09.02.2014 Views

COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

464<br />

Mental retardation<br />

(FAS), the most serious case of FASD [5]. Several years<br />

later, Jones and Smith [6] and Jones et al. [7] of the<br />

United States brought this disorder to the attention of<br />

the professional community by publishing their ®ndings<br />

in the Lancet and naming this disorder `Fetal Alcohol<br />

Syndrome'. They observed that infants with dysmorphic<br />

features and growth retardation were being born to<br />

mothers who abused alcohol during pregnancy. Naming<br />

this disorder brought to the attention of the community<br />

the fact that alcohol use and abuse during pregnancy is a<br />

serious public health hazard, and should be avoided in<br />

those who are pregnant, or expecting to become<br />

pregnant. The identi®cation of this disorder also brought<br />

to the forefront the very serious problem of alcohol<br />

abuse and addiction in women and men of childbearing<br />

age, making it a `family disease'.<br />

Definitions and diagnostic issues<br />

Diagnosis, and what diagnostic labels actually refer to<br />

functionally in individuals affected, is an intensely<br />

studied area in the ®eld of alcohol-related teratogenesis.<br />

The term fetal alcohol effects (FAE) was widely used in<br />

research and became a useful clinical term to describe<br />

any alcohol-related disorder that is not speci®cally FAS.<br />

The term is being used less often in favor of other less<br />

ambiguous terms. In an effort at avoiding confusion and<br />

providing organization and coherency to research ®ndings<br />

regarding diagnostic issues, Congress mandated the<br />

Institute of Medicine (IOM) of the National Academy of<br />

Sciences in 1996, to study FAS and related disorders [8].<br />

The IOM arrived at ®ve categories of alcohol-related<br />

disability, which are summarized as follows:<br />

(i)<br />

(ii)<br />

FAS, with con®rmed maternal alcohol exposure:<br />

evidence of a characteristic pattern of facial<br />

anomalies, such as small palpebral ®ssures, thin<br />

upper lip, ¯attened ®ltrum and midface; evidence<br />

of growth retardation; and neurodevelopmental<br />

disability such as microcephaly, structural brain<br />

anomalies, or neurological hard signs;<br />

FAS, without con®rmed maternal alcohol exposure:<br />

the use of the same criteria as (i) without con®rmed<br />

maternal alcohol exposure;<br />

(iii) partial FAS, with con®rmed maternal alcohol<br />

exposure: some components of the characteristic<br />

facial anomalies, evidence of growth retardation,<br />

central nervous system (CNS) neurodevelopmental<br />

abnormalities, a complex pattern of behavior or<br />

cognitive abnormality that is inconsistent with<br />

developmental level and cannot be explained by<br />

familial background or environment;<br />

(iv) Alcohol-related birth defects (ARBD): the presence<br />

of congenital anomalies, malformations or dysplasias<br />

arising as a consequence of prenatal alcohol exposure;<br />

(v) Alcohol-related neurodevelopmental disorder<br />

(ARND): evidence of CNS neurodevelopmental<br />

abnormalities such as decreased cranial size, structural<br />

brain anomalies, presence of neurological hard<br />

or soft signs, or a complex pattern of behavioral or<br />

cognitive abnormalities inconsistent with developmental<br />

level, which cannot be explained by familial<br />

background or environment [9].<br />

These de®ned categories continue to be used to<br />

speci®cally communicate the impairment of the prenatally<br />

alcohol exposed individual. However, it is generally<br />

accepted that there is a continuum of disability from lethal<br />

and not consistent with life, to severe, moderate, and mild<br />

effects that can still leave the individual quite disabled.<br />

FASD, a new term introduced by O'Malley and<br />

colleagues, refers to all of the prenatal alcohol-related<br />

disorders: including FAS, ARND, alcohol-related birth<br />

defects (ARBD) and FAE. This term implies that the<br />

disabilities related to prenatal alcohol exposure can occur<br />

across a continuum and overlap across behavioral,<br />

emotional, cognitive, social and physical domains of the<br />

same individual. Astley and Clarren [10,11 . ] have<br />

created a diagnostic system based on the degree to<br />

which the facial dysmorphic features, growth retardation,<br />

and CNS involvement exists as a consequence of<br />

prenatal alcohol exposure.<br />

Despite the necessity of being con®ned by labels,<br />

improved diagnostic accuracy, consistency and clarity is<br />

provided by an active research community that continues<br />

to move forward in ®ne-tuning our understanding<br />

of this spectrum of disorders.<br />

Prevalence<br />

Determining the prevalence of FASD worldwide is<br />

dif®cult, as a result of differences in maternal alcohol<br />

consumption from region to region, the variability of the<br />

criteria that are being used for its de®nition, and<br />

dif®culties determining a diagnosis of FASD at birth.<br />

However, on the basis of studies by Sampson and<br />

colleagues [12] it is estimated that there are approximately<br />

one to three infants born with FAS per 1000 live<br />

deliveries. The rate of occurrence of both FAS and<br />

ARND in the Seattle study is estimated to be 9.1 per<br />

1000 cases, or approximately one child in 100 live births<br />

with FASD [12]. In other areas of the world, owing to<br />

harsh economic circumstances, the incidence of FAS can<br />

be staggeringly high. For example, evaluation of all ®rst<br />

grade children in a Western Cape community in South<br />

Africa resulted in 48 out of 1000 children meeting criteria<br />

for FAS [12].<br />

Susceptibility factors to alcohol-induced<br />

neurotoxicity<br />

The cause of alcohol's deleterious effects on the CNS<br />

appears to be multifactorial, with fetuses differentially

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!