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Kiarashi Y, Lantz J, Reyna MA, Anderson C, Rad AB, Foster J, Villavicencio T, Hamlin T, Clifford GD. Forecasting High-Risk Behavioral and Medical Events in Children with Autism through Analysis of Digital Behavioral Records. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.06.24306938. [PMID: 38766049 PMCID: PMC11100855 DOI: 10.1101/2024.05.06.24306938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Individuals with Autism Spectrum Disorder may display interfering behaviors that limit their inclusion in educational and community settings, negatively impacting their quality of life. These behaviors may also signal potential medical conditions or indicate upcoming high-risk behaviors. This study explores behavior patterns that precede high-risk, challenging behaviors or seizures the following day. We analyzed an existing dataset of behavior and seizure data from 331 children with profound ASD over nine years. We developed a deep learning-based algorithm designed to predict the likelihood of aggression, elopement, and self-injurious behavior (SIB) as three high-risk behavioral events, as well as seizure episodes as a high-risk medical event occurring the next day. The proposed model attained accuracies of 78.4%, 80.68%, 85.43%, and 69.95% for predicting the next-day occurrence of aggression, SIB, elopement, and seizure episodes, respectively. The results were proven significant for more than 95% of the population for all high-risk event predictions using permutation-based statistical tests. Our findings emphasize the potential of leveraging historical behavior data for the early detection of high-risk behavioral and medical events, paving the way for behavioral interventions and improved support in both social and educational environments.
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2
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Capal JK, Jeste SS. Autism and Epilepsy. Pediatr Clin North Am 2024; 71:241-252. [PMID: 38423718 DOI: 10.1016/j.pcl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Epilepsy is one of the most common comorbidities in individuals with autism spectrum disorders (ASDs). Risk factors include the presence of developmental delay/intellectual disability, female sex, age, and an underlying genetic condition. Due to higher prevalence of epilepsy in ASD, it is important to have a high index of suspicion for seizures and refer to a neurologist if there are concerns. Genetic testing is recommended for all children with ASD but it becomes more high yield in children with epilepsy and ASD.
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Affiliation(s)
- Jamie K Capal
- Department of Neurology, University of North Carolina at Chapel Hill, 170 Manning Drive, CB 7025, Chapel Hill, NC 27599, USA.
| | - Shafali S Jeste
- Children's Hospital of Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
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3
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Bosetti C, Ferrini L, Ferrari AR, Bartolini E, Calderoni S. Children with Autism Spectrum Disorder and Abnormalities of Clinical EEG: A Qualitative Review. J Clin Med 2024; 13:279. [PMID: 38202286 PMCID: PMC10779511 DOI: 10.3390/jcm13010279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/22/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
Over the last decade, the comorbidity between Autism Spectrum Disorder (ASD) and epilepsy has been widely demonstrated, and many hypotheses regarding the common neurobiological bases of these disorders have been put forward. A variable, but significant, prevalence of abnormalities on electroencephalogram (EEG) has been documented in non-epileptic children with ASD; therefore, several scientific studies have recently tried to demonstrate the role of these abnormalities as a possible biomarker of altered neural connectivity in ASD individuals. This narrative review intends to summarize the main findings of the recent scientific literature regarding abnormalities detected with standard EEG in children/adolescents with idiopathic ASD. Research using three different databases (PubMed, Scopus and Google Scholar) was conducted, resulting in the selection of 10 original articles. Despite an important lack of studies on preschoolers and a deep heterogeneity in results, some authors speculated on a possible association between EEG abnormalities and ASD characteristics, in particular, the severity of symptoms. Although this correlation needs to be more strongly elucidated, these findings may encourage future studies aimed at demonstrating the role of electrical brain abnormalities as an early biomarker of neural circuit alterations in ASD, highlighting the potential diagnostic, prognostic and therapeutic value of EEG in this field.
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Affiliation(s)
- Chiara Bosetti
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Pisa, Italy; (C.B.); (L.F.); (A.R.F.); (S.C.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Luca Ferrini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Pisa, Italy; (C.B.); (L.F.); (A.R.F.); (S.C.)
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy
| | - Anna Rita Ferrari
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Pisa, Italy; (C.B.); (L.F.); (A.R.F.); (S.C.)
| | - Emanuele Bartolini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Pisa, Italy; (C.B.); (L.F.); (A.R.F.); (S.C.)
- Tuscany PhD Programme in Neurosciences, 50139 Florence, Italy
| | - Sara Calderoni
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Pisa, Italy; (C.B.); (L.F.); (A.R.F.); (S.C.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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4
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Caiola HO, Wu Q, Soni S, Wang XF, Monahan K, Pang ZP, Wagner GC, Zhang H. Neuronal connectivity, behavioral, and transcriptional alterations associated with the loss of MARK2. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.05.569759. [PMID: 38105965 PMCID: PMC10723285 DOI: 10.1101/2023.12.05.569759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Neuronal connectivity is essential for adaptive brain responses and can be modulated by dendritic spine plasticity and the intrinsic excitability of individual neurons. Dysregulation of these processes can lead to aberrant neuronal activity, which has been associated with numerous neurological disorders including autism, epilepsy, and Alzheimer's disease. Nonetheless, the molecular mechanisms underlying aberrant neuronal connectivity remains unclear. We previously found that the serine/threonine kinase Microtubule Affinity Regulating Kinase 2 (MARK2), also known as Partitioning Defective 1b (Par1b), is important for the formation of dendritic spines in vitro. However, despite its genetic association with several neurological disorders, the in vivo impact of MARK2 on neuronal connectivity and cognitive functions remains unclear. Here, we demonstrate that loss of MARK2 in vivo results in changes to dendritic spine morphology, which in turn leads to a decrease in excitatory synaptic transmission. Additionally, loss of MARK2 produces substantial impairments in learning and memory, anxiety, and social behavior. Notably, MARK2 deficiency results in heightened seizure susceptibility. Consistent with this observation, RNAseq analysis reveals transcriptional changes in genes regulating synaptic transmission and ion homeostasis. These findings underscore the in vivo role of MARK2 in governing synaptic connectivity, cognitive functions, and seizure susceptibility.
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Gundogdu BS, Gaitanis J, Adams JB, Rossignol DA, Frye RE. Age-Related Changes in Epilepsy Characteristics and Response to Antiepileptic Treatment in Autism Spectrum Disorders. J Pers Med 2023; 13:1167. [PMID: 37511780 PMCID: PMC10381477 DOI: 10.3390/jpm13071167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Despite the high prevalence of epilepsy in individuals with autism spectrum disorder (ASD), there is little information regarding whether seizure characteristics and treatment effectiveness change across age. Using an online survey, seizure characteristics, effectiveness of antiepileptic treatments, comorbidities, potential etiologies, and ASD diagnosis were collected from individuals with ASD and seizures. We previously reported overall general patterns of treatment effectiveness but did not examine the effect of seizure characteristics or age on antiepileptic treatment effectiveness. Such information would improve the personalized medicine approach to the treatment of seizures in ASD. Survey data from 570 individuals with ASD and clinical seizures were analyzed. Seizure severity (seizure/week) decreased with age of onset of seizures, plateauing in adolescence, with a greater reduction in generalized tonic-clonic (GTC) seizures with age. Seizure severity was worse in those with genetic disorders, neurodevelopmental regression (NDR) and poor sleep maintenance. Carbamazepine and oxcarbazepine were reported to be more effective when seizures started in later childhood, while surgery and the Atkins/modified Atkins Diet (A/MAD) were reported to be more effective when seizures started early in life. A/MAD and the ketogenic diet were reported to be more effective in those with NDR. Interestingly, atypical Landau-Kleffner syndrome was associated with mitochondrial dysfunction and NDR, suggesting a novel syndrome. These interesting findings need to be verified in independent, prospectively collected cohorts, but nonetheless, these data provide insights into novel relationships that may assist in a better understanding of epilepsy in ASD and provide insight into personalizing epilepsy care in ASD.
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Affiliation(s)
| | - John Gaitanis
- Department of Neurology and Pediatrics, Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - James B Adams
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, AZ 85281, USA
| | - Daniel A Rossignol
- Rossignol Medical Center, Aliso Viejo, CA 92656, USA
- Autism Discovery and Treatment Foundation, Phoenix, AZ 85050, USA
| | - Richard E Frye
- Autism Discovery and Treatment Foundation, Phoenix, AZ 85050, USA
- Rossignol Medical Center, Phoenix, AZ 85050, USA
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Detection of Electroencephalographic Abnormalities and Its Associated Factors among Children with Autism Spectrum Disorder in Thailand. Healthcare (Basel) 2022; 10:healthcare10101969. [PMID: 36292416 PMCID: PMC9601834 DOI: 10.3390/healthcare10101969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022] Open
Abstract
Epilepsy often causes more severe behavioral problems in children with autism spectrum disorder (ASD) and is strongly associated with poor cognitive functioning. Interestingly, individuals with ASD without a history of epilepsy can have abnormal electroencephalographic (EEG) activity. The aim of this study was to examine associations between EEG abnormalities and the ASD severity in children. The children with ASD who enrolled at the Rajanagarindra Institute of Child Development, Thailand were included in this study. The severity of ASD was measured by interviewing their parents with the Thai autism treatment evaluation checklist. The short sensory profile checklist was used for screening the abnormality of children in each domain. Ordinal logistic regression analysis was used to examine associations between factors potentially linked to EEG abnormalities. Most of the study participants were boys (87.5%) and the median age was 5 years. Among the 128 children, 69.5% showed EEG abnormalities (41.4% slow-wave and 28.1% epileptiform-discharge). The results show that a larger number of symptoms and increased severity of ASD were independently associated with a higher risk of EEG abnormalities. Our results emphasize the need for guidelines on the presence of EEG abnormalities in children with ASD for the early detection of epilepsy and improving treatment outcomes.
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7
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Sharma V, Saini AG, Malhi P, Singhi P. Epilepsy and EEG Abnormalities in Children with Autism Spectrum Disorders. Indian J Pediatr 2022; 89:975-982. [PMID: 34843062 DOI: 10.1007/s12098-021-03928-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/07/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the prevalence of epilepsy and electroencephalographic abnormalities in children with autism spectrum disorders (ASD) and determine their risk factors. METHODS This cross-sectional study was conducted over one year in children with ASD aged between 3 and 14 y. Classification of epilepsy and routine electroencephalography (EEG) recordings were done for all the patients. Developmental and cognitive assessments were done using Developmental Profile 3. Children were divided into three groups: ASD with epilepsy, ASD with isolated electroencephalographic abnormalities, and ASD with neither epilepsy nor electroencephalographic abnormalities. RESULTS One hundred children with ASD were enrolled. Epilepsy was reported in 23% and subclinical electroencephalographic abnormalities were documented in 8%. The most common seizure types were generalized-onset tonic-clonic (48%), focal-onset with impaired awareness (17%), and focal to bilateral tonic-clonic seizures (17%). In children with subclinical epileptiform discharges, focal abnormalities were most common (75%) and were maximally seen over the temporal region (50%). Subnormal intellect (88.6%) and abnormal global developmental score (82%) were noted in the majority of children. Female gender, abnormal neurological examination, and adverse perinatal events were significantly associated with epilepsy. Of these, female gender and adverse perinatal events were independent predictors of epilepsy. Isolated EEG abnormalities were significantly associated with abnormal neurological examination in comparison with autistic children without epilepsy/EEG abnormalities. CONCLUSION Epilepsy is seen in up to one-fourth children with ASD. Female gender and adverse perinatal events are independent risk factors for epilepsy. Subclinical or isolated EEG abnormalities are associated with abnormal neurological examination.
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Affiliation(s)
- Vinod Sharma
- Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Gahlot Saini
- Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prahbhjot Malhi
- Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratibha Singhi
- Department of Pediatric Neurology and Neurodevelopment, Medanta, The Medicity, Gurgaon, Haryana, 122001, India.
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8
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Zhang W, Thompson KL. Access to Care for US Children with Co-Occurrence of Autism Spectrum Disorder and Epilepsy. CHILDREN 2022; 9:children9071094. [PMID: 35884078 PMCID: PMC9318523 DOI: 10.3390/children9071094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
Epilepsy is a common comorbidity among children with autism spectrum disorder (ASD). There is a lack of understanding of the inequality in access to care for children with co-occurring ASD and epilepsy (ASD-EP). The purpose of this study is to examine key indicators for access to care and care coordination for children with ASD-EP in the US National Survey of Children’s Health (NSCH). Data were collected from the 2017–2019 NSCH. Our analytic sample included children with ASD without epilepsy (N = 2150), children with both ASD and epilepsy (N = 143), and children with epilepsy without ASD (N = 711). The dependent variables included important access to care indicators such as having usual sources of care, having adequate coverage, being frustrated in efforts to get service, and receiving care coordination. The independent variables included ASD-EP status, child demographics, and an intellectual disability (ID) diagnosis. Our results show that demographic characteristics such as sex, race, income level, and insurance type affect access to care. Inadequate access to healthcare was significantly higher among female children, children from low-income families, and children with ID. The access barriers among children with ASD-EP were more likely due to the interplay of multiple clinical and individual factors.
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Affiliation(s)
- Wanqing Zhang
- Department of Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Correspondence:
| | - Kelsey L. Thompson
- Division of Speech and Hearing Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
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9
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Sassu KA, Volkmar FR. Autism and intersectionality: Considerations for school‐based practitioners. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kari A. Sassu
- Department of Counseling and School Psychology Southern Connecticut State University New Haven Connecticut USA
| | - Fred R. Volkmar
- Center of Excellence on Autism Spectrum Disorders Yale University School of Medicine & Southern Connecticut State University New Haven Connecticut USA
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10
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Byrne K, Sterrett K, Elias R, Bal VH, McCauley JB, Lord C. Trajectories of Seizures, Medication Use, and Obesity Status into Early Adulthood in Autistic Individuals and Those with Other Neurodevelopmental Conditions. AUTISM IN ADULTHOOD 2022; 4:110-119. [PMID: 36605975 PMCID: PMC9242707 DOI: 10.1089/aut.2020.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Physical and psychiatric health conditions affect the lives of many autistic adults. However, relatively little is known about individual trajectories in autistic individuals' physical and mental health from adolescence to adulthood. Methods This study uses a well-characterized longitudinal sample (n = 253) to investigate rates of seizures, medication use, and obesity, from early adolescence (age 10 years) into adulthood (age 30 years). Within this sample, 196 participants were diagnosed with autism spectrum disorder (ASD), whereas the remaining 57 participants never received an ASD diagnosis, but, rather, were diagnosed with other neurodevelopmental conditions. Data were collected through parent report questionnaires and in-person interviews and assessments. Results Seizure onset continued well into adulthood, with two individuals experiencing their first seizure at the age of 25 years. Seizures and neuropsychiatric medication use were both higher for those with lower intelligence quotient (IQs). In addition, medication use increased over time for these individuals, whereas those with higher IQs saw a reduction in medication use with age. Between the ages of 15 to 30 years, the predicted probability of medication use increased from 82% to 88% for those with lower IQs and decreased from 37% to 13% for those with higher IQs. Collectively, almost 70% of all participants in this study were classified as either overweight or obese. Body mass index (BMI) increased throughout adulthood, especially for those with higher IQs. The steepest increase in BMI over time occurred for those with higher IQs who also took antipsychotic medications. Conclusion Overall, continued risk for developing seizures, high rates of neuropsychiatric medication use, and significant and increasing rates of obesity from adolescence to adulthood underscore the importance of monitoring health issues in autistic individuals and those diagnosed with other neurodevelopmental conditions throughout the lifespan.
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Affiliation(s)
- Katherine Byrne
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA.,Address correspondence to: Katherine Byrne, BA, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza 68-217, Los Angeles, CA 90024, USA
| | - Kyle Sterrett
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Rebecca Elias
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Vanessa H. Bal
- Graduate School of Applied and Professional Psychology, Rutgers University–New Brunswick, New Brunswick, New Jersey, USA
| | - James B. McCauley
- Department of Psychology, St. Mary's College of California, Moraga, California, USA
| | - Catherine Lord
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
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11
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Levy KA, Weisz ED, Jongens TA. Loss of neurexin-1 in Drosophila melanogaster results in altered energy metabolism and increased seizure susceptibility. Hum Mol Genet 2022; 31:3422-3438. [PMID: 35617143 PMCID: PMC9558836 DOI: 10.1093/hmg/ddac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/28/2022] [Accepted: 05/09/2022] [Indexed: 12/04/2022] Open
Abstract
Although autism is typically characterized by differences in language, social interaction and restrictive, repetitive behaviors, it is becoming more well known in the field that alterations in energy metabolism and mitochondrial function are comorbid disorders in autism. The synaptic cell adhesion molecule, neurexin-1 (NRXN1), has previously been implicated in autism, and here we show that in Drosophila melanogaster, the homologue of NRXN1, called Nrx-1, regulates energy metabolism and nutrient homeostasis. First, we show that Nrx-1-null flies exhibit decreased resistance to nutrient deprivation and heat stress compared to controls. Additionally, Nrx-1 mutants exhibit a significantly altered metabolic profile characterized by decreased lipid and carbohydrate stores. Nrx-1-null Drosophila also exhibit diminished levels of nicotinamide adenine dinucleotide (NAD+), an important coenzyme in major energy metabolism pathways. Moreover, loss of Nrx-1 resulted in striking abnormalities in mitochondrial morphology in the flight muscle of Nrx-1-null Drosophila and impaired flight ability in these flies. Further, following a mechanical shock Nrx-1-null flies exhibited seizure-like activity, a phenotype previously linked to defects in mitochondrial metabolism and a common symptom of patients with NRXN1 deletions. The current studies indicate a novel role for NRXN1 in the regulation of energy metabolism and uncover a clinically relevant seizure phenotype in Drosophila lacking Nrx-1.
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Affiliation(s)
- Kyra A Levy
- Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.,Neuroscience Graduate Group, University of Pennsylvania, Philadelphia, PA 19104, USA.,Autism Spectrum Program of Excellence, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Eliana D Weisz
- Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.,Autism Spectrum Program of Excellence, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Thomas A Jongens
- Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.,Autism Spectrum Program of Excellence, University of Pennsylvania, Philadelphia, PA 19104, USA
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Watkins LV, O'Dwyer M, Shankar R. A review of the pharmacotherapeutic considerations for managing epilepsy in people with autism. Expert Opin Pharmacother 2022; 23:841-851. [PMID: 35341433 DOI: 10.1080/14656566.2022.2055461] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Autism, like other neurodevelopmental disorders (NDDs), has a strong association with epilepsy. There are known common genetic pathways in both autism and epilepsy. There are also specific genetic syndromes associated with both complex epilepsy and the autism phenotype. AREAS COVERED This review explores the evidence for common genetic etiologies and pathophysiological pathways in relation to both epilepsy and autism. Autism with comorbid epilepsy are associated with a high prevalence of medical and psychiatric comorbidities. This paper discusses how this influences assessment, treatment, and outcomes. The evidence for the treatment of specific seizure types in the context of NDDs is also examined alongside clinical commentary. EXPERT OPINION Despite the strong association, there is a limited evidence base to support the efficacy and tolerability of anti-seizure medications specifically in autism, with no Level 1 evidence or National Guidance available. Autism and epilepsy should be approached under a NDD model with cautious introduction and titration of anti-seizure medication. Alongside this, there is evidence to support a move toward precision medicine in specific genetic syndromes such as Tuberous Sclerosis Complex and other genetic seizure disorders. The first-line treatments that should be considered for focal seizures include carbamazepine, lamotrigine, and levetiracetam.
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Affiliation(s)
- Lance V Watkins
- Epilepsy Specialist Service Swansea Bay University Health Board, Cardiff, UK
| | - Maire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences Trinity College, Dublin 2, Ireland
| | - Rohit Shankar
- Department of Intellectual Disability Neuropsychiatry, Cornwall Partnership NHS Foundation Trust, Truro, UK.,Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Medical School, Truro, UK
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13
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Wang Y, Huo X, Li W, Xiao L, Li M, Wang C, Sun Y, Sun T. Knowledge Atlas of the Co-Occurrence of Epilepsy and Autism: A Bibliometric Analysis and Visualization Using VOSviewer and CiteSpace. Neuropsychiatr Dis Treat 2022; 18:2107-2119. [PMID: 36157199 PMCID: PMC9507454 DOI: 10.2147/ndt.s378372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/14/2022] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study aimed to analyze research on epilepsy in autism and autism in epilepsy using VOSviewer and CiteSpace to identify research hotspots and future directions. METHODS We searched the Web of Science Core Collection (WoSCC) for relevant studies about epilepsy in autism and autism in epilepsy published from inception to 31 May 2022. VOSviewer and CiteSpace were used to analyze the authors, institutions, countries, publishing journals, reference co-citation patterns, keyword co-occurrence, keyword clustering, keywords with citation bursts, and other aspects to construct a knowledge atlas. RESULTS A total of 473 publications related to epilepsy/autism were retrieved. The number of publications about epilepsy/ASD has generally increased over time, with some fluctuations. The USA (202 papers) and University of California-Los Angeles (15 papers) were the leading country and institution, respectively, in this field. Frye, Richard E. was the most published author (9 papers). Notably, collaboration between institutions, countries, and authors does not appear to be active. Hot topics and research frontiers include intellectual disability and exploring the mechanism of epilepsy/ASD from a genetics perspective. CONCLUSION This analysis identified the most influential publications, authors, journals, institutions, and countries in the field of epilepsy/ASD research. Using co-occurrence and evolution analyses, the status of the field was identified and future trends were predicted.
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Affiliation(s)
- Yangyang Wang
- Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Xianhao Huo
- Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Wenchao Li
- Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Lifei Xiao
- Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Mei Li
- Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Chaofan Wang
- Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Yangyang Sun
- Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Tao Sun
- Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, People's Republic of China
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14
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Rosen NE, Lord C, Volkmar FR. The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond. J Autism Dev Disord 2021; 51:4253-4270. [PMID: 33624215 PMCID: PMC8531066 DOI: 10.1007/s10803-021-04904-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/27/2022]
Abstract
In this paper we review the impact of DSM-III and its successors on the field of autism-both in terms of clinical work and research. We summarize the events leading up to the inclusion of autism as a "new" official diagnostic category in DSM-III, the subsequent revisions of the DSM, and the impact of the official recognition of autism on research. We discuss the uses of categorical vs. dimensional approaches and the continuing tensions around broad vs. narrow views of autism. We also note some areas of current controversy and directions for the future.
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Affiliation(s)
| | | | - Fred R. Volkmar
- Yale University, New Haven, USA
- Southern Connecticut State University, New Haven, USA
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15
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Antipsychotic Medication and Risk of Incident Seizure in People with Autism Spectrum Disorder: Analyses with Cohort and Within Individual Study Designs. J Autism Dev Disord 2021; 52:4817-4827. [PMID: 34751867 PMCID: PMC9556371 DOI: 10.1007/s10803-021-05208-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/08/2022]
Abstract
There are many case reports of seizures apparently associated with the prescription of antipsychotics. This study aimed to examine whether there is an association between the prescription of antipsychotics and incident seizures in individuals with autism spectrum disorder using retrospective data based on patients’ chart review. A cohort study was conducted to compare the rate of incident seizure between 3923 users of antipsychotics with 10,086 users of other psychotropics. This was followed by a self-controlled case series (SCCS) analysis of 149 patients to eliminate the effect of time-invariant confounders. The results showed no evidence of increased risk of seizure after exposure to antipsychotic agents (Hazard Ratio 1.28, 95% CI 0.74–2.19) compared to other psychotropics.
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Hanci F, Türay S, Öztürk Y, Kabakus N. Electroencephalogram Abnormalities and Epilepsy in Autism Spectrum Disorders: Clinical and Electroencephalogram Findings. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0041-1736557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractIt has been known for several decades that epilepsy and autism spectrum disorders (ASD) are related to each other. Epilepsy frequently accompanies ASD. The purpose of this study was to investigate relationship between clinical and electroencephalogram (EEG) findings in ASD patients and to identify EEG characteristics that may create a disposition to epilepsy in ASD by examining differences in clinical and EEG findings between patients diagnosed with ASD without epilepsy and ASD with epilepsy. A total of 102 patients aged 2 to 18 years and diagnosed with ASD based on Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic criteria between January 2017 and June 2019 were included in the study. Patients were assigned into two groups: (1) ASD with epilepsy and (2) ASD without epilepsy. Clinical findings were retrieved from patients' files, and EEG findings from first EEG records in the EEG laboratory at the time of diagnosis. EEG findings were defined as central, parietal, frontal, temporal, or generalized, depending on the location of rhythmic discharges. The incidence of epilepsy in our ASD patients was 33.7% and that of febrile convulsion was 4%. Generalized motor seizures were the most common seizure type. Epileptic discharges most commonly derived from the central and frontal regions. These abnormalities, especially frontal and central rhythmic discharges, may represent a precursor for the development of epilepsy in ASD patients.
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Affiliation(s)
- Fatma Hanci
- Department of Pediatrics, Division of Child Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Sevim Türay
- Department of Pediatrics, Division of Child Neurology, Faculty of Medicine, Düzce University, Düzce, Turkey
| | - Yusuf Öztürk
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Nimet Kabakus
- Department of Pediatrics, Division of Child Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
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17
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Liu X, Sun X, Sun C, Zou M, Chen Y, Huang J, Wu L, Chen WX. Prevalence of epilepsy in autism spectrum disorders: A systematic review and meta-analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:33-50. [PMID: 34510916 DOI: 10.1177/13623613211045029] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Autistic individuals experience higher co-occurring medical conditions than the general population, and yet the estimates of autistic individuals with epilepsy are not updated. Co-occurrence of epilepsy in autistic individuals often aggravated cognitive impairment and increased the risk of poor long-term prognosis. Thus, an updated systematic review and meta-analysis was conducted to study the relevant articles published from inception to 2020, evaluate the prevalence of epilepsy in autistic individuals, and further explore the putative factors influencing the prevalence. A total of 66 studies from 53 articles were included in this study. The results showed that epilepsy is more common in autistic individuals than in the general population. The prevalence of epilepsy in autistic individuals in the clinical sample-based studies was higher than that in the population-based based cross-sectional or cohort studies. The prevalence of epilepsy in autistic adults was higher than that in autistic children. A significantly increased prevalence of epilepsy was detected in the autistic adolescent group (11-17 years old), and a higher trend of prevalence of epilepsy was observed in the autistic pre-school group (⩽ 6 -years-old) than that of the autistic school-aged group (7-10 years-old). The prevalence of epilepsy increased with age, female rate, and low intellectual function rate of autistic individuals. However, the human development index of countries was negatively associated with the pooled prevalence, which could be attributed to the different levels of awareness, diagnostic technologies, and autism-service support worldwide. About 1/10 autistic individuals also had epilepsy, which was common in the clinical setting, adolescents, adults, females, or patients with intellectual disability and less common in the country with high human development index. Thus, these findings provided critical and innovative views on the prevalence of epilepsy in autistic individuals and contributed to the targeted clinical management and preventive measures.
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Affiliation(s)
- Xian Liu
- Guangzhou Medical University, China.,Harbin Medical University, China
| | - Xin Sun
- Shanghai Jiao Tong University, China
| | | | | | | | | | - Lijie Wu
- Harbin Medical University, China
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18
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Jeradeh Boursoulian L, Adeseye V, Malow BA, Ess K. Recurrence rate of the first nonfebrile seizure in children with autism spectrum disorder. Epilepsy Behav 2021; 122:108187. [PMID: 34274745 PMCID: PMC9991869 DOI: 10.1016/j.yebeh.2021.108187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Epilepsy prevalence is higher in children with Autism Spectrum Disorder (ASD) and is a contributor to morbidity and mortality. Little is known about the recurrence rate after the first nonfebrile seizure in this population, specifically in regard to seizure type and electroencephalogram (EEG) findings. METHODS We reviewed pediatric medical records at our institution between 2006 and 2016 for subjects with ASD who had a first seizure. We then looked for risk of a recurrent non-provoked seizure within the next two years. RESULTS Overall, the recurrence rate in this study was 70.9%. This is much higher than the general population. The recurrence rate was higher in patients who had a generalized convulsion compared to those who had a behavioral arrest. When the first seizure was a generalized convulsion, there was an 84% chance of developing a second convulsion, whereas the recurrence rate was 59% for behavioral arrest type seizures (p = 0.002). The odds of having recurrence when the first seizure is a generalized convulsion was 5.36 higher than when it was a behavioral arrest (95% CI 2.14-13.42, p < 0.001). An abnormal EEG was a strong predictor of seizure recurrence in both seizure types. However, even with a normal EEG, generalized convulsions were more likely to recur within 2 years compared to behavioral arrest (OR 6.3, 95% CI 2.1-19). SIGNIFICANCE The recurrence rate for nonfebrile seizures in children with ASD is much higher than the general population, especially for generalized convulsions. An abnormal EEG has a strong predictive value for seizure recurrence. However, even when the EEG is normal, the recurrence rate for generalized convulsions is quite high. This is an important finding as epilepsy contributes to morbidity and mortality in this group and may impact clinical decisions about when to start anti-seizure medications.
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Affiliation(s)
- Lana Jeradeh Boursoulian
- Division of Pediatric Pulmonology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, United States.
| | - Victoria Adeseye
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Beth A Malow
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Kevin Ess
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, United States
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19
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Smit DJA, Andreassen OA, Boomsma DI, Burwell SJ, Chorlian DB, de Geus EJC, Elvsåshagen T, Gordon RL, Harper J, Hegerl U, Hensch T, Iacono WG, Jawinski P, Jönsson EG, Luykx JJ, Magne CL, Malone SM, Medland SE, Meyers JL, Moberget T, Porjesz B, Sander C, Sisodiya SM, Thompson PM, van Beijsterveldt CEM, van Dellen E, Via M, Wright MJ. Large-scale collaboration in ENIGMA-EEG: A perspective on the meta-analytic approach to link neurological and psychiatric liability genes to electrophysiological brain activity. Brain Behav 2021; 11:e02188. [PMID: 34291596 PMCID: PMC8413828 DOI: 10.1002/brb3.2188] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 03/12/2021] [Accepted: 04/30/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE The ENIGMA-EEG working group was established to enable large-scale international collaborations among cohorts that investigate the genetics of brain function measured with electroencephalography (EEG). In this perspective, we will discuss why analyzing the genetics of functional brain activity may be crucial for understanding how neurological and psychiatric liability genes affect the brain. METHODS We summarize how we have performed our currently largest genome-wide association study of oscillatory brain activity in EEG recordings by meta-analyzing the results across five participating cohorts, resulting in the first genome-wide significant hits for oscillatory brain function located in/near genes that were previously associated with psychiatric disorders. We describe how we have tackled methodological issues surrounding genetic meta-analysis of EEG features. We discuss the importance of harmonizing EEG signal processing, cleaning, and feature extraction. Finally, we explain our selection of EEG features currently being investigated, including the temporal dynamics of oscillations and the connectivity network based on synchronization of oscillations. RESULTS We present data that show how to perform systematic quality control and evaluate how choices in reference electrode and montage affect individual differences in EEG parameters. CONCLUSION The long list of potential challenges to our large-scale meta-analytic approach requires extensive effort and organization between participating cohorts; however, our perspective shows that these challenges are surmountable. Our perspective argues that elucidating the genetic of EEG oscillatory activity is a worthwhile effort in order to elucidate the pathway from gene to disease liability.
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Affiliation(s)
- Dirk J A Smit
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Scott J Burwell
- Department of Psychology, Minnesota Center for Twin and Family Research, University of Minnesota, Minneapolis, MN, USA.,Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - David B Chorlian
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Eco J C de Geus
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Torbjørn Elvsåshagen
- Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Reyna L Gordon
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Jeremy Harper
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Goethe Universität Frankfurt am Main, Frankfurt, Germany
| | - Tilman Hensch
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.,LIFE - Leipzig Research Center for Civilization Diseases, Universität Leipzig, Leipzig, Germany.,IU International University, Erfurt, Germany
| | - William G Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Philippe Jawinski
- LIFE - Leipzig Research Center for Civilization Diseases, Universität Leipzig, Leipzig, Germany.,Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Erik G Jönsson
- TOP-Norment, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Jurjen J Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Outpatient Second Opinion Clinic, GGNet Mental Health, Apeldoorn, The Netherlands
| | - Cyrille L Magne
- Psychology Department, Middle Tennessee State University, Murfreesboro, TN, USA.,Literacy Studies Ph.D. Program, Middle Tennessee State University, Mufreesboro, TN, USA
| | - Stephen M Malone
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Jacquelyn L Meyers
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, Downstate Health Sciences University, Brooklyn, NY, USA.,Department of Psychiatry, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Torgeir Moberget
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Bernice Porjesz
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | | | - Edwin van Dellen
- Department of Psychiatry, Department of Intensive Care Medicine, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marc Via
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, and Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
| | - Margaret J Wright
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia.,Centre for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
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20
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Abstract
This paper, written in honor of Professor Ed Zigler, focuses on some of the themes in developmental disabilities research that were so central to his work. It has now been nearly 80 years since Leo Kanner first identified the prototypic form - early infantile autism - of what is now autism spectrum disorder. In this article we summarize the development of the concept and the important accumulation of knowledge over time that has now led us to the recognition of a broader autism phenotype just as, at the same time, the current official diagnostic system in the USA has narrowed the concept. We also address current controversies regarding autism as the diagnosis is impacted by age and developmental factors, gender, and cultural issues. In parallel to the work on intellectual deficiency and development pioneered by Zigler and his colleagues, we summarize some of the challenges for the years ahead.
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21
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Abstract
Epilepsy and autism frequently co-occur. Epilepsy confers an increased risk of autism and autism confers an increased risk of epilepsy. Specific epilepsy syndromes, intellectual disability, and female gender present a particular risk of autism in individuals with epilepsy. Epilepsy and autism are likely to share common etiologies, which predispose individuals to either or both conditions. Genetic factors, metabolic disorders, mitochondrial disorders, and immune dysfunction all can be implicated.
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Affiliation(s)
- Frank M C Besag
- East London NHS Foundation Trust, 5-7 Rush Court, Bedford MK40 3JT, UK; University College London, London, UK; King's College London, London, UK.
| | - Michael J Vasey
- East London NHS Foundation Trust, 5-7 Rush Court, Bedford MK40 3JT, UK
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22
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Pan PY, Bölte S, Kaur P, Jamil S, Jonsson U. Neurological disorders in autism: A systematic review and meta-analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:812-830. [PMID: 32907344 DOI: 10.1177/1362361320951370] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
LAY ABSTRACT Neurological disorders, such as epilepsy and cerebral palsy, have been reported to occur among individuals with autism beyond chance and may have an impact on daily living across the lifespan. Although there has been research investigating neurological disorders in autism, the findings are not always conclusive. Previous summaries of existing studies have not evaluated the full range of neurological disorders. This study aimed to comprehensively explore the neurological problems appearing in autism to provide updated information that is needed for better healthcare and support in this population. We looked at already published studies focusing on risk or frequency of neurological disorders in autism. Our results suggest that individuals with autism are more likely than the general population to have a range of neurological disorders, including epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headache, and inborn abnormalities of the nervous system. In order to provide individualized healthcare and support of high quality to individuals diagnosed with autism, health care professionals and other support providers need to be attentive to neurological complications. To further improve our understanding about the link between autism and neurological disorders, future research should follow the neurological health of children who are diagnosed with or are at increased likelihood of autism.
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Affiliation(s)
- Pei-Yin Pan
- Karolinska Institutet, Sweden.,Region Stockholm, Sweden
| | - Sven Bölte
- Karolinska Institutet, Sweden.,Region Stockholm, Sweden.,Curtin University, Australia
| | - Preet Kaur
- Karolinska Institutet, Sweden.,Region Stockholm, Sweden
| | - Sadia Jamil
- Karolinska Institutet, Sweden.,Region Stockholm, Sweden
| | - Ulf Jonsson
- Karolinska Institutet, Sweden.,Region Stockholm, Sweden.,Uppsala University, Sweden
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23
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Precenzano F, Parisi L, Lanzara V, Vetri L, Operto FF, Pastorino GMG, Ruberto M, Messina G, Risoleo MC, Santoro C, Bitetti I, Marotta R. Electroencephalographic Abnormalities in Autism Spectrum Disorder: Characteristics and Therapeutic Implications. ACTA ACUST UNITED AC 2020; 56:medicina56090419. [PMID: 32825169 PMCID: PMC7559692 DOI: 10.3390/medicina56090419] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/03/2022]
Abstract
A large body of literature reports the higher prevalence of epilepsy in subjects with Autism Spectrum Disorder (ASD) compared to the general population. Similarly, several studies report an increased rate of Subclinical Electroencephalographic Abnormalities (SEAs) in seizure-free patients with ASD rather than healthy controls, although with varying percentages. SEAs include both several epileptiform discharges and different non-epileptiform electroencephalographic abnormalities. They are more frequently associated with lower intellectual functioning, more serious dysfunctional behaviors, and they are often sign of severer forms of autism. However, SEAs clinical implications remain controversial, and they could represent an epiphenomenon of the neurochemical alterations of autism etiology. This paper provides an overview of the major research findings with two main purposes: to better delineate the state-of-the-art about EEG abnormalities in ASD and to find evidence for or against appropriateness of SEAs pharmacological treatment in ASD.
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Affiliation(s)
- Francesco Precenzano
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
| | - Lucia Parisi
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90127 Palermo, Italy
| | - Valentina Lanzara
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
| | - Luigi Vetri
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
- Correspondence: or ; Tel.: +39-328-643-4126
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy;
| | - Grazia Maria Giovanna Pastorino
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy;
| | - Maria Ruberto
- Centro Pro Juventute Minerva SRL, 80131 Napoli, Italy;
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Maria Cristina Risoleo
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
- Department of Medical and Surgical Science, University “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Claudia Santoro
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
| | - Ilaria Bitetti
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
| | - Rosa Marotta
- Department of Medical and Surgical Science, University “Magna Graecia”, 88100 Catanzaro, Italy;
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24
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Abstract
Epilepsy and autism frequently co-occur. Epilepsy confers an increased risk of autism and autism confers an increased risk of epilepsy. Specific epilepsy syndromes, intellectual disability, and female gender present a particular risk of autism in individuals with epilepsy. Epilepsy and autism are likely to share common etiologies, which predispose individuals to either or both conditions. Genetic factors, metabolic disorders, mitochondrial disorders, and immune dysfunction all can be implicated.
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Affiliation(s)
- Frank M C Besag
- East London NHS Foundation Trust, 5-7 Rush Court, Bedford MK40 3JT, UK; University College London, London, UK; King's College London, London, UK.
| | - Michael J Vasey
- East London NHS Foundation Trust, 5-7 Rush Court, Bedford MK40 3JT, UK
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25
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Patak J, Faraone SV, Zhang-James Y. Sodium hydrogen exchanger 9 NHE9 (SLC9A9) and its emerging roles in neuropsychiatric comorbidity. Am J Med Genet B Neuropsychiatr Genet 2020; 183:289-305. [PMID: 32400953 DOI: 10.1002/ajmg.b.32787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 12/09/2019] [Accepted: 02/22/2020] [Indexed: 12/16/2022]
Abstract
Variations in SLC9A9 gene expression and protein function are associated with multiple human diseases, which range from Attention-deficit/hyperactivity disorder (ADHD) to glioblastoma multiforme. In an effort to determine the full spectrum of human disease associations with SLC9A9, we performed a systematic review of the literature. We also review SLC9A9's biochemistry, protein structure, and function, as well as its interacting partners with the goal of identifying mechanisms of disease and druggable targets. We report gaps in the literature regarding the genes function along with consistent trends in disease associations that can be used to further research into treating the respective diseases. We report that SLC9A9 has strong associations with neuropsychiatric diseases and various cancers. Interestingly, we find strong overlap in SLC9A9 disease associations and propose a novel role for SLC9A9 in neuropsychiatric comorbidity. In conclusion, SLC9A9 is a multifunctional protein that, through both its endosome regulatory function and its protein-protein interaction network, has the ability to modulate signaling axes, such as the PI3K pathway, among others.
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Affiliation(s)
- Jameson Patak
- Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, USA.,College of Medicine, MD Program, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Stephen V Faraone
- Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, USA.,Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Yanli Zhang-James
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, New York, USA
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26
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Abstract
PURPOSE OF REVIEW The steady rise in number of youth diagnosed with autism spectrum disorder (ASD) has led to the need to examine transition of care considerations specific to ASD. Improved understanding and guidance addressing these needs will allow pediatric and adult providers to work together to optimize social, medical, and occupational outcomes for these patients. RECENT FINDINGS Health-care transition is a delicate time when children with ASD outgrow the services of pediatric programs and enter a fragmented healthcare system that is unfamiliar, insufficiently knowledgeable, and underfunded for their needs. SUMMARY Increasing autism prevalence and an aging population with autism lend urgency to improve outcomes in children transitioning to adult-care. Research reveals poor consequences in social support, education, vocational training and employment, housing, and healthcare. Specific considerations to address these issues and ensure successful transition from pediatric to adult care are needed.
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27
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The co-occurrence of epilepsy and autism: A systematic review. Epilepsy Behav 2019; 98:238-248. [PMID: 31398688 DOI: 10.1016/j.yebeh.2019.07.037] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aimed to review the literature to determine the incidence and prevalence of autism in epilepsy and epilepsy in autism, conditions that are often comorbid. METHODS We adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards, and the protocol was registered with PROSPERO. MEDLINE, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews were searched from inception until July 4, 2016. Studies were included if they reported an incidence or prevalence of autism in epilepsy or epilepsy in autism. These estimates were described using mean, standard deviation, median, and interquartile range. RESULTS Seventy-four studies reporting on 283,549 patients were included. The median overall period prevalence of epilepsy in people with autism was 12.1% while the median overall period prevalence of autism in people with epilepsy was 9.0% when including all population types. When excluding studies that investigated patients with syndromic epilepsy or developmental delay, the median overall period prevalence of epilepsy in people with autism was 11.2% while the median overall period prevalence of autism in people with epilepsy was 8.1%. We observed trends for sex as the prevalence of autism in epilepsy was higher in males while the prevalence of epilepsy in autism was higher in females. It is important to interpret these estimates with caution, as there was significant heterogeneity between studies. Meta-regression found no association between study quality and prevalence or incidence estimates (all p-values > 0.05). CONCLUSIONS The period prevalence of epilepsy in people with autism, and vice versa, was consistently higher than previously reported estimates of the occurrence of these disorders in the general population. These findings highlight the importance of screening for autism in people who have epilepsy and epilepsy in people who have autism and may help shed light on shared pathogenesis between these conditions.
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28
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Berry KP, Lu QR. Chromatin modification and epigenetic control in functional nerve regeneration. Semin Cell Dev Biol 2019; 97:74-83. [PMID: 31301357 DOI: 10.1016/j.semcdb.2019.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/08/2019] [Indexed: 12/13/2022]
Abstract
The repair and functional recovery of the nervous system is a highly regulated process that requires the coordination of many different components including the proper myelination of regenerated axons. Dysmyelination and remyelination failures after injury result in defective nerve conduction, impairing normal nervous system functions. There are many convergent regulatory networks and signaling mechanisms between development and regeneration. For instance, the regulatory mechanisms required for oligodendrocyte lineage progression could potentially play fundamental roles in myelin repair. In recent years, epigenetic chromatin modifications have been implicated in CNS myelination and functional nerve restoration. The pro-regenerative transcriptional program is likely silenced or repressed in adult neural cells including neurons and myelinating cells in the central and peripheral nervous systems limiting the capacity for repair after injury. In this review, we will discuss the roles of epigenetic mechanisms, including histone modifications, chromatin remodeling, and DNA methylation, in the maintenance and establishment of the myelination program during normal oligodendrocyte development and regeneration. We also discuss how these epigenetic processes impact myelination and axonal regeneration, and facilitate the improvement of current preclinical therapeutics for functional nerve regeneration in neurodegenerative disorders or after injury.
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Affiliation(s)
- Kalen P Berry
- Department of Pediatrics, Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Q Richard Lu
- Department of Pediatrics, Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
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29
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EEG Abnormalities as a Neurophysiological Biomarker of Severity in Autism Spectrum Disorder: A Pilot Cohort Study. J Autism Dev Disord 2019; 49:2337-2347. [PMID: 30726535 DOI: 10.1007/s10803-019-03908-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To date, the phenotypic significance of EEG abnormalities in patients with ASD is unclear. In a population affected by ASD we aimed to evaluate: the phenotypic characteristics; the prevalence of EEG abnormalities; the potential correlations between EEG abnormalities and behavioral and cognitive variables. Sixty-nine patients with ASD underwent cognitive or developmental testing, language assessment, and adaptive behavior skills evaluation as well as sleep/wake EEG recording. EEG abnormalities were found in 39.13% of patients. EEG abnormalities correlated with autism severity, hyperactivity, anger outbursts, aggression, negative or destructive behavior, motor stereotypies, intellectual disability, language impairment and self-harm. Our findings confirmed that EEG abnormalities are present in the ASD population and correlate with several associated phenotypic features.
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30
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Luz-Escamilla L, Morales-González JA. Association between Interictal Epileptiform Discharges and Autistic Spectrum Disorder. Brain Sci 2019; 9:brainsci9080185. [PMID: 31366163 PMCID: PMC6721430 DOI: 10.3390/brainsci9080185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 02/07/2023] Open
Abstract
It has been reported that bioelectric alterations in an electroencephalogram (EEG) may play an etiological role in neurodevelopmental disorders. The clinical impact of interictal epileptiform discharges (IEDs) in association with autistic spectrum disorder (ASD) is unknown. The Autism Diagnostic Interview-Revised (ADI-R) is one of the gold standards for the diagnosis of autistic spectrum disorder. Some studies have indicated high comorbidity of IED and ASD, while other studies have not supported an association between the central symptoms of autism and IED. This review examines the high comorbidity and clinical impact of IED; patients with epilepsy are excluded from the scope of this review. ASD can be disabling and is diagnosed at an average age of 5 years old, at which point the greatest neurological development has occurred. If an association between IED and ASD is identified, a clinical tool that entails an innocuous procedure could enable diagnosis in the first years of life. However, in the absence of reports that prove an association between IED and ASD, patients should not be subjected to expensive treatments, such as the administration of anticonvulsant therapies.
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Affiliation(s)
- Laura Luz-Escamilla
- Laboratorio de Medicina de Conservación y Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón S/N, Col. Casco de Santo Tomás, Alcaldía Miguel Hidalgo CP 11340, México.
- Departamento de Higiene Mental, Hospital General Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Distrito Federal CP 02990, México.
| | - José Antonio Morales-González
- Laboratorio de Medicina de Conservación y Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón S/N, Col. Casco de Santo Tomás, Alcaldía Miguel Hidalgo CP 11340, México.
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31
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Swatzyna RJ, Boutros NN, Genovese AC, MacInerney EK, Roark AJ, Kozlowski GP. Electroencephalogram (EEG) for children with autism spectrum disorder: evidential considerations for routine screening. Eur Child Adolesc Psychiatry 2019; 28:615-624. [PMID: 30218395 DOI: 10.1007/s00787-018-1225-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/06/2018] [Indexed: 12/22/2022]
Abstract
Routine electroencephalograms (EEG) are not recommended as a screen for epileptic discharges (EDs) in current practice guidelines for children with autism spectrum disorder (ASD). However, a review of the research from the last three decades suggests that this practice should be reevaluated. The significant comorbidity between epilepsy and ASD, its shared biological pathways, risk for developmental regression, and cognitive challenges demand increased clinical investigation requiring a proactive approach. This review highlights and explains the need for screening EEGs for children with ASD. EEG would assist in differentiating EDs from core features of ASD and could be included in a comprehensive assessment. EEG also meets the demand for evidence-based precision medicine and focused care for the individual, especially when overlapping processes of development are present.
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Affiliation(s)
- Ronald J Swatzyna
- Electro-Neuro Analysis Research, Tarnow Center for Self-Management, 1001 West Loop South, Suite 215, Houston, TX, 77027, USA.
| | - Nash N Boutros
- Behavioral Neurology Division, The Saint Luke's Marion Bloch Neuroscience Institute, Kansas City, MO, USA
| | - Ann C Genovese
- Department of Child and Adolescent Psychiatry, The University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Gerald P Kozlowski
- Department of Clinical Psychology, Saybrook University, Oakland, CA, USA
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32
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Milovanovic M, Radivojevic V, Radosavljev-Kircanski J, Grujicic R, Toskovic O, Aleksić-Hil O, Pejovic-Milovancevic M. Epilepsy and interictal epileptiform activity in patients with autism spectrum disorders. Epilepsy Behav 2019; 92:45-52. [PMID: 30611007 DOI: 10.1016/j.yebeh.2018.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to determine the prevalence of epilepsy and subclinical epileptiform abnormalities in children with autism spectrum disorder (ASD), and to investigate its effects on core autistic symptoms and adaptive behavior skills. METHODS Patients with diagnosis of ASD who met full criteria on Autism Diagnostic Interview-Revised (ADI-R) were included in the study. Adaptive behavior skills were assessed by Vineland Adaptive Behavior Scale-II (VABS-II). Clinical assessment for epilepsy and video electroencephalography (EEG) (v-EEG) examinations during wakefulness and/or sleep were prospectively performed in all patients. RESULTS A total of 112 patients with diagnosis of ASD of mean age 6.58 ± 3.72 were included in the study. Based on clinical and v-EEG assessments, three groups of patients were defined: 1) patients with epilepsy (n = 17; 15.2%); 2) patients with epileptiform discharges in absence of clinical seizures (n = 14; 12.5%); 3) patients without epilepsy and without epileptiform discharges (n = 81; 72.3%). There were no significant differences between three groups of patients on ADI-R subscores. Speech development was also not significantly related to epilepsy. There was a slight tendency of the VABS-II motor skills score to be higher in the group of patients with autism without clinical diagnosis of epilepsy and without subclinical epileptiform discharges (p < 0.05) in comparison with the two other groups. According to this tendency, we might claim that patients with higher scores on motor skills could have 0.88 times lower odds for having epileptiform EEG activity. CONCLUSIONS According to our results, we were not able to detect differences in the ADI-R between the three populations with ASD, all with unknown etiology. Epilepsy, as well as subclinical epileptic discharges, showed small effects on Motor Skills in patients with autism, and had no effect on adaptive behavior Communication/Socialization/Daily Living Skills.
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Affiliation(s)
- Maja Milovanovic
- Institute of Mental Health, Belgrade, Serbia; Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | | | | | | | - Oliver Toskovic
- Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | | | - Milica Pejovic-Milovancevic
- Institute of Mental Health, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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33
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The Experiences of College Students on the Autism Spectrum: A Comparison to Their Neurotypical Peers. J Autism Dev Disord 2019; 49:2320-2336. [PMID: 30734173 DOI: 10.1007/s10803-019-03910-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study describes the academic, social, and health experiences of college students on the autism spectrum as they compare to students with other disabilities and their non-disabled, neurotypical peers. Data were from an online survey of college students at 14 public institutions (N = 3073). There were few significant differences between students on the spectrum and students with other disabilities. Both groups of students reported significantly worse outcomes than neurotypical students on academic performance, social relationships and bullying, and physical and mental health. The findings suggest that some of the challenges students on the spectrum face in college result from the stigma and social rejection associated with disability rather than from the unique characteristics of autism.
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34
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Garbarino VR, Gilman TL, Daws LC, Gould GG. Extreme enhancement or depletion of serotonin transporter function and serotonin availability in autism spectrum disorder. Pharmacol Res 2019; 140:85-99. [PMID: 30009933 PMCID: PMC6345621 DOI: 10.1016/j.phrs.2018.07.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/22/2018] [Accepted: 07/12/2018] [Indexed: 12/15/2022]
Abstract
A variety of human and animal studies support the hypothesis that serotonin (5-hydroxytryptamine or 5-HT) system dysfunction is a contributing factor to the development of autism in some patients. However, many questions remain about how developmental manipulation of various components that influence 5-HT signaling (5-HT synthesis, transport, metabolism) persistently impair social behaviors. This review will summarize key aspects of central 5-HT function important for normal brain development, and review evidence implicating perinatal disruptions in 5-HT signaling in the pathophysiology of autism spectrum disorder. We discuss the importance, and relative dearth, of studies that explore the possible correlation to autism in the interactions between important intrinsic and extrinsic factors that may disrupt 5-HT homeostasis during development. In particular, we focus on exposure to 5-HT transport altering mechanisms such as selective serotonin-reuptake inhibitors or genetic polymorphisms in primary or auxiliary transporters of 5-HT, and how they relate to neurological stores of serotonin and its precursors. A deeper understanding of the many mechanisms by which 5-HT signaling can be disrupted, alone and in concert, may contribute to an improved understanding of the etiologies and heterogeneous nature of this disorder. We postulate that extreme bidirectional perturbations of these factors during development likely compound or synergize to facilitate enduring neurochemical changes resulting in insufficient or excessive 5-HT signaling, that could underlie the persistent behavioral characteristics of autism spectrum disorder.
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Affiliation(s)
- Valentina R Garbarino
- Department of Cellular and Integrative Physiology, United States; The Sam and Ann Barshop Institute for Longevity and Aging Studies, United States.
| | - T Lee Gilman
- Department of Cellular and Integrative Physiology, United States; Addiction Research, Treatment & Training Center of Excellence, United States.
| | - Lynette C Daws
- Department of Cellular and Integrative Physiology, United States; Addiction Research, Treatment & Training Center of Excellence, United States; Department of Pharmacology, United States.
| | - Georgianna G Gould
- Department of Cellular and Integrative Physiology, United States; Center for Biomedical Neuroscience, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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35
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Epilepsy in Children with Autistic Spectrum Disorder. CHILDREN-BASEL 2019; 6:children6020015. [PMID: 30691036 PMCID: PMC6406948 DOI: 10.3390/children6020015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 12/21/2022]
Abstract
The comorbidity of autistic spectrum disorder (ASD) and epilepsy has been widely discussed but many questions still remain unanswered. The aim of this study was to establish the occurrence of epilepsy among children with ASD to define the type of epileptic seizures and syndromes, the age of onset of epilepsy, EEG abnormalities, the used antiepileptic drugs and the therapeutic responses for seizures and autistic behavior, as well as to find some correlations between epilepsy and gender, etiology and intellectual disability (ID). A retrospective study of medical files of 59 patients (aged 1–18 years) with ASD during a 5-year period was performed. ASD diagnosis was based on the DSM-5 diagnostic criteria. The patients were examined with a detailed medical history, physical and neurological examination, as well as some additional functional, imaging, laboratory and genetic investigations ASD etiology was syndromic in 9, probable syndromic in 9, and idiopathic in 41 children. ID was established in 90% of ASD children, and epilepsy in 44.4%. The onset of epilepsy prevailed before 7 years of age. The most common seizure types were focal with or without secondary generalization (53.4%). Focal epileptiform EEG abnormalities prevailed. Therapeutic response to seizures was good: 58% were seizure-free, while 27% had >50% seizure reduction but no improvement in autistic behavior. There was no correlation between epilepsy and either occurrence or degree of ID. There was a correlation between the frequency of epileptic seizures and the degree of ID. There was no significant difference among epilepsy rates in different etiologic, gender, and ID groups, probably because of the high percentage of ID and because this was a hospital-based study. Our study showed a significant percentage of epilepsy in ASD population and more than 1/4 were of symptomatic etiology. Those could be managed with specific treatments based on the pathophysiology of the gene defect.
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36
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Sojar SH, Goldner JSV, Krishnamoorthy K, Murphy SA, Masiakos PT, Klig JE. A 17-Year-Old Boy With High-Functioning Autism, Gastrointestinal Illness, and Seizures. Pediatrics 2019; 143:peds.2017-3964. [PMID: 30545828 DOI: 10.1542/peds.2017-3964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 11/24/2022] Open
Abstract
A healthy 17-year-old boy with a high-functioning pervasive developmental disorder presented to the emergency department after having a 4-minute episode of seizure-like activity in the setting of presumed viral gastroenteritis. Within an hour of emergency department arrival, he developed a forehead-sparing facial droop, right-sided ptosis, and expressive aphasia, prompting stroke team assessment and urgent neuroimaging. Laboratory results later revealed a serum sodium of 119 mmol/L. Neurologic deficits self-resolved, and a full physical examination revealed diffuse abdominal tenderness in the lower abdomen with rebound tenderness in the right-lower quadrant. The patient was admitted to the PICU for electrolyte management and monitoring. A computed tomography (CT) scan of the abdomen obtained the following morning revealed the patient's final diagnosis.
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Affiliation(s)
- Sakina H Sojar
- Massachusetts General Hospital, Boston, Massachusetts; and
| | | | | | - Sarah A Murphy
- Massachusetts General Hospital, Boston, Massachusetts; and
| | | | - Jean E Klig
- Massachusetts General Hospital, Boston, Massachusetts; and
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37
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Rosenberg A, Sunkara A. Does attenuated divisive normalization affect gaze processing in autism spectrum disorder? A commentary on Palmer et al. (2018). Cortex 2018; 111:316-318. [PMID: 30086826 DOI: 10.1016/j.cortex.2018.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/13/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Ari Rosenberg
- Department of Neuroscience, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA.
| | - Adhira Sunkara
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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38
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Dual Requirement of CHD8 for Chromatin Landscape Establishment and Histone Methyltransferase Recruitment to Promote CNS Myelination and Repair. Dev Cell 2018; 45:753-768.e8. [PMID: 29920279 DOI: 10.1016/j.devcel.2018.05.022] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/16/2018] [Accepted: 05/19/2018] [Indexed: 01/02/2023]
Abstract
Disruptive mutations in chromatin remodeler CHD8 cause autism spectrum disorders, exhibiting widespread white matter abnormalities; however, the underlying mechanisms remain elusive. We show that cell-type specific Chd8 deletion in oligodendrocyte progenitors, but not in neurons, results in myelination defects, revealing a cell-intrinsic dependence on CHD8 for oligodendrocyte lineage development, myelination and post-injury remyelination. CHD8 activates expression of BRG1-associated SWI/SNF complexes that in turn activate CHD7, thus initiating a successive chromatin remodeling cascade that orchestrates oligodendrocyte lineage progression. Genomic occupancy analyses reveal that CHD8 establishes an accessible chromatin landscape, and recruits MLL/KMT2 histone methyltransferase complexes distinctively around proximal promoters to promote oligodendrocyte differentiation. Inhibition of histone demethylase activity partially rescues myelination defects of CHD8-deficient mutants. Our data indicate that CHD8 exhibits a dual function through inducing a cascade of chromatin reprogramming and recruiting H3K4 histone methyltransferases to establish oligodendrocyte identity, suggesting potential strategies of therapeutic intervention for CHD8-associated white matter defects.
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39
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Medical Conditions in the First Years of Life Associated with Future Diagnosis of ASD in Children. J Autism Dev Disord 2018; 47:2067-2079. [PMID: 28434058 PMCID: PMC5487747 DOI: 10.1007/s10803-017-3130-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study examines medical conditions diagnosed prior to the diagnosis of autism spectrum disorder (ASD). Using a matched case control design with 3911 ASD cases and 38,609 controls, we found that 38 out of 79 medical conditions were associated with increased ASD risk. Developmental delay, mental health, and neurology conditions had the strongest associations (ORs 2.0–23.3). Moderately strong associations were observed for nutrition, genetic, ear nose and throat, and sleep conditions (ORs 2.1–3.2). Using machine learning methods, we clustered children based on their medical conditions prior to ASD diagnosis and demonstrated ASD risk stratification. Our findings provide new evidence indicating that children with ASD have a disproportionate burden of certain medical conditions preceding ASD diagnosis.
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40
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Abstract
Autism is more common in people with epilepsy, approximately 20%, and epilepsy is more common in people with autism with reported rates of approximately 20%. However, these figures are likely to be affected by the current broader criteria for autism spectrum disorder (ASD), which have contributed to an increased prevalence of autism, with the result that the rate for ASD in epilepsy is likely to be higher and the figure for epilepsy in ASD is likely to be lower. Some evidence suggests that there are two peaks of epilepsy onset in autism, in infancy and adolescence. The rate of autism in epilepsy is much higher in those with intellectual disability. In conditions such as the Landau-Kleffner syndrome and nonconvulsive status epilepticus, the epilepsy itself may present with autistic features. There is no plausible mechanism for autism causing epilepsy, however. The co-occurrence of autism and epilepsy is almost certainly the result of underlying factors predisposing to both conditions, including both genetic and environmental factors. Conditions such as attention deficit hyperactivity disorder, anxiety and sleep disorders are common in both epilepsy and autism. Epilepsy is generally not a contraindication to treating these conditions with suitable medication, but it is important to take account of relevant drug interactions. One of the greatest challenges in autism is to determine why early childhood regression occurs in perhaps 25%. Further research should focus on finding the cause for such regression. Whether epilepsy plays a role in the regression of a subgroup of children with autism who lose skills remains to be determined.
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Affiliation(s)
- Frank Mc Besag
- Neurodevelopmental Team, East London Foundation NHS Trust, Family Consultation Clinic, Bedford, UK
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41
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Brooks J, Kellett J, Seeanner J, Jenkins C, Buchanan C, Kinsman A, Kelly D, Pierce S. Training the Motor Aspects of Pre-driving Skills of Young Adults With and Without Autism Spectrum Disorder. J Autism Dev Disord 2017; 46:2408-26. [PMID: 27055416 DOI: 10.1007/s10803-016-2775-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to investigate the utility of using a driving simulator to address the motor aspects of pre-driving skills with young adults with Autism Spectrum Disorder (ASD). A group of neurotypical control participants and ten participants with ASD completed 18 interactive steering and pedal exercises with the goal to achieve error-free performance. Most participants were able to achieve this goal within five trials for all exercises except for the two most difficult ones. Minimal performance differences were observed between the two groups. Participants with ASD needed more time to complete the tasks. Overall, the interactive exercises and the process used worked well to address motor related aspects of pre-driving skills in young adults with ASD.
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Affiliation(s)
- Johnell Brooks
- Department of Automotive Engineering, Clemson University International Center for Automotive Research, 4 Research Drive, Greenville, SC, USA.
| | - Julie Kellett
- Division of Pediatric Psychology, Children's Hospital, Greenville Health System, 200 Patewood Drive, Greenville, SC, USA
| | - Julia Seeanner
- Department of Automotive Engineering, Clemson University International Center for Automotive Research, 4 Research Drive, Greenville, SC, USA
| | - Casey Jenkins
- Department of Automotive Engineering, Clemson University International Center for Automotive Research, 4 Research Drive, Greenville, SC, USA
| | - Caroline Buchanan
- Division of Developmental-Behavioral Pediatrics, Children's Hospital, Greenville Health System, 200 Patewood Drive, Greenville, SC, USA
| | - Anne Kinsman
- Division of Pediatric Psychology, Children's Hospital, Greenville Health System, 200 Patewood Drive, Greenville, SC, USA
| | - Desmond Kelly
- Division of Developmental-Behavioral Pediatrics, Children's Hospital, Greenville Health System, 200 Patewood Drive, Greenville, SC, USA
| | - Susan Pierce
- Adaptive Mobility Services, 1726 S. Bumby Ave, Orlando, FL, USA
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42
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EEG abnormalities and long term seizure outcome in high functioning autism. Acta Neurol Belg 2017; 117:729-732. [PMID: 28447214 DOI: 10.1007/s13760-017-0785-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/20/2017] [Indexed: 01/28/2023]
Abstract
Electroencephalographic abnormalities may occur in autistic spectrum disorders (ASD) even in the absence of clinical seizures. These abnormalities may vary from nonspecific changes to epileptiform abnormalities and are more common compared to the overall population. The level of intelligence is a significant risk factor for epilepsy in ASD. However, the relation between the functionality of the individuals with autism and the electroencephalographic (EEG) abnormalities, and the clinical significance of these abnormalities still remain relatively unclear. In this study we investigated the presence of EEG abnormalities in sixteen children diagnosed with high-functioning ASD. EEG recording was performed for at least 2 h and included at least 90 min of sleep activity. While none of the patients had clinical seizures, 5 patients (31.3%) were detected to have EEG abnormalities. Four of these were epileptiform (25%), and one patient developed seizure during follow-up. Our results support the fact that EEG abnormalities are observed at a higher rate also in ASD with a better functionality. The potential impact of EEG abnormalities on cognition and behavior, and the risk of epilepsy should be considered during long-term follow-up of these patients.
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43
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Qadir AA, Obringer E, Hageman J, Marcuccilli C. Risk of Second Seizure in Pediatric Patients With Idiopathic Autism. J Child Neurol 2017; 32:876-879. [PMID: 28604149 DOI: 10.1177/0883073817713906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Epilepsy is a comorbidity of idiopathic autism spectrum disorder. The aim was to characterize the risk and time of second seizure in children with idiopathic autism spectrum disorder. METHODS A retrospective review was performed at the University of Chicago and NorthShore University HealthSystem. Patients with idiopathic autism spectrum disorder, ≥1 seizure, and age 2 to 23 years were included. RESULTS 153 patients were included; 141 (92%) had a second seizure. The average age at first seizure was 7.14 years (median: 5.08 years) and 8.12 years (median: 7.3 years) at second seizure. Average time between first and second seizure was 7.68 months. DISCUSSION A high risk of seizure recurrence was found in this population. There was a short time to second seizure, with most having a recurrence within 1 year. These findings may be used to guide therapy in children with autism spectrum disorder and epilepsy.
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Affiliation(s)
- Asad A Qadir
- 1 Department of Pediatrics, University of Chicago Medical Center, Chicago, IL, USA
| | - Emily Obringer
- 1 Department of Pediatrics, University of Chicago Medical Center, Chicago, IL, USA
| | - Joseph Hageman
- 1 Department of Pediatrics, University of Chicago Medical Center, Chicago, IL, USA
| | - Charles Marcuccilli
- 2 Department of Pediatric Neurology, University of Chicago Medical Center, Chicago, IL, USA
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44
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van Schalkwyk GI, Volkmar FR. Autism Spectrum Disorders: Challenges and Opportunities for Transition to Adulthood. Child Adolesc Psychiatr Clin N Am 2017; 26:329-339. [PMID: 28314459 DOI: 10.1016/j.chc.2016.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Improved outcomes for individuals with autism spectrum disorder (ASD) have opened a range of potential pathways during the transition to adulthood. These include attending college, entering the labor force, and achieving a degree of independent living. Less cognitively able individuals may be eligible for state benefits and may enter supported employment programs. Those attending college require careful support and planning. Practitioners need to be familiar with the unique needs of young adults with ASD. Further research should attempt to define the priorities of individuals and families with ASD making this transition and clarify the value of existing supports and interventions.
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Affiliation(s)
| | - Fred R Volkmar
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
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45
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Mintz M. Evolution in the Understanding of Autism Spectrum Disorder: Historical Perspective. Indian J Pediatr 2017; 84:44-52. [PMID: 27053182 DOI: 10.1007/s12098-016-2080-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/24/2016] [Indexed: 01/19/2023]
Abstract
The study of the evolution in the diagnosis and treatment of autism is a lesson in the dangers of medical beliefs or doctrines that are not grounded in medical science. The early descriptions of autism suggested that it was the result of childhood psychoses or psychodynamic disturbances of parent-child relationships. This flawed conceptualization of autism spectrum disorders (ASD) gave way to advances in medical science, which have established ASD as a neurobiological disorder of early brain development. There are many genetic, epigenetic, metabolic, hormonal, immunological, neuroanatomical and neurophysiological etiologies of ASD, as well as an array of gastrointestinal and other systemic co-morbid disorders. Thus, ASD are a biologically heterogeneous population with extensive neurodiversity. Early identification and understanding of ASD is crucial; interventions at younger ages are associated with improved outcomes. The advent of understanding the biological sub-phenotypes of ASD, along with targeted medical therapies, coupled with a multimodal therapeutic approach that encompasses behavioral, educational, social, speech, occupational, creative arts, and other forms of therapies has created a new and exciting era for individuals with ASD and their families: "personalized" and "precision" medical care based upon underlying biological sub-phenotypes and clinical profiles. For many individuals and their families dealing with the scourge of autism, their long and frustrating diagnostic journey is beginning to come to an end, with a hope for improved outcomes and quality of life.
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Affiliation(s)
- Mark Mintz
- The Center for Neurological and Neurodevelopmental Health, Voorhees, NJ, USA.
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Abstract
Autism is a complex neurodevelopmental disorder, which has captured the attention of not only pediatricians but also the parents. From the symptoms until the final diagnosis, parents undergo a diagnostic odyssey that involves a battery of tests without much yield. This has led to an increase in the referrals to the clinical geneticists to rule out the possible genetic etiology that can have implications for the parents for future pregnancy. This chapter focuses on the various genetic causes and their appropriate application in the evaluation of a child with Autism Spectrum Disorders (ASDs).
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Affiliation(s)
- Shruthi Sudarshan
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Neerja Gupta
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Madhulika Kabra
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Su CC, Chi MH, Lin SH, Yang YK. Bidirectional association between autism spectrum disorder and epilepsy in child and adolescent patients: a population-based cohort study. Eur Child Adolesc Psychiatry 2016; 25:979-87. [PMID: 26791195 DOI: 10.1007/s00787-016-0817-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 01/08/2016] [Indexed: 11/26/2022]
Abstract
This study aimed to assess whether there is a bidirectional association between autism spectrum disorder (ASD) and epilepsy in child and adolescent patients. The National Health Insurance Research Database of Taiwan was used to conduct two cohort studies of patients who were under 18 years of age during the period 1997-2008. Cohort 1 comprised patients with newly diagnosed ASD but excluded those diagnosed with epilepsy prior to ASD. A non-ASD comparison group was matched to each case in terms of age and sex. Cohort 2 comprised patients with newly diagnosed epilepsy but excluded those diagnosed with ASD prior to epilepsy. A non-epilepsy comparison group was matched to each case in terms of age and sex. We calculated the incidence of epilepsy in patients with ASD and hazard ratio (HR) to estimate the risk of epilepsy in association with ASD in cohort 1, and the reverse in cohort 2. In cohort 1, the incidence of epilepsy was 13.7 in the ASD group and 1.3 in the non-ASD group (per 1000 person-years). The adjusted HR for epilepsy was 8.4 (95 % CI 5.5-12.7) in the ASD group when compared with the non-ASD group. In cohort 2, the incidence of ASD was 3.4 in the epilepsy group and 0.3 in the non-epilepsy group (per 1000 person-years). The adjusted HR for ASD was 8.4 (95 % CI 6.2-11.4) in the epilepsy group when compared with the non-epilepsy group. A bidirectional association was, therefore, found to exist between ASD and epilepsy. These findings implicate that ASD and epilepsy probably share common risk factors. However, further studies are required to reveal more detail on the mechanism of this bidirectional association.
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Affiliation(s)
- Chien-Chou Su
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan
- Institue of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mei Hung Chi
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan.
| | - Shin-Hsien Lin
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan
- Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan
- Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
- Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Cade R, Privette M, Fregly M, Rowland N, Sun Z, Zele V, Wagemaker H, Edelstein C. Autism and Schizophrenia: Intestinal Disorders. Nutr Neurosci 2016; 3:57-72. [PMID: 27416160 DOI: 10.1080/1028415x.2000.11747303] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We examined Dohan's hypothesis that schizophrenia is associated with the absorption of "exorphins" contained in gluten and casein. In addition, because of the work of Reichelt et al. (Reichelt, K.L., Saelid, G., Lindback, J. and Orbeck, H. (1986) Biological Psychiatry 21:1279-1290) and Rodriguez et al. (Rodriguez, Trav, A.L., Barreiro Marin, R, Galvez, Borrero, I.M., del Olmo Romero-Nieva, F. and Diaz Alvarez, A. (1994) Journal of Nervous and Mental Disease Aug; 182(8): 478-479), we carried out similar studies on a group of children with autism. In both syndromes we found similar patterns of peptide containing peaks (Ninhydrin positive) after molecular screening with Sephadex G-15. Immunoglobulin assay of IgA and IgG against gliadin and casein in serum was done. High titer IgG antibodies to gliadin were found in 87% of autistic and 86% of schizophrenic patients and high titer IgG antibodies to bovine casein were found in 90% of autistic and in 93% of schizophrenic patients. High titer IgA antibodies to gluten or casein were found in 30% of children with autism while in schizophrenic patients 86% had elevated IgA antibodies to gluten and 67% to casein; some normal children and adults have these antibodies but only in trace amounts. When schizophrenic patients were treated with dialysis or a gluten-casein free diet, or both (Cade, R., Wagemaker, H., Privette, R.M., Fregly, M., Rogers, J. and Orlando, J. (1990) Psychiatry: A World Prespective 1: 494-500) peptiduria and Brief Psychiatric Rating Scores fell while abnormal behavior diminished. A gluten-casein free diet was accompanied by improvement in 81% of autistic children within 3 months in most of the behavior categories. Our data provide support for the proposal that many patients with schizophrenia or autism suffer due to absorption of exorphins formed in the intestine from incomplete digestion of gluten and casein.
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Affiliation(s)
- R Cade
- a Departments of Medicine, Physiology, Psychology and Psychiatry , University of Florida , Gainesville , FL 32610-0204 , USA
| | - M Privette
- a Departments of Medicine, Physiology, Psychology and Psychiatry , University of Florida , Gainesville , FL 32610-0204 , USA
| | - M Fregly
- a Departments of Medicine, Physiology, Psychology and Psychiatry , University of Florida , Gainesville , FL 32610-0204 , USA
| | - N Rowland
- a Departments of Medicine, Physiology, Psychology and Psychiatry , University of Florida , Gainesville , FL 32610-0204 , USA
| | - Z Sun
- a Departments of Medicine, Physiology, Psychology and Psychiatry , University of Florida , Gainesville , FL 32610-0204 , USA
| | - V Zele
- a Departments of Medicine, Physiology, Psychology and Psychiatry , University of Florida , Gainesville , FL 32610-0204 , USA
| | - H Wagemaker
- a Departments of Medicine, Physiology, Psychology and Psychiatry , University of Florida , Gainesville , FL 32610-0204 , USA
| | - C Edelstein
- a Departments of Medicine, Physiology, Psychology and Psychiatry , University of Florida , Gainesville , FL 32610-0204 , USA
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Abstract
Autism is a prevalent and strongly genetic brain-based disorder. Early focus in the field on the relevance of psychogenic factors led to the blaming of parents for the occurrence of the disorder, and as a result mainstream research on psychotherapeutic approaches has until recently been limited. Although psychoanalytic approaches continue to be considered of limited relevance for these individuals, dynamic theory is both informative and informed by conceptual approaches to the understanding of autism. Theory of mind in particular is a prominent model for understanding the core deficits of autism and bears strong resemblance to the concept of mentalization. Although cognitive-behavioral and social skills interventions may form the cornerstone of psychotherapy for individuals with autism, the formation of a treatment alliance remains crucial and may require a particular willingness for flexibility on the part of the therapist.
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Broadstock M, Doughty C, Eggleston M. Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 11:335-48. [PMID: 17656398 DOI: 10.1177/1362361307078132] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The variable expression of autism over the lifespan is likely to lead to different symptoms and support requirements, and to distinct responses to pharmacotherapy treatment, in older patients compared to children. This systematic review considers the effectiveness of pharmacological treatment in managing autism spectrum disorder in adolescents and adults. Following a comprehensive search of literature published in English from 1980, methodological criteria were applied to identify studies designed to reliably assess treatment effectiveness. Only five double-blind, randomized controlled trials were eligible for appraisal. All had small sample sizes (mean = 30) and brief treatment duration of no more than 12 weeks. The paucity of trials and their methodological limitations means that there is only preliminary evidence about the short-term effectiveness of a few drug treatments for this age group. There was also a lack of reliable data reported on drug safety profiles. Methodological challenges and directions for future research are discussed.
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