ABSTRACT
Global developmental delay (GDD) and intellectual development disorder (IDD) are common but heterogeneous pediatric conditions. Guided by a rigorous clinical and anamnestic examination, the diagnostic approach is a dynamic process which is not limited to the intelligence quotient measurement. A large panel of paraclinical tests allows etiological exploration; this generally includes biological, genetic, metabolic and iconographic examinations. To maximize therapeutic efficiency and standardize practices, this document provides a guideline for the management of pediatric GDD/IDD.
Le retard global du développement (RGD) et le trouble du développement intellectuel (TDI) forment un groupe hétérogène de pathologies pédiatriques relativement fréquentes. Orientée par un examen clinique et anamnestique rigoureux, la démarche diagnostique est un processus dynamique qui ne se limite pas au quotient intellectuel. Son exploration étiologique est menée à travers un large panel d'examens paracliniques qui comprend généralement des examens biologiques, génétiques, métaboliques et iconographiques. Afin d'optimiser le rendement thérapeutique et d'homogénéiser les pratiques, ce document propose un cadre pour la mise au point des RGD/TDI en pédiatrie.
Subject(s)
Developmental Disabilities , Intellectual Disability , Child , Cognition , Developmental Disabilities/diagnosis , Developmental Disabilities/etiology , Family , Humans , Intellectual Disability/diagnosis , Intellectual Disability/etiologyABSTRACT
A case of Refsum's disease treated by serial plasma exchanges together with a moderate low phytanate diet is reported. Serial plasma exchanges determined a rapid significant clinical improvement (neuropathy and cerebellar ataxia) that allowed immediate return to full-time employment. The initial improvement could be maintained by intermittent serial plasmapheresis despite partial failure of the initially introduced low phytanate diet bringing 20 mg phytanic acid daily. A new dietary regimen bringing 10 mg phytanic acid was later introduced that was well tolerated. No liquid formula was used. The clinical improvement was clearly correlated to a fall in serum phytanic acid from 45.3 to 16.2 mg/100 ml.
