Abstract Details
10/10/2023 | 2:00 PM - 2:25 PM | 6619
Targeted therapies for behavioral disorders among children with congenital CMV infection
Abstract Summary
Background: Children with congenital CMV (cCMV) infection are frequently diagnosed with behavioural disorders such as oppositional defiant disorder (ODD), attention deficit hyperactivity disorder (ADHD), or autism spectrum disorder (ASD). However, these presentations may be due to an underlying sensory integration disorder, from the effects of CMV on the developing hearing, vestibular, proprioceptive, and olfactory systems. The objective of this study was to describe the evaluation and treatment of children with cCMV infection and behavioural disorders at a single center. Methods: Medical records of children with cCMV followed in the CIME CMV clinic (Montreal) were reviewed between 2008-2021 (retrospective review). Since 2018, children with suspected behavioural disorders have been referred for assessment by a developmental pediatric clinic with expertise in congenital infections (prospective evaluation). Their diagnoses, as well as targeted medical interventions, are described. Results: In the total cohort (n=85, retrospective review), 12 (15%) were diagnosed with a behavioural disorder, including 4 with ADHD, 2 ASD, 1 ODD; and 11 behavioural disorder non-specified. Of these, only 1 was asymptomatic at birth; 7 had hearing loss, and 9 had abnormal neuroimaging. Of the eleven (age >4 years) referred for prospective evaluation, 8 were diagnosed with sensory integration disorder (SID) with ADHD, 2 ADHD alone, and 1 with attachment disorder. All 8 with SID/ADHD responded to treatment with a combination of non-stimulant (Guanfacine or Clonidine) and a stimulant (Biphentin or Vyvanse), with behavioural adaptation (ex: weighted blankets, hammocks), while those with ADHD alone responded to stimulant medications alone. Discussion: The majority of children with cCMV referred for behavioural disorders demonstrated SID, though previously labelled as ADHD, ODD and ASD. The addition of non-stimulant medications and behavioural adaptation was necessary to address the hypersensitivity underlying behavioural outbursts. Future work needs to be directed towards understanding SID and therapeutic interventions among children with cCMV.
Learning Objectives
- To describe commonly diagnosed behavioural disorders among children with congenital CMV infection.
- To review how CMV infection can manifest at sensory integration disorders with dysregulated behaviour in childhood.
- To describe the combined use of both stimulant and non-stimulant medications for behavioural disorders among children with cCMV
Presentation
3440589_16088AlejandraSandoval Carmona.pdf
Handouts
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Presenters
Alejandra Sandoval Carmona | Primary Presenter, Author
carmen.alejandra.sandoval@umontreal.ca;
Fellow in Pediatric and Neonatology Infectieuses Diseases CHU Sainte-Justine, Université de Montréal, Canada.
Interest during the fellowship in all congenital infections, especially in CMV, on which his fellowship research has been focused
ASHA DISCLOSURE
Financial - No relevant financial relationship exists.
Nonfinancial - No relevant nonfinancial relationship exists.
AAA DISCLOSURE
Financial - Receives support from non financial for non financial.
Jean-François Chicoine | Author, Co-Author
doc.chic@lemondeestailleurs.com;
Pediatrician at the CHU Sainte-Justine and associate professor in the department of pediatrics at the University of Montreal.
He now exercises his clinical with hospitalized children as well as in outpatient pediatrics, adoption, international health consultations and especially in the problems of development and attachment of children affected by congenital infections
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Sandra Caron | Author, Co-Author
sandra.caron.hsj@ssss.gouv.qc.ca;
Nurse at the CHU Sainte-Justine in infectious diseases. Her career focuses primarily on children with problems of development and attachment
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Christian Renaud | Co-Author
christian.renaud@umontreal.ca;
Christian Renaud is a pediatric infectious diseases specialist and medical microbiologist, who specialises in paediatric virology.
ASHA DISCLOSURE
Financial - No relevant financial relationship exists.
Nonfinancial - No relevant nonfinancial relationship exists.
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Soren Gantt | Co-Author
soren.gantt.med@ssss.gouv.qc.ca;
Dr. Gantt is a Pediatric Infectious Diseases specialist, the Director of Clinical Research at CHU Sainte-Justine, and Full Professor in the Departments of Microbiology, Infectious Diseases & Immunology and of Pediatrics at the University of Montreal. Dr. Gantt’s current research focuses primarily on the development of CMV vaccines as well as newborn CMV screening programs.
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - Receives support from Moderna, Merck, GSK, VBI, Pfizer, Altona, Meridian Biosciences, CMV Canada, National CMV Foundation for Consultant (Moderna, Merck, GSK) Research support (Moderna, Merck, GSK, VBI, Altona, Meridian) Advisory Board (CMV Canada, National CMV Foundation).
Fatima Kakkar | Co-Presenter, Author, Co-Author
fatima.kakkar@umontreal.ca;
Dr Fatima Kakkar is a pediatric infectious diseases specialist and clinician-researcher in congenital infectious at Sainte-Justine University Health Center in Montreal, Canada, and Associate Professor of Pediatrics at the University of Montreal. Since 2017, she has co-directed the Women and Children’s Infectious Diseases Center “Centre d’infectiologie mère-enfant”, which provides care for infants affected by congenital infections in pregnancy. Her clinical and research
ASHA DISCLOSURE
Financial - No relevant financial relationship exists.
Nonfinancial - No relevant nonfinancial relationship exists.
AAA DISCLOSURE
Financial - Receives support from Altona Diagnostics for Support for CMV testing kits (donated in kind).