Effect of Serotonin 1A Agonists and Selective Serotonin Reuptake Inhibitors on Behavioral and Nighttime Respiratory Symptoms in Rett Syndrome

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• 作者：Koyo Ohno ; MD^a ; ^{oonok@med.tottori-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Yoshiaki Saito ; MD ; PhD^a ; Riyo Ueda ; MD^a ; Masami Togawa ; MD^a ; ^b ; Takanori Ohmae ; MD^a ; Eriko Matsuda ; MT^c ; Misato Fujiyama ; MT^c ; Yoshihiro Maegaki ; MD ; PhD^a
• 关键词：polysomnography ; post-sigh apnea ; decrementing expiratory neurons ; breath holding ; apneusis
• 刊名：Pediatric Neurology
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：60
• 期：Complete
• 页码：54-59.e1
• 全文大小：1265 K

文摘

Rett syndrome is characterized by psychomotor regression during early childhood, autistic-like behaviors, and aberrant breathing patterns. Dysfunction of the serotonergic system has been postulated to play a role in the pathophysiology of these symptoms.

Patient Description

We present an 11-year-old girl with Rett syndrome who exhibited marked respiratory symptoms, including frequent apneic events during sleep. She had been treated for these respiratory symptoms using noninvasive positive pressure ventilation since age six years. Treatment with serotonin 1A receptor agonist was initiated at age eight years, whereas treatment using a selective serotonin reuptake inhibitor began at age nine years. Noninvasive positive pressure ventilation therapy was effective in reducing symptoms of sleep apnea, and administration of serotonergic agents resulted in amelioration of sleep apneic events even in the absence of noninvasive positive pressure ventilation. In addition, improvements in hand stereotypy and social skills were observed after initiation of serotonin-based therapy.

Discussion

The respiratory difficulties our patient experienced during non-rapid eye movement (REM) sleep are characteristic of post-sigh central apnea. Exaggerated activity of expiratory neurons during such apneic events has been observed in mouse models of Rett syndrome. We suggest that prescribed serotonergic agents might serve to inhibit such activity, attenuating the imbalance between inspiratory and expiratory neurons. These agents might also be useful in the treatment of autistic-like behaviors caused by impaired serotonergic transmission in the brain.