Review Article | DOI: https://doi.org/10.31579/2578-8868/413
Neurobiology of Anxiety and mood disorders, Nantes University, 98 rue Joseph Blanchart, 44100 Nantes. France.
*Corresponding Author: Michel Bourin, Neurobiology of Anxiety and mood disorders, Nantes University, 98 rue Joseph Blanchart, 44100 Nantes. France.
Citation: Michel Bourin, (2026 Pitt-Hopkins Syndrome: Diagnosis, Clinical Presentation, and Management, J. Neuroscience and Neurological Surgery, 19(4); DOI:10.31579/2578-8868/413
Copyright: © 2026, Michel Bourin. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Received: 30 March 2026 | Accepted: 06 April 2026 | Published: 10 April 2026
Keywords: Pitt–Hopkins syndrome; PTHS; TCF4 gene; neurodevelopmental disorder; intellectual disability; speech impairment; genetic diagnosis; hyperventilation; apnea
Pitt–Hopkins syndrome (PTHS) is a rare neurodevelopmental disorder caused by pathogenic variants in the TCF4 gene. It is characterized by severe intellectual disability, absent or minimal speech, distinctive facial features, behavioral abnormalities, and episodic hyperventilation with apnea. The estimated prevalence ranges from 1 in 100,000 to 1 in 300,000 individuals. Clinical manifestations typically emerge in early childhood and include hypotonia, global developmental delay, epilepsy, gastrointestinal disturbances, and musculoskeletal abnormalities. Diagnosis is based on clinical features and confirmed by molecular genetic testing. Differential diagnoses include several neurodevelopmental syndromes with overlapping phenotypes. Management is supportive and multidisciplinary, focusing on rehabilitation therapies, communication strategies, and treatment of associated complications. Although no curative therapy exists, early intervention significantly improves outcomes and quality of life. Advances in genetic research are expected to further enhance understanding and management of this condition.
Pitt–Hopkins syndrome (PTHS) is a rare neurodevelopmental disorder characterized by distinctive morphological, cognitive, and behavioral features (1). It is caused by abnormalities in the TCF4 gene, located on chromosome 18q21.2, and most cases de novo (2). The syndrome was first described in 1978 by David Pitt and Ian Hopkins, who reported two unrelated patients presenting with intellectual disability, episodic hyperventilation, and shared facial characteristics(3). In 2007, three independent research groups identified TCF4 as the causative gene by describing patients with deletions involving 18q21.2 (4). Subsequent studies have refined the phenotypic spectrum of PTHS, which includes global developmental delay, usually severe intellectual disability with absent or limited speech, characteristic facial features, stereotypic behaviors, episodic hyperventilation and apnea, and frequent comorbidities involving gastrointestinal, orthopedic, ophthalmological, and ENT systems.
Prevalence
The prevalence of PTHS has not been definitively established. A prevalence of 1 in 225,000 to 1 in 300,000 was estimated considering the number of patients in the United Kingdom and the Netherlands (5). It was estimated that the frequency of 18q21 deletions associated with PTHS is between 1/34,000 and 1/41,000 (6). Based on cohorts of patients with intellectual disability (ID) whose genetic study was performed using non-targeted approaches (ID gene panels, exome, or genome) . It was found that PTHS was a relatively frequent cause of ID, estimating it at approximately 0.7% of moderate to severe ID, which suggests an overall prevalence of PTHS between 1/100,000 and 150,000. PTHS affects men and women equally and regardless of origin (7).
Circumstances of Discovery
- In the Perinatal Period
During pregnancy, there are no signs that specifically suggest a diagnosis of PTHS. Conversely, the diagnosis may be made incidentally during chromosomal analysis on a DNA chip or high-throughput sequencing (exome or genome sequencing) prompted by one or more ultrasound findings, an abnormality in serum markers, etc. At birth, newborns may present with nonspecific signs such as hypotonia and/or feeding difficulties. More rarely, suggestive morphology may be noted, but most often the morphological signs become more evident with age (8).
-In childhood and adolescence
During the first year of life, various signs may prompt a consultation, such as persistent hypotonia, psychomotor delay, feeding difficulties, and constipation. Epilepsy may begin early in some. Subsequently, the delay in psychomotor development is evident, and the children develop with intellectual disability (ID), most often severe. Walking is delayed, and language is absent or limited. Behavioral disturbances are common, including motor restlessness, stereotypies, and hyperventilation. Facial features are often suggestive. Epilepsy may be present, as well as other variable signs (1).
- In adulthood
The diagnosis is sometimes made in adulthood in the absence of prior specialist consultation. Adults have severe intellectual disability with reduced autonomy. Behavioral signs are also present and sometimes exacerbated (restlessness, anxiety, stereotypies, hyperventilation). Morphological characteristics are more pronounced than in children. Adults exhibit the other signs described in this syndrome to varying degrees (1).
Diagnostic Confirmation
When PTHS is clinically suspected, it is essential to confirm the diagnosis by identifying the molecular abnormality of the TCF4 gene in the patient (using a blood sample). This will also allow for more precise genetic counseling (9).
Available genetic tests include:
- targeted sequencing of the TCF4 gene, or high-throughput sequencing of a gene panel including TCF4, to detect intragenic variants or very small deletions.
- exome or genome sequencing (to detect intragenic variants, and rearrangements using genome sequencing).
- Chromosomal microarray analysis can be used to identify large deletions that include TCF4 or several exons of the gene, while karyotyping helps detect translocations affecting 18q21.2.
Differential diagnoses
If genetic tests do not reveal abnormalities in the TCF4 gene, doctors should also consider other syndromes that may show symptoms like PTHS. Examples include Angelman syndrome , ATRX syndrome , Rett syndrome , Kleefstra syndrome , Mowat-Wilson syndrome and syndromes linked to the genes CDKL5 This list is not exhaustive, and other neurodevelopmental disorders may present similarly to PTHS (5,10)
Clinical Signs
- Perinatal Period
Pregnancy is usually uneventful. During pregnancy, mild intrauterine growth restriction (IUGR) was seen in 23% of patients; however, only 8% of infants were born with low birth weight (T ≤ -2 SD). In the neonatal period, axial hypotonia was present in 75% of infants, persisting into the first year of life, sometimes associated with digestive problems (feeding difficulties, gastroesophageal reflux, constipation, vomiting) (11).
-Neurodevelopmental Disorders
Delayed motor development is always present. Most patients acquire hand grasping, head control, and sitting, but with delay and at varying ages. Independent walking is achieved in approximately 75% of patients, always delayed, with an average onset between 5 and 7 years of age (ranging from 2 to 14 years), and is often unsteady and ataxic. Fine motor abilities are restricted. Reports of loss of hand function are uncommon (12).
- Language and Communication
Patients with PTHS typically have no verbal language or language limited to a few words. 55% of individuals express only one word before the age of 10, and most have little or no expressive language throughout their lives. Even among those who were able, their communicative intent was often unclear. Qualitative difficulties, including both immediate and delayed echolalia, were also noted (5).
-Cognitive Impairment, Autonomy
Severe intellectual disability (more rarely moderate) is present in most individuals with PTHS, and there is little detailed information regarding cognitive abilities. Patients are difficult to assess with standard tests due to their motor difficulties and near absence of language. To assess individuals with PTHS, it is necessary to adapt communication methods to understand their true potential (13). Therefore, preliminary work is necessary to determine the most suitable communication method for a given individual. By using an augmentative and alternative communication (AAC) tool with a patient, you can evaluate their ability to understand spoken language, assess their vocabulary skills, and gain insight into their cognitive reasoning. A range of typical non-verbal tasks are achievable, alongside modified verbal exercises and established phrases.
-Morphological Signs
A distinctive facial morphology remains the primary diagnostic criterion. This condition is marked by sunken eyeballs, a noticeable nasal root, a wide nasal bridge, a broad and hooked tip of the nose, a large mouth, an outward-turned lower lip, an upper lip shaped like a gendarme hat with a pronounced Cupid's bow, and prominent ears featuring a thick, overly conspicuous, horizontally oriented helix. Most patients present with a typical facial morphology, either from early childhood or which becomes typical with age. Hand characteristics include a single transverse palmar crease (63%), persistence of the fetal
pads of the fingertips (61%), long/thin fingers (65%), camptodactyly, and reduced thumb mobility that can progress to thumb ankylosis (13%). Foot abnormalities are frequently observed, with flat feet occurring, and overlapping toes present . This report details five patients who exhibit brachydactyly affecting one or more of their three smallest toes (15).
-Height and weight growth and head circumference
At birth, growth parameters are normal for most patients. However, moderate postnatal short stature (slightly less than -2 SD) is present in 18% of adults. So far, no hormonal causes like growth hormone deficiency or hypothyroidism have been identified. Moderate microcephaly, defined as between -2 and -3 standard deviations, occurs in about 50% of cases, while postnatal fractures are seen in 25% of patients. Overweight or obesity are rare. It is advisable to track high and weight growth, following the usual practices for the general population (5).
Neurological Signs
During the first year of a child's life, hypotonia is observed in about 75% of cases; it may appear as early as the newborn stage and frequently remains throughout this period. Peripheral hypertonia has been noted in one-third of patients, and axial hypertonia is rare (16). Patients with PTHS often exhibit a gait that is unstable and may occasionally display signs of ataxia (17).
-Imaging
Brain MRI scans in patients with PTHS often show a range of non-specific abnormalities. Approximately 40% show alterations in the corpus callosum, which may include shortening, thinning, or complete absence. Approximately 30% of cases show enlarged ventricles, while posterior fossa abnormalities are also seen in about 30%. Posterior fossa abnormalities are variable (18):
-cerebellar atrophy, vermian hypoplasia, thin brainstem, enlarged cisterna magna,
-retrocerebellar cysts, verticalized tentorium cerebelli, and hyperintensity of the dentate nuclei.
Additional, less common findings include underdeveloped hippocampi, increased signal intensity in the temporal lobe, underdevelopment of the frontal lobe, or enlargement of the caudate nuclei. Brain imaging is recommended only if there are neurological symptoms or signs, as it has no impact on treatment decisions once the diagnosis is confirmed.
-Epilepsy
Epilepsy occurs in 37% to 50% of individuals with PTHS, and its features such as seizure type and severity can vary widely. Reported seizures are varied, including absence seizures, generalized tonic-clonic seizures, and infantile spasms (19). The age of onset is variable and can range from the first year of life to young adulthood. For most patients, antiepileptic medications effectively manage seizures. Individuals with respiratory stereotypies might frequently stop breathing and develop cyanosis, which could be mistaken for epilepsy and create difficulties in accurate diagnosis and treatment. Conversely, epileptic seizures can sometimes present as respiratory stereotypies and delay diagnosis. More rarely, episodes of respiratory distress can trigger a seizure (20). If there is uncertainty, a video-assisted EEG may be provided to support the determination of suitable treatment. Interictal EEG tracings in individuals with PTHS can be normal or abnormal and may change over time, but most often the results are nonspecific. It is recommended performing an EEG combined with video at the slightest suspicion in individuals with PTHS, particularly due to the difficulty in distinguishing epileptic seizures from apneas (21).
Valproic acid, levetiracetam, lamotrigine, and carbamazepine are the most used antiepileptic drugs, but there is insufficient data to indicate whether one drug is more effective than another. The selection of antiepileptic therapy will depend on the seizure type and underlying abnormalities and will involve guidance from a specialist neurologist or pediatric neurologist. When an episode continues for more than five minutes or occurs frequently, doctors may prescribe oral midazolam or rectal diazepam to parents.
Respiratory abnormalities
Disruption of respiratory regulation is one of the cardinal criteria of PTHS and is linked to general dysautonomia, which can also manifest as dilated pupils with slow reactivity to light, unstable body temperature, vasomotor disturbances of the extremities, constipation, or urinary retention (5). Hyperventilation is present in more than half of patients, occurring spontaneously or triggered by emotional situations (stress, joy). The age of onset varies among patients. In the literature, the youngest patient is 9 months old and the oldest is 16 years old. In certain cases, patients may experience hyperventilation for several years before symptoms diminish or become less frequent. Around half of patients experience apnea episodes, which can happen on their own, separate from hyperventilation, and may also occur during sleep. The typical respiratory pattern consists of rapid breathing, both regular and irregular, followed by a cessation of breathing. The duration is usually 2 to 5 minutes. The occurrence of episodes demonstrates considerable variability, with frequencies ranging from multiple times per hour to just a few instances annually. Following a period of apnea, cyanosis may occur and, in rare cases, it can lead to loss of consciousness. Oxygen saturation may decrease during a period of abnormal breathing. No deaths related to an episode of hyperventilation or apnea have ever been reported (22). Respiratory abnormalities may precede or follow the onset of a seizure, but it is rare for an episode of hyperventilation to cause a seizure (23). Clubbing of the fingers often appears in people with PTHS a few years after respiratory issues begin (24). Respiratory problems can be alarming, but most patients do not appear bothered and remain comfortable. In some cases, these problems cause anxiety in patients; others stop their activities, some sit down to prevent a fall, and in a minority of cases, loss of consciousness may occur. In a small number of patients, irregular breathing at night and catathrenia have been reported. Most often, no treatment is necessary for hyperventilation and apnea, as they do not cause major consequences. Some studies have analyzed the effect of certain drug classes on respiratory disorders. Studies have shown that daily acetazolamide treatment leads to a decrease in the frequency and duration of hyperventilation and apnea episodes and an improvement in oxygen saturation in individuals with post-hyperventilation syndrome (PHTS) (25,26). Nonetheless, this treatment can cause significant hypokalemia, so caution is advised and it is not considered a first-line option.
Behavioral Disorders
- Stereotypies
Stereotyped movements are present in almost all PTHS patients, including arm flapping , hand biting , finger movements , wrist movements , hand-washing gestures , and head movements , particularly rotation. Repetitive motions of the lower limbs have occasionally been observed, often taking the form of continuous flexing and extending movements. Typical movements like these frequently become more noticeable when a person experiences strong emotions, whether those feelings are positive such as joy or excitement or negative, like anxiety or stress. Engaging repeatedly with toys or objects, exhibiting intense interest in particular items, and consistently performing certain actions have also been observed (27) .
-Anxiety and Agitation
Beyond stereotypical behaviors, individuals with PTHS often display a typically cheerful expression and may also exhibit spontaneous laughter without apparent cause . Anxiety is common among these patients . Initially described as having a cheerful demeanor, patients with PTHS more often appear anxious but with a smiling demeanor (28). Agitation is frequently mentioned , often characterized by calm but incessant movements, possibly related to anxiety.
-Autistic Disorders
Difficulties with social interaction and communication are frequently observed in patients with PTHS. Limited data exists regarding precise assessments of autism spectrum disorder, although various studies have reported on language development and emphasized the similarity to patients with ASD and the behavioral patterns of repetitive behaviors and stereotypies (29). It was described as more severe communication and interaction difficulties in individuals with PTSD compared to those with Angelman syndrome, where the cognitive phenotype is similar, with a usual absence of expressive language (30). Therefore, careful behavioral observations and autism-specific social functioning assessments are warranted to determine whether deficits in social communication skills and behavioral patterns are greater than expected for the individual's level of cognitive development.
-Sleep Disorders
Sleep disturbances are reported in a minority of individuals, with many parents stating that their child sleeps well. More rarely, some have been described as experiencing sleep difficulties or night terrors. Nighttime problems may also have other causes, such as obstructive sleep apnea syndrome or seizures. In a small number of patients, irregular breathing at night and catathrenia (inspiratory apnea and expiratory moaning during sleep) were reported (31). Some individuals were treated with melatonin or gabapentin
Digestive Signs
Gastrointestinal problems are common in children and adults with PTHS and include constipation , gastroesophageal reflux , and belching(32) .
-Feeding difficulties
Feeding difficulties are sometimes encountered in early childhood (poor food intake, gastroesophageal reflux), but overall, individuals with PTHS have a normal appetite. Food refusal and/or very strict mealtime rituals are rare. If feeding difficulties are accompanied by oral motor disorders, speech therapy should be considered to work on orofacial motor skills and oral stimulation. It is rarely necessary to use feeding aids such as nasogastric tubes or gastrostomy tubes (33).
-Constipation
Constipation is common and severe, generally present throughout life. Hirschsprung's disease, initially described in PTHS syndrome, is ultimately rare, having been reported in only one individual (34). The management of constipation is like that of the general population. Medication (mild laxatives) is often prescribed if lifestyle modifications (a diet with sufficient fiber, adequate hydration, physical activity, and/or regular standing) are insufficient to regulate constipation.
- Gastroesophageal Reflux Disease (GERD)
Management of GERD is like that of the general population. Proton pump inhibitors (PPIs) are the first-line treatment. People with PTHS respond well to medication administered at sufficient doses. It is particularly important to consider this option in cases of unusual behavioral changes and/or the onset of sleep disturbances in a patient who did not previously experience these symptoms (35).
-Other Digestive Problems
Hypersalivation and/or salivary incontinence are common , especially young children. Speech therapy can be helpful, particularly if salivary incontinence is related to oral hypotonia and swallowing difficulties (36). If salivary incontinence becomes problematic (for example, due to skin irritation), medical treatments may be prescribed. Scopolamine patches, placed behind the ear, reduce saliva production but can have significant side effects: drowsiness, constipation, urinary retention, thickening of bronchial secretions, etc.
Sensory Disorders
- Ophthalmological Signs
Refractive errors are common and consist of myopia in half of those affected and hyperopia less often. Myopia is generally severe (greater than -6 diopters), and children usually require glasses before the age of 2. Strabismus has been reported in approximately 50% of cases. Less frequently, nystagmus, lacrimal duct obstruction, optic nerve hypoplasia, macular degeneration, and dilated pupils with a slow response to light have been noted (37). Visual impairments are therefore common, and once a clinical diagnosis of PTHS is suspected, the child or adult should be referred for an ophthalmological consultation, with regular follow-up thereafter. The management and treatment of visual problems are the same as for the general population. In cases of strabismus, preventing amblyopia is essential, and patching, glasses, or surgery may be considered to prevent or correct the strabismus.
-Hearing and ENT (Ear, Nose, and Throat)
Hearing loss (usually conductive) is present in PTHS. It is recommended to have a hearing assessment at the time of diagnosis and then regularly thereafter. Management will be the same as for the general population. Hearing aids should be offered if necessary to avoid further disability (38).
-Pain
It is difficult to recognize and manage pain in people with PTHS due to their limited ability to communicate verbally and their sometimes-different ways of reacting to pain. Some parents' anecdotal evidence suggests that children with PTHS are more bothered and more sensitive to minor painful stimuli, such as a small scratch or cut, than to major painful events such as post-surgical pain (39). Tools have been developed to aid in the recognition and assessment of pain in children with intellectual disabilities (ID), and their use in children with post-traumatic stress disorder (PTSD) is recommended (40).
-Other sensory signs
It is reported that most individuals with PTSD enjoy music, and parents have mentioned using music to improve their child's mood (5). De Winter et al. reported hypersensitivity to odors in 4 out of 101 patients, and anosmia in two. There is no detailed assessment of the sense of smell in individuals with
PTSD in the literature. Individuals with PTSD may experience difficulties processing sensory information perceived by the brain (reception, filtering, and interpretation) (41). Difficult to understand and anticipate, these sensory disturbances vary depending on the time of day, fatigue, or stress levels. An assessment may be recommended to establish a sensory profile, which will help identify appropriate methods and accommodations. Occupational therapists or psychomotor therapists are specifically trained in sensory integration.
Orthopedic Signs
Musculoskeletal problems are common in people with PTHS and particularly affect the feet and spine (42).
-Foot Abnormalities
The feet are most often narrow and flat, and a valgus deformity is often present . More rarely, some patients have high arches. Overlapping toes are also described. Most individuals require orthopedic shoes, insoles, and/or orthotics to facilitate walking and prevent further deformity or contractures. An assessment of whether these devices are necessary requires consultation with a physical medicine and rehabilitation specialist and/or an orthopedist. In some cases where symptomatic treatments fail, surgery may be indicated and beneficial, for example, surgical treatment of flat feet (43).
- Spinal Anomalies
Scoliosis is reported and can occur during puberty but also at an earlier age. The literature does not describe any specific characteristics of scoliosis and its treatment. Currently, it is recommended to manage scoliosis as well as the general population, with follow-up in Physical Medicine and Rehabilitation and/or orthopedics as needed (44).
- Other Orthopedic Signs
Thumb mobility may be reduced. A less pronounced or absent distal thumb flexion crease is present (45). Thumb ankylosis has been reported but is infrequent. Camptodactyly has been reported in five individuals with a microdeletion. Joint hypermobility has been described.
Urogenital Signs
Genital abnormalities have been reported, with hypoplastic penis in boys and abnormal labia (fusion or hypoplasia) in girls. Cryptorchidism is observed in 33% of boys and should be surgically corrected if it persists. Rarely have absence of the vagina, uterus, and ovaries have been reported (1). Most individuals reach puberty at a typical age and pace. Little data is available on male or female fertility; however, it was described a patient with typical PTHS who gave birth to a boy who was also affected (46). Sex education should be offered according to the individual's level of emotional and cognitive functioning. Contraceptive options for women can be considered, particularly when the woman is receiving care in a group setting. Menstrual suppression using contraceptives may also be considered for some adolescent girls and women who experience significant difficulties managing their periods. From a urological standpoint, there are no common abnormalities in PTHS. However, episodes of bladder distension in adulthood have sometimes been reported and should be investigated in cases of discomfort or changes in behavior.
Dental Signs
No dental abnormalities are observed other than increased interdental spacing. The age of dentition and the loss of deciduous teeth are normal. Bruxism is described in some patients. Regular follow-up should be implemented with the same methods and treatments as for the general population.
Other clinical signs
Visceral malformations are rarely observed, but as a matter of course, an assessment for cardiac and abdominal-renal malformations should be performed at the time of diagnosis. Overall, general health is relatively well preserved, and life expectancy appears normal. There does not appear to be a higher incidence of cardiovascular disease or cancer than in the general population. There is no specific treatment for Pitt-Hopkins syndrome, and therefore, the variability of the clinical presentation necessitates personalized monitoring and management, depending on the symptoms. Pediatric and adult follow-up is required, as for the general population, for growth monitoring, vaccinations, management of intercurrent illnesses, screenings.
Pitt-Hopkins syndrome is a rare but increasingly recognized genetic disorder with a distinctive combination of developmental, behavioral, and respiratory features. Although there is no curative treatment, early diagnosis and a comprehensive multidisciplinary approach can significantly improve quality of life and functional outcomes. Advances in genetic testing have enhanced diagnostic accuracy, while supportive therapies particularly in communication and motor development play a crucial role in patient care. Ongoing research is essential to better understand the condition and develop targeted therapies in the future.
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I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
