- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02738281
Natural History of Rett Syndrome & Related Disorders
August 3, 2021 updated by: Alan Percy, University of Alabama at Birmingham
Rett Syndrome, MECP2 Duplication Disorder, and Rett- Related Disorders Natural History Protocol
The purpose of this study is to advance understanding of the natural history of Rett syndrome (RTT), MECP2-duplication disorder (MECP2 Dup), CDKL5, FOXG1, and individuals with MECP2 mutations who do not have RTT including the range of clinical involvement and to correlate genotype-phenotype over a broad spectrum of phenotypes.
While much has been learned about RTT, improvements are required in understanding the role of factors such as X chromosome inactivation, genetic background, and others including the environment, on the great variability observed even between individuals with the same MECP2 mutation.
These data will be essential to the development and conduct of clinical trials that are anticipated from ongoing studies in animal models for RTT.
This study will not include clinical trials, but should set the stage for such trials and other translational research projects (e.g., development of biomarkers).
Study Overview
Status
Completed
Detailed Description
At the present time, effective treatments for RTT, MECP2 Dup, or Rett-related disorders are lacking.
Substantial progress has been made in RTT over the past eleven years such that this study represents a narrowing of focus to mutations or duplications of the MECP2 gene and related disorders, including those with phenotypic overlap.
Understanding of RTT has advanced remarkably well through the Rett Syndrome Natural History Clinical Protocol (NHS) and correspondingly advancement in the basic science realm has moved forward with equivalent success.
Thus, progress in clinical and basic science has led to the establishment of clinical trials and other translational studies that hold promise for additional clinical trials in future.
In the process, however, additional MECP2- and RTT-related disorders that were unknown at the time the original proposal have been identified.
In addition, substantial clinical variability in individuals with RTT that cannot be explained by differences in mutations alone must be explored further.
In fact, variability among individuals with identical mutations has led to the search for additional explanations.
At the time of the initial application (2002), just three years after the identification of the gene, MECP2, as the molecular link to RTT, the variation in clinical disorders related to MECP2 mutations or to the related but quite different MECP2 Dup were unknown.
Each disorder is characterized by significant neurodevelopmental features related either to alterations in the MECP2 gene or related to phenotypes closely resembling those seen in individuals with RTT.
Further, the phenotypic overlap with RTT due to mutations in CDKL5 and FOXG1 was also unexplored.
This new study will build on the substantial progress made in understanding both classic and variant RTT and to add these related disorders, MECP2 Dup and the Rett-related disorders including CDKL5, FOXG1, and individuals with MECP2 mutations who do not have RTT.
A comprehensive clinical research program will be performed including clinical, neurophysiologic, and molecular and biochemical markers across these different, but related disorders.
This protocol will address the natural history components only and will serve as the basis for other study protocols including the neurophysiologic and biomarker studies.
Thereby, these studies will represent a continuing pathway to focus and inform not only the ongoing but also the emerging clinical trials.
Study Type
Observational
Enrollment (Actual)
1044
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Alabama
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Birmingham, Alabama, United States, 35294
- University of Alabama at Birmingham
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California
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Oakland, California, United States, 94709
- UCSF Oakland Benioff Children's Hospital
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San Diego, California, United States, 92123
- University of California San Diego
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Colorado
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Denver, Colorado, United States, 80045-2571
- University of Colorado Denver
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Illinois
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Chicago, Illinois, United States, 60612
- Rush University Medical Center
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Massachusetts
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Boston, Massachusetts, United States, 02115
- Children's Hospital Boston
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Minnesota
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Saint Paul, Minnesota, United States, 55101
- Gillette Children's Specialty Healthcare
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Missouri
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Saint Louis, Missouri, United States, 63110-1093
- Washington University School of Medicine and St. Louis Children's Hospital
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Ohio
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Cincinnati, Ohio, United States, 45229
- Cincinnati Children's Hospital Medical Center
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Cleveland, Ohio, United States, 44195
- Cleveland Clinic
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Pennsylvania
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Philadelphia, Pennsylvania, United States, 19104-4318
- Children's Hospital of Philadelphia
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South Carolina
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Greenwood, South Carolina, United States, 29646
- Greenwood Genetic Center
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Tennessee
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Nashville, Tennessee, United States, 37212
- Vanderbilt University
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Texas
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Houston, Texas, United States, 77030
- Baylor College of Medicine
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Sampling Method
Probability Sample
Study Population
Females and males of all ages must have complete testing for MECP2, FOXG1 and CDKL5 genes mutations AND must meet these requirements:
Gene positive for a sequence mutation, duplication or deletion in one of these 3 genes.
OR Meet consensus criteria for Rett syndrome (typical or atypical)
Description
Inclusion Criteria:
- Individuals of both genders and of all ages, with RTT, MECP2 Dup, and, RTT-related disorders including those with mutations or deletions in CDKL5 and FOXG1 genes, or those with RTT (atypical or typical) who are mutation negative.
Exclusion Criteria:
- Individuals who do not meet the above criteria will be excluded.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Observational Models: Cohort
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
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Rett Syndrome
This is a prospective natural history study examining the phenotypic variations of individuals with mutations in MECP2 or meeting the diagnostic criteria for classic (typical) or variant (atypical) Rett syndrome.
The overwhelming majority will be female, but males meeting diagnostic criteria will be included.
No interventions are planned.
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MECP2 Duplication
This is a prospective natural history study examining the phenotypic variations of individuals with MECP2 duplications.
The majority are expected to be males, but females expressing a duplication will be included.
No interventions are planned.
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RTT related disorders
This is a prospective natural history study examining individuals, both females and males who do not meet criteria for Rett syndrome, but have a mutation in MECP2, CDKL5, or FOXG1.
No interventions are planned.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinical longitudinal assessments in Rett syndrome (RTT) as measured by mean growth over 5 years.
Time Frame: at 5 years after enrollment
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subject's height will be measured in inches at baseline and at 5 years.
The change will be calculated and then the mean change will be reported.
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at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in Rett syndrome (RTT) as measured by mean change in head circumference over 5 years
Time Frame: at 5 years after enrollment
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the mean change in head circumference (measured in Centimeters) will be reported
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at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in Rett syndrome (RTT) as measured by mean number of stereotypic movements at 5 years
Time Frame: at 5 years after enrollment
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The mean number of stereotypic movements in a 24 hour period at 5 years.
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at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in Rett syndrome (RTT) as the percent of subjects with reported epilepsy at 5 years
Time Frame: 5 years after enrollment
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The Percent of subjects reporting epilepsy by 5 years
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5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in Rett syndrome (RTT) as the percent of subjects with reported scoliosis at 5 years
Time Frame: at 5 years after enrollment
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Percent of subjects with reported scoliosis
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at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in Rett syndrome (RTT) as the percent of subjects with MECP2 mutations at 5 years
Time Frame: at 5 years after enrollment
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% of subjects with MECP2 mutations to 5 years
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at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in Rett syndrome (RTT) as reported by the mean Clinical Severity Scale (CSS) at 5 years
Time Frame: at 5 years after enrollment
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The CSS is the clinical severity scale.
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at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in Rett syndrome (RTT) as measured by the mean Motor Behavioral Assessment (MBA) at 5 years
Time Frame: at 5 years after enrollment
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the MBA is the motor behavioral (performance) score
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at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in MECP2 duplication syndrome: mean growth rate over 5 years with subjects having MECP2 duplication syndrome
Time Frame: at 5 years after enrollment
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subject's height will be measured in inches at baseline and at 5 years.
The change will be calculated and then the mean change will be reported.
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at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in MECP2 duplication syndrome: mean change in head circumference 5 years with subjects having MECP2 duplication syndrome
Time Frame: at 5 years after enrollment
|
the mean change in head circumference (measured in Centimeters) will be reported
|
at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in MECP2 duplication syndrome: mean number of stereotypic movements in a 24 hour period at 5 years with subjects having MECP2 duplication syndrome
Time Frame: at 5 years after enrollment
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The mean number of stereotypic movements in a 24 hour period at 5 years.
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at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in MECP2 duplication syndrome: percent of subjects reporting scoliosis 5 years with subjects having MECP2 duplication syndrome
Time Frame: at 5 years after enrollment
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Percent of subjects with reported scoliosis
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at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in MECP2 duplication syndrome: percent of subjects surviving at 5 years with subjects having MECP2 duplication syndrome
Time Frame: at 5 years after enrollment
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Percent of subjects surviving at 5 years after start of study
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at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in MECP2 duplication syndrome: the mean CSS score at 5 years with subjects having MECP2 duplication syndrome
Time Frame: at 5 years after enrollment
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the CSS........
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at 5 years after enrollment
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Clinical and neurobehavioral longitudinal assessments in MECP2 duplication syndrome: the mean MAB score at 5 years with subjects having MECP2 duplication syndrome
Time Frame: at 5 years after enrollment
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the MBA........
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at 5 years after enrollment
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Quality of Life Measures in RTT
Time Frame: at 5 years post enrollment
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Summative data are provided by the quality of life assessments for children (CHQ), the mean score will.be reported
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at 5 years post enrollment
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Quality of Life Measures in MECP2 duplication syndrome
Time Frame: at 5 years post enrollment
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Summative data are provided by the quality of life assessments for children (CHQ), the mean scores will be reported.
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at 5 years post enrollment
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Quality of Life Measures in RTT-related disorders.
Time Frame: at 5 years post enrollment
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Summative data are provided by the quality of life assessments for children (CHQ), the mean score will be reported.
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at 5 years post enrollment
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Quality of Life Measures in RTT
Time Frame: at 5 years post enrollment
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Summative data are provided by the quality of life assessments from the principal caregiver (SF-36), the mean score will be reported.
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at 5 years post enrollment
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Quality of Life Measures in MECP2 duplication syndrome
Time Frame: at 5 years post enrollment
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Summative data are provided by the quality of life assessments from the principal caregiver (SF-36), the mean score will be reported.
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at 5 years post enrollment
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Quality of Life Measures in RTT-related disorders
Time Frame: at 5 years post enrollment
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Summative data are provided by the quality of life assessments from the principal caregiver (SF-36), the mean score will be reported.
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at 5 years post enrollment
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Alan K Percy, MD, University of Alabama at Birmingham
- Study Director: Jeffrey L Neul, MD, PhD, Vanderbilt University
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
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- Tropea D, Giacometti E, Wilson NR, Beard C, McCurry C, Fu DD, Flannery R, Jaenisch R, Sur M. Partial reversal of Rett Syndrome-like symptoms in MeCP2 mutant mice. Proc Natl Acad Sci U S A. 2009 Feb 10;106(6):2029-34. doi: 10.1073/pnas.0812394106.
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- Suter B, Treadwell-Deering D, Zoghbi HY, Glaze DG, Neul JL. Brief report: MECP2 mutations in people without Rett syndrome. J Autism Dev Disord. 2014 Mar;44(3):703-11. doi: 10.1007/s10803-013-1902-z.
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- Nectoux J, Bahi-Buisson N, Guellec I, Coste J, De Roux N, Rosas H, Tardieu M, Chelly J, Bienvenu T. The p.Val66Met polymorphism in the BDNF gene protects against early seizures in Rett syndrome. Neurology. 2008 May 27;70(22 Pt 2):2145-51. doi: 10.1212/01.wnl.0000304086.75913.b2. Epub 2008 Apr 23.
- Zeev BB, Bebbington A, Ho G, Leonard H, de Klerk N, Gak E, Vecsler M, Christodoulou J. The common BDNF polymorphism may be a modifier of disease severity in Rett syndrome. Neurology. 2009 Apr 7;72(14):1242-7. doi: 10.1212/01.wnl.0000345664.72220.6a. Erratum In: Neurology. 2009 Jul 14;73(2):161. Vecksler, M [corrected to Vecsler, M].
- Buchovecky CM, Turley SD, Brown HM, Kyle SM, McDonald JG, Liu B, Pieper AA, Huang W, Katz DM, Russell DW, Shendure J, Justice MJ. A suppressor screen in Mecp2 mutant mice implicates cholesterol metabolism in Rett syndrome. Nat Genet. 2013 Sep;45(9):1013-20. doi: 10.1038/ng.2714. Epub 2013 Jul 28.
- Ramocki MB, Peters SU, Tavyev YJ, Zhang F, Carvalho CM, Schaaf CP, Richman R, Fang P, Glaze DG, Lupski JR, Zoghbi HY. Autism and other neuropsychiatric symptoms are prevalent in individuals with MeCP2 duplication syndrome. Ann Neurol. 2009 Dec;66(6):771-82. doi: 10.1002/ana.21715.
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- del Gaudio D, Fang P, Scaglia F, Ward PA, Craigen WJ, Glaze DG, Neul JL, Patel A, Lee JA, Irons M, Berry SA, Pursley AA, Grebe TA, Freedenberg D, Martin RA, Hsich GE, Khera JR, Friedman NR, Zoghbi HY, Eng CM, Lupski JR, Beaudet AL, Cheung SW, Roa BB. Increased MECP2 gene copy number as the result of genomic duplication in neurodevelopmentally delayed males. Genet Med. 2006 Dec;8(12):784-92. doi: 10.1097/01.gim.0000250502.28516.3c.
- Carvalho CM, Zhang F, Liu P, Patel A, Sahoo T, Bacino CA, Shaw C, Peacock S, Pursley A, Tavyev YJ, Ramocki MB, Nawara M, Obersztyn E, Vianna-Morgante AM, Stankiewicz P, Zoghbi HY, Cheung SW, Lupski JR. Complex rearrangements in patients with duplications of MECP2 can occur by fork stalling and template switching. Hum Mol Genet. 2009 Jun 15;18(12):2188-203. doi: 10.1093/hmg/ddp151. Epub 2009 Mar 26.
- Reardon W, Donoghue V, Murphy AM, King MD, Mayne PD, Horn N, Birk Moller L. Progressive cerebellar degenerative changes in the severe mental retardation syndrome caused by duplication of MECP2 and adjacent loci on Xq28. Eur J Pediatr. 2010 Aug;169(8):941-9. doi: 10.1007/s00431-010-1144-4. Epub 2010 Feb 23.
- Honda S, Hayashi S, Nakane T, Imoto I, Kurosawa K, Mizuno S, Okamoto N, Kato M, Yoshihashi H, Kubota T, Nakagawa E, Goto Y, Inazawa J. The incidence of hypoplasia of the corpus callosum in patients with dup (X)(q28) involving MECP2 is associated with the location of distal breakpoints. Am J Med Genet A. 2012 Jun;158A(6):1292-303. doi: 10.1002/ajmg.a.35321. Epub 2012 Apr 23.
- Vignoli A, Borgatti R, Peron A, Zucca C, Ballarati L, Bonaglia C, Bellini M, Giordano L, Romaniello R, Bedeschi MF, Epifanio R, Russo S, Caselli R, Giardino D, Darra F, La Briola F, Banderali G, Canevini MP. Electroclinical pattern in MECP2 duplication syndrome: eight new reported cases and review of literature. Epilepsia. 2012 Jul;53(7):1146-55. doi: 10.1111/j.1528-1167.2012.03501.x. Epub 2012 May 11.
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Helpful Links
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
November 1, 2015
Primary Completion (Actual)
July 31, 2021
Study Completion (Actual)
July 31, 2021
Study Registration Dates
First Submitted
November 22, 2015
First Submitted That Met QC Criteria
April 8, 2016
First Posted (Estimate)
April 14, 2016
Study Record Updates
Last Update Posted (Actual)
August 5, 2021
Last Update Submitted That Met QC Criteria
August 3, 2021
Last Verified
August 1, 2021
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- RDCRN 5211
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Yes
IPD Plan Description
This consortium will follow the RDCRN agreement to share data.
This plan releases data five years after acquisition.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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