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Odedra A, Blumenow W, Dainty J, Dasgupta S, Dominguez-Gonzalez S, Gonzalez-Martin J, Hartley H, Kelly M, McKay VH, Sharma R, Spinty S, Fattah AY. Multidisciplinary Care for Moebius Syndrome and Related Disorders: Building a Management Protocol. J Clin Med 2024; 13:3309. [PMID: 38893020 PMCID: PMC11172851 DOI: 10.3390/jcm13113309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/18/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Moebius syndrome is a collection of orofacial anomalies with highly variable features affecting many different systems but characterised by bilateral facial palsy and absent eye abduction. We largely regard Moebius syndrome as a diagnosis of exclusion. Lack of awareness and knowledge means that children often fall between services, leading to treatment delays and difficulty interfacing with social care and schools, with long-term impact on physical health and psychosocial development. We developed a multidisciplinary team comprising core clinicians (lead physician, geneticist, speech and language therapist, psychologist and specialist nurse) and an expanded group to encompass the other affected systems. The interactions between our specialties lead to the development of a treatment protocol, which we present. The protocol harnesses the aspects of care of children with a range of other rare diseases at a specialised paediatric centre and synthesises them into a holistic approach for MBS and related conditions. Management is sequenced on an "ABC-style" basis, with airway, feeding, vision and speech taking priority in the early years. We define management priorities as airway stabilisation with swallow assessment, ocular surface protection and maintenance of nutritional support. Management principles for issues such as speech, reflux, drooling and sleep issues are outlined. In later years, psychological support has a prominent role geared towards monitoring and interventions for low mood, self-esteem and bullying.
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Affiliation(s)
- Amar Odedra
- Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Wendy Blumenow
- Department of Speech and Language Therapy, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK;
| | - Jennifer Dainty
- Department of Psychology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Soumit Dasgupta
- Department of Audiology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Susana Dominguez-Gonzalez
- Department of Orthodontics and Paediatric Dentistry, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Jose Gonzalez-Martin
- Department of Ophthalmology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Helen Hartley
- Therapy Department, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Maria Kelly
- Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Victoria H. McKay
- Department of Genetics, Liverpool Women’s Hospital, Liverpool L8 7SS, UK
| | - Ravi Sharma
- Ear Nose and Throat Department, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Stefan Spinty
- Department of Paediatric Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Adel Y. Fattah
- Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
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Brockmann K, Kaulfuß S. Moebius syndrome and gastroschisis-The second case of a rare association. Am J Med Genet A 2024; 194:111-114. [PMID: 37743766 DOI: 10.1002/ajmg.a.63411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center, Göttingen, Germany
| | - Silke Kaulfuß
- Institute of Human Genetics, University Medical Center, Göttingen, Germany
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Nguyen GV, Goncalves LF, Vaughn J, Friedman N, Wickland J, Cornejo P. Prenatal diagnosis of Poland-Möbius syndrome by multimodality fetal imaging. Pediatr Radiol 2023; 53:2144-2148. [PMID: 37423914 DOI: 10.1007/s00247-023-05712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
We describe prenatal diagnosis of Poland-Möbius syndrome using a combination of ultrasound and MRI. Poland syndrome was diagnosed based on absence of the pectoralis muscles associated with dextroposition of the fetal heart and elevation of the left diaphragm. Associated brain anomalies that led to the diagnosis of Poland-Möbius syndrome, included ventriculomegaly, hypoplastic cerebellum, tectal beaking, and a peculiar flattening of the posterior aspect of the pons and medulla oblongata, which has been reported by postnatal diffusion tensor imaging studies as a reliable neuroimaging marker for Möbius syndrome. Since abnormalities of cranial nerves VI and VII may be difficult to detect prenatally, careful attention to the appearance of the brain stem as illustrated in the current report may aid in the prenatal diagnosis of Möbius syndrome.
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Affiliation(s)
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA.
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA.
- Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA.
- Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA.
| | - Jennifer Vaughn
- Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA
- Department of Neuroradiology, Barrow Neurological Institute at Phoenix Children's, Phoenix, AZ, USA
| | - Neil Friedman
- Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's, Phoenix, AZ, USA
| | - Jessica Wickland
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Neonatology, Phoenix Children's, Phoenix, AZ, USA
| | - Patricia Cornejo
- Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Scottsdale, AZ, USA
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Rawhani R, Sharma K, Maertens P. Echoencephalography of Möbius sequence: A congenital cranial dysinnervation disorder with brainstem calcifications. J Neuroimaging 2023; 33:35-43. [PMID: 36349559 DOI: 10.1111/jon.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Möbius sequence (MBS) previously known as Möbius syndrome is a rare nonprogressive developmental defect of the rhombencephalon leading to congenital abducens (VIth) and facial (VIIth) nerve palsy. Echoencephalography is the first, safe, noninvasive, and cost-effective imaging modality available at bedside. No study on the use of echoencephalography in neonates for the diagnosis of MBS has been previously reported. METHODS In this single tertiary center study, more than 18,000 neonates underwent echoencephalographic imaging over the span of two decades. Imaging was performed through the anterior, posterior, and lambdoid fontanelles. All neonates found to have calcifications of brainstem tegmental nuclei underwent additional imaging studies. Each neonate with MBS was carefully examined by the same investigator. RESULTS Five neonates were shown to have punctate, bilateral, symmetrical tegmental pontine calcifications through all three acoustic windows. These calcifications extended caudally in most patients, and rostrally in 2 patients. Brainstem hypoplasia was best seen through the posterior fontanelle. Three out of five infants were noted to have brainstem hypoplasia with straightening of the floor of the fourth ventricle. In two children, facial collicular bulges and hypoglossal eminences were present. All five infants fulfilled clinical diagnostic criteria of MBS. In addition, a wide array of cerebral defects is identified. Echoencephalographic findings were confirmed by other imaging modalities. CONCLUSION Knowledge of echoencephalographic features of MBS should improve its early recognition. A detailed description of the various imaging phenotypes of MBS is necessary to characterize the etiology of this heterogeneous congenital cranial dysinnervation disorder.
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Affiliation(s)
- Ramez Rawhani
- Department of Pediatrics, University of South Alabama, Mobile, Alabama, USA
| | - Kamal Sharma
- Department of Pediatrics, Pediatric Critical Care Division, University of South Alabama, Mobile, Alabama, USA
| | - Paul Maertens
- Department of Neurology, Child Neurology Division, University of South Alabama, Mobile, Alabama, USA
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Monawwer SA, Ali S, Naeem R, Ali SH, Rabbani A, Khan M, Qazi SS, Shah SMI, Farooqui SK. Moebius Syndrome: An Updated Review of Literature. Child Neurol Open 2023; 10:2329048X231205405. [PMID: 37868706 PMCID: PMC10588417 DOI: 10.1177/2329048x231205405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 10/24/2023] Open
Abstract
Moebius Syndrome, is a rare, non-progressive congenital neuropathological syndrome characterized primarily by the underdevelopment of the facial (CN VII) and abducens nerve (CN VI). Other features of Moebius Syndrome include facial nerve paresis, ophthalmoplegias, orthodontic deficiencies (including crowded dentition, swollen and hyperplastic gingiva, dental calculus, etc.), musculoskeletal abnormalities, and impaired mental function. Due to the rarity of the disorder, very few case studies have been reported in the literature. This article summarizes the significant features of the disease according to commonalities in reported cases, along with several newly recognized features cited in recent literature. We have explored the different diagnostic criteria and the newly recognized imaging modalities that may be used. Understandably, the condition detrimentally affects a patient's quality of life; thus, treatment measures have also been outlined. This study aims to provide updated literature on Moebius Syndrome MBS and improve understanding of the condition.
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Affiliation(s)
| | - Sajjad Ali
- Department of Internal Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Raahim Naeem
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Hasan Ali
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Azkah Rabbani
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Maria Khan
- Department of Internal Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Saba Saleem Qazi
- Department of Internal Medicine, Ziauddin Medical University, Karachi, Pakistan
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Belluardo M, De Stefani E, Barbot A, Bianchi B, Zannoni C, Ferrari A, Rayson H, Di Nuovo S, Belluardo G, Sessa P, Ferrari PF. Facial Expression Time Processing in Typical Development and in Patients with Congenital Facial Palsy. Brain Sci 2022; 12:516. [PMID: 35624903 PMCID: PMC9138467 DOI: 10.3390/brainsci12050516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 01/27/2023] Open
Abstract
Temporal dynamics of behavior, particularly facial expressions, are fundamental for communication between individuals from very early in development. Facial expression processing has been widely demonstrated to involve embodied simulative processes mediated by the motor system. Such processes may be impaired in patients with congenital facial palsy, including those affected by Moebius syndrome (MBS). The aims of this study were to investigate (a) the role of motor mechanisms in the processing of dynamic facial expression timing by testing patients affected by congenital facial palsy and (b) age-dependent effects on such processing. Accordingly, we recruited 38 typically developing individuals and 15 individuals with MBS, ranging in age from childhood to adulthood. We used a time comparison task where participants were asked to identify which one of two dynamic facial expressions was faster. Results showed that MBS individuals performed worse than controls in correctly estimating the duration of facial expressions. Interestingly, we did not find any performance differences in relation to age. These findings provide further evidence for the involvement of the motor system in processing facial expression duration and suggest that a sensorimotor matching mechanism may contribute to such timing perception from childhood.
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Affiliation(s)
- Mauro Belluardo
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy; (E.D.S.); (A.F.)
| | - Elisa De Stefani
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy; (E.D.S.); (A.F.)
- Unit of Paediatric Neuropsychiatry, Reggio Emilia Hospital, 42019 Scandiano, Italy
| | - Anna Barbot
- Unit of Audiology and Paediatric Otorhinolaryngology, University Hospital of Parma, 43125 Parma, Italy;
| | - Bernardo Bianchi
- Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University of Parma, 43125 Parma, Italy; (B.B.); (C.Z.)
| | - Cecilia Zannoni
- Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University of Parma, 43125 Parma, Italy; (B.B.); (C.Z.)
| | - Alberto Ferrari
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy; (E.D.S.); (A.F.)
| | - Holly Rayson
- Institut des Sciences Cognitives Marc Jeannerod, CNRS/Université Claude Bernard Lyon, 69675 Bron, France;
| | - Santo Di Nuovo
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy;
- Italian Association of Psychology (AIP), 00186 Rome, Italy
| | - Giovanni Belluardo
- Department of Political Sciences, University of Catania, 95131 Catania, Italy;
- EGLE Institute of Psychology and Psychotherapy, 95131 Catania, Italy
| | - Paola Sessa
- Department of Developmental Psychology and Socialization, University of Padova, 35131 Padova, Italy;
| | - Pier Francesco Ferrari
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy; (E.D.S.); (A.F.)
- Institut des Sciences Cognitives Marc Jeannerod, CNRS/Université Claude Bernard Lyon, 69675 Bron, France;
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Lehky T, Joseph R, Toro C, Wu T, Van Ryzin C, Gropman A, Facio FM, Webb BD, Jabs EW, Barry BS, Engle EC, Collins FS, Manoli I. Differentiating Moebius syndrome and other congenital facial weakness disorders with electrodiagnostic studies. Muscle Nerve 2021; 63:516-524. [PMID: 33389762 DOI: 10.1002/mus.27159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Congenital facial weakness (CFW) can result from facial nerve paresis with or without other cranial nerve and systemic involvement, or generalized neuropathic and myopathic disorders. Moebius syndrome is one type of CFW. In this study we explored the utility of electrodiagnostic studies (EDx) in the evaluation of individuals with CFW. METHODS Forty-three subjects enrolled prospectively into a dedicated clinical protocol and had EDx evaluations, including blink reflex and facial and peripheral nerve conduction studies, with optional needle electromyography. RESULTS MBS and hereditary congenital facial paresis (HCFP) subjects had low-amplitude cranial nerve 7 responses without other neuropathic or myopathic findings. Carriers of specific pathogenic variants in TUBB3 had, in addition, a generalized sensorimotor axonal polyneuropathy with demyelinating features. Myopathic findings were detected in individuals with Carey-Fineman-Ziter syndrome, myotonic dystrophy, other undefined myopathies, or CFW with arthrogryposis, ophthalmoplegia, and other system involvement. DISCUSSION EDx in CFW subjects can assist in characterizing the underlying pathogenesis, as well as guide diagnosis and genetic counseling.
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Affiliation(s)
- Tanya Lehky
- EMG Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Reversa Joseph
- EMG Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.,Chalmers P. Wylie Veterans Administration, Columbus, Ohio, USA
| | - Camilo Toro
- Undiagnosed Disease Program, OCD, NHGRI, NIH, Bethesda, Maryland, USA
| | - Tianxia Wu
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Carol Van Ryzin
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea Gropman
- Neurodevelopmental Pediatrics and Neurogenetics, Children's National Medical Center, Washington, District of Columbia, USA
| | - Flavia M Facio
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Bryn D Webb
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ethylin W Jabs
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brenda S Barry
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA.,Howard Hughes Medical Institute, Chevy Chase, Maryland, USA
| | - Elizabeth C Engle
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA.,Howard Hughes Medical Institute, Chevy Chase, Maryland, USA.,Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Francis S Collins
- Medical Genomics and Metabolic Genetics Branch, Immediate Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Irini Manoli
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
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