title: Twenty years of surveillance in Rett syndrome: what does this tell us?
abstract: BACKGROUND
  The clinical characteristics of children diagnosed with Rett syndrome are well described. Survival and how these characteristics persist or change in adulthood are less well documented. This study aimed to describe overall survival and adult health in those with Rett syndrome.
  
  
  METHODS
  Using the Kaplan-Meier method, we estimated survival of individuals registered with the Australian Rett syndrome Database (ARSD) who had been followed for up to 20 years (n = 396). We then conducted logistic and linear regression analyses investigating epilepsy, musculoskeletal, gastrointestinal, autonomic dysfunction and behaviour of individuals aged 18 years and over using cross sectional cohorts from the ARSD (n = 150) and the international database InterRett (n = 273).
  
  
  RESULTS
  The likelihood of survival was 77.6% at 20 years, 71.5% at 25 years and 59.8% at 37 years. The median age of the combined cross-sectional cohort was 25 years (range 18 to 54 years), the majority (71%) were living in their parental home and the remainder being cared for in group homes or other institutions. Just over half walked either independently (18%) or with assistance (43%). The majority (86%) had scoliosis with 40% of those having undergone corrective surgery. Almost two-thirds (64%) of the women were taking anti-epileptic medications at the time of data collection. Constipation was highly prevalent (83%) and many experienced bloating (53%). Biliary dyskinesia, inflammation or infection of the gallbladder was reported for 20 women (5%) and of those 13 had undergone gallbladder surgery. Sleep disturbance was relatively common (63%), and adverse mood events and anxiety were slightly more prevalent in those aged 26-30 years in comparison to the younger and older age groups. Other frequently reported medical conditions included urinary tract infections, pneumonia and other respiratory conditions.
  
  
  CONCLUSIONS
  Survival in Rett syndrome has now been estimated with the most accurate follow up to date. During adulthood, continuation of multidisciplinary services and programs is necessary to optimise health and wellbeing.
authors.forename: Alison
authors.initials: A
authors.lastname: Anderson
authors.forename: Kingsley
authors.initials: K
authors.lastname: Wong
authors.forename: Peter
authors.initials: P
authors.lastname: Jacoby
authors.forename: Jenny
authors.initials: J
authors.lastname: Downs
authors.affiliation: Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, WA 6872, Australia. helen.leonard@telethonkids.org.au.
authors.forename: Helen
authors.initials: H
authors.lastname: Leonard
mesh_terms: D001315:Australia; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D011159:Population Surveillance; D015518:Rett Syndrome / Q000453:epidemiology* / Q000503:physiopathology; D016019:Survival Analysis