Williams syndrome: Difference between revisions

	WikiDoc Resources for Williams syndrome
Articles
Most recent articles on Williams syndrome Most cited articles on Williams syndrome Review articles on Williams syndrome Articles on Williams syndrome in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Williams syndrome Images of Williams syndrome Photos of Williams syndrome Podcasts & MP3s on Williams syndrome Videos on Williams syndrome
Evidence Based Medicine
Cochrane Collaboration on Williams syndrome Bandolier on Williams syndrome TRIP on Williams syndrome
Clinical Trials
Ongoing Trials on Williams syndrome at Clinical Trials.gov Trial results on Williams syndrome Clinical Trials on Williams syndrome at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Williams syndrome NICE Guidance on Williams syndrome NHS PRODIGY Guidance FDA on Williams syndrome CDC on Williams syndrome
Books
Books on Williams syndrome
News
Williams syndrome in the news Be alerted to news on Williams syndrome News trends on Williams syndrome
Commentary
Blogs on Williams syndrome
Definitions
Definitions of Williams syndrome
Patient Resources / Community
Patient resources on Williams syndrome Discussion groups on Williams syndrome Patient Handouts on Williams syndrome Directions to Hospitals Treating Williams syndrome Risk calculators and risk factors for Williams syndrome
Healthcare Provider Resources
Symptoms of Williams syndrome Causes & Risk Factors for Williams syndrome Diagnostic studies for Williams syndrome Treatment of Williams syndrome
Continuing Medical Education (CME)
CME Programs on Williams syndrome
International
Williams syndrome en Espanol Williams syndrome en Francais
Business
Williams syndrome in the Marketplace Patents on Williams syndrome
Experimental / Informatics
List of terms related to Williams syndrome

VisualWikitext

Latest revision as of 17:53, 5 September 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Synonyms and keywords: Beuren-Williams syndrome; supravalvular aortic stenosis hypercalcemia syndrome; Williams syndrome; Williams-Beuren syndrome; Chromosome 7q11.23 deletion syndrome, 1.5- to 1.8-mb; WMS; WS

Overview

Williams syndrome (also Williams-Beuren syndrome) is a rare genetic disorder characterized by a distinctive, "elfin" facial appearance, along with a low nasal bridge; an unusually cheerful demeanor and ease with strangers, coupled with unpredictably occurring negative outbursts; mental retardation coupled with unusual (for persons who are diagnosed as mentally retarded) language skills; a love for music; and cardiovascular problems, such as supravalvular aortic stenosis and transient hypercalcemia.

Historical Perspective

The syndrome was first identified in 1961 by Dr. J. C. P. Williams of New Zealand.^[1]

Classification

There is no established system for the classification of Williams syndrome.

Pathophysiology

It is thought that Williams syndrome is caused by the deletion of genetic material that contains elastin (ELN) gene from the region q11.2 of chromosome 7. There are several other genes, apart from ELN gene that contributes to manifestation of williams syndrome and, therefore, is considered a contiguous gene deletion syndrome.^[2]. ^[3] LIMK1 and a number of other genes such as GTF1IRD1, GTF2I, NCF1, STX1A, CLIP2, and TFII-1 are felt to influence the cognitive profile of Williams syndrome.^[4] Some other genes are considered for manifestation of conditions such as elevated calcium, glucose metabolism, and hypertension.

Epidemiology and Demographics

The incidence of Williams syndrome is approximately 1 per 75,000 individuals worldwide.^[5] Williams syndrome is considered for about 6% of all genetic cases of developmental disability.^[6] William syndrome affects male and female in equal numbers and infants of any race may be affected.

Risk Factors

There are no established risk factors for Williams syndrome.

Screening

There is insufficient evidence to recommend routine screening for Williams syndrome.

Natural History, Complications, and Prognosis

Common complications of Williams syndrome include:

There is no significant reduction in life expectancy in children diagnosed with Williams syndrome unless there is any significant heart condition or problems in the kidney.

Diagnosis

The clinical diagnosis of Williams syndrome can be made in early childhood based on characteristic facial features. However, the diagnosis of Williams syndrome is confirmed by genetic testing (fluorescent in situ hybridization) that can detect deletion of one elastin gene on chromosome 7.^[7]

Symptoms

The hallmark feature of Williams syndrome is typical 'elfin' facies (upturned nose, wide forehead, and small teeth). A positive history of congenital heart disease and neuro-developmental delay is suggestive of Williams syndrome. Williams syndrome can be manifested with various non- specific complains such as poor growth, short stature, muscle weakness, hyperflexible joints, intellectual disability, visual disturbances, chronic ear infections or hearing loss, dental abnormalities. ^[8] ^[9]

Physical Examination

Patients with Williams syndrome usually have typical 'elfin facies' in appearance. Physical examination of patients with Williams syndrome is usually remarkable for characteristic cardiac lesion such as supravalvar aortic stenosis (SVAS), pulmonary stenosis and mitral valve regurgitation along with arterial hypertension.

On physical examination, ocular findings in Williams syndrome can include strabismus, a stellate iris, cataract or retinal vascular tortuosity. Audiological evaluation may report sensorineural hearing loss in some patient. Other findings include joint hyperelasticity, contractures, kyphoscoliosis, and lordosis along with generalised hypotonia. ^[10]

Laboratory Findings

Laboratory findings consistent with the diagnosis of Williams syndrome include elevated calcium level with hypercalciuria ^[11], mild thyroid-stimulating hormone elevation with normal thyroxine T4 (sub-clinical hypothyroidism in 5 to 10 percent ) ^[12], and abnormal glucose tolerance test in 60 to 75 percent. ^[13]

Electrocardiogram

An ECG may be helpful to look for any cardiac anomalies such as septal defects that may be related to Williams syndrome.

X-ray

There are no x-ray findings associated with Williams syndrome. However, an x-ray may be helpful to look for associated anomalies with Williams syndrome.

Echocardiography or Ultrasound

Renal ultrasound may be helpful in the diagnosis of Williams syndrome. Findings on renal ultrasound suggestive of Williams syndrome include bladder diverticula, ectopic or horseshoe kidney, and renal aplasia or hypoplasia. Nephrocalcinosis secondary to hypercalciuria is detected in approximately 5 to 10 percent of patients undergoing renal ultrasound. ^[14]

CT scan

There are no CT scan findings associated with Williams syndrome.

MRI

There are no MRI findings associated with Williams syndrome.

Other Imaging Findings

There are no other imaging findings associated with Williams syndrome.

Other Diagnostic Studies

Other diagnostic studies for Williams syndrome include audiologic evaluation, which demonstrates high tone sensorineural hearing loss, and ophthalmic evaluation, which demonstrates strabismus and refractive errors.

Treatment

Based on 2020 American Academy of Pediatrics (AAP) healthcare supervision guidelines for Williams Syndrome, the approach to the management of Williams syndrome consists of 3 major steps:^[15]

1. Initial evaluation- Our initial evaluation is based upon a comprehensive evaluation that includes growth measurements; a multidisciplinary developmental evaluation; thorough cardiac, renal, and neurologic assessments; and laboratory testing. ^[16]
2. Continued surveillance- Because of the risk of progressive disease, continued surveillance is recommended throughout the lifetime of the affected person to look for any complications associated with Williams syndrome.
3. Management of specific conditions- There are no effective pharmacologic agents to treat arterial stenosis. As a result, approximately one-third of patients with cardiovascular anomalies undergo surgical or catheter-based intervention. Proper growth of the child with adequate nutrition need to be accessed. Ophthalmic evaluation of child needed for any visual disturbances. Thyroxine supplement for hypothyroid child might be necessary. Proper evaluation and management of any ear infections should be done.

Medical Therapy

There is no treatment for Williams syndrome; the mainstay of therapy is supportive care and management of specific conditions or complications related to Williams syndrome.

Surgery

Surgery is the mainstay of treatment for supra-valvular aortic stenosis, which is one of the specific condition related to Williams syndrome.

Primary Prevention

There are no established measures for the primary prevention of Williams syndrome.

Secondary Prevention

There are no established measures for the secondary prevention of Williams syndrome.

References

↑ "The Gregarious Brain," by David Dobbs. The New York Times, July 8, 2007. [1]
↑ Merla G, Ucla C, Guipponi M, Reymond A. Identification of additional transcripts in the Williams-Beuren syndrome critical region. Hum Genet. 2002 May. 110(5):429-38.
↑ Mari A, Amati F, Mingarelli R, et al. Analysis of the elastin gene in 60 patients with clinical diagnosis of Williams syndrome. Hum Genet. 1995 Oct. 96(4):444-8.
↑ assabehji M, Metcalfe K, Fergusson WD, et al. LIM-kinase deleted in Williams syndrome. Nat Genet. 1996 Jul. 13(3):272-3.
↑ "Morris CA, Braddock SR, COUNCIL ON GENETICS. Health Care Supervision for Children With Williams Syndrome. Pediatrics 2020; 145.
↑ Stromme, P.; Bjomstad, P. G.; Ramstad, K. (2002). "Prevalence Estimation of Williams Syndrome". Journal of Child Neurology. 17 (4): 269–71.
↑ Lowery MC, Morris CA, Ewart A, et al. Strong correlation of elastin deletions, detected by FISH, with Williams syndrome: evaluation of 235 patients. Am J Hum Genet 1995; 57:49.
↑ Pober BR (2010). "Williams-Beuren syndrome". N Engl J Med. 362 (3): 239–52. doi:10.1056/NEJMra0903074. PMID 20089974.
↑ Game X, Panicker J, Fowler CJ (2010). "Williams-Beuren syndrome". N Engl J Med. 362 (15): 1449, author reply 1450. doi:10.1056/NEJMc1001965. PMID 20393184.
↑ Bruno E, Rossi N, Thuer O, et al. Cardiovascular findings, and clinical course, in patients with Williams syndrome. Cardiol Young. 2003 Dec. 13(6):532-6.
↑ Sindhar S, Lugo M, Levin MD, et al. Hypercalcemia in Patients with Williams-Beuren Syndrome. J Pediatr 2016; 178:254.
↑ Kim YM, Cho JH, Kang E, et al. Endocrine dysfunctions in children with Williams-Beuren syndrome. Ann Pediatr Endocrinol Metab 2016; 21:15.
↑ Pober BR, Wang E, Caprio S, et al. High prevalence of diabetes and pre-diabetes in adults with Williams syndrome. Am J Med Genet C Semin Med Genet 2010; 154C:291.
↑ Ingelfinger JR, Newburger JW. The spectrum of renal anomalies in patients with Williams syndrome. J Pediatr 1991; 119:771.
↑ Lacroix A, Pezet M, Capel A, Bonnet D, Hennequin M, Jacob MP; et al. (2009). "[Williams-Beuren syndrome: a multidisciplinary approach]". Arch Pediatr. 16 (3): 273–82. doi:10.1016/j.arcped.2008.11.011. PMID 19097873.
↑ Morris CA, Braddock SR, COUNCIL ON GENETICS (2020). "Health Care Supervision for Children With Williams Syndrome". Pediatrics. 145 (2). doi:10.1542/peds.2019-3761. PMID 31964759.

External links

Williams Syndrome Association

da:Williams syndrom de:Williams-Beuren-Syndrom it:Sindrome di Williams-Beuren he:תסמונת ויליאמס hu:Williams-szindróma nl:Williams-syndroom

[1] "The Gregarious Brain," by David Dobbs. The New York Times, July 8, 2007. [1]

[2] Merla G, Ucla C, Guipponi M, Reymond A. Identification of additional transcripts in the Williams-Beuren syndrome critical region. Hum Genet. 2002 May. 110(5):429-38.

[3] Mari A, Amati F, Mingarelli R, et al. Analysis of the elastin gene in 60 patients with clinical diagnosis of Williams syndrome. Hum Genet. 1995 Oct. 96(4):444-8.

[4] ssabehji M, Metcalfe K, Fergusson WD, et al. LIM-kinase deleted in Williams syndrome. Nat Genet. 1996 Jul. 13(3):272-3.

[5] "Morris CA, Braddock SR, COUNCIL ON GENETICS. Health Care Supervision for Children With Williams Syndrome. Pediatrics 2020; 145.

[6] Stromme, P.; Bjomstad, P. G.; Ramstad, K. (2002). "Prevalence Estimation of Williams Syndrome". Journal of Child Neurology. 17 (4): 269–71.

[7] Lowery MC, Morris CA, Ewart A, et al. Strong correlation of elastin deletions, detected by FISH, with Williams syndrome: evaluation of 235 patients. Am J Hum Genet 1995; 57:49.

[pmid20089974-8] Pober BR (2010). "Williams-Beuren syndrome". N Engl J Med. 362 (3): 239–52. doi:10.1056/NEJMra0903074. PMID 20089974.

[pmid20393184-9] Game X, Panicker J, Fowler CJ (2010). "Williams-Beuren syndrome". N Engl J Med. 362 (15): 1449, author reply 1450. doi:10.1056/NEJMc1001965. PMID 20393184.

[10] Bruno E, Rossi N, Thuer O, et al. Cardiovascular findings, and clinical course, in patients with Williams syndrome. Cardiol Young. 2003 Dec. 13(6):532-6.

[11] Sindhar S, Lugo M, Levin MD, et al. Hypercalcemia in Patients with Williams-Beuren Syndrome. J Pediatr 2016; 178:254.

[12] Kim YM, Cho JH, Kang E, et al. Endocrine dysfunctions in children with Williams-Beuren syndrome. Ann Pediatr Endocrinol Metab 2016; 21:15.

[13] Pober BR, Wang E, Caprio S, et al. High prevalence of diabetes and pre-diabetes in adults with Williams syndrome. Am J Med Genet C Semin Med Genet 2010; 154C:291.

[14] Ingelfinger JR, Newburger JW. The spectrum of renal anomalies in patients with Williams syndrome. J Pediatr 1991; 119:771.

[pmid19097873-15] Lacroix A, Pezet M, Capel A, Bonnet D, Hennequin M, Jacob MP; et al. (2009). "[Williams-Beuren syndrome: a multidisciplinary approach]". Arch Pediatr. 16 (3): 273–82. doi:10.1016/j.arcped.2008.11.011. PMID 19097873.

[pmid31964759-16] Morris CA, Braddock SR, COUNCIL ON GENETICS (2020). "Health Care Supervision for Children With Williams Syndrome". Pediatrics. 145 (2). doi:10.1542/peds.2019-3761. PMID 31964759.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

@@ Line 1: / Line 1: @@
-{{DiseaseDisorder infobox |
+__NOTOC__
-  Name           = {{PAGENAME}} |
-  ICD10          = {{ICD10|Q|93|8|q|90}} |
-  ICD9           = {{ICD9|758.9}} |
-  ICDO           = |
-  Image          = |
-  Caption        = |
-  OMIM           = 194050 |
-  MedlinePlus    = 001116 |
-  eMedicineSubj  = |
-  eMedicineTopic = |
-  DiseasesDB     = 859 |
-  MeshID         = D018980 |
-}}
 {{SI}}
 {{CMG}}
+{{SK}} [[Beuren-Williams syndrome]]; [[supravalvular aortic stenosis hypercalcemia syndrome]]; [[Williams syndrome]]; Williams-Beuren syndrome; [[Chromosome 7q11.23 deletion syndrome,]] 1.5- to 1.8-mb; WMS;  WS
 ==Overview==
-'''Williams syndrome''' (also '''Williams-Beuren syndrome''') is a rare [[genetic disorder]],<ref name="NINDS">{{Cite web|url=http://www.ninds.nih.gov/disorders/williams/williams.htm|title=NINDS Williams Syndrome Information Page|accessyear=2007|accessmonthday=September 13|publisher=National Institute of Neurological Disorders and Stroke|year=02.14.2007|language=English}}</ref> occurring in fewer than 1 in 7,500 live births.
+'''Williams syndrome''' (also ''' Williams-Beuren syndrome''') is a rare [[genetic disorder]] characterized by a distinctive, "elfin" facial appearance, along with a low nasal bridge; an unusually cheerful demeanor and ease with strangers, coupled with unpredictably occurring negative outbursts; [[mental retardation]] coupled with unusual (for persons who are diagnosed as mentally retarded)  [[language]] skills; a love for music; and [[cardiovascular]] problems, such as [[supravalvular aortic stenosis]] and transient [[hypercalcemia]].
 ==Historical Perspective==
 The syndrome was first identified in 1961 by Dr. [[J. C. P. Williams]] of New Zealand.<ref>"The Gregarious Brain," by David Dobbs. The New York Times, July 8, 2007. [http://www.nytimes.com/2007/07/08/magazine/08sociability-t.html]</ref>
+==Classification==
+There is no established system for the classification of Williams syndrome.
+==Pathophysiology==
+It is thought that [[Williams syndrome]] is caused by the deletion of [[genetic]] material that contains [[elastin]] (ELN) [[gene]] from the region q11.2 of chromosome 7. There are several other genes, apart from ELN gene that contributes to manifestation of [[williams syndrome]] and, therefore, is considered a contiguous [[gene deletion syndrome]].<ref> Merla G, Ucla C, Guipponi M, Reymond A. Identification of additional transcripts in the Williams-Beuren syndrome critical region. Hum Genet. 2002 May. 110(5):429-38.</ref>. <ref> Mari A, Amati F, Mingarelli R, et al. Analysis of the elastin gene in 60 patients with clinical diagnosis of Williams syndrome. Hum Genet. 1995 Oct. 96(4):444-8.</ref> [[LIMK1]] and a number of other genes such as [[GTF1IRD1]], [[GTF2I]], [[NCF1C|NCF1]], [[STX1A]], [[CLIP2]], and [[TFIIA|TFII]]-1 are felt to influence the cognitive profile of Williams syndrome.<ref>assabehji M, Metcalfe K, Fergusson WD, et al. LIM-kinase deleted in Williams syndrome. Nat Genet. 1996 Jul. 13(3):272-3.</ref> Some other genes are considered for manifestation of conditions such as elevated [[calcium]], [[glucose]] [[metabolism]], and [[hypertension]].
+==Epidemiology and Demographics==
+The [[incidence]] of Williams syndrome is approximately 1 per 75,000 individuals worldwide.<ref>"Morris CA, Braddock SR, COUNCIL ON GENETICS. Health Care Supervision for Children With Williams Syndrome. Pediatrics 2020; 145.</ref> Williams syndrome is considered for about 6% of all [[genetic]] cases of [[Developmental abnormality|developmental]] [[disability]].<ref>Stromme, P.; Bjomstad, P. G.; Ramstad, K. (2002). "Prevalence Estimation of Williams Syndrome". Journal of Child Neurology. 17 (4): 269–71.</ref> William syndrome affects male and female in equal numbers and infants of any [[race]] may be affected.
+==Risk Factors==
+There are no established [[Risk factor|risk factors]] for [[Williams syndrome]].
+==Screening==
+There is insufficient [[evidence]] to recommend routine [[screening]] for Williams syndrome.
+==Natural History, Complications, and Prognosis==
+Common complications of Williams syndrome include:
+*[[Cardiovascular disease]]
+*[[Failure to thrive]]
+*[[Connective tissue changes]]
+*[[Endocrine]] abnormalities
+There is no significant reduction in [[life expectancy]] in children diagnosed with Williams syndrome unless there is any significant [[heart]] condition or problems in the [[kidney]].
 ==Diagnosis==
+The clinical diagnosis of Williams syndrome can be made in early childhood based on characteristic facial features. However, the [[diagnosis]] of Williams syndrome is confirmed by [[genetic]] testing ([[fluorescent in situ hybridization]]) that can detect [[Deletion (genetics)|deletion]] of one [[elastin]] [[gene]] on [[chromosome]] 7.<ref>Lowery MC, Morris CA, Ewart A, et al. Strong correlation of elastin deletions, detected by FISH, with Williams syndrome: evaluation of 235 patients. Am J Hum Genet 1995; 57:49.</ref>
 ===Symptoms===
-It is characterized by a distinctive, "elfin" facial appearance, along with a low nasal bridge; an unusually cheerful demeanor and ease with strangers, coupled with unpredictably occurring negative outbursts; [[mental retardation]] coupled with unusual (for persons who are diagnosed as mentally retarded)  [[language]] skills; a love for music; and cardiovascular problems, such as [[supravalvular aortic stenosis]] and transient [[hypercalcaemia]].
+The hallmark feature of Williams syndrome is typical 'elfin' facies (upturned nose, wide forehead, and small teeth). A positive history of [[congenital heart disease]] and [[neuro-developmental delay]] is suggestive of Williams syndrome. Williams syndrome can be manifested with various non- specific complains such as poor growth, short stature, muscle weakness, hyperflexible joints, intellectual disability, visual disturbances, chronic ear infections or hearing loss, dental abnormalities. <ref name="pmid20089974">{{cite journal| author=Pober BR| title=Williams-Beuren syndrome. | journal=N Engl J Med | year= 2010 | volume= 362 | issue= 3 | pages= 239-52 | pmid=20089974 | doi=10.1056/NEJMra0903074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20089974  }} </ref> <ref name="pmid20393184">{{cite journal| author=Game X, Panicker J, Fowler CJ| title=Williams-Beuren syndrome. | journal=N Engl J Med | year= 2010 | volume= 362 | issue= 15 | pages= 1449; author reply 1450 | pmid=20393184 | doi=10.1056/NEJMc1001965 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20393184  }} </ref>
+===Physical Examination===
+Patients with Williams syndrome usually have typical 'elfin facies' in appearance. Physical examination of patients with Williams syndrome is usually remarkable for characteristic cardiac lesion such as supravalvar [[aortic]] [[stenosis]] (SVAS), pulmonary stenosis and mitral valve regurgitation along with arterial hypertension.
-Williams syndrome shares some features with [[autism]] (such as difficulty understanding the [[theory of mind|state of mind of conversational partners]]<ref>"Rare Disorder Offers Fresh Insight into Language" by Rhitu Chatterjee. National Public Radio. 10 Jul 2006 (text only). [http://www.npr.org/templates/story/story.php?storyId=5545504]</ref>) and [[Fetal alcohol syndrome]] (e.g., certain facial features, possible mental retardation, and negative potential outbursts),<ref>CDC. (2004). ''Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis''. Can be downloaded at http://www.cdc.gov/fas/faspub.htm</ref> although persons with Williams generally possess very good social skills, such that this condition is sometimes called "cocktail-party syndrome".  There also appears to be a higher prevalence of left-handedness and [[ocular dominance|left-eye dominance]] in those with Williams,<ref>Van Strien JW, Lagers-Van Haselen GC, Van Hagen JM, De Coo IF, Frens MA, Van Der Geest JN. "Increased prevalences of left-handedness and left-eye sighting dominance in individuals with Williams-Beuren syndrome." ''J Clin Exp Neuropsychol.'' 2005 Nov;27(8):967-76. PMID 16207621.</ref> and cases of absolute pitch appear to be significantly higher amongst those with the condition.<ref name="Sacks1995">{{cite journal | first=Oliver | last=Sacks | year=1995 | month=May | title=Musical Ability | journal=Science | volume=268 | issue=5211 | pages=621&ndash;622}}</ref>
+On physical examination, [[ocular]] findings in Williams syndrome can include [[strabismus]], a [[stellate iris]], [[cataract]] or [[retinal]] [[vascular]] [[tortuosity]]. Audiological evaluation may report  [[Sensorineural hearing loss|sensorineural]] [[hearing loss]] in some patient. Other findings include [[Joint (anatomy)|joint]] [[hyperelasticity]], [[Contracture|contractures]], [[kyphoscoliosis]], and [[lordosis]] along with generalised [[hypotonia]].
+<ref> Bruno E, Rossi N, Thuer O, et al. Cardiovascular findings, and clinical course, in patients with Williams syndrome. Cardiol Young. 2003 Dec. 13(6):532-6. </ref>
-===Relativity and perception===
+===Laboratory Findings===
-Another symptom of Williams syndrome is lack of [[depth perception]] and an inability to visualize how different parts assemble into larger objects (in assembling jigsaw puzzles, for example). This problem is caused by a defect in the [[brain]] that creates a sparsity of tissue in the visual systems of the brain. When asked to perform tasks involving spatial relations, with their brains scanned by [[Functional magnetic resonance imaging|fMRI]], people with Williams Syndrome showed weaker activity in the dorsal area of the brain, which is along the top and back of the brain and associated with vision and spatial relations. (fMRI measures brain activity by measuring blood flow through different parts of the brain.)
-When asked to copy a picture, those with Williams Syndrome drew the small details while those diagnosed with Down Syndrome drew the big picture. (Navon Task)<ref>Bihrle, A. M., Bellugi, U., Delis, D., and Marks, S. (1989) Seeing either the forest or the trees: Dissociation in visual processing. Brain and Cognition, 11:37–49
+Laboratory findings consistent with the diagnosis of Williams syndrome include [[elevated calcium level]] with [[hypercalciuria]] <ref> Sindhar S, Lugo M, Levin MD, et al. Hypercalcemia in Patients with Williams-Beuren Syndrome. J Pediatr 2016; 178:254. </ref>, mild [[thyroid]]-stimulating [[hormone]] elevation with normal [[thyroxine]] T4 (sub-clinical [[hypothyroidism]] in 5 to 10 percent ) <ref> Kim YM, Cho JH, Kang E, et al. Endocrine dysfunctions in children with Williams-Beuren syndrome. Ann Pediatr Endocrinol Metab 2016; 21:15. </ref>, and [[abnormal glucose tolerance test]] in 60 to 75 percent. <ref> Pober BR, Wang E, Caprio S, et al. High prevalence of diabetes and pre-diabetes in adults with Williams syndrome. Am J Med Genet C Semin Med Genet 2010; 154C:291.</ref>
-<br>
-Cited by
+===Electrocardiogram===
-*[http://nasw.org/finn/ws.html Different Minds - Robert Finn]
-*[http://mokk.bme.hu/Members/hp/otka/docs/lukacs_dissertation.doc Language Abilities in Williams Syndrome - Agnes Luckacks]
+An ECG may be helpful to look for any [[cardiac]] [[anomalies]] such as [[Septal defect|septal]] defects that may be related to Williams syndrome.
-*[http://www.psyc.bbk.ac.uk/research/DNL/personalpages/Annaz_thesis_2006.pdf The Development of Visuo-spatial Processing in children with Autism, Down Syndrome, and Williams Syndrome - Dagmara Annaz]</ref>
+===X-ray===
+There are no x-ray findings associated with Williams syndrome. However, an x-ray may be helpful to look for associated [[anomalies]] with Williams syndrome.
+===Echocardiography or Ultrasound===
+[[Renal]] [[ultrasound]]  may be helpful in the diagnosis of Williams syndrome. Findings on renal ultrasound suggestive of Williams syndrome include [[bladder diverticula]], [[ectopic]] or [[Horseshoe kidney|horseshoe]] kidney, and renal [[aplasia]] or [[hypoplasia]]. [[Nephrocalcinosis]] secondary to [[hypercalciuria]] is detected in approximately 5 to 10 percent of patients undergoing [[renal]] [[ultrasound]]. <ref> Ingelfinger JR, Newburger JW. The spectrum of renal anomalies in patients with Williams syndrome. J Pediatr 1991; 119:771. </ref>
+===CT scan===
+There are no [[CT-scans|CT]] scan findings associated with Williams syndrome.
+===MRI===
+There are no [[MRI]] findings associated with Williams syndrome.
+===Other Imaging Findings===
+There are no other imaging findings associated with Williams syndrome.
+===Other Diagnostic Studies===
+Other diagnostic studies for Williams syndrome include audiologic evaluation, which demonstrates high tone [[Sensorineural hearing loss|sensorineural]] [[hearing loss]], and [[ophthalmic]] evaluation, which demonstrates [[strabismus]] and [[Refractive error|refractive]] errors.
+==Treatment==
+Based on  2020 American Academy of Pediatrics (AAP) healthcare supervision guidelines for Williams Syndrome, the approach to the management of Williams syndrome consists of 3 major steps:<ref name="pmid19097873">{{cite journal| author=Lacroix A, Pezet M, Capel A, Bonnet D, Hennequin M, Jacob MP | display-authors=etal| title=[Williams-Beuren syndrome: a multidisciplinary approach]. | journal=Arch Pediatr | year= 2009 | volume= 16 | issue= 3 | pages= 273-82 | pmid=19097873 | doi=10.1016/j.arcped.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19097873  }} </ref>
+*1. Initial evaluation- Our initial evaluation is based upon a comprehensive evaluation that includes [[growth]] measurements; a [[Multidisciplinary Association for Psychedelic Studies|multidisciplinary]] developmental evaluation; thorough [[cardiac]], [[renal]], and [[neurologic]] assessments; and [[laboratory]] [[testing]]. <ref name="pmid31964759">{{cite journal| author=Morris CA, Braddock SR, COUNCIL ON GENETICS| title=Health Care Supervision for Children With Williams Syndrome. | journal=Pediatrics | year= 2020 | volume= 145 | issue= 2 | pages=  | pmid=31964759 | doi=10.1542/peds.2019-3761 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31964759  }} </ref>
+*2. Continued [[surveillance]]- Because of the risk of progressive [[disease]], continued [[surveillance]] is recommended throughout the lifetime of the affected person to look for any complications associated with Williams syndrome.
+*3. Management of specific conditions- There are no effective [[Pharmacology|pharmacologic]] agents to treat [[arterial]] [[stenosis]]. As a result, approximately one-third of patients with [[cardiovascular]] [[anomalies]] undergo surgical or [[catheter]]-based intervention. Proper [[growth]] of the child with adequate [[nutrition]] need to be accessed. [[Ophthalmic]] evaluation of child needed for any [[Visual disturbance|visual]] disturbances. [[Thyroxine]] [[Supplements|supplement]] for [[hypothyroid]] child might be necessary. Proper evaluation and management of any [[ear]] [[Infection|infections]] should be done.
+===Medical Therapy===
+There is no treatment for Williams syndrome; the mainstay of [[therapy]] is [[supportive care]] and management of specific conditions or [[complications]] related to Williams syndrome.
+===Surgery===
+[[Surgery operation|Surgery]] is the mainstay of treatment for [[supra-valvular]] [[aortic]] [[Aortic stenosis|stenosis]], which is one of the specific condition related to Williams syndrome.
+===Primary Prevention===
+There are no established measures for the [[primary prevention]] of Williams syndrome.
-==Cause==
+===Secondary Prevention===
-Williams syndrome is caused by the deletion of genetic material from the region q11.2 of chromosome 7. The deleted region includes more than 20 [[gene]]s, and researchers believe that the loss of several of these genes probably contributes to the characteristic features of this disorder. {{Gene|CLIP2}}, [[Elastin|ELN]], {{Gene|GTF2I}}, {{Gene|GTF2IRD1}}, and {{Gene|LIMK1}} are among the genes that are typically deleted in people with Williams syndrome. Researchers have found that loss of the ''ELN'' gene, which codes for the protein [[elastin]], is associated with the connective-tissue abnormalities and cardiovascular disease (specifically [[Aortic valve stenosis|supravalvular aortic stenosis]] (SVAS) and [[Pulmonary valve stenosis|supravalvular pulmonary stenosis]] (SVPS)) found in many people with this syndrome. Studies suggest that deletion of ''LIMK1'', ''GTF2I'', ''GTF2IRD1'', and perhaps other genes may help explain the characteristic difficulties with visual–spatial tasks. Additionally, there is evidence that the loss of several of these genes, including ''CLIP2'', may contribute to the unique behavioral characteristics, mental retardation, and other cognitive difficulties seen in Williams syndrome.
+There are no established measures for the [[Secondary Prevention|secondary]] [[prevention]] of Williams syndrome.
 ==References==
 {{Reflist|2}}
-== External links ==
+==External links==
-* [http://www.williams-syndrome.org Williams Syndrome Association]
+*[http://www.williams-syndrome.org Williams Syndrome Association]
 <br>
 [[Category:Genetic disorders]]
 [[Category:Syndromes]]
 [[Category:Disease]]
+[[Category:Cardiology]]
+[[Category:Pediatrics]]
 [[da:Williams syndrom]]
@@ Line 63: / Line 121: @@
 [[pt:Síndrome de Williams]]
 [[ru:Синдром Вильямса]]
-{{WikiDoc Help Menu}}
-{{WS}}