What is Chromosome 15q Duplication Syndrome?

by Nicole Cleary, M.S.S.
IDEAS Executive Director
August, 2006

Chromosome 15q duplication syndrome (dup15q) is a clinically identifiable syndrome which results from duplications of chromosome 15q11-13.¹ These duplications most commonly occur in one of two forms. These include an extra isodicentric 15 chromosome, abbreviated idic(15), or an interstitial duplication 15. When the extra genetic material comes from the paternal chromosome, a child may have normal development. However, when the duplicated material comes from the maternal chromosome, developmental problems are often the result. In most cases of chromosome 15q duplication syndrome, the chromosome duplication is not inherited, but occurred as a random event during the formation of reproductive cells (eggs and sperm).

It is important to acknowledge that there is a wide range of severity in the developmental disabilities experienced by individuals with dup15q syndrome. Two children with the same dup15q chromosome pattern may be very different in terms of their abilities. Reviews of the scientific literature do not show an obvious correlation between the size of the duplication region and the severity of the symptoms. However, the following features are found in most individuals with dup15q to some degree.

Physical Features
Since chromosomes carry genes that determine how our bodies grow and develop, having extra chromosomal material can alter a person’s physical development. Unlike many other chromosomal syndromes, there are few characteristic physical findings associated with chromosome 15q syndrome. The physical findings are fairly non-specific and may include the following:

• Hypotonia: Babies with dup15q usually have hypotonia (poor muscle tone). They may appear 'floppy' and have difficulty sucking and feeding. Some parents report that their babies with dup15q have an unusual, weak cry. Motor milestones such as rolling over, sitting up, and walking are significantly delayed. Older children and adults with hypotonia often tire easily. Hypotonia in dup15q syndrome generally decreases with age and sometimes progresses to hypertonia (tight muscle tone), particularly in the lower legs. 
• Physical Features: Many children with dup15q share similar facial characteristics. These include a flat nasal bridge which gives them a 'button' nose. There may be skin folds, called 'epicanthi', at the inner corners of the eyes, and the eyes may be deep set. Ears may be low-set and/or posteriorly rotated. There may also be noticeable unfolding of the edge of the ears. The palate (roof of the mouth) may be unusually high. There are also reports of areas of increased and reduced skin pigmentation.
• Growth: Growth is retarded in about 20 – 30% of individuals with dup15q. Although puberty appears to be normal in most individuals, pubertal disorders such as central precocious puberty have been observed in some girls.
• Other Abnormalities: Rarely, babies with dup15q may be born with a cleft lip and/or palate or differences in the way their hearts, kidneys, or other body organs are formed. For this reason, it is important for newly diagnosed children with dup15q to be carefully evaluated for the possibility of such structural differences. Check with your genetics specialist for specific recommendations.

Developmental problems in chromosome 15q duplication syndrome

• Gross Motor Delays: Due to the hypotonia experienced by young children with dup15q syndrome, gross motor delays are very common. In a 2005 scientific review article, sitting was reportedly achieved between 10 and 20 months of age, and walking between 2 and 3 years.² A current study of children with dup15q found that kids with isodicentric duplications achieved independent walking at an average of 25.5 months (range 13-54 months), with 3 kids (out of 47) who were not ambulatory at the time of testing.³ The vast majority of people with dup15q are able to walk independently.
• Fine Motor Delays: Parent report suggests that fine motor delays are widespread among children with dup15q syndrome. Nonfunctional use of objects with an immature type of exploration has been reported in the scientific literature.⁴
• Cognitive Delays: Most individuals with dup15q show some degree of cognitive delay/disability (mental retardation) from very early on. These cognitive disabilities are often associated with behavioral problems as children age.
• Autism Spectrum Disorders: There are now over 20 reports in the literature of individuals with both autism and idic(15). Two studies that included a total of 226 patients with autism found dup15q in approximately 3-5% of the patients.^{5, 6} Chromosome 15q11 – 13 duplications are the most frequently identified chromosome problem in individuals with autism.
• Speech/Language Delays: Most children with dup15q are affected by speech/language delays. Expressive language may be absent or may remain very poor, and is often echolalic with immediate and delayed echolalia and pronoun reversal.⁷ In her study of dup15q, Dr. Carolyn Schanen found 26 of 47 children had some language at the time of their participation in the research study, with the first word achieved at an average of 28.7 months (range 7-84 months) and phrase speech beginning by an average of 44.1m (range 9-114). While the majority of children with dup15q experience speech delays, some children are highly verbal.
• Sensory Processing Disorders: Parent report suggests that sensory processing disorders are widespread in dup15q syndrome. These sensory processing disorders disrupt the affected child’s ability to achieve and maintain an optimal range of arousal and to adapt to challenges in daily life. These disorders are often manifested by an over-responsiveness or under-responsiveness to sensory input or fluctuations in response to sensory input.
• Behavior Challenges: Many children with dup15q have difficulties of behavior and social communication, with a lack of response to social cues frequently observed. In older individuals, there is some suggestion of improving social awareness with age.⁸

Medical problems in chromosome 15q duplication syndrome

• Seizure Disorders: Seizures represent an important medical feature of idic(15) syndrome. Over half of all people with idic(15) will have at least one seizure. The majority of those will experience their first seizure before age 5, but seizure onset occurs up through puberty and young adulthood in this population. There are many different types of seizures experienced by individuals with dup15q. Children can start with one seizure type and other seizure types may emerge as the child ages. Response to treatment is variable. Some seizures are easily controlled with the first medication, other seizures are controlled for a while and then become more complex, and some children experience intractable seizures that have never been controlled with medication.
• Attention Deficit Disorders: Attention Deficit Disorder/Hyperactivity has been reported in a number of cases of children with dup15q syndrome.⁹
• Anxiety Disorders: Parent report of anxiety disorders in children with dup15q syndrome has been noted on the IDEAS listserve. More research in this area is needed.
• Other Medical Problems: Other reported medical problems include recurrent respiratory infections in childhood, middle ear effusions requiring tubes, eczema, precocious puberty, other menstrual irregularities, overeating and weight gain.^{10, 11} Scoliosis is also reported in adolescence.

Treatments for chromosome 15q duplication syndrome
At the present time, there is no specific treatment that can undo the genetic pattern seen in people chromosome 15q duplications.  Although the fundamental genetic differences cannot be reversed, therapies are available to help address many of the symptoms associated with dup15q.  Physical, occupational, and speech therapy along with special education techniques can stimulate children with dup15q to develop to their full potential.

In terms of medical management of the symptoms associated with dup15q syndrome, families should be aware that individuals with chromosome 15 duplications may tolerate medications differently and may be more sensitive to side effects for some classes of medications, such at the serotonin reuptake inhibitor type medications (SSRI).¹² Thus, these should be used with caution and any new medication should be instituted in a controlled setting, with slow titration up to the expected therapeutic dose and with a clear endpoint as to what the expected outcome for treatment is. This includes supplements.

This information has been reviewed by IDEAS Professional Advisor Brenda Finucane, MS, CGC, Genetic Services at Elwyn, Elwyn, PA..
Information Last Updated: August 20, 2006

Resources

1. Battaglia, A: The inv dup(15) or idic(15) syndrome: a clinically recognizable neurogenetic disorder. Brain Dev. 2005. 27:365-369.
2. Battaglia, A (2005).
3. Schanen, C: Molecular Investigations of Duplications of Chromosome 15 Update.  Published in MIRROR Newsletter, Fall 2006.
4. Battaglia, A. (2005).
5. Schroer RJ, Phelan MC, Michaelis RC, et al.: Autism and maternally derived aberrations of chromosome 15q American Journal of Medical Genetics. 1998;76:327-336.
6. Wang CH, Villaca-Norat E, Papendick BD: Molecular analysis of the chromosome 15q11-q13 region in children with autism American Journal of Human Genetics. 1998;63.
7. Battaglia, A. (2005).
8. Dennis NR, Veltman MW, Thompson R, Craig E, Bolton PF, Thomas NS: Clinical findings in 33 subjects with large supernumerary marker(15) chromosomes and 3 subjects with triplication of 15q11-q13. Am J Med Genet A. 2006 Mar 1;140(5):434-41.
9. Battaglia A, Gurrieri F, Bertini E, Bellacosa A, Pomponi MG, Paravatou-Petsotas M, et al. The inv dup(15) syndrome: a clinically recognizable syndrome with altered behaviour, mental retardation and epilepsy. Neurology 1997;48:1081–6.
10. Dennis NR, et al (2006).
11. Grosso S, Balestri P, Anichini C, Bartalini G, Pucci L, Morgese G, Berardi R.: Pubertal disorders in inv dup(15) syndrome. Gynecol Endocrinol. 2001 Jun;15(3):165-9
12. Schanen, C: Research update on chromosome 15 duplications – idic(15) and interstitial duplications: The duplication 15q syndrome.  Presentation at 2005 International Conference on Isodicentric 15 and Related Disorders.