CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(11): 950-956
DOI: 10.1590/0004-282X-ANP-2020-0450
Article

Nationwide questionnaire data of 229 Williams-Beuren syndrome patients using WhatsApp tool

Resultados de um questionário nacional de 229 pacientes com síndrome de Williams-Beuren obtidos por WhatsApp
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Unidade de Genética, São Paulo SP, Brazil.
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2   Universidade Federal de Uberlândia, Faculdade de Engenharia Civil, Uberlândia MG, Brazil.
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3   Universidade de Brasília, Brasília DF, Brazil.
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1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Unidade de Genética, São Paulo SP, Brazil.
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1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Unidade de Genética, São Paulo SP, Brazil.
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4   Universidade Presbiteriana Mackenzie, Programa de Pós-Graduação em Distúrbios do Desenvolvimento, São Paulo SP, Brazil.
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5   Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil.
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1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Unidade de Genética, São Paulo SP, Brazil.
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1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Unidade de Genética, São Paulo SP, Brazil.
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1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Unidade de Genética, São Paulo SP, Brazil.
› Institutsangaben

ABSTRACT

Background: Williams-Beuren syndrome is a multisystemic disorder caused by a microdeletion of the 7q11.23 region. Although familial cases with autosomal dominant inheritance have been reported, the vast majority are sporadic. Objective: To investigate the main complaints and clinical findings of patients with Williams-Beuren syndrome. Methods: A total of 757 parents of patients registered in the Brazilian Association of Williams-Beuren Syndrome (ABSW) received a questionnaire via WhatsApp from March to July 2017. Results: In total, 229 parents answered the survey. Age of diagnosis ranged from 2 days to 34 years (median: 3 years). The main clinical findings reported by the parents were abdominal colic (83.3%), failure to thrive (71.5%), feeding difficulty in the first year (68.9%), otitis (56.6%), urinary tract infections (31.9%), precocious puberty (27.1%) and scoliosis (15.9%). Cardiac defects were present in 66% of patients, and the most frequent defect was supravalvular aortic stenosis (36%). Arterial hypertension was reported in 23%. Hypercalcemia was reported in 10.5% of patients, mainly during the first year of life. Hyperacusis and hypersociability were common complaints (both present in 89%). Other behavioral and neuropsychiatric symptoms reported by the parents included attention deficit (89%), anger crises (83%), excessive fear (66%), depression (64%), anxiety (67%) and hypersexuality (33%). The most common complaints were hypersensitivity to sounds, talkative personality, emotional dependence and learning difficulties. In 98.3%, the parents denied family history. Conclusions: Williams-Beuren syndrome requires close follow-up with different medical specialties due to their variable clinical comorbidities, including language and school learning difficulties, behavioral and psychiatric problems.

RESUMO

Antecedentes: A síndrome de Williams-Beauren é doença de acometimento multisistêmico causado pela microdeleção da região 7q11.23. Apesar de haver casos familiares com herança autossômica dominante, a grande maioria dos casos é esporádica. Objetivo: Investigar as principais queixas e achados clínicos da síndrome. Métodos: 757 pais de pacientes inscritos na Associação Brasileira de Síndrome de Williams-Beuren (ABSW) receberam um questionário pelo WhatsApp, entre março e julho de 2017. Resultados: 229 pais de pacientes responderam à pesquisa. A idade de diagnóstico variou de 2 dias até 34 anos (mediana: 3 anos). Os principais achados reportados pelos pais: cólicas abdominais (83,3%), deficiência ponderoestatural (71,5%), dificuldade de alimentação no primeiro ano (68,9%), otite (56,6%), infecções do trato urinário (31,9%), puberdade precoce (27,1%) e escoliose (15,9%). Cardiopatias estavam presentes em 66%, sendo que a mais frequente era a estenose pulmonar supravalvar (36%). Hipertensão arterial foi reportada em 23%. Hipercalcemia foi reportada em 10,5%, principalmente no primeiro ano de vida. Hiperacusia e hiperssociabilidade foram achados comuns (89%). Os principais achados comportamentais e psiquiátricos reportados pelos pais foram: déficit de atenção (89%), crises de raiva (83%), medo excessivo (66%), depressão (64%), ansiedade (67%) e hiperssexualidade (33%). As queixas principais referidas foram hipersensibilidade a sons, personalidade excessivamente amigável, dependência emocional e dificuldades escolares. Em 98,3% dos casos os pais negaram história familial. Conclusões: A síndrome de Williams-Beuren é requer um seguimento e manejo estritos, com diferentes especialidades médicas devido às comorbidades clínicas variadas, que incluem dificuldades de linguagem e aprendizagem escolar, além de dificuldades comportamentais e psiquiátricas.

Authors’ contributions:

LVLP: conceptualization, data curation, methodology, writing of original draft (lead), writing, review & editing (lead); RLR: investigation, methodology (lead), project administration (lead); AMS: methodology, project administration; BDWL: writing of original draft, writing, review & editing; SEP: supervision; MCTVT: investigation, methodology (lead), project administration; MDBL: methodology; RSH: supervision; DRB: supervision (lead); CAK: conceptualization (lead), methodology (lead), supervision (lead).




Publikationsverlauf

Eingereicht: 21. September 2020

Angenommen: 08. April 2021

Artikel online veröffentlicht:
04. Juli 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 Pober BR. Williams-Beuren syndrome. N Engl J Med. 2010 Jan 21;362(3):239-52. https://doi.org/10.1056/NEJMra0903074
  • 2 Twite MD, Stenquist S, Ing RJ. Williams syndrome. Pediatr Anesth. 2019 May;29(5):483-90. https://doi.org/10.1111/pan.13620
  • 3 Honjo RS, Dutra RL, Furusawa EA, Zanardo EA, Costa LSA, Kulikowski LD, et al. Williams-Beuren syndrome: a clinical study of 55 brazilian patients and the diagnostic use of MLPA. Biomed Res Int. 2015;2015:903175. https://doi.org/10.1155/2015/903175
  • 4 Ramírez-Velazco A, Domínguez-Quezada MG. Atypical deletions in Williams-Beuren syndrome. Rev Med Inst Mex Seguro Soc. 2017 sep-Oct;55(5):615-20.
  • 5 Strømme P, Bjømstad PG, Ramstad K. Prevalence estimation of Williams Syndrome. J Child Neurol. 2002 Apr 1;17(4):269-71. https://doi.org/10.1177/088307380201700406
  • 6 Williams JC, Barratt-Boyes BG, Lowe JB. Supravalvular aortic stenosis. Circulation. 1961 Dec;24:1311-8. https://doi.org/10.1161/01.CIR.24.6.1311
  • 7 Beuren AJ, Apitz J, Harmjanz D. Supravalvular aortic stenosis in association with mental retardation and a certain facial appearance. Circulation. 1962 Dec 1;26(6):1235-40. https://doi.org/10.1161/01.CIR.26.6.1235
  • 8 Garcia RE, Friedman WF, Kaback MM, Rowe RD. Idiopathic hypercalcemia and supravalvular aortic stenosis: documentation of a new syndrome. N Engl J Med. 2010 Jul 16;271(3):117-20. https://doi.org/10.1056/NEJM196407162710302
  • 9 Black JA, Carter REB. Association between aortic stenosis and facies of severe infantile hypercalcaemia. Lancet. 1963 Oct 12;2(7311):745-9. https://doi.org/10.1016/S0140-6736(63)90553-1
  • 10 Yuan S-M. Congenital heart defects in Williams syndrome. Turk J Pediatr. 2017;59(3):225-32. https://doi.org/10.24953/turkjped.2017.03.001
  • 11 Ouertani I, Chaabouni M, Chelly I, Kraoua L, Maazoul F, Trabelsi M, et al. Clinical and molecular cytogenetic study of 38 Williams-Beuren syndrome tunisian patients. Open J Genet. 2014 Sep;4(5):385-91. https://doi.org/10.4236/ojgen.2014.45036
  • 12 Committee on Genetics. American academy of pediatrics: health care supervision for children with Williams syndrome. Pediatrics. 2001 May;107(5):1192-204.
  • 13 Thakur D, Martens MA, Smith DS, Roth E. Williams syndrome and music: a systematic integrative review. Front Psychol. 2018 Nov 14;9:2203. https://doi.org/10.3389/fpsyg.2018.02203
  • 14 Martens MA, Wilson SJ, Reutens DC. Research Review: Williams syndrome: a critical review of the cognitive, behavioral, and neuroanatomical phenotype. J Child Psychol Psychiatry. 2008 Jun 1;49(6):576-608. https://doi.org/10.1111/j.1469-7610.2008.01887.x
  • 15 Brock J. Language abilities in Williams syndrome: a critical review. Dev Psychopathol. 2007 Jan;19(1):97-127. https://doi.org/10.1017/S095457940707006X
  • 16 Lough E, Rodgers J, Janes E, Little K, Riby DM. Parent insights into atypicalities of social approach behaviour in Williams syndrome. J Intellect Disabil Res. 2016 Nov;60(11):1097-108. https://doi.org/10.1111/jir.12279
  • 17 Collins RT. Cardiovascular disease in Williams syndrome. Curr Opin Pediatr. 2018 Oct;30(5):609-15. https://doi.org/10.1097/MOP.20200450202004500664
  • 18 Abbas E, Cox DM, Smith T, Butler MG. The 7q11.23 microduplication syndrome: a clinical report with review of literature. J Pediatr Genet. 2016 Sep;5(3):129-40. https://doi.org/10.1055/s-0036-1584361
  • 19 Lasio MLD, Kozel BA. Elastin-driven genetic diseases. Matrix Biol. 2018 Oct;71-72:144-60. https://doi.org/10.1016/j.matbio.2018.02.021
  • 20 Merla G, Brunetti-Pierri N, Piccolo P, Micale L, Loviglio MN. Supravalvular aortic stenosis: elastin arteriopathy. Circ Cardiovasc Genet. 2012 Dec 1;5(6):692-6. https://doi.org/10.1161/CIRCGENETICS.112.962860
  • 21 Furusawa EA, Esposito CSL, Honjo RS, Suzuki L, Leal GN, Kim CA, et al. Diagnosis and management of systemic hypertension due to renovascular and aortic stenosis in patients with Williams-Beuren syndrome. Rev Assoc Med Bras (1992). 2018 Aug;64(8):723-8. https://doi.org/10.1590/1806-9282.64.08.723
  • 22 Del Campo M, Antonell A, Magano LF, Muñoz FJ, Flores R, Bayés M, et al. Hemizygosity at the NCF1 gene in patients with Williams-Beuren syndrome decreases their risk of hypertension. Am J Hum Genet. 2006 Apr 1;78(4):533-42. https://doi.org/10.1086/501073
  • 23 Morris CA, Braddock SR, Council on Genetics. Health care supervision for children with Williams syndrome. Pediatrics. 2020 Feb 1;145(2):e20193761. https://doi.org/10.1542/peds.2019-3761
  • 24 Silva EN, Sousa TRV. Avaliação econômica no âmbito das doenças raras: Isto é possível? Cad Saúde Pública. 2015 Mar;31(3):1-11. Available from: https://doi.org/10.1590/0102-311X00213813
  • 25 Lima SFB, Teixeira MCTV, Carreiro LRR, Seraceni MFF, Kim CA, Segin M, et al. Manejo comportamental de crianças e adolescentes com Síndrome de Williams: guia para professores, pais e cuidadores [Internet]. 1st ed. São Paulo (SP): Memnon Edições Científicas Ltda.; 2013. 47 p. [cited 2021 February 17]. Available from: http://www.swbrasil.org.br/uploads/download/53d97a4ff58de3258a57ec77cdc065d5bfa00e82.pdf
  • 26 Sindhar S, Lugo M, Levin MD, Danback JR, Brink BD, Yu E, et al. Hypercalcemia in patients with Williams-Beuren Syndrome. J Pediatr. 2016 Nov;178:254-60. https://doi.org/10.1016/j.jpeds.2016.08.027
  • 27 Varma TH, Sahitya DSK, Dusad S, Agarwal A, Dayal D. Oral prednisolone for management of persistent hypercalcemia afterhypercalcemic crisis in the Williams-Beuren syndrome. Pediatr Endocrinol Diabetes Metab. 2018;24(2):106-9. https://doi.org/10.18544/PEDM-24.02.0109
  • 28 Baştuğ F, Nalçacıoğlu H, Baş VN, Tekatlı-çelik B, Çetinkaya H, Yel S. Acute renal failure due to severe hypercalcemia and nephrocalcinosis treated with two doses of pamidronate in an infant with Williams-Beuren syndrome. Turk J Pediatr. 2018;60(2):210-5. https://doi.org/10.24953/turkjped.2018.02.017
  • 29 Kutilek S, Plasilova I, Chrobok V. Two different causes of Paediatric Hypercalcaemia. Sultan Qaboos Univ Med J. 2018 Aug;18(3):e389-92. https://doi.org/10.18295/squmj.2018.18.03.022
  • 30 Lense MD, Dykens EM. Beat perception and sociability: evidence from Williams Syndrome. Front Psychol. 2016 Jun 20;7:886. https://doi.org/10.3389/fpsyg.2016.00886
  • 31 Niego A, Benítez-Burraco A. Williams Syndrome, human self-domestication, and language evolution. Front Psychol. 2019 Mar 18;10:521. https://doi.org/10.3389/fpsyg.2019.00521
  • 32 Doyle TF, Bellugi U, Korenberg JR, Graham J. “Everybody in the world is my friend” hypersociability in young children with Williams syndrome. Am J Med Genet. 2004 Jan 30;124A(3):263-73. https://doi.org/10.1002/ajmg.a.20416
  • 33 Royston R, Waite J, Howlin P. Williams syndrome: recent advances in our understanding of cognitive, social and psychological functioning. Curr Opin Psychiatry. 2019 Mar;32(2):60-6. https://doi.org/10.1097/YCO.20200450202004500477
  • 34 Lough E, Fisher MH. Parent and Self-Report ratings on the perceived levels of social vulnerability of adults with Williams Syndrome. J Autism Dev Disord. 2016 Nov;46(11):3424-33. https://doi.org/10.1007/s10803-016-2885-3
  • 35 Watson SL, Richards DA, Miodrag N, Fedoroff JP. Sex and genes, part 1: sexuality and down, Prader-Willi, and Williams syndromes. Intellect Dev Disabil. 2012 Apr 1;50(2):155-68. https://doi.org/10.1352/1934-9556-50.2.155
  • 36 Paula CS, Bordin IAS, Mari JJ, Velasque L, Rohde LA, Coutinho ESF. The mental health care gap among children and adolescents: data from an epidemiological survey from four Brazilian regions. PLoS One. 2014 Feb 18;9(2):e88241. https://doi.org/10.1371/journal.pone.0088241
  • 37 Ng R, Bellugi U, Järvinen A. Anxiety and autonomic response to social-affective stimuli in individuals with Williams syndrome. Res Dev Disabil. 2016 Dec;59:387-98. https://doi.org/10.1016/j.ridd.2016.08.017
  • 38 Van Herwegen J, Ashworth M, Palikara O. Parental views on special educational needs provision: Cross-syndrome comparisons in Williams Syndrome, Down Syndrome, and Autism Spectrum Disorders. Res Dev Disabil. 2018 Sep;80:102-11. https://doi.org/10.1016/j.ridd.2018.06.014
  • 39 Lima SFB, Teixeira MCTV, Segin M, Carreiro LRR. Recomendações psicopedagógicas para o trabalho da equipe educacional com escolares com síndrome de Williams. Rev Psicopedag. 2012;29(88):74-6.
  • 40 Lima SFB, Carreiro LRR, Seraceni MFF, Khoury LP, Braga AC, Araújo MV de, et al. Inattention and hyperactivity behavioral pattern of a child with Williams Syndrome. Clin Case Stud. 2012 Aug 4;11(4):312-25. https://doi.org/10.1177/1534650112457020