Preclinical research in Rett syndrome: setting the foundation for translational success

In September of 2011, the National Institute of Neurological Disorders and Stroke (NINDS), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the International Rett Syndrome Foundation (IRSF) and the Rett Syndrome Research Trust (RSRT) convened a workshop involving a broad cross-section of basic scientists, clinicians and representatives from the National Institutes of Health (NIH), the US Food and Drug Administration (FDA), the pharmaceutical industry and private foundations to assess the state of the art in animal studies of Rett syndrome (RTT). The aim of the workshop was to identify crucial knowledge gaps and to suggest scientific priorities and best practices for the use of animal models in preclinical evaluation of potential new RTT therapeutics. This review summarizes outcomes from the workshop and extensive follow-up discussions among participants, and includes: (1) a comprehensive summary of the physiological and behavioral phenotypes of RTT mouse models to date, and areas in which further phenotypic analyses are required to enhance the utility of these models for translational studies; (2) discussion of the impact of genetic differences among mouse models, and methodological differences among laboratories, on the expression and analysis, respectively, of phenotypic traits; and (3) definitions of the standards that the community of RTT researchers can implement for rigorous preclinical study design and transparent reporting to ensure that decisions to initiate costly clinical trials are grounded in reliable preclinical data.

[1]  Hye-Seung Lee,et al.  Growth failure and outcome in Rett syndrome , 2012, Neurology.

[2]  S. Lazic,et al.  A call for transparent reporting to optimize the predictive value of preclinical research , 2012, Nature.

[3]  D. Katz,et al.  Brain Activity Mapping in Mecp2 Mutant Mice Reveals Functional Deficits in Forebrain Circuits, Including Key Nodes in the Default Mode Network, that are Reversed with Ketamine Treatment , 2012, The Journal of Neuroscience.

[4]  Wei Li,et al.  Activity-dependent BDNF release and TRPC signaling is impaired in hippocampal neurons of Mecp2 mutant mice , 2012, Proceedings of the National Academy of Sciences.

[5]  M. Bear,et al.  Reversal of Disease-Related Pathologies in the Fragile X Mouse Model by Selective Activation of GABAB Receptors with Arbaclofen , 2012, Science Translational Medicine.

[6]  M. Bear,et al.  Effects of STX209 (Arbaclofen) on Neurobehavioral Function in Children and Adults with Fragile X Syndrome: A Randomized, Controlled, Phase 2 Trial , 2012, Science Translational Medicine.

[7]  A. Bird,et al.  Postnatal inactivation reveals enhanced requirement for MeCP2 at distinct age windows. , 2012, Human molecular genetics.

[8]  Hye-Seung Lee,et al.  Gastrointestinal and Nutritional Problems Occur Frequently Throughout Life in Girls and Women With Rett Syndrome , 2012, Journal of pediatric gastroenterology and nutrition.

[9]  A. Bird,et al.  Morphological and functional reversal of phenotypes in a mouse model of Rett syndrome. , 2012, Brain : a journal of neurology.

[10]  K. Vogt,et al.  Fingolimod, a sphingosine-1 phosphate receptor modulator, increases BDNF levels and improves symptoms of a mouse model of Rett syndrome , 2012, Proceedings of the National Academy of Sciences.

[11]  G. Mandel,et al.  MeCP2 Is Critical for Maintaining Mature Neuronal Networks and Global Brain Anatomy during Late Stages of Postnatal Brain Development and in the Mature Adult Brain , 2012, The Journal of Neuroscience.

[12]  Berj L. Bardakjian,et al.  Daily Rhythmic Behaviors and Thermoregulatory Patterns Are Disrupted in Adult Female MeCP2-Deficient Mice , 2012, PloS one.

[13]  C. Fiorentini,et al.  Modulation of RhoGTPases Improves the Behavioral Phenotype and Reverses Astrocytic Deficits in a Mouse Model of Rett Syndrome , 2012, Neuropsychopharmacology.

[14]  S. Siegel,et al.  MeCP2+/− mouse model of RTT reproduces auditory phenotypes associated with Rett syndrome and replicate select EEG endophenotypes of autism spectrum disorder , 2012, Neurobiology of Disease.

[15]  C. Begley,et al.  Drug development: Raise standards for preclinical cancer research , 2012, Nature.

[16]  W. Kaufmann,et al.  Social impairments in Rett syndrome: characteristics and relationship with clinical severity. , 2012, Journal of intellectual disability research : JIDR.

[17]  A. Punzo,et al.  7,8-dihydroxyflavone exhibits therapeutic efficacy in a mouse model of Rett syndrome. , 2012, Journal of applied physiology.

[18]  V. Bolivar,et al.  Mecp2 Truncation in Male Mice Promotes Affiliative Social Behavior , 2012, Behavior genetics.

[19]  O. Steward,et al.  Replication and reproducibility in spinal cord injury research , 2012, Experimental Neurology.

[20]  Tao Yang,et al.  A TrkB Small Molecule Partial Agonist Rescues TrkB Phosphorylation Deficits and Improves Respiratory Function in a Mouse Model of Rett Syndrome , 2012, The Journal of Neuroscience.

[21]  Elliot A. Ludvig,et al.  Comparative psychology and the grand challenge of drug discovery in psychiatry and neurodegeneration , 2012, Behavioural Processes.

[22]  S. Skinner,et al.  Pathogenesis of Lethal Cardiac Arrhythmias in Mecp2 Mutant Mice: Implication for Therapy in Rett Syndrome , 2011, Science Translational Medicine.

[23]  G. Shepherd,et al.  Synaptic microcircuit dysfunction in genetic models of neurodevelopmental disorders: focus on Mecp2 and Met , 2011, Current Opinion in Neurobiology.

[24]  Michael E. Greenberg,et al.  Rett Syndrome Mutation MeCP2 T158A Disrupts DNA Binding, Protein Stability and ERP Responses , 2011, Nature Neuroscience.

[25]  Harrison W. Gabel,et al.  Genome-Wide Activity-Dependent MeCP2 Phosphorylation Regulates Nervous System Development and Function , 2011, Neuron.

[26]  S. Cobb,et al.  MeCP2 and Rett syndrome: reversibility and potential avenues for therapy. , 2011, The Biochemical journal.

[27]  Kimberly Scearce-Levie,et al.  Animal Models of Alzheimer's Disease: Modeling Targets, Not Disease Accelerating Drug Discovery for Alzheimer's Disease: Best Practices for Preclinical Animal Studies , 2022 .

[28]  F. Prinz,et al.  Believe it or not: how much can we rely on published data on potential drug targets? , 2011, Nature Reviews Drug Discovery.

[29]  K. Neve,et al.  Loss of Mecp2 in Substantia Nigra Dopamine Neurons Compromises the Nigrostriatal Pathway , 2011, The Journal of Neuroscience.

[30]  Juan I. Young,et al.  Transgenic complementation of MeCP2 deficiency: phenotypic rescue of Mecp2-null mice by isoform-specific transgenes , 2011, European Journal of Human Genetics.

[31]  J. Raber,et al.  A role for glia in the progression of Rett’s syndrome , 2011, Nature.

[32]  J. Noebels,et al.  MeCP2 Is Critical within HoxB1-Derived Tissues of Mice for Normal Lifespan , 2011, The Journal of Neuroscience.

[33]  Rodney C. Samaco,et al.  Adult Neural Function Requires MeCP2 , 2011, Science.

[34]  D. Horn,et al.  The core FOXG1 syndrome phenotype consists of postnatal microcephaly, severe mental retardation, absent language, dyskinesia, and corpus callosum hypogenesis , 2011, Journal of Medical Genetics.

[35]  J. Hablitz,et al.  Network hyperexcitability in hippocampal slices from Mecp2 mutant mice revealed by voltage-sensitive dye imaging. , 2011, Journal of neurophysiology.

[36]  A. Percy,et al.  Experimental models of Rett syndrome based on Mecp2 dysfunction , 2011, Experimental biology and medicine.

[37]  W. Kaufmann,et al.  Rett syndrome: Revised diagnostic criteria and nomenclature , 2010, Annals of neurology.

[38]  P. Huppke,et al.  Readthrough of nonsense mutations in Rett syndrome: evaluation of novel aminoglycosides and generation of a new mouse model , 2010, Journal of Molecular Medicine.

[39]  J. Paton,et al.  Correction of respiratory disorders in a mouse model of Rett syndrome , 2010, Proceedings of the National Academy of Sciences.

[40]  Jennifer M. Moriuchi,et al.  Cognitive and social functions and growth factors in a mouse model of Rett syndrome , 2010, Physiology & Behavior.

[41]  H. Leonard,et al.  Linking MECP2 and pain sensitivity: The example of Rett syndrome , 2010, American journal of medical genetics. Part A.

[42]  D. Kunze,et al.  Exogenous Brain-Derived Neurotrophic Factor Rescues Synaptic Dysfunction in Mecp2-Null Mice , 2010, The Journal of Neuroscience.

[43]  M. Giustetto,et al.  Early Environmental Enrichment Moderates the Behavioral and Synaptic Phenotype of MeCP2 Null Mice , 2010, Biological Psychiatry.

[44]  James H. Eubanks,et al.  Alterations of cortical and hippocampal EEG activity in MeCP2-deficient mice , 2010, Neurobiology of Disease.

[45]  Hye-Seung Lee,et al.  Profiling Scoliosis in Rett Syndrome , 2010, Pediatric Research.

[46]  S. Skinner,et al.  Epilepsy and the natural history of Rett syndrome , 2010, Neurology.

[47]  L. Ricceri,et al.  Early postnatal behavioral changes in the Mecp2‐308 truncation mouse model of Rett syndrome , 2010, Genes, brain, and behavior.

[48]  David Moher,et al.  CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomised Trials , 2010, PLoS medicine.

[49]  Vinodh Narayanan,et al.  Abnormalities of cell packing density and dendritic complexity in the MeCP2 A140V mouse model of Rett syndrome/X-linked mental retardation , 2010, BMC Neuroscience.

[50]  D. Ransohoff,et al.  Sources of bias in specimens for research about molecular markers for cancer. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[51]  S. Nelson,et al.  Pathophysiology of Locus Ceruleus Neurons in a Mouse Model of Rett Syndrome , 2009, The Journal of Neuroscience.

[52]  S. Nelson,et al.  Intact Long-Term Potentiation but Reduced Connectivity between Neocortical Layer 5 Pyramidal Neurons in a Mouse Model of Rett Syndrome , 2009, The Journal of Neuroscience.

[53]  S. Zanella,et al.  Early breathing defects after moderate hypoxia or hypercapnia in a mouse model of Rett syndrome , 2009, Respiratory Physiology & Neurobiology.

[54]  S. Kudo,et al.  Dendritic spine pathologies in hippocampal pyramidal neurons from Rett syndrome brain and after expression of Rett-associated MECP2 mutations , 2009, Neurobiology of Disease.

[55]  Marc Fisher,et al.  Update of the Stroke Therapy Academic Industry Roundtable Preclinical Recommendations , 2009, Stroke.

[56]  Richard Paylor,et al.  Questioning standardization in science , 2009, Nature Methods.

[57]  G. Cevenini,et al.  Diagnostic criteria for the Zappella variant of Rett syndrome (the preserved speech variant) , 2009, Brain and Development.

[58]  Nathan R. Wilson,et al.  Partial reversal of Rett Syndrome-like symptoms in MeCP2 mutant mice , 2009, Proceedings of the National Academy of Sciences.

[59]  J. Roux,et al.  Tyrosine hydroxylase deficit in the chemoafferent and the sympathoadrenergic pathways of the Mecp2 deficient mouse , 2008, Neuroscience Letters.

[60]  Debra E Weese-Mayer,et al.  Autonomic dysregulation in young girls with Rett Syndrome during nighttime in‐home recordings , 2008, Pediatric pulmonology.

[61]  Alessandra Renieri,et al.  FOXG1 is responsible for the congenital variant of Rett syndrome. , 2008, American journal of human genetics.

[62]  Juan I. Young,et al.  Defective body-weight regulation, motor control and abnormal social interactions in Mecp2 hypomorphic mice. , 2008, Human molecular genetics.

[63]  Rodney C. Samaco,et al.  A partial loss of function allele of methyl-CpG-binding protein 2 predicts a human neurodevelopmental syndrome. , 2008, Human molecular genetics.

[64]  A. Hannan,et al.  Environmental enrichment ameliorates a motor coordination deficit in a mouse model of Rett syndrome –Mecp2 gene dosage effects and BDNF expression , 2008, The European journal of neuroscience.

[65]  J. Brotchie,et al.  Targeted delivery of an Mecp2 transgene to forebrain neurons improves the behavior of female Mecp2-deficient mice. , 2008, Human molecular genetics.

[66]  Daniela C. Zarnescu,et al.  Identification of small molecules rescuing fragile X syndrome phenotypes in Drosophila. , 2008, Nature chemical biology.

[67]  H. McFarlane,et al.  Autism‐like behavioral phenotypes in BTBR T+tf/J mice , 2008, Genes, brain, and behavior.

[68]  Liang Zhang,et al.  The MeCP2‐null mouse hippocampus displays altered basal inhibitory rhythms and is prone to hyperexcitability , 2008, Hippocampus.

[69]  S. Zanella,et al.  Oral treatment with desipramine improves breathing and life span in Rett syndrome mouse model , 2008, Respiratory Physiology & Neurobiology.

[70]  J. E. Kranz,et al.  Design, power, and interpretation of studies in the standard murine model of ALS , 2008, Amyotrophic lateral sclerosis : official publication of the World Federation of Neurology Research Group on Motor Neuron Diseases.

[71]  J. Coyle,et al.  Ube3a mRNA and protein expression are not decreased in Mecp2 R168X mutant mice , 2007, Brain Research.

[72]  M. Greenberg,et al.  Brain-Derived Neurotrophic Factor Expression and Respiratory Function Improve after Ampakine Treatment in a Mouse Model of Rett Syndrome , 2007, The Journal of Neuroscience.

[73]  Juan I. Young,et al.  Cell-specific expression of wild-type MeCP2 in mouse models of Rett syndrome yields insight about pathogenesis. , 2007, Human molecular genetics.

[74]  Malcolm Macleod,et al.  How can we improve the pre-clinical development of drugs for stroke? , 2007, Trends in Neurosciences.

[75]  N. Nag,et al.  Behavioral and anatomical abnormalities in Mecp2 mutant mice: A model for Rett syndrome , 2007, Neuroscience.

[76]  N. Walton,et al.  Lacosamide, a novel anti-convulsant drug, shows efficacy with a wide safety margin in rodent models for epilepsy , 2007, Epilepsy Research.

[77]  N. Nag,et al.  Postnatal dietary choline supplementation alters behavior in a mouse model of Rett syndrome , 2007, Neurobiology of Disease.

[78]  P. Maciel,et al.  Evidence for abnormal early development in a mouse model of Rett syndrome , 2007, Genes, brain, and behavior.

[79]  J. Roux,et al.  Treatment with desipramine improves breathing and survival in a mouse model for Rett syndrome , 2007, The European journal of neuroscience.

[80]  J. Bissonnette,et al.  Effect of inspired oxygen concentration on periodic breathing in methyl‐CpG‐binding protein 2 (Mecp2) deficient mice , 2007 .

[81]  Jonathan Pevsner,et al.  FXYD1 is an MeCP2 target gene overexpressed in the brains of Rett syndrome patients and Mecp2-null mice. , 2007, Human molecular genetics.

[82]  D. Richter,et al.  Breathing dysfunctions associated with impaired control of postinspiratory activity in Mecp2−/y knockout mice , 2007, The Journal of physiology.

[83]  A. Bird,et al.  Reversal of Neurological Defects in a Mouse Model of Rett Syndrome , 2007, Science.

[84]  R. Jaenisch,et al.  Partial rescue of MeCP2 deficiency by postnatal activation of MeCP2 , 2007, Proceedings of the National Academy of Sciences.

[85]  Monica Coenraads Face to Face with Rett Syndrome , 2007, Epigenetics.

[86]  Christina Thaller,et al.  Enhanced anxiety and stress-induced corticosterone release are associated with increased Crh expression in a mouse model of Rett syndrome , 2006, Proceedings of the National Academy of Sciences.

[87]  D. Katz,et al.  Dysregulation of Brain-Derived Neurotrophic Factor Expression and Neurosecretory Function in Mecp2 Null Mice , 2006, The Journal of Neuroscience.

[88]  Debra E Weese-Mayer,et al.  Autonomic Nervous System Dysregulation: Breathing and Heart Rate Perturbation During Wakefulness in Young Girls with Rett Syndrome , 2006, Pediatric Research.

[89]  E. Macedo,et al.  Cognitive performance in Rett syndrome girls: a pilot study using eyetracking technology. , 2006, Journal of intellectual disability research : JIDR.

[90]  J. Tolmie,et al.  CDKL5 mutations cause infantile spasms, early onset seizures, and severe mental retardation in female patients , 2006, Journal of Medical Genetics.

[91]  E. Kavalali,et al.  MeCP2-Dependent Transcriptional Repression Regulates Excitatory Neurotransmission , 2006, Current Biology.

[92]  L. Ricceri,et al.  An altered neonatal behavioral phenotype in Mecp2 mutant mice , 2006, Neuroreport.

[93]  P. Tam,et al.  Mecp2 deficiency is associated with learning and cognitive deficits and altered gene activity in the hippocampal region of mice. , 2006, Brain : a journal of neurology.

[94]  J. Bissonnette,et al.  Separate Respiratory Phenotypes in Methyl-CpG-Binding Protein 2 (Mecp2) Deficient Mice , 2006, Pediatric Research.

[95]  S. Nelson,et al.  The Disease Progression of Mecp2 Mutant Mice Is Affected by the Level of BDNF Expression , 2006, Neuron.

[96]  James H. Eubanks,et al.  Hippocampal synaptic plasticity is impaired in the Mecp2-null mouse model of Rett syndrome , 2006, Neurobiology of Disease.

[97]  H. Zoghbi,et al.  Learning and Memory and Synaptic Plasticity Are Impaired in a Mouse Model of Rett Syndrome , 2006, The Journal of Neuroscience.

[98]  P. Julu,et al.  Assessment of the maturity-related brainstem functions reveals the heterogeneous phenotypes and facilitates clinical management of Rett syndrome , 2005, Brain and Development.

[99]  D. Glaze Neurophysiology of Rett Syndrome , 2005, Mental retardation and developmental disabilities research reviews.

[100]  Rudolf Jaenisch,et al.  Reduced cortical activity due to a shift in the balance between excitation and inhibition in a mouse model of Rett syndrome. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[101]  G. Donnan,et al.  Systematic Review and Metaanalysis of the Efficacy of FK506 in Experimental Stroke , 2005, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[102]  H. Zoghbi,et al.  Abnormalities of social interactions and home-cage behavior in a mouse model of Rett syndrome. , 2005, Human molecular genetics.

[103]  H. Zoghbi,et al.  Mild overexpression of MeCP2 causes a progressive neurological disorder in mice. , 2004, Human molecular genetics.

[104]  R. Jaenisch,et al.  Expression of MeCP2 in postmitotic neurons rescues Rett syndrome in mice. , 2004, Proceedings of the National Academy of Sciences of the United States of America.

[105]  G. Calamandrei,et al.  Nerve Growth Factor Plasma Levels and Ventricular Repolarization in Rett Syndrome , 2004, Pediatric Cardiology.

[106]  R. Hastings,et al.  Features of Autism in Rett Syndrome and Severe Mental Retardation , 2003, Journal of autism and developmental disorders.

[107]  Kennon Heard,et al.  Emergency medicine animal research: does use of randomization and blinding affect the results? , 2003, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[108]  R. Hastings,et al.  Behaviour problems in adult women with Rett syndrome. , 2002, Journal of intellectual disability research : JIDR.

[109]  Sheena Reilly,et al.  The Rett Syndrome Behaviour Questionnaire (RSBQ): refining the behavioural phenotype of Rett syndrome. , 2002, Journal of child psychology and psychiatry, and allied disciplines.

[110]  Juan I. Young,et al.  Mice with Truncated MeCP2 Recapitulate Many Rett Syndrome Features and Display Hyperacetylation of Histone H3 , 2002, Neuron.

[111]  T. Steckler,et al.  The fallacy of behavioral phenotyping without standardisation , 2002, Genes, brain, and behavior.

[112]  M. Nakao,et al.  Functional analyses of MeCP2 mutations associated with Rett syndrome using transient expression systems , 2001, Brain and Development.

[113]  G. Jamal,et al.  Characterisation of breathing and associated central autonomic dysfunction in the Rett disorder , 2001, Archives of disease in childhood.

[114]  R. Jaenisch,et al.  Deficiency of methyl-CpG binding protein-2 in CNS neurons results in a Rett-like phenotype in mice , 2001, Nature Genetics.

[115]  W. Kaufmann,et al.  Dendritic cytoskeletal protein expression in mental retardation: an immunohistochemical study of the neocortex in Rett syndrome. , 2000, Cerebral cortex.

[116]  H. Zoghbi,et al.  Rett syndrome is caused by mutations in X-linked MECP2, encoding methyl-CpG-binding protein 2 , 1999, Nature Genetics.

[117]  K. Motil,et al.  Oropharyngeal dysfunction and gastroesophageal dysmotility are present in girls and women with Rett syndrome. , 1999, Journal of pediatric gastroenterology and nutrition.

[118]  B. Antalffy,et al.  Decreased Dendritic Branching in Frontal, Motor and Limbic Cortex in Rett Syndrome Compared with Trisomy 21 , 1998, Journal of neuropathology and experimental neurology.

[119]  J. Stables,et al.  Synthesis and anticonvulsant activities of N-Benzyl-2-acetamidopropionamide derivatives. , 1996, Journal of medicinal chemistry.

[120]  W. Löscher,et al.  D-23129: a new anticonvulsant with a broad spectrum activity in animal models of epileptic seizures , 1996, Epilepsy Research.

[121]  T. Kemper,et al.  Pervasive neuroanatomic abnormalities of the brain in three cases of Rett's syndrome , 1995, Neurology.

[122]  W. Kaufmann,et al.  Abnormal expression of microtubule-associated protein 2 (MAP-2) in neocortex in Rett syndrome. , 1995, Neuropediatrics.

[123]  T. Kemper,et al.  Microscopic Observations of the Brain in Rett Syndrome , 1995, Neuropediatrics.

[124]  B. Antalffy,et al.  Selective Dendritic Alterations in the Cortex of Rett Syndrome , 1995, Journal of neuropathology and experimental neurology.

[125]  C. Marcus,et al.  Polysomnographic characteristics of patients with Rett syndrome. , 1994, The Journal of pediatrics.

[126]  J. K. Dunn,et al.  Electrocardiographic findings in Rett syndrome: an explanation for sudden death? , 1994, The Journal of pediatrics.

[127]  B Hagberg,et al.  Rett syndrome: 3‐D confocal microscopy of cortical pyramidal dendrites and afferents , 1994, Neuroreport.

[128]  A. Reiss,et al.  Neuroanatomy of Rett syndrome: A volumetric imaging study , 1993, Annals of neurology.

[129]  D. D. del Junco,et al.  The pattern of growth failure in Rett syndrome. , 1993, American journal of diseases of children.

[130]  M. Elian,et al.  EEG and respiration in Rett syndrome , 1991, Acta neurologica Scandinavica.

[131]  J. Jankovic,et al.  Extrapyramidal involvement in Rett's syndrome , 1990, Neurology.

[132]  Jean Aicardi,et al.  A progressive syndrome of autism, dementia, ataxia, and loss of purposeful hand use in girls: Rett's syndrome: Report of 35 cases , 1983, Annals of neurology.

[133]  Rodney C. Samaco,et al.  Female Mecp2(+/-) mice display robust behavioral deficits on two different genetic backgrounds providing a framework for pre-clinical studies. , 2013, Human molecular genetics.

[134]  M. Missler,et al.  Early defects of GABAergic synapses in the brain stem of a MeCP2 mouse model of Rett syndrome. , 2008, Journal of neurophysiology.

[135]  B. Hagberg Clinical manifestations and stages of Rett syndrome. , 2002, Mental retardation and developmental disabilities research reviews.

[136]  D. Armstrong Neuropathology of Rett syndrome. , 2002, Mental retardation and developmental disabilities research reviews.

[137]  A. Bird,et al.  A mouse Mecp2-null mutation causes neurological symptoms that mimic Rett syndrome , 2001, Nature Genetics.

[138]  J. Frost,et al.  Rett syndrome: characterization of seizures versus non-seizures. , 1998, Electroencephalography and clinical neurophysiology.

[139]  R. Prescott,et al.  Rett syndrome: analysis of deaths in the British survey. , 1997, European child & adolescent psychiatry.

[140]  P. M. Fitzgerald,et al.  Rett syndrome and associated movement disorders , 1990, Movement disorders : official journal of the Movement Disorder Society.

[141]  M. Giustetto,et al.  Synaptic Determinants of Rett Syndrome , 2010, Front. Syn. Neurosci..