Sindroma Down

dr.Ayling Sanjaya,M.Kes,SpA Fakultas Kedokteran Universitas Wijaya Kusuma Surabaya

Pengertian
Disebut juga Trisomi 21. Suatu kondisi di mana adanya tambahan bahan genetik menyebabkan gangguan dalam pertumbuhan dan perkembangan seorang anak. Sindroma Down adalah fenotip akibat terdapatnya 3 buah kromosom no. 21, ditandai lebih dari 30 sifat-sifat fenotip.

Down Syndrome
Dr. John Langdon Down described the syndrome in 1866. Diagnosis was made clinically until 1959

The chromosome abnormality was discovered in 1959 (by Lejeune)

Down syndrome is one of the first symptom complexes associated with mental retardation to be identified as a syndrome.

Epidemiologi DS
1 in 700 live births >60% spontaneously aborted 1 child in every 800-1,100 births has DS 250,000 people in the U.S. have DS Tiap tahun lahir di Jawa Timur 462 bayi dengan DS

Sekurang-kurangnya 20 % lahir mati; Meningkat dengan bertambahnya usia ibu hamil

Genetics
Trisomy 21 (47, +21), - 94 %, The frequency of trisomy increases with increasing maternal age. Robertsonian translocation involving chromosome 21- Approx. 3-4 %, not related to maternal age. Trisomy 21 mosaicism 2 to 3 % cases
The trisomy 21 type of Down syndrome is the result of an error in meiosis, and has a recurrence risk of about 1 in 100.

Trisomy 21 Karyotype

 95% kasus trisomi murni; umumnya karena non-disjunction pada meosis I (80%); kadang-2 meosis II Pada 85% kasus ibu penyumbang kopi ekstra kromosom; saham ayah 15% Sekurang-kurangnya 1% penderita mosaik; terdapat garis- garis sel normal dan garis-garis sel trisomi 21. Karena non-disjunction mitotik pada zygot trisomi 21 (80%) atau zygot normal (20%); gejala-2 pada individu-2 ini cenderung lebih ringan 4% kasus penderita mendapat kopi kromosom 21 ekstra dari orang tua carrier translokasi seimbang atau merupakan translokasi de Novo

Trisomy 21 amniocyte

CLINICAL FEATURES DS
Extra and loose neck skin Single creases on the palms Clinodactyly (curved fifth finger) Broad space between the first and second toes A deep plantar crease The tongue often protrudes, more because of low muscle tone than true enlargement. Central hair whorl (cowlick) Flat occiput (back of the head) Upslanting eyes Epicanthal folds (folds around the corner of the eye) White spots in the iris of the eye (Brushfield spots) Upturned nose

Ophthalmologic Features
Keratoconus
Brushfield Spots

Related Conditions
Congenital Heart Disease Seizures Eye Anomalies Hearing Loss Genito-Urinary Tract Anomalies Respiratory Disease Behaviour Obesity Sleep Apnea Developmental Delays Blood Disease Endocrine Disease Blood Disorders Alzheimers Disease Mental Retardation

Diagnosis
Prenatal screening If no screening It is recognized from the characteristic phenotypic features. Confirmed by Karyotype.

Can Down Syndrome Be Diagnosed Prenatally?

Yes, it can be diagnosed or more likely ruled out.
Alpha fetoprotein (AFP) blood test, a screening test, can be done around the 16th week of pregnancy. Amniocentesis or chorionic villus sampling are the most reliable tests used, but should be used cautiously due to

the risks associated with them.

Management
Early intervention services, which begin shortly after birth, help children with Down syndrome develop to their full potential. Quality educational programs, along with a stimulating home environment and good medical care enable people with Down syndrome to become contributing members of their families and communities.

Counseling
May begin when a prenatal diagnosis is made. Discuss the wide range of variability in manifestation and prognosis. Medical and educational treatments and interventions should be discussed. Initial referrals for early intervention, informative publications, parent groups, and advocacy groups.

Mortality
Median age of death has increased from 25 yrs in 1983 to 49 yrs in 1997, an average of 1.7 yrs increase per year. Most likely cause of death is CHD, Dementia, Hypothyroidism and Leukemia. Improved survival is because of increased placements of infants in homes and changes in treatment for common causes of death.

Survival is better for males and blacks.

 Children with Down syndrome can do most things that any young child can do, such as walking, talking, dressing, and being toilet trained, but usually develop later than other children.

How Will Children With Down Syndrome Develop Compared To Other Children?

Down syndrome usually results in some degree of mental retardation, the degree of which varies widely. However, many will learn to read and write.

Many people with Down syndrome hold supported employment, and frequently live semi-independently.

Yayasan ISDI (Ikatan Sindroma Down Indonesia) NDSS (National Down Syndrome Society)
Di USA Undang2 Federal IDEA (Individual with Disabilities Education)
mewajibkan negara2 bagian u/ menyediakan lembaga2 pelayanan intervensi dini bagi anak2 yg memenuhi syarat2 undang2 tsb (meningkatkan pertumbuhan bayi dan balita, serta membantu keluarga memahami kebutuhan2 dari anak2nya penderita DS.

TERIMA KASIH