REV 3/24/09 The UCNS Geriatric Neurology examination was established to determine the level of competence

More information

Dr Ruwan Parakramawansha MBBS, MD, MRCP(UK),MRCPE, DMT(UK) (2013/04/02)

Dr Ruwan Parakramawansha MBBS, MD, MRCP(UK),MRCPE, DMT(UK) (2013/04/02) DRUGS USED IN MOOD DISORDERS Dr Ruwan Parakramawansha MBBS, MD, MRCP(UK),MRCPE, DMT(UK) (2013/04/02) LEARNING OUTCOMES By the end of the lecture, students will be able to describe the following with regard

More information

Creutzfelt-Jakob Disease (CJD)

Creutzfelt-Jakob Disease (CJD) Creutzfelt-Jakob Disease (CJD) Introduction Creutzfeldt-Jakob disease (CJD) is an illness of the nervous system that causes damage to the brain. (The disease is named after 2 German scientists). CJD is

More information

Piecing the Puzzle Together: Pharmacologic Approaches to Behavioral Management in Autism Spectrum Disorder

Piecing the Puzzle Together: Pharmacologic Approaches to Behavioral Management in Autism Spectrum Disorder Piecing the Puzzle Together: Pharmacologic Approaches to Behavioral Management in Autism Spectrum Disorder Hannah Sauer, PharmD PGY1 Pediatric Pharmacy Resident Mayo Clinic 2015 MFMER slide-1 Objectives

More information

RELATED DISORDERS ADHD. ADHD DSM-IV Criteria

RELATED DISORDERS ADHD. ADHD DSM-IV Criteria RELATED DISORDERS ADHD ADHD DSM-IV Criteria I. Either A or B: A. Inattention: Inattention 1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

More information

Autism: Treatment Trends

Autism: Treatment Trends Lewis County Autism Coalition Friday, November 2 nd, 2012 Autism: Treatment Trends Glenn C. Tripp, M.D. Developmental Behavioral Pediatrics Medical Director, Developmental Services Mary Bridge Children

More information

Developmental Disabilities: Diagnosis and Treatment. Sara Sanders, Psy.D. 03/05/15

Developmental Disabilities: Diagnosis and Treatment. Sara Sanders, Psy.D. 03/05/15 Developmental Disabilities: Diagnosis and Treatment Sara Sanders, Psy.D. 03/05/15 1 Developmental Disability A severe and chronic disability that is attributable to a mental or physical impairment that

More information

Pervasive Developmental Disorders

Pervasive Developmental Disorders Pervasive Developmental Disorders Pervasive Developmental Disorders are characterized by severe and pervasive impairment in several areas of development: reciprocal social interaction skills, communication

More information

Genetic Testing for CHARGE Syndrome. Description

Genetic Testing for CHARGE Syndrome. Description Subject: Genetic Testing for CHARGE Syndrome Page: 1 of 9 Last Review Status/Date: December 2014 Genetic Testing for CHARGE Syndrome Description CHARGE syndrome is a rare genetic condition associated with

More information

Hanan Azouz, Hesham Kouzou,Mona Khalil, Rania Abdou, Mohamed sakr

Hanan Azouz, Hesham Kouzou,Mona Khalil, Rania Abdou, Mohamed sakr Hanan Azouz, Hesham Kouzou,Mona Khalil, Rania Abdou, Mohamed sakr Autism spectrum disorder (ASD), a major neuropsychiatric condition in children, is generally recognized as a developmental condition in

More information

Chapter 13. DiGeorge Syndrome

Chapter 13. DiGeorge Syndrome Chapter 13 DiGeorge Syndrome DiGeorge Syndrome is a primary immunodeficiency disease caused by abnormal migration and development of certain cells and tissues during fetal development. As part of the developmental

More information

Update on Dystonia Samer D. Tabbal, M.D.

Update on Dystonia Samer D. Tabbal, M.D. Update on Dystonia Samer D. Tabbal, M.D. Associate Professor of Neurology May 2016 Director of The Parkinson Disease & Other Movement Disorders Program Mobile: +961 70 65 89 85 email: st45@aub.edu.lb Dystonia

More information