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What is POTS, the disease affecting Olympic swimmer Katie Ledecky?

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What is POTS, the disease affecting Olympic swimmer Katie Ledecky?

After nearly a decade of keeping it under wraps, Olympic medalist Katie Ledecky has shared her POTS diagnosis with the world.

The athlete, who has won 14 Olympic medals for swimming, the most of any female Olympian, said she has POTS (postural orthostatic tachycardia syndrome).

In “Just Add Water: My Swimming Life,” Ledecky’s new memoir, which was published by Simon & Schuster in June, she wrote that the disease can cause “dizziness, fainting and exhaustion.”

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Here’s more. 

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What is POTS?

POTS is a disturbance in the autonomic nervous system, which controls some of the normal regulatory functions of the body, according to Dr. Blair Grubb, a cardiologist and expert on POTS at The University of Toledo College of Medicine and Life Sciences.

Katie Ledecky competes in the swimming 400m Freestyle Women Heats during the Paris 2024 Olympic Games at La Defense Arena on July 27, 2024. After nearly a decade of keeping it under wraps, Ledecky has shared her POTS diagnosis with the world. (Getty Images)

“When the person stands, gravity will try to displace downward roughly 20% to 30% of the body’s blood volume,” he told Fox News Digital. 

In response to this displacement, the brain tells the heart to beat faster and more forcibly, and tells the blood vessels in the lower half of the body to tighten, or constrict, to three times the level they were previously, the doctor said.

“This allows for accumulation of much more blood than normal in the lower half of the body,” Grubb said.

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As more blood is displaced downward, the brain gets less and less oxygen. 

Ledecky discussed this effect in her book. She wrote, “I pool blood in the vessels below my heart when I stand. My body then releases extra norepinephrine or epinephrine, which adds additional stressors on my heart, making it beat faster.”

What causes the condition?

Individuals with a genetic trait called Ehlers-Danlos syndrome (also known as joint hypermobility syndrome) appear to be more susceptible to developing this condition, according to Grubb. 

“However, POTS is frequently triggered by a viral infection, such as Epstein-Barr virus or COVID-19,” he told Fox News Digital.

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Katie Ledecky

Katie Ledecky reacts after competing in the swimming 400m Freestyle Women Heats during the Paris 2024 Olympic Games at La Defense Arena on July 27, 2024. (Getty Images)

One of these infections can trigger an autoimmune response, in which the body’s immune system attacks itself and produces antibodies that interfere with the ability of blood vessels to tighten, the doctor said.

POTS can also occur on its own, without any obvious triggers.

Symptoms of POTS

A POTS patient’s symptoms will depend on how much blood is displaced downward, experts say.

“It can vary from mild cases where your heart races and you get a little dizzy upon standing, all the way to presenting as a disabling condition, disallowing patients from being upright,” Valerie Iovine, PT, a physical therapist at Strive Physical Therapy in Philadelphia, told Fox News Digital.

“It can also change over the course of life, but can also change day to day or week to week.”

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“When the person stands, gravity will try to displace downward roughly 20% to 30% of the body’s blood volume.”

The disorder’s name — postural orthostatic tachycardia syndrome — literally translates to “when you become more upright, your heart races,” noted Iovine, who treats many patients with POTS and also has the disorder herself.

“The heart will flutter in an attempt to properly oxygenate the brain,” she said. 

Fatigued woman

Symptoms can include “disabling fatigue, exercise intolerance, heat intolerance, palpitations, lightheadedness, dizziness, fainting and brain fog,” a doctor said. (iStock)

“But in addition to the dizziness, headaches, passing out or near passing out, many with this disorder don’t realize that it can account for other issues, like temperature dysregulation, blood pressure dysregulation and GI dysfunction.”

In more extreme cases, patients may have difficulty thinking, concentrating or remembering — sometimes called brain fog, according to Grubb.

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People may also experience blurred vision, black spots in their visual field, tunnel vision and headache. 

“Even greater displacement of blood can cause the individual to lose consciousness,” Grubb said.

Treatments and therapies

The primary treatment for POTS is increasing water and salt intake, Grubb said. 

“It is also important to recondition the patient through exercise, building the strength in their lower extremities,” he said.

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Some medications, such as midodrine and droxidopa — known as vasoconstrictors — can work to tighten blood vessels and increase blood return to the heart, according to Grubb. 

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Still other drugs, such as fludrocortisone or desmopressin, work by increasing the volume of fluids available for the heart to pump. 

“Medications such as pyridostigmine facilitate nerve transmission and help the nervous system work more effectively to maintain normal vascular function,” Grubb added.

Dizzy man running

The disease can often cause a flu-like feeling after exercise, something called post-exertional malaise/post-exertional symptom exacerbation (PEM/PESE).  (iStock)

Many often use the term “exercise intolerance” when describing symptoms of POTS, but Iovine said that “poorly prescribed and dosed exercise” is the problem.

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“Exercise is the best management for POTS,” she said.

“I would argue that for these patients, movement is medicine.”

In her book, Ledecky noted that swimming can be an effective treatment for POTS, writing that “reclined aerobic exercise, such as swimming, and strengthening your core, can provide relief.”

“For these patients, movement is medicine.”

Seeking care from a cardiologist and a physical therapist is essential, according to Iovine.

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The cardiologist can help to get vital signs like heart rate and blood pressure under control, she said, while a knowledgeable physical therapist can help to manage symptoms and increase upright tolerance. 

Girl drinking energy drinks

“Things like proper hydration, extra electrolytes, and being able to keep cool can also help manage symptoms,” an expert advised. (iStock)

“Things like proper hydration, extra electrolytes, and being able to keep cool can also help manage symptoms,” Iovine advised.

“The heat will make the blood vessels expand, making it harder to get the blood up the head against gravity,” she said.

How POTS impacts athletes

“POTS can be a challenge for anyone — from people with complicated pre-existing conditions, all the way to the top athletes, like Katie Ledecky,” Iovine told Fox News Digital. 

The disease can often cause a flu-like feeling after exercise, something called post-exertional malaise/post-exertional symptom exacerbation (PEM/PESE). 

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“This is when the autonomic nervous system can have a reflexive reaction to stress or exercise, either making existing symptoms worse or creating a new host of issues in people with POTS,” Iovine said. 

“This can pose an issue in the sense of rigorous exercise for an Olympic athlete — or in other cases, exertion may be as simple as getting out of bed and walking to the kitchen.”

Woman physical therapy

While there is no cure for POTS, many patients are able to manage their symptoms and return to their daily activities with the help of a care team. (iStock)

POTS causes a “dynamic disability,” Iovine noted.

“One day, it may allow you to swim like an Olympic athlete, and other days, [it will] have you stuck in bed or even in a wheelchair.”

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POTS is particularly challenging in athletic activities that involve frequent “start and stop” activities, such as basketball, volleyball, soccer and field hockey, added Grubb.

‘A real illness’

Both experts emphasized that POTS is a “real illness.”

“People who were previously quite healthy develop severe limitations and disabilities,” Grubb said.

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“They can experience disabling fatigue, exercise intolerance, heat intolerance, palpitations, lightheadedness, dizziness, fainting and brain fog.”

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Iovine said that due to the “invisibility” of the disease combined with the high heart rate and variability of presentations, it is often dismissed as a function of mental health.

“One day, it may allow you to swim like an Olympic athlete, and other days, have you stuck in bed or even in a wheelchair.”

“Patients are often turned away from proper care, made to believe it is all in their heads,” she said.

“POTS is a very real condition, and the good news is that there are very real management strategies as well,” Iovine went on.

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While there is no cure for POTS, many patients are able to manage their symptoms and return to their daily activities.

Added Iovine, “Build up your care team and your confidence to advocate for your health and keep to your regimented routines for management.”

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Howie Cohen, Whose Alka-Seltzer Ads Spawned Catchphrases, Dies at 81

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Howie Cohen, Whose Alka-Seltzer Ads Spawned Catchphrases, Dies at 81

Howie Cohen, an advertising copywriter, often said he was congenitally familiar with indigestion. So perhaps it was only natural that in the 1970s, he, along with an ad agency colleague, would conjure up a catchy slogan that would not only sell more Alka-Seltzer but also become an American pop culture punchline: “I can’t believe I ate the whole thing.”

That bedside lament, spoken by the comedian and dialectician Milt Moss — he actually said that thing on camera — vaulted from a 30-second TV commercial to sweatshirts, supermarket windows and even church marquees.

It proved even more popular than “Try it, you’ll like it,” the first catchphrase for Alka-Seltzer that Mr. Cohen coined with his business partner, Bob Pasqualina, an art director at the Manhattan agency Wells Rich Greene.

Mr. Cohen, who helped popularize products and companies like Petco (“Where the pets go”) and the fast-food chain Jack in the Box (exploding its clown mascot in a TV commercial in announcing a new, more sophisticated menu), died on March 2 at his home in Los Angeles. He was 81.

His death, which wasn’t widely reported at the time, was announced on Facebook by his brother, Jerry, who said the cause was cancer.

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Alka-Seltzer’s creative advertising had already found success in the 1950s and ’60s. It had introduced its mascot Speedy and its “plop, plop, fizz, fizz” jingle. It had brought “tummies” to television commercials. And it had played on cultural stereotypes (“that’s a spicy meatball”), offending some viewers. But by the early 1970s, sales were lagging.

Mr. Cohen and Mr. Pasqualina, who had recently joined Wells Rich Greene, were tasked with creating an ad campaign that would run until the agency could come up with a long-term strategy to make Alka-Seltzer a household name again.

Mr. Cohen recalled in a 2019 memoir that those two popular ads the partners came up with, both in 1972, were inspired by his upbringing in the Pelham Parkway neighborhood of the East Bronx.

The “try it” tag line had its roots, he wrote, in his mother’s dinnertime plea that he eat the liver and onions that regularly congealed untouched on his plate.

“We only had 30 seconds, so we couldn’t get too complicated,” Mr. Cohen told The New York Times in 1972. “One of us came up with ‘Try it, you’ll like it.’ We said it over and over again, because we couldn’t think of another line, and the repetition became the thing.”

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In the ad, Jack Aaron, a stage actor who had appeared in commercials, plays a man sitting in a restaurant recounting a meal he once had — an indigestible one, it turned out — at the encouragement of a waiter, who kept telling him, “Try it, you’ll like it.”

“I used to work part time as a waiter,” Mr. Aaron told The Times in 1972. “Now I eat at Sardi’s, and the waiters all say, ‘Try it, you’ll like it.’”

If “try it” was inspired by Mr. Cohen’s abstinence, the “whole thing” line resulted from his overindulgence. He, Mr. Pasqualina and a production crew were in London gorging on an Italian dinner hosted by the director Milos Forman, who had filmed a commercial that the two admen had created for Diet Rite Cola.

“I’m a nice Jewish kid from the Bronx, so I ate everything until I couldn’t fit one more thing in my body,” Mr. Cohen would often recall. “I leaned back in my chair and said, ‘I can’t believe I ate the whole thing.’ And my wife said, ‘There’s your next Alka-Seltzer commercial.’”

In the commercial, a woman, trying to fall back to sleep, urges her pajama-clad husband, who is sitting groaning on the edge of their bed, to take two Alka-Seltzer tablets to settle his stomach after overindulging. He repeats the “whole thing” line over and over.

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Both ads are enshrined in the advertising industry’s Clio Awards Hall of Fame.

A marketing survey found that about 85 percent of Americans could identify Alka-Seltzer through the “whole thing” slogan, which would later be immortalized in the game Trivial Pursuit and on the TV animated series “The Simpsons.”

“They say the best lines come from the heart,” Mr. Cohen wrote in his book, “I Can’t Believe I Lived the Whole Thing: A Memoir From the Golden Age of Advertising.” “‘I can’t believe I ate the whole thing’ came from my stomach.’”

Mary Wells Lawrence, one of the founders of Wells Rich Greene and Mr. Cohen’s mentor, described Mr. Cohen and Mr. Pasqualina as “two of the most talented people we ever had.”

Ms. Wells Lawrence, who died in May, wrote in her own memoir that earlier Alka-Seltzer ads had grabbed attention and entertained, but that “they were not as believable, as earnestly sincere and therefore not as persuasive as Howie and Bob’s sweet, funny commercials — especially ‘I ate the whole thing.’”

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Howard Stephen Cohen was born on Sept. 25, 1942, in the Bronx to Samuel and Jeannette Cohen. The elder Mr. Cohen owned a steel fabrication company that he had inherited from his father.

Howie Cohen wrote in his memoir that he grew up in a one-bedroom apartment adjacent to an elevated train. When he was 13, he was given a tape recorder as a bar mitzvah gift and began producing commercials. After graduating from New Rochelle High School in Westchester County, he attended the University of Miami and earned a bachelor’s degree in business from New York University.

Destined to inherit his father’s company but eager not to, he applied to ad agencies and in 1965 landed a job as a copy trainee on the Volkswagen account at Doyle Dane Bernbach.

He joined Wells Rich Greene in 1967; left to start his own firm with Mr. Pasqualina; returned to Wells Rich Greene as a creative director; became the president of its Los Angeles office; and founded another agency with the adman Mark Johnson, which he sold in 1997 to the Phelps Group. He remained as partner and chief creative officer until he retired in 2017. He also wrote a blog called Mad Mensch.

In addition to his brother, his survivors include his wife, Carol (Trifari) Cohen, whom he married in 1972; two children, Jonathan and Johanna; a stepdaughter, Cristina; and a granddaughter.

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In 2012, Mr. Cohen was asked by Google to reimagine the “I can’t believe I ate the whole thing” ad for a 21st-century digital version.

“I look at the internet tools and technologies that we have and see exciting new ways to express an idea,” he told The Los Angeles Times. “But emotions will always trump algorithms. Advertising is about connecting in a human way.”

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J. Robin Warren, Who Proved That Bacteria Cause Ulcers, Dies at 87

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J. Robin Warren, Who Proved That Bacteria Cause Ulcers, Dies at 87

Dr. J. Robin Warren, an Australian pathologist who shared a Nobel Prize for discovering that most stomach ulcers were caused by the bacterium Helicobacter pylori — and not, as had been widely believed, stress, alcohol or spicy foods — died on July 23 in Inglewood, Australia. He was 87.

His death, at a care home, was announced by the University of Western Australia in Perth, where he was an emeritus professor for many years. His daughter-in-law Gigi Warren said the cause was complications after a recent fall.

In 1984, Dr. Warren and his collaborator, the gastroenterologist Barry Marshall, published a paper in the British medical journal The Lancet describing their finding that the spiral-shaped bacterium now commonly called H. pylori festered in the stomachs of patients with ulcers and gastritis. Dr. Warren had first noticed the bacterium on a gastric biopsy sample in 1979.

The paper’s conclusion upended centuries of conventional wisdom about the cause of ulcers. (Psychoanalysts had even written of the “peptic ulcer personality.”) Doctors typically prescribed stress reduction, a bland diet and, starting in 1977, drugs like Tagamet and Zantac to tame the burning acids. Severe cases were sometimes treated with surgery.

When the study was published, gastroenterologists were skeptical. They expressed concern about whether to trust potentially paradigm-shifting findings made by two unknown researchers in Australia. And the idea that bacteria could even grow in the stomach was considered blasphemy.

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“For about 100 years, or 1,000 years, the standard teaching in medicine was that the stomach was sterile and nothing grew there because of corrosive gastric juices,” Dr. Warren told The New York Times in 2005 after he and Dr. Marshall won the Nobel Prize in Physiology or Medicine. “So everybody believed there were no bacteria in the stomach. When I said they were there, no one believed it.”

The study was also at odds with the marketing done by pharmaceutical companies, which had spent millions of dollars developing acid reduction drugs. Those medicines cleared up ulcers, but the condition often returned again and again. Dr. Warren and Dr. Marshall’s work suggested that antibiotics would be a more effective treatment.

“The prospect that antibiotics might cure ulcers was a serious threat to the world record profitability of the recently developed wonder drugs that stopped the secretion of gastric acid and healed ulcers rapidly,” Dr. William S. Hughes wrote in “The Great Ulcer War” (2014), a history of the Australian duo’s fight over proving that H. pylori caused ulcers.

Fed up with the skepticism and pushback after their paper was published, Dr. Marshall had a rather unconventional idea: infecting themselves with H. pylori.

“I didn’t like that idea at all,” Dr. Warren later said, “so I think I just said no.”

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But Dr. Marshall went through with it, gulping down a broth of the bacterium. A few days later, he became severely ill with gastritis — the precursor to an ulcer.

That still wasn’t enough proof. It would take almost a decade for physicians to finally accept the findings and change how they treated ulcers: with antibiotics, just as they would treat any other bacterial infection.

“Now there is the possibility of curing the condition, which was unthought of before,” Hugo Gallo-Torres, a Food and Drug Administration official, said in 1994, adding, “We had treated ulcers with anti-secretory compounds for so many years, it was hard to accept that a germ, a bacterium, would produce a disease like that.”

John Robin Warren was born on June 11, 1937, in North Adelaide, Australia. His father, Roger, studied viticulture and was a winemaker. His mother, Helen (Verco) Warren, was a nurse who had dreams of becoming a doctor but couldn’t afford medical school.

He studied medicine at the University of Adelaide, graduating in 1961. He wanted to specialize in psychiatry, but he wasn’t accepted into the residency program. He chose clinical pathology instead, committing himself to a solitary life staring into a microscope.

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“In practice, ‘Clinical Pathology’ meant mainly laboratory hematology, which I thoroughly enjoyed,” Dr. Warren wrote in his Nobel autobiography. “Although the usual work entailed reporting on blood smears and bone marrow, we had a wide range of other tasks, including examining feces for parasites, examining urine and testing skin and nails for fungus.”

In 1968, he became a pathologist at Royal Perth Hospital, which is affiliated with the University of Western Australia.

“He was a bit eccentric,” Dr. Marshall said in an interview. “You’re a pathologist living down in the basement there, cutting up dead bodies and that. So you didn’t have to be a people person really to succeed at that job.”

What Dr. Warren did have was a kind of scholarly stubbornness.

“He’s uninfluenced by other people’s opinions,” Dr. Marshall said, adding that even when colleagues laughed at their attempts to prove H. pylori caused ulcers, “as far as he’s concerned, that was the facts. And if you didn’t believe it, it’s because you were just incompetent or something.”

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Dr. Warren married Winifred Williams, a psychiatrist, in 1962. She died in 1997. They had five children. (Complete information on survivors was not immediately available.)

At the outset of Dr. Warren’s obsession with H. pylori, his wife was among the few people in his life not to deem him crazy — though she was certainly qualified to do so.

“Before I met Barry, Win was the only person to accept my work and encourage me,” he wrote in his Nobel autobiography. “As a psychiatrist, she could have suggested I was mad. But she stood beside me and helped me when no one else would.”

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What is Angelman syndrome? Colin Farrell’s son is living with this rare disease

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What is Angelman syndrome? Colin Farrell’s son is living with this rare disease

Actor Colin Farrell is launching a new foundation to raise awareness of a rare genetic condition called Angelman syndrome, so that his son and others with the disorder will have more support and resources as they transition into adulthood.

“I want the world to be kind to James,” Farrell, 48, told People magazine ahead of his son’s 21st birthday in September.

“All the safeguards that are put in place, special ed classes — that all goes away, so you’re left with a young adult who should be an integrated part of our modern society and, more often than not, is left behind.” 

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What is Angelman syndrome?

The syndrome was first described in 1965 by physician Dr. Harry Angelman, according to the National Organization for Rare Disorders (NORD).

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It is a disorder of the nervous system, which helps control movements, thoughts and behaviors, as stated by Cleveland Clinic.

Actor Colin Farrell is launching a new foundation to raise awareness of a rare genetic condition called Angelman syndrome, which affects his son — pictured with Farrell, at right, in 2009. (Getty Images)

Most cases are caused by a random genetic change during early development, which means those who are affected usually have no family history of the disease, the National Institutes of Health (NIH) adds.

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“Angelman syndrome is a complex neurodevelopmental disorder resulting from the loss of function of a specific gene called UBE3A, which plays a crucial role in brain development,” Dr. Issac Molinero, pediatric neurologist at Ochsner Children’s Hospital in New Orleans, Louisiana, told Fox News Digital.

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The genetic changes that occur with Angelman syndrome lead to significant challenges, including severe intellectual disability, communication difficulties and characteristic behavioral patterns, such as frequent laughter and smiling, according to Molinero.

Colin Farrell and Kim Bordenave

Model Kim Bordenave and actor Colin Farrell, parents of son James Farrell, are pictured at the 75th Annual Academy Awards at the Kodak Theater on March 23, 2003, in Hollywood, California. (Getty Images)

Dr. Dana Price, pediatric neurologist and director of Angelman Clinic at NYU in New York City, described the disorder as a “spectrum.”

It can include “low muscle tone, developmental delay, poor gait, seizures (ranging from febrile seizures to refractory epilepsy), constipation, poor sleep and challenging behavior,” she told Fox News Digital in an email.

Developmental delays

The condition causes delays in development for the children it affects.

Newborn babies may have trouble latching on or swallowing milk, and after a few months, they may not be able to lift their heads, according to Cedars Sinai.

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They may also miss the milestones of sitting up alone, crawling, standing up by themselves or taking their first steps.

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Infants can develop microcephaly, a condition where their heads are characteristically smaller compared to other children of the same age, per NIH.

“Generally, developmental delays associated with Angelman syndrome will become noticeable around six to 12 months of age,” Molinero told Fox News Digital.

Nonverbal communication

Children with the disorder often learn to communicate in other ways, like gesturing, and may be able to understand a simple conversation. (iStock)

Silence is another hallmark clue, experts say. 

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The baby may be able to say words like “Dada” and follow simple commands, but won’t be able to put together complete sentences or have a verbal conversation, according to Cedars Sinai.

At age 2 or 3 years old, some children may start to have seizures, Mayo Clinic notes.

The rare disorder only affects roughly 500,000 people worldwide.

One typical hallmark of the syndrome is unprovoked fits of laughter, along with frequent smiling and hand-flapping movements, according to NIH. 

Children with the disorder often have short attention spans, with most having difficulty sleeping or needing less sleep than normal.

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The sleep issues tend to improve as the child gets older, but the limited speech, intellectual disabilities and seizures may continue throughout life.

Although most people with the condition can’t speak, they learn to communicate in other ways, such as gesturing, and may be able to understand a simple conversation, according to NORD.

Diagnosis and treatment

Doctors diagnose the condition based on blood tests that look for the genetic mutation, experts say.

The syndrome is often misdiagnosed, as initial symptoms can be confused with more well-known diseases like autism or cerebral palsy, according to the Angelman Syndrome Foundation.

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Boy from behind

Children are often not diagnosed until they are 3 or 4 years old, when they have already started pre-school. (iStock)

Children are often not diagnosed until they are 3 or 4 years old, when they have already started pre-school, experts say.

The rare disorder only affects roughly 500,000 people worldwide, Molinero noted.

Those with the condition have a normal life expectancy, according to NIH.

Individualized treatment

“Although there is no definitive cure for Angelman syndrome, proactive early intervention through therapies, educational support and community resources can significantly enhance the quality of life for affected individuals and their families,” Molinero said.

      

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Depending on symptoms, treatments may include various medications for seizures, sleep, mood, reflux and constipation, Price added.

Boy in therapy

Those with the disorder may also receive various types of therapy to learn how to communicate non-verbally, to manage hyperactivity and to improve balance. (iStock)

Those with the disorder may also receive various types of therapy to learn how to communicate non-verbally, to manage hyperactivity and to improve balance.

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“This is a very exciting time to work with the Angelman Community, because drug companies are working to develop precision medicine to turn on the missing gene (UBE3A),” Price said.

“Genetic treatment with precision medicine is such a revolutionary prospect — for the first time, we would be treating the disease, not the symptoms.”

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For more Health articles, visit www.foxnews/health

Those who have a family member with Angelman Syndrome or are affected themselves can visit an Angelman Clinic or the Angelman Syndrome Foundation’s website at https://www.angelman.org.

Fox News Digital reached out to the Colin Farrell Foundation for comment.

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