title: Effect of Serotonin 1A Agonists and Selective Serotonin Reuptake Inhibitors on Behavioral and Nighttime Respiratory Symptoms in Rett Syndrome.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan. Electronic address: oonok@med.tottori-u.ac.jp.
authors.forename: Koyo
authors.initials: K
authors.lastname: Ohno
authors.affiliation: Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Riyo
authors.initials: R
authors.lastname: Ueda
authors.affiliation: Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Pediatrics, Tottori Prefectural Central Hospital, Tottori, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Togawa
authors.affiliation: Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Ohmae
authors.affiliation: Division of Otolaryngology, Department of Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Eriko
authors.initials: E
authors.lastname: Matsuda
authors.affiliation: Division of Otolaryngology, Department of Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Misato
authors.initials: M
authors.lastname: Fujiyama
authors.affiliation: Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Maegaki
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D012119:Respiration / Q000187:drug effects*; D015518:Rett Syndrome / Q000503:physiopathology / Q000628:therapy*; D058825:Serotonin 5-HT1 Receptor Agonists / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012890:Sleep / Q000187:drug effects / Q000502:physiology; D012891:Sleep Apnea Syndromes / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D058825:Serotonin 5-HT1 Receptor Agonists; D017367:Selective Serotonin Reuptake Inhibitors
keywords: apneusis; breath holding; decrementing expiratory neurons; polysomnography; post-sigh apnea