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Bransfield RC, Mao C, Greenberg R. Microbes and Mental Illness: Past, Present, and Future. Healthcare (Basel) 2023; 12:83. [PMID: 38200989 PMCID: PMC10779437 DOI: 10.3390/healthcare12010083] [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: 10/31/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
A review of the association between microbes and mental illness is performed, including the history, relevant definitions, infectious agents associated with mental illnesses, complex interactive infections, total load theory, pathophysiology, psychoimmunology, psychoneuroimmunology, clinical presentations, early-life infections, clinical assessment, and treatment. Perspectives on the etiology of mental illness have evolved from demonic possession toward multisystem biologically based models that include gene expression, environmental triggers, immune mediators, and infectious diseases. Microbes are associated with a number of mental disorders, including autism, schizophrenia, bipolar disorder, depressive disorders, and anxiety disorders, as well as suicidality and aggressive or violent behaviors. Specific microbes that have been associated or potentially associated with at least one of these conditions include Aspergillus, Babesia, Bartonella, Borna disease virus, Borrelia burgdorferi (Lyme disease), Candida, Chlamydia, coronaviruses (e.g., SARS-CoV-2), Cryptococcus neoformans, cytomegalovirus, enteroviruses, Epstein-Barr virus, hepatitis C, herpes simplex virus, human endogenous retroviruses, human immunodeficiency virus, human herpesvirus-6 (HHV-6), human T-cell lymphotropic virus type 1, influenza viruses, measles virus, Mycoplasma, Plasmodium, rubella virus, Group A Streptococcus (PANDAS), Taenia solium, Toxoplasma gondii, Treponema pallidum (syphilis), Trypanosoma, and West Nile virus. Recognition of the microbe and mental illness association with the development of greater interdisciplinary research, education, and treatment options may prevent and reduce mental illness morbidity, disability, and mortality.
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Affiliation(s)
- Robert C. Bransfield
- Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA
- Hackensack Meridian School of Medicine, Nutey, NJ 07110, USA
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Kaminski VDL, Michita RT, Ellwanger JH, Veit TD, Schuch JB, Riesgo RDS, Roman T, Chies JAB. Exploring potential impacts of pregnancy-related maternal immune activation and extracellular vesicles on immune alterations observed in autism spectrum disorder. Heliyon 2023; 9:e15593. [PMID: 37305482 PMCID: PMC10256833 DOI: 10.1016/j.heliyon.2023.e15593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 06/13/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a set of neurodevelopmental disorders usually observed in early life, with impacts on behavioral and social skills. Incidence of ASD has been dramatically increasing worldwide, possibly due to increase in awareness/diagnosis as well as to genetic and environmental triggers. Currently, it is estimated that ∼1% of the world population presents ASD symptoms. In addition to its genetic background, environmental and immune-related factors also influence the ASD etiology. In this context, maternal immune activation (MIA) has recently been suggested as a component potentially involved in ASD development. In addition, extracellular vesicles (EVs) are abundant at the maternal-fetal interface and are actively involved in the immunoregulation required for a healthy pregnancy. Considering that alterations in concentration and content of EVs have also been associated with ASD, this article raises a debate about the potential roles of EVs in the processes surrounding MIA. This represents the major differential of the present review compared to other ASD studies. To support the suggested correlations and hypotheses, findings regarding the roles of EVs during pregnancy and potential influences on ASD are discussed, along with a review and update concerning the participation of infections, cytokine unbalances, overweight and obesity, maternal anti-fetal brain antibodies, maternal fever, gestational diabetes, preeclampsia, labor type and microbiota unbalances in MIA and ASD.
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Affiliation(s)
- Valéria de Lima Kaminski
- Laboratório de Imunobiologia e Imunogenética, Departamento de Genética, Universidade Federal do Rio Grande do Sul – UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular, Departamento de Genética, Universidade Federal do Rio Grande do Sul – UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-Graduação em Biotecnologia, Laboratório de Imunologia Aplicada, Instituto de Ciência e Tecnologia - ICT, Universidade Federal de São Paulo - UNIFESP, São José dos Campos, São Paulo, Brazil
| | - Rafael Tomoya Michita
- Laboratório de Genética Molecular Humana, Universidade Luterana do Brasil - ULBRA, Canoas, Rio Grande do Sul, Brazil
| | - Joel Henrique Ellwanger
- Laboratório de Imunobiologia e Imunogenética, Departamento de Genética, Universidade Federal do Rio Grande do Sul – UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular, Departamento de Genética, Universidade Federal do Rio Grande do Sul – UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Tiago Degani Veit
- Instituto de Ciências Básicas da Saúde, Departmento de Microbiologia, Imunologia e Parasitologia, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jaqueline Bohrer Schuch
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul – UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rudimar dos Santos Riesgo
- Child Neurology Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Tatiana Roman
- Programa de Pós-Graduação em Genética e Biologia Molecular, Departamento de Genética, Universidade Federal do Rio Grande do Sul – UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - José Artur Bogo Chies
- Laboratório de Imunobiologia e Imunogenética, Departamento de Genética, Universidade Federal do Rio Grande do Sul – UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular, Departamento de Genética, Universidade Federal do Rio Grande do Sul – UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
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Sala R, Amet L, Blagojevic-Stokic N, Shattock P, Whiteley P. Bridging the Gap Between Physical Health and Autism Spectrum Disorder. Neuropsychiatr Dis Treat 2020; 16:1605-1618. [PMID: 32636630 PMCID: PMC7335278 DOI: 10.2147/ndt.s251394] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022] Open
Abstract
Autism spectrum disorder (ASD) is a highly complex and heterogeneous developmental disorder that affects how individuals communicate with other people and relate to the world around them. Research and clinical focus on the behavioural and cognitive manifestations of ASD, whilst important, have obscured the recognition that ASD is also commonly associated with a range of physical and mental health conditions. Many physical conditions appear with greater frequency in individuals with ASD compared to non-ASD populations. These can contribute to a worsening of social communication and behaviour, lower quality of life, higher morbidity and premature mortality. We highlight some of the key physical comorbidities affecting the immune and the gastrointestinal systems, metabolism and brain function in ASD. We discuss how healthcare professionals working with individuals with ASD and parents/carers have a duty to recognise their needs in order to improve their overall health and wellbeing, deliver equality in their healthcare experiences and reduce the likelihood of morbidity and early mortality associated with the condition.
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Affiliation(s)
- Regina Sala
- Centre for Psychiatry, Wolfson Institute, Barts & The London School of Medicine & Dentistry Queen Mary University of London, London, UK
| | | | | | - Paul Shattock
- Education & Services for People with Autism, Sunderland, UK
| | - Paul Whiteley
- Education & Services for People with Autism Research, Sunderland, UK
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Mehmood A, Kaushik AC, Wei DQ. Prediction and validation of potent peptides against herpes simplex virus type 1 via immunoinformatic and systems biology approach. Chem Biol Drug Des 2019; 94:1868-1883. [PMID: 31437863 DOI: 10.1111/cbdd.13602] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/23/2019] [Accepted: 08/10/2019] [Indexed: 12/19/2022]
Abstract
The human herpes simplex virus type 1 (HSV-1) is an extremely rampant human pathogen, and its infection could cause life-long diseases, including the central nervous system disorders. The glycoproteins of HSV-1 such as glycoprotein B, glycoprotein C, glycoprotein D, glycoprotein H, and glycoprotein L are highly involved in mediating the viral attachment and infection of the host cell. Therefore, immunoinformatic approaches followed by molecular dynamics simulation and systems biology has been used to analyze these glycoproteins in order to propose effective peptide-based vaccine candidates against the HSV-1 infection. The ElliPro and NetCTL.1.2 online tools were employed to forecast the B- and T-lymphocyte (CTL) epitopes for gB, gC, gD, gH, and gL. The 3D coordinates of these epitopes were modeled and docked against the human major histocompatibility complex molecule-1. The outcomes obtained from postdocking analysis along with TAP (Transporter associated with antigen processing), MHC binding, and C-terminal cleavage score assisted in the selection of potential epitopes. These epitopes were further subjected to molecular dynamics simulation and systems biology approach which showed significant results. On the basis of these substantial outcomes, peptides are proposed that could be used to provoke immunity against the HSV-1 infection.
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Affiliation(s)
- Aamir Mehmood
- State Key Laboratory of Microbial Metabolism, College of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Aman Chandra Kaushik
- State Key Laboratory of Microbial Metabolism, College of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Dong-Qing Wei
- State Key Laboratory of Microbial Metabolism, College of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
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Zheng X, Wang X, Wang T, Zhang H, Wu H, Zhang C, Yu L, Guan Y. Gestational Exposure to Particulate Matter 2.5 (PM 2.5) Leads to Spatial Memory Dysfunction and Neurodevelopmental Impairment in Hippocampus of Mice Offspring. Front Neurosci 2019; 12:1000. [PMID: 30666183 PMCID: PMC6330280 DOI: 10.3389/fnins.2018.01000] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022] Open
Abstract
Prenatal exposure to air pollutants has long-term impact on growth retardation of nervous system development and is related to central nervous system diseases in children. However, it is not well-characterized whether gestational exposure to air pollutants affects the development of nervous system in offspring. Here, we investigated the effects of gestational exposure to particulate matter 2.5 (PM2.5) on hippocampus development in mice offspring, through neurobehavioral, ultrastructural, biochemical and molecular investigations. We found that spatial memory in mice offspring from PM2.5 high-dosage group was impaired. Next, hippocampal ultrastructure of the mice offspring in puberty exhibited mitochondrial damage related to PM2.5 exposure. Interestingly, EdU-positive cells in the subgranular zone (SGZ) of offspring from PM2.5 high-dosage group decreased, with NeuN+/EdU+cells reduced significantly. Furthermore, the numbers of NeuN+/TUNEL+, GFAP+/TUNEL+, and Iba1+/TUNEL+ double-labeled cells increased with PM2.5 exposure in a dosage-dependent manner. In addition, gestational exposure to PM2.5 resulted in increased levels of both mRNAs and proteins involved in apoptosis, including caspase-3, -8, -9, p53, and c-Fos, and decreased Bcl-2/Bax ratios in the hippocampus of mice offspring. Moreover, gestational exposure to PM2.5 was dosage-dependently associated with the increased secretions of inflammatory proteins, including NF-κB, TNF-α, and IL-1β. Collectively, our results suggest that gestational exposure to PM2.5 leads to spatial memory dysfunction and neurodevelopmental impairment by exerting effects on apoptotic and neuroinflammatory events, as well as the neurogenesis in hippocampus of mice offspring.
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Affiliation(s)
- Xinrui Zheng
- Neurologic Disorders and Regeneration Repair Lab of Shandong Higher Education, Department of Histology and Embryology, Weifang Medical University, Weifang, China
| | - Xia Wang
- School of Public Health and Management, Weifang Medical University, Weifang, China
| | - Tingting Wang
- Neurologic Disorders and Regeneration Repair Lab of Shandong Higher Education, Department of Histology and Embryology, Weifang Medical University, Weifang, China
| | - Hongxia Zhang
- Neurologic Disorders and Regeneration Repair Lab of Shandong Higher Education, Department of Histology and Embryology, Weifang Medical University, Weifang, China
| | - Hongjuan Wu
- Neurologic Disorders and Regeneration Repair Lab of Shandong Higher Education, Department of Histology and Embryology, Weifang Medical University, Weifang, China
| | - Can Zhang
- Genetics and Aging Research Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Li Yu
- Neurologic Disorders and Regeneration Repair Lab of Shandong Higher Education, Department of Histology and Embryology, Weifang Medical University, Weifang, China
| | - Yingjun Guan
- Neurologic Disorders and Regeneration Repair Lab of Shandong Higher Education, Department of Histology and Embryology, Weifang Medical University, Weifang, China
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Zappulo E, Riccio MP, Binda S, Pellegrinelli L, Pregliasco F, Buonomo AR, Pinchera B, D'Urso G, Bravaccio C, Borgia G, Gentile I. Prevalence of HSV1/2 Congenital Infection Assessed Through Genome Detection on Dried Blood Spot in Individuals with Autism Spectrum Disorders. In Vivo 2018; 32:1255-1258. [PMID: 30150453 PMCID: PMC6199606 DOI: 10.21873/invivo.11373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/16/2018] [Accepted: 06/19/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND/AIM Etiopathogenesis of autism spectrum disorders (ASD) remains to be elucidated. Congenital infections, particularly viral infections, have repeatedly been associated with the onset of such disorders. Our study aimed at assessing the prevalence of herpes simplex type 1 and 2 (HSV1/2) congenital infections in patients with ASD. MATERIALS AND METHODS In our case-control study, a total of 38 children with ASD were compared to 44 age- and sex-matched controls regarding the presence of HSV1/2 infection though viral DNA polymerase chain reaction performed on dried blood spots collected at birth. RESULTS No HSV congenital infection was detected in either group. CONCLUSION Our negative finding is in agreement with other studies that failed to demonstrate a definitive role of HSV on the onset of ASD. Further investigation of congenital HSV prevalence in larger and more powerful studies is needed to undeniably discard a role of such virus in the etiopathogenesis of ASD.
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Affiliation(s)
- Emanuela Zappulo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Maria Pia Riccio
- Department of Medical Translational Science, Federico II University of Naples, Naples, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Fabrizio Pregliasco
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio Riccardo Buonomo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Biagio Pinchera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Giordano D'Urso
- Section of Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Carmela Bravaccio
- Department of Medical Translational Science, Federico II University of Naples, Naples, Italy
| | - Guglielmo Borgia
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
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Gentile I, Zappulo E, Riccio MP, Binda S, Bubba L, Pellegrinelli L, Scognamiglio D, Operto F, Margari L, Borgia G, Bravaccio C. Prevalence of Congenital Cytomegalovirus Infection Assessed Through Viral Genome Detection in Dried Blood Spots in Children with Autism Spectrum Disorders. ACTA ACUST UNITED AC 2018; 31:467-473. [PMID: 28438881 DOI: 10.21873/invivo.11085] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIM Autism spectrum disorders (ASD) are neurodevelopmental disorders without a definitive etiology in most cases. Environmental factors, such as viral infections, have been linked with anomalies in brain growth, neuronal development, and functional connectivity. Congenital cytomegalovirus (CMV) infection has been associated with the onset of ASD in several case reports. The aim of this study was to evaluate the prevalence of congenital CMV infection in children with ASD and in healthy controls. PATIENTS AND METHODS The CMV genome was tested by polymerase chain reaction (PCR) on dried blood spots collected at birth from 82 children (38 with ASD and 44 controls). RESULTS The prevalence of congenital CMV infection was 5.3% (2/38) in cases and 0% (0/44) in controls (p=0.212). CONCLUSION The infection rate was about 10-fold higher in patients with ASD than in the general Italian population at birth. For this reason, detection of CMV-DNA on dried blood spots could be considered in the work-up that is usually performed at ASD diagnosis to rule-out a secondary form. Given the potential prevention and treatment of CMV infection, this study could have intriguing consequences, at least for a group of patients with ASD.
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Affiliation(s)
- Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Maria Pia Riccio
- Department of Physical and Mental Health and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Bubba
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Domenico Scognamiglio
- Screening Center for Metabolic Diseases, AORN Santobono - Pausilipon - Hospital Annunziata, Naples, Italy
| | - Francesca Operto
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Lucia Margari
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Guglielmo Borgia
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Carmela Bravaccio
- Department of Medical Translational Science, University of Naples "Federico II", Naples, Italy
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Gentile I, Zappulo E, Riccio MP, Binda S, Limauro R, Scuccimarra G, Borgia G, Bravaccio C. No evidence of congenital varicella zoster virus infection assessed through dried blood spot in children with autism spectrum disorders. Future Virol 2017. [DOI: 10.2217/fvl-2017-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Several authors have hypothesized an association between congenital viral infections and the onset of autism spectrum disorders (ASD). We aimed to assess the prevalence of congenital varicella zoster virus (VZV) infection in patients with ASD. Patients & methods: Congenital infection by VZV was evaluated in a cohort of 38 children with ASD and in 44 healthy controls. PCR for VZV-DNA performed on dried blood spots collected at birth. Results & conclusion: No VZV infection was detected in both groups. With the limitation of the small sample size of this study, the results are not in favor of a role of VZV in the etiology of ASD.
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Affiliation(s)
- Ivan Gentile
- Department of Clinical Medicine & Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine & Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Maria Pia Riccio
- Department of Medical Translational Science, University of Naples “Federico II”, Naples, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Guglielmo Borgia
- Department of Clinical Medicine & Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Carmela Bravaccio
- Department of Medical Translational Science, University of Naples “Federico II”, Naples, Italy
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Chi RP, Snyder AW. Treating autism by targeting the temporal lobes. Med Hypotheses 2014; 83:614-8. [PMID: 25227333 DOI: 10.1016/j.mehy.2014.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/19/2014] [Accepted: 08/05/2014] [Indexed: 12/21/2022]
Abstract
Compelling new findings suggest that an early core signature of autism is a deficient left anterior temporal lobe response to language and an atypical over-activation of the right anterior temporal lobe. Intriguingly, our recent results from an entirely different line of reasoning and experiments also show that applying cathodal stimulation (suppressing) at the left anterior temporal lobe together with anodal stimulation (facilitating) at the right anterior temporal lobe, by transcranial direct current stimulation (tDCS), can induce some autistic-like cognitive abilities in otherwise normal adults. If we could briefly induce autistic like cognitive abilities in healthy individuals, it follows that we might be able to mitigate some autistic traits by reversing the above stimulation protocol, in an attempt to restore the typical dominance of the left anterior temporal lobe. Accordingly, we hypothesize that at least some autistic traits can be mitigated, by applying anodal stimulation (facilitating) at the left anterior temporal lobe together with cathodal stimulation (suppressing) at the right anterior temporal lobe. Our hypothesis is supported by strong convergent evidence that autistic symptoms can emerge and later reverse due to the onset and subsequent recovery of various temporal lobe (predominantly the left) pathologies. It is also consistent with evidence that the temporal lobes (especially the left) are a conceptual hub, critical for extracting meaning from lower level sensory information to form a coherent representation, and that a deficit in the temporal lobes underlies autistic traits.
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Affiliation(s)
| | - Allan W Snyder
- Sydney Medical School, Medical Foundation Building (K25), The University of Sydney, NSW 2006, Australia.
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10
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Marques F, Brito MJ, Conde M, Pinto M, Moreira A. Autism spectrum disorder secondary to enterovirus encephalitis. J Child Neurol 2014; 29:708-14. [PMID: 24782421 DOI: 10.1177/0883073813508314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Millions of children are infected by enteroviruses each year, usually exhibiting only mild symptoms. Nevertheless, these viruses are also associated with severe and life-threatening infections, such as meningitis and encephalitis. We describe a 32-month-old patient with enteroviral encephalitis confirmed by polymerase chain reaction in cerebrospinal fluid, with unfavorable clinical course with marked developmental regression, autistic features, persistent stereotypes and aphasia. She experienced slow clinical improvement, with mild residual neurologic and developmental deficits at follow-up. Viral central nervous system infections in early childhood have been associated with autism spectrum disorders but the underlying mechanisms are still poorly understood. This case report is significant in presenting a case of developmental regression with autistic features and loss of language improving on follow-up. To our knowledge, this is the first published report of enterovirus encephalitis leading to an autism spectrum disorder.
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Affiliation(s)
- Filipa Marques
- 1Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central-EPE, Lisbon, Portugal
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11
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McGinnis WR, Audhya T, Edelson SM. Proposed toxic and hypoxic impairment of a brainstem locus in autism. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:6955-7000. [PMID: 24336025 PMCID: PMC3881151 DOI: 10.3390/ijerph10126955] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/07/2013] [Accepted: 11/11/2013] [Indexed: 01/15/2023]
Abstract
Electrophysiological findings implicate site-specific impairment of the nucleus tractus solitarius (NTS) in autism. This invites hypothetical consideration of a large role for this small brainstem structure as the basis for seemingly disjointed behavioral and somatic features of autism. The NTS is the brain's point of entry for visceral afference, its relay for vagal reflexes, and its integration center for autonomic control of circulatory, immunological, gastrointestinal, and laryngeal function. The NTS facilitates normal cerebrovascular perfusion, and is the seminal point for an ascending noradrenergic system that modulates many complex behaviors. Microvascular configuration predisposes the NTS to focal hypoxia. A subregion--the "pNTS"--permits exposure to all blood-borne neurotoxins, including those that do not readily transit the blood-brain barrier. Impairment of acetylcholinesterase (mercury and cadmium cations, nitrates/nitrites, organophosphates, monosodium glutamate), competition for hemoglobin (carbon monoxide, nitrates/nitrites), and higher blood viscosity (net systemic oxidative stress) are suggested to potentiate microcirculatory insufficiency of the NTS, and thus autism.
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Affiliation(s)
- Woody R. McGinnis
- Autism Research Institute, 4182 Adams Avenue, San Diego, CA 92116, USA; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-541-326-8822; Fax: +1-619-563-6840
| | - Tapan Audhya
- Division of Endocrinology, Department of Medicine, New York University Medical School, New York, NY 10016, USA; E-Mail:
| | - Stephen M. Edelson
- Autism Research Institute, 4182 Adams Avenue, San Diego, CA 92116, USA; E-Mail:
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12
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Etiopathogenesis of autism spectrum disorders: fitting the pieces of the puzzle together. Med Hypotheses 2013; 81:26-35. [PMID: 23622947 DOI: 10.1016/j.mehy.2013.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 03/26/2013] [Accepted: 04/01/2013] [Indexed: 12/19/2022]
Abstract
Autism spectrum disorders (ASD) are disorders of the central nervous system characterized by impairments in communication and social reciprocity. Despite thousands of studies on this topic, the etiopathogenesis of these disorders remains unclear, apart from a general belief that they derive from an interaction between several genes and the environment. Given the mystery surrounding the etiopathogenesis of ASD it is impossible to plan effective preventive and treatment measures. This is of particular concern due to the progressive increase in the prevalence of ASD, which has reached a figure as high as 1:88 children in the USA. Here we present data corroborating a novel unifying hypothesis of the etiopathogenesis of ASD. We suggest that ASD are disorders of the immune system that occur in a very early phase of embryonic development. In a background of genetic predisposition and environmental predisposition (probably vitamin D deficiency), an infection (notably a viral infection) could trigger a deranged immune response which, in turn, results in damage to specific areas of the central nervous system. If proven, this hypothesis would have dramatic consequences for strategies aimed at preventing and treating ASD. To confirm or refute this hypothesis, we need a novel research approach, which unlike former approaches in this field, examine the major factors implicated in ASD (genetic, infections, vitamin D deficiency, immune system deregulation) not separately, but collectively and simultaneously.
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Hrdlicka M, Dudova I. Controversies in autism: is a broader model of social disorders needed? Child Adolesc Psychiatry Ment Health 2013; 7:9. [PMID: 23506384 PMCID: PMC3606474 DOI: 10.1186/1753-2000-7-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 03/11/2013] [Indexed: 12/28/2022] Open
Abstract
This article examines the most significant, contradictory evidence pertaining to autism. The first section of the article includes reports of recovery from autism, data obtained from studies involving oxytocin, early deprivation, autism in preterm children, late-onset autism, and symptom overlap among ASD, social phobias and personality disorders. In the second section of the article, we offer a model that better incorporates current findings and address controversies that continue to surround ASD. We propose an umbrella term "social inhibition disorders" which integrates autism spectrum disorders and social phobias, as well as schizoid, schizotypal, and obsessive-compulsive personality disorders. It would also include "quasi-autism," which has been found in early deprivation studies, autism in preterm children, and cases of late-onset autism presenting after herpes encephalitis infection. Finally, we discuss suggestions for further research and clinical perspectives.
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Affiliation(s)
- Michal Hrdlicka
- Department of Child Psychiatry, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic.
| | - Iva Dudova
- Department of Child Psychiatry, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
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14
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Depino AM. Peripheral and central inflammation in autism spectrum disorders. Mol Cell Neurosci 2013; 53:69-76. [PMID: 23069728 DOI: 10.1016/j.mcn.2012.10.003] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 09/23/2012] [Accepted: 10/04/2012] [Indexed: 12/30/2022] Open
Affiliation(s)
- Amaicha Mara Depino
- Instituto de Fisiología, Biología Molecular y Neurociencias, CONICET-UBA, C1428EHA Buenos Aires, Argentina.
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Abstract
Autism, a member of the pervasive developmental disorders (PDDs), has been increasing dramatically since its description by Leo Kanner in 1943. First estimated to occur in 4 to 5 per 10,000 children, the incidence of autism is now 1 per 110 in the United States, and 1 per 64 in the United Kingdom, with similar incidences throughout the world. Searching information from 1943 to the present in PubMed and Ovid Medline databases, this review summarizes results that correlate the timing of changes in incidence with environmental changes. Autism could result from more than one cause, with different manifestations in different individuals that share common symptoms. Documented causes of autism include genetic mutations and/or deletions, viral infections, and encephalitis following vaccination. Therefore, autism is the result of genetic defects and/or inflammation of the brain. The inflammation could be caused by a defective placenta, immature blood-brain barrier, the immune response of the mother to infection while pregnant, a premature birth, encephalitis in the child after birth, or a toxic environment.
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O'Brien FM, Page L, O'Gorman RL, Bolton P, Sharma A, Baird G, Daly E, Hallahan B, Conroy RM, Foy C, Curran S, Robertson D, Murphy KC, Murphy DGM. Maturation of limbic regions in Asperger syndrome: a preliminary study using proton magnetic resonance spectroscopy and structural magnetic resonance imaging. Psychiatry Res 2010; 184:77-85. [PMID: 20952166 DOI: 10.1016/j.pscychresns.2010.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 07/05/2010] [Accepted: 08/11/2010] [Indexed: 11/27/2022]
Abstract
People with autistic spectrum disorders (ASD, including Asperger syndrome) may have developmental abnormalities in the amygdala-hippocampal complex (AHC). However, in vivo, age-related comparisons of both volume and neuronal integrity of the AHC have not yet been carried out in people with Asperger syndrome (AS) versus controls. We compared structure and metabolic activity of the right AHC of 22 individuals with AS and 22 healthy controls aged 10-50 years and examined the effects of age between groups. We used structural magnetic resonance imaging (sMRI) to measure the volume of the AHC, and magnetic resonance spectroscopy ((1)H-MRS) to measure concentrations of N-acetyl aspartate (NAA), creatine+phosphocreatine (Cr+PCr), myo-inositol (mI) and choline (Cho). The bulk volume of the amygdala and the hippocampus did not differ significantly between groups, but there was a significant difference in the effect of age on the hippocampus in controls. Compared with controls, young (but not older) people with AS had a significantly higher AHC concentration of NAA and a significantly higher NAA/Cr ratio. People with AS, but not controls, had a significant age-related reduction in NAA and the NAA/Cr ratio. Also, in people with AS, but not controls, there was a significant relationship between concentrations of choline and age so that choline concentrations reduced with age. We therefore suggest that people with AS have significant differences in neuronal and lipid membrane integrity and maturation of the AHC.
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Stefanatos GA. Regression in autistic spectrum disorders. Neuropsychol Rev 2008; 18:305-19. [PMID: 18956241 DOI: 10.1007/s11065-008-9073-y] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 09/14/2008] [Indexed: 12/13/2022]
Abstract
A significant proportion of children diagnosed with Autistic Spectrum Disorder experience a developmental regression characterized by a loss of previously-acquired skills. This may involve a loss of speech or social responsitivity, but often entails both. This paper critically reviews the phenomena of regression in autistic spectrum disorders, highlighting the characteristics of regression, age of onset, temporal course, and long-term outcome. Important considerations for diagnosis are discussed and multiple etiological factors currently hypothesized to underlie the phenomenon are reviewed. It is argued that regressive autistic spectrum disorders can be conceptualized on a spectrum with other regressive disorders that may share common pathophysiological features. The implications of this viewpoint are discussed.
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Affiliation(s)
- Gerry A Stefanatos
- Cognitive Neurophysiology Laboratory, Department of Communication Sciences and Disorders, Temple University, 1701 N. 13th St., Philadelphia, PA 19122, USA.
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20
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Ichim TE, Solano F, Glenn E, Morales F, Smith L, Zabrecky G, Riordan NH. Stem cell therapy for autism. J Transl Med 2007; 5:30. [PMID: 17597540 PMCID: PMC1914111 DOI: 10.1186/1479-5876-5-30] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 06/27/2007] [Indexed: 12/18/2022] Open
Abstract
Autism spectrum disorders (ASD) are a group of neurodevelopmental conditions whose incidence is reaching epidemic proportions, afflicting approximately 1 in 166 children. Autistic disorder, or autism is the most common form of ASD. Although several neurophysiological alterations have been associated with autism, immune abnormalities and neural hypoperfusion appear to be broadly consistent. These appear to be causative since correlation of altered inflammatory responses, and hypoperfusion with symptology is reported. Mesenchymal stem cells (MSC) are in late phases of clinical development for treatment of graft versus host disease and Crohn's Disease, two conditions of immune dysregulation. Cord blood CD34+ cells are known to be potent angiogenic stimulators, having demonstrated positive effects in not only peripheral ischemia, but also in models of cerebral ischemia. Additionally, anecdotal clinical cases have reported responses in autistic children receiving cord blood CD34+ cells. We propose the combined use of MSC and cord blood CD34+cells may be useful in the treatment of autism.
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Affiliation(s)
| | - Fabio Solano
- Institute for Cellular Medicine, San Jose, Costa Rica
| | - Eduardo Glenn
- Institute for Cellular Medicine, San Jose, Costa Rica
| | - Frank Morales
- Institute for Cellular Medicine, San Jose, Costa Rica
| | - Leonard Smith
- Institute for Cellular Medicine, San Jose, Costa Rica
| | | | - Neil H Riordan
- Medistem Laboratories Inc, Tempe, Arizona, USA
- 2027 E. Cedar Street Suite 102 Tempe, AZ 85281, USA
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21
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Mankoski RE, Collins M, Ndosi NK, Mgalla EH, Sarwatt VV, Folstein SE. Etiologies of autism in a case-series from Tanzania. J Autism Dev Disord 2007; 36:1039-51. [PMID: 16897390 DOI: 10.1007/s10803-006-0143-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Most autism has a genetic cause although post-encephalitis cases are reported. In a case-series (N = 20) from Tanzania, 14 met research criteria for autism. Three (M:F = 1:2) had normal development to age 22, 35, and 42 months, with onset of autism upon recovery from severe malaria, attended by prolonged high fever, convulsions, and in one case prolonged loss of consciousness. In four other cases (M:F = 3:1), the temporal relationship between onset of autism and severe infection was close, but possibly spurious since malaria is common in Tanzania and there were indications of abnormal development in the child or a family member. In seven cases, (M:F = 6:1) autism onset was unrelated to malaria. The excess of non-verbal cases (N = 10) is related local diagnostic practice.
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Affiliation(s)
- Raymond E Mankoski
- Tufts University School of Medicine and Sackler School of Graduate Biomedical Sciences, Boston, MA, USA
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22
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Abstract
OBJECTIVE The purpose of this work was to investigate the association between infections in the first 2 years and subsequent diagnosis of autism spectrum disorders. METHODS We conducted a case-control study among children born at Kaiser Permanente Northern California from 1995 to 1999. Case subjects (n = 403) were children with an autism diagnosis recorded in Kaiser Permanente databases. Control subjects (n = 2100) were randomly sampled from the remaining children without autism and frequency matched to case subjects on gender, birth year, and birth hospital. Information on infections and covariates were obtained from Kaiser Permanente and birth certificate databases. RESULTS Overall, infection diagnoses in the first 2 years of life were recorded slightly less often for children with autism than control children (95.0% vs 97.5%). Among specific diagnoses, upper respiratory infections were significantly less frequently diagnosed and genitourinary infections more frequently diagnosed in children with autism. In the first 30 days of life, the frequency of having an infection was slightly higher among children with autism (22.6% vs 18.7%). CONCLUSIONS Children with subsequent diagnoses of autism do not have more overall infections in the first 2 years of life than children without autism. Data suggest that children with autism may have modestly elevated rates of infection in the first 30 days and that, during the first 2 years, children with autism may be at higher risk for certain types of infections and lower risk for others. Additional studies that explore the associations between prenatal and early childhood infections and autism may help clarify the role of infection and the immune system in the etiology of autism spectrum disorder.
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Affiliation(s)
- Nila J Rosen
- Division of Research, Kaiser Permanente, Oakland, California, USA.
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Abstract
This review paper integrates recent structural and functional imaging, postmortem, animal lesion, and neurochemical research about the pathophysiology of autism. An understanding of the neurobiological correlates of autism is becoming increasingly important as more children are diagnosed with the condition and funding for well-targeted interventions increases. Converging evidence suggests that autism involves abnormalities in brain volume, neurotransmitter systems, and neuronal growth. In addition, evidence firmly links autism with abnormalities in the cerebellum, the medial temporal lobe, and the frontal lobe. Potential implications of these findings and suggestions for future research are reviewed.
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Affiliation(s)
- Helen E Penn
- Clinical-Developmental Psychology Program, York University, Toronto, Ontario M3J IP3, Canada.
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24
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Rossignol DA, Rossignol LW. Hyperbaric oxygen therapy may improve symptoms in autistic children. Med Hypotheses 2006; 67:216-28. [PMID: 16554123 DOI: 10.1016/j.mehy.2006.02.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 02/03/2006] [Accepted: 02/07/2006] [Indexed: 01/25/2023]
Abstract
Autism is a neurodevelopmental disorder that currently affects as many as 1 out of 166 children in the United States. Recent research has discovered that some autistic individuals have decreased cerebral perfusion, evidence of neuroinflammation, and increased markers of oxidative stress. Multiple independent single photon emission computed tomography (SPECT) and positron emission tomography (PET) research studies have revealed hypoperfusion to several areas of the autistic brain, most notably the temporal regions and areas specifically related to language comprehension and auditory processing. Several studies show that diminished blood flow to these areas correlates with many of the clinical features associated with autism including repetitive, self-stimulatory and stereotypical behaviors, and impairments in communication, sensory perception, and social interaction. Hyperbaric oxygen therapy (HBOT) has been used with clinical success in several cerebral hypoperfusion syndromes including cerebral palsy, fetal alcohol syndrome, closed head injury, and stroke. HBOT can compensate for decreased blood flow by increasing the oxygen content of plasma and body tissues and can even normalize oxygen levels in ischemic tissue. In addition, animal studies have shown that HBOT has potent anti-inflammatory effects and reduces oxidative stress. Furthermore, recent evidence demonstrates that HBOT mobilizes stem cells from human bone marrow, which may aid recovery in neurodegenerative diseases. Based upon these findings, it is hypothesized that HBOT will improve symptoms in autistic individuals. A retrospective case series is presented that supports this hypothesis.
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Affiliation(s)
- Daniel A Rossignol
- Blue Ridge Medical Center, 4038 Thomas Nelson Highway, Arrington, VA 22922, USA.
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25
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Abstract
Autistic disorder (autism) is a behaviorally defined developmental disorder with a wide range of behaviors. Although the etiology of autism is unknown, data suggest that autism results from multiple etiologies with both genetic and environmental contributions, which may explain the spectrum of behaviors seen in this disorder. One proposed etiology for autism is viral infection very early in development. The mechanism, by which viral infection may lead to autism, be it through direct infection of the central nervous system (CNS), through infection elsewhere in the body acting as a trigger for disease in the CNS, through alteration of the immune response of the mother or offspring, or through a combination of these, is not yet known. Animal models in which early viral infection results in behavioral changes later in life include the influenza virus model in pregnant mice and the Borna disease virus model in newborn Lewis rats. Many studies over the years have presented evidence both for and against the association of autism with various viral infections. The best association to date has been made between congenital rubella and autism; however, members of the herpes virus family may also have a role in autism. Recently, controversy has arisen as to the involvement of measles virus and/or the measles, mumps, rubella (MMR) vaccine in the development of autism. Biological assays lend support to the association between measles virus or MMR and autism whereas epidemiologic studies show no association between MMR and autism. Further research is needed to clarify both the mechanisms whereby viral infection early in development may lead to autism and the possible involvement of the MMR vaccine in the development of autism.
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Affiliation(s)
- Jane E Libbey
- Department of Neurology, University of Utah, Salt Lake City, Utah 84132-2305, USA
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26
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Rutter M. Aetiology of autism: findings and questions. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2005; 49:231-8. [PMID: 15816809 DOI: 10.1111/j.1365-2788.2005.00676.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Although there is good evidence that autism is a multifactorial disorder, an adequate understanding of the genetic and non-genetic causes has yet to be achieved. METHODS Empirical research findings and conceptual reviews are reviewed with respect to evidence on possible causal influences. RESULTS Much the strongest evidence concerns the importance of susceptibility genes, but such genes have yet to be identified. Specific somatic conditions (such as tuberous sclerosis and the fragile X anomaly) account for a small proportion of cases. Over recent decades there has been a major rise in the rate of diagnosed autism. The main explanation for this rise is to be found in better ascertainment and a broadening of the diagnostic concept. Nevertheless, some degree of true rise cannot be firmly excluded. However, the epidemiological evidence on the main hypothesized environmental explanation, namely the measles-mumps-rubella vaccine, is consistently negative. CONCLUSION Progress on the elucidation of the causes of autism will be crucially dependent on the combination of epidemiology with more basic science laboratory studies.
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Affiliation(s)
- M Rutter
- SGDP Centre, Institute of Psychiatry, Denmark Hill, London, UK.
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27
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Abstract
Clinically, Japanese B encephalitis (JBE) is often overlooked as its occurrence in Western countries is rare. However, its neurological, cognitive and psychiatric sequelae constitute a major public health problem in the Far East where JBE is endemic. European and American subjects may however experience the JBE when returning from a Far East journey. In such cases, misdiagnosis is frequent because of the unawareness of psychiatrists and physicians. The present review, therefore, documents the behavioural and cognitive sequelae of JBE. This reactivates the debate concerning the vaccination against the virus all the more that the literature enlightens the importance of the vaccination for those who undertake frequent and extensive tourist excursions to the Orient but still discusses it for occasional travellers. Following is a case-report of a young western European post-graduate student who has contracted JBE by experiencing an acute febrile delirium during an unusual short stay in South East Asia. Pyramidal syndrome, Parkinsonism and amnesia were the prominent acute deficits. Whereas these faded in great part during convalescence, emotional and behavioural instability associated with affective involvement, obsessive-compulsive symptoms and cognitive impairments appeared. A partial recovery was however obtained with neuroleptics, lithium and following electro-convulsive therapy. Organic personality syndrome was persistent and thereafter constituted the main sequelae syndrome. Hypersomnia and several enuretic episodes persisted.
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MESH Headings
- Adult
- Amnesia, Retrograde/diagnosis
- Amnesia, Retrograde/physiopathology
- Amnesia, Retrograde/psychology
- Bipolar Disorder/diagnosis
- Bipolar Disorder/physiopathology
- Bipolar Disorder/psychology
- Brain Damage, Chronic/diagnosis
- Brain Damage, Chronic/physiopathology
- Brain Damage, Chronic/psychology
- Brain Stem/physiopathology
- Cognition Disorders/diagnosis
- Cognition Disorders/physiopathology
- Cognition Disorders/psychology
- Dementia/diagnosis
- Dementia/physiopathology
- Dementia/psychology
- Diagnosis, Differential
- Electroencephalography
- Encephalitis, Japanese/diagnosis
- Encephalitis, Japanese/physiopathology
- Encephalitis, Japanese/psychology
- Follow-Up Studies
- Frontal Lobe/physiopathology
- Humans
- Impulsive Behavior/diagnosis
- Impulsive Behavior/physiopathology
- Impulsive Behavior/psychology
- Male
- Mental Disorders/diagnosis
- Mental Disorders/physiopathology
- Mental Disorders/psychology
- Neurologic Examination
- Obsessive-Compulsive Disorder/diagnosis
- Obsessive-Compulsive Disorder/physiopathology
- Obsessive-Compulsive Disorder/psychology
- Paranoid Disorders/diagnosis
- Paranoid Disorders/physiopathology
- Paranoid Disorders/psychology
- Parkinsonian Disorders/diagnosis
- Parkinsonian Disorders/physiopathology
- Parkinsonian Disorders/psychology
- Personality Disorders/diagnosis
- Personality Disorders/physiopathology
- Personality Disorders/psychology
- Temporal Lobe/physiopathology
- Travel
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Affiliation(s)
- François P Monnet
- Etablissement Public de Santé CHARCOT, 30 rue Marc-Laurent, 78370 Plaisir cedex, France.
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28
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Abstract
Face recognition is one of the most complex visual tasks performed by the human brain. Data from monkeys suggest that area IT may play a key role in identifying faces, and functional imaging research suggests that the human homologue of IT may be located in the medial occipitotemporal cortex, where a FFA has been located. Damage to medial occipitotemporal structures on the right or bilaterally leads to prosopagnosia, the failure to recognize facial identity. Prosopagnosia is not a single functional disorder but a family of dysfunctions, with different patients having different degrees of impairments to various perceptual and memory stages involved in face processing. Understanding the perceptual basis of this disorder and epiphenomena, such as covert recognition, is a goal of current research. Deficits in face perception also may contribute to Capgras syndrome and may be related to the impaired social development of patients with Asperger syndrome. More recently, identified deficits in face processing include the false recognition of unfamiliar faces and the impaired extraction of social information from faces, independent of the recognition of identity. Many of these prosopagnosia and other face processing deficits can be placed in the context of cognitive models of face processing stages, which are being refined continually by data from neurologic patients and functional imaging in normal subjects.
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Affiliation(s)
- Jason J Barton
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston University, Boston, MA, USA.
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Sweeten TL, Posey DJ, Shekhar A, McDougle CJ. The amygdala and related structures in the pathophysiology of autism. Pharmacol Biochem Behav 2002; 71:449-55. [PMID: 11830179 DOI: 10.1016/s0091-3057(01)00697-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Autism is a neurodevelopmental disorder that is defined behaviorally by severe deficiencies in reciprocal social interaction, verbal and nonverbal communication, and restricted interests. The amygdala is involved in the regulation of social behaviors and may be an important site of pathology for the social dysfunction seen in autism. This review focuses on lesion, postmortem, and neuroimaging studies that investigate the amygdala and related structures in this disorder. Other brain regions potentially involved in the neuropathology of autism are also briefly discussed. Although supportive evidence exists for amygdala dysfunction in autism, the currently available data are inconsistent and additional research is needed.
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Affiliation(s)
- Thayne L Sweeten
- Department of Psychiatry, Indiana University School of Medicine, 541 Clinical Drive, Room 298, Indianapolis, IN 46202-5111, USA
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30
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Boddaert N, Zilbovicius M. L'imagerie cérébrale et l'autisme infantile. ENFANCE 2002. [DOI: 10.3917/enf.541.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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31
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Affiliation(s)
- S B Edelson
- Edelson Center for Environmental and Preventive Medicine, Atlanta, Georgia, USA
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32
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Abstract
From among the subjects of a follow-up study on cases of autism conducted by the authors in 1990, 179 cases for which precise records were available on the infancy period were selected for evaluation of the relationship between the occurrence of setback phenomenon in infancy and long-term prognosis. The following results were obtained: (i) a significantly higher rate of epilepsy among the setback group compared to the non-setback group; and (ii) a significantly lower level of language development among the setback group upon entering elementary school compared to the non-setback group, although the difference between the present levels of adaptation of the two groups was not significant. Factors determining the long-term prognosis of the setback group are discussed.
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Affiliation(s)
- R Kobayashi
- Department of Social Work, Tokai University School of Health Sciences, Kanagawa, Japan
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33
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Jambaqué I, Mottron L, Ponsot G, Chiron C. Autism and visual agnosia in a child with right occipital lobectomy. J Neurol Neurosurg Psychiatry 1998; 65:555-60. [PMID: 9771784 PMCID: PMC2170287 DOI: 10.1136/jnnp.65.4.555] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Autistic disorder is a developmental handicap with an unknown neurological basis. Current neuropsychological models for autism suggest an abnormal construction of visual perceptual representation or a deficit in executive functions. These models predict cerebral lesions in the temporo-occipital or frontal regions of autistic patients. The present study aimed at studying the presence of symptoms of autism and visual agnosia in a 13 year old girl who had a right temporo-occipital cortical dysplasia that was surgically removed at the age of 7. METHODS Neuropsychological evaluation included Wechsler and Kaufman intelligence scales, a test of word fluency, digit span, Corsi block, California verbal learning, Trail making, Benton facial recognition, Snoodgrass object recognition tests, Rivermead face learning subtest, and developmental test of visual perception. The ADI-R was used to show current and retrospective diagnosis of autistic disorder. Neuroimagery included brain MRI, single photon emission computed tomography (SPECT), and PET. RESULTS Brain MRI showed a right occipital defect and an abnormal hyperintensity of the right temporal cortex. PET and SPECT disclosed a left frontal hypometabolism together with the right occipital defect. Neuropsychological testing showed a visual apperceptive agnosia and executive function deficits. Psychiatric study confirmed the diagnosis of autistic disorder. CONCLUSIONS Although the possibility that autism and visual agnosia were dissociable factors in this patient cannot be excluded, the finding of both deficits supports the possibility that occipito-temporal lesions can predispose to the development of autism.
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Affiliation(s)
- I Jambaqué
- Hôpital Saint Vincent de Paul, Service de Neuropédiatrie, Université René Descartes, Paris, France
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34
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Abstract
The advances in medical technology during the last four decades has provided evidence for an underlying neurological basis for autism. The etiology for the variations of neurofunctional anomalies found in the autistic spectrum behaviors appears inconclusive as of this date but growing evidence supports the proposal that chronic exposure to toxic agents, i.e., xenobiotic agents, to a developing central nervous system may be the best model for defining the physiological and behavioral data found in these populations. A total of 20 subjects (15 males and 5 females) who received a formal diagnosis of autism by a developmental pediatrician, pediatric neurologist, or licensed psychologist were included. The mean age for the sample was 6.35 yrs offnge = 3-12 years). This study employed several measures that collectively would provide evidence of burden levels of xenobiotic agents and abnormal liver detoxication processes. These included: (1) Glucaric Acid Analysis, (2) blood analyses for identification of specific xenobiotic agents, and (3) Comprehensive Liver Detoxification Evaluation. Kolmogorov-Smirnov testing for a chi-square and Normal distribution of the Glucaric Acid finding indicates that each of these distributions is significantly different from expected distributions (p < .01). It is most noteworthy that of the 20 cases examined for this study, 100% of the cases showed liver detoxication profiles outside of normal. An examination of 18 autistic children in blood analyses that were available showed that 16 of these children showed evidence of levels of toxic chemicals exceeding adult maximum tolerance. In the two cases where toxic chemical levels were not found, there was abnormal D-glucaric acid findings suggesting abnormal xenobiotic influences on liver detoxication processes. A proposed mechanism for the interaction of xenobiotic toxins with immune system dysfunction and continuous and/or progressive endogenous toxicity is presented as it relates to the development of behaviors found in the autistic spectrum.
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Affiliation(s)
- S B Edelson
- Environmental and Preventive Health Center of Atlanta, GA 30342, USA
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35
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Duchan JF. Describing the unusual behavior of children with autism. JOURNAL OF COMMUNICATION DISORDERS 1998; 31:93-112. [PMID: 9549669 DOI: 10.1016/s0021-9924(97)00084-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The behaviors of children with autism have been described by professionals, by family members, and also by those with autism. This article analyzes four different types of reports that contain descriptions of those with autism: (1) case studies, (2) diagnostic reports and single-subject research studies, (3) family accounts, and (4) autobiographical descriptions. Authors describe the behaviors of those with autism differently depending upon their relationship with the person they are describing, their intended audience, their goals, and the genre they use for conveying their descriptions. Authors were found to use the following types of descriptions, to varying degrees in order to achieve their goals: (1) descriptions of what a child did on a particular occasion; (2) descriptions of what a child typically does or did; (3) descriptions of what a child should have done; (4) descriptions of how behavior was experienced by a child or family member; (5) descriptions of how a third party reported a behavior; (6) metaphoric descriptions of behaviors; and (7) descriptions of how behaviors mesh with traits often associated with autism. A detailed examination of how behaviors of children with autism are described indicates that the way someone with autism is regarded and described is strongly related to what the describer wants to accomplish.
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Affiliation(s)
- J F Duchan
- Department of Communicative Disorders and Sciences, University of New York at Buffalo, USA
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36
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37
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Affiliation(s)
- L Wing
- Centre for Social and Communication Disorders, Kent, UK
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38
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Mottron L, Mineau S, Décarie JC, Jambaqué I, Labrecque R, Pépin JP, Aroichane M. Visual agnosia with bilateral temporo-occipital brain lesions in a child with autistic disorder: a case study. Dev Med Child Neurol 1997; 39:699-705. [PMID: 9352734 DOI: 10.1111/j.1469-8749.1997.tb07367.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 2-year-old boy meeting the criteria for autistic disorder was diagnosed 2 years later with a visual agnosia characterised by a combination of certain aspects of associative and apperceptive agnosia. MRI then revealed a severe encephalomalacia of the right temporal lobe and bilateral temporo-occipital areas. This association is discussed in terms of a clinical and aetiological relation between autistic disorder and visual agnosia.
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Affiliation(s)
- L Mottron
- Service de Recherche, Hôpital Rivière-des-Prairies, Montréal, Québec, Canada
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Rodier PM, Ingram JL, Tisdale B, Nelson S, Romano J. Embryological origin for autism: developmental anomalies of the cranial nerve motor nuclei. J Comp Neurol 1996; 370:247-61. [PMID: 8808733 DOI: 10.1002/(sici)1096-9861(19960624)370:2<247::aid-cne8>3.0.co;2-2] [Citation(s) in RCA: 404] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The underlying brain injury that leads to autism has been difficult to identify. The diagnostic criteria of the disease are not readily associated with any brain region or system, nor are they mimicked by vascular accidents, tumors, or degenerative neurological diseases occurring in adults. Fortuitously, a recent report of autism induced by thalidomide exposure provides evidence that the disease originates by an injury at the time of closure of the neural tube. The human data suggest that the initiating lesion includes the motor cranial nerve nuclei. To test this hypothesis, we first examined motor nuclei in the brainstem of a human autistic case. The autopsy brain exhibited near-complete absence of the facial nucleus and superior olive along with shortening of the brainstem between the trapezoid body and the inferior olive. A similar deficit has been reported in Hoxa-1 gene knockout mice in which pattern formation of the hindbrain is disrupted during neurulation. Alternatively, exposure to antimitotic agents just after neural tube closure could produce the observed pattern of deficits. Thus, the lesions observed in the autopsy case appear to match those predicted by the thalidomide cases in both time of origin and central nervous system (CNS) location. To produce similar brain lesions experimentally, we exposed rat embryos to valproic acid, a second teratogen newly linked to autism. Dams received 350 mg/kg of valproic acid (VPA) on day 11.5 (the day of neural tube closure), day 12, or day 12.5 gestation. Each treatment significantly reduced the number of motor neurons counted in matched sections of the earliest-forming motor nuclei (V, XII), and progressively later exposures affected the VIth and IIIrd cranial nerve nuclei. All treatments spared the facial nucleus, which forms still later. Counts from the mesencephalic nucleus of trigeminal, the dorsal motor nucleus of the vagus, and the locus ceruleus were not affected by exposure to VPA, even though these nuclei form during the period when exposure occurred. Despite its effects on the motor nuclei, valproic acid exposure did not alter the further development of the brain in any obvious way. Treated animals were robust and had no external malformations. The autopsy data and experimental data from rats confirm that CNS injuries occurring during or just after neural tube closure can lead to a selective loss of neurons derived from the basal plate of the rhombencephalon. The results add two new lines of evidence that place the initiating injury for autism around the time of neural tube closure.
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Affiliation(s)
- P M Rodier
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine, New York 14642, USA
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Abstract
The authors reviewed all the population studies on autism published in the English language with particular reference to the rate of medical disorders. Seven studies met criteria for inclusion in the survey. The mean of possibly autism-related medical disorders in persons with autism across these studies was 24.4%. There was a trend for higher rates of medical disorders among subjects with severe mental retardation. The evidence in respect of atypical autism was equivocal, and the overall prevalence of medical disorders in this group was similar to that found in typical autism.
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Affiliation(s)
- C Gillberg
- Department of Child and Adolescent Psychiatry, University of Göteborg, Annedals Clinics, Sweden
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Affiliation(s)
- C Gillberg
- NYU Medical Center, Department of Child and Adolescent Psychiatry, NYC 10016, USA
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Abstract
At least a third of autistic toddlers regress in language, sociability, play, and often cognition. Many fewer children undergo a similar, unexplained regression after language is fully developed (disintegrative disorder [DD]). Epilepsy or a paroxysmal electroencephalogram (EEG) with/without clinical seizures, including electrical status epilepticus in slow wave sleep (ESES), may be associated, in occasional children, with either selective loss of language (Landau-Kleffner syndrome [LKS]) or with pervasive autistic regression. Fluctuation in language and behavior deficits should raise the suspicion of epilepsy. Review of the literature and of the author's experience suggests that epilepsy probably plays a relatively minor, although non-negligible, pathogenetic role in autistic regression. Multidisciplinary, possibly multi-institutional, longitudinal studies that encompass the regression are needed to sharpen diagnostic criteria to devise more effective therapies.
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Affiliation(s)
- I Rapin
- Saul R. Korey Department of Neurology, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
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Abstract
Childhood autism is conceptualized as a behavioural syndrome with several different aetiologies. Its prevalence is estimated at about one in every thousand children born. The male:female ratio is considerably higher than in the general population, but possibly not as high as 3-4:1 (as has been suggested for almost 50 years in the literature). A number of specific medical conditions are associated with autism and a comprehensive medical work-up is required in all cases with pervasive autistic symptomatology. Genetic factors contribute to the development of autism in some cases. Recent neurobiological and psychological studies contribute to a concept of the autistic syndrome as but one of several different syndromes characterized by impaired empathy skills.
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Affiliation(s)
- C Gillberg
- Department of Child and Adolescent Psychiatry, Annedals Clinics, Göteborg, Sweden
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Coleman M. Clinical review: Medical differential diagnosis and treatment of the autistic syndrome. Eur Child Adolesc Psychiatry 1993; 2:161-168. [PMID: 29871432 DOI: 10.1007/bf02125571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Autism, like mental retardation, is not a definitive diagnosis. This paper discusses the medical differential diagnosis to consider when patients present with autistic symptoms. Summarizing the medical literature, the known infectious, metabolic, chromosomal and structural lesions are reviewed. Autism also can be associated with sensory handicaps, such as blindness and deafiness. When the autistic syndrome is associated with a second syndrome, this produces a "double syndrome" in the patient. A thorough medical evaluation of all individuals with autism is suggested.
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Affiliation(s)
- Mary Coleman
- , 270 Glenwood Road, 60045, Lake Forest, IL, USA
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Cook EH, Perry BD, Dawson G, Wainwright MS, Leventhal BL. Receptor inhibition by immunoglobulins: specific inhibition by autistic children, their relatives, and control subjects. J Autism Dev Disord 1993; 23:67-78. [PMID: 8463203 DOI: 10.1007/bf01066419] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Forty-two parents of children with autistic disorder, 15 children with autistic disorder, 17 siblings of children with autistic disorder, and 12 unrelated normal adult controls were studied to determine if immunoglobulins isolated from their plasma would inhibit binding of the 5HT1A agonist, [3H]-8-hydroxy-N,N-dipropyl-2-aminotetralin (DPAT) to 5HT1A receptors in human hippocampal membranes. There were no significant differences among the means of percentage inhibition of DPAT binding of parents, children with autistic disorder, siblings, or unrelated controls. In addition, there were no differences in the proportion of subjects with > 15% DPAT inhibition among autistic children, their parents, their siblings, or unrelated controls. Immunoglobulin inhibition was not specific for the 5HT1A receptor binding site, since immunoglobulins inhibited binding to 5HT2, D1, D2, and alpha 2-adrenergic binding sites. The immunoglobulins isolated from normal controls inhibited [3H]-rauwolscine binding at alpha 2-adrenergic sites less than immunoglobulins of children with autistic disorder and their parents and siblings. This study did not support the hypothesis that autoantibodies to 5HT1A or 5HT2 receptors are characteristic of autistic disorder.
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Affiliation(s)
- E H Cook
- Department of Psychiatry, University of Chicago
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Carina Gillberg I, Bjure J, Uvebrant P, Vestergren E, Gillberg C. SPECT (Single Photon Emission Computed Tomography) in 31 children and adolescents with autism and autistic-like conditions. Eur Child Adolesc Psychiatry 1993; 2:50-9. [PMID: 21590529 DOI: 10.1007/bf02098830] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
SPECT with Tc-99m-HM-PAO was used in examining 31 patients with autism and autistic-like conditions. Sixteen of these had autistic disorder/autistic-like conditions with associated epilepsy. The autistic disorder group without epilepsy was relatively high functioning. All 31 patients showed reduction of regional cerebral blood flow in the temporal lobes. There was no clear difference between the groups with and without epilepsy, suggesting that seizure disorder per se could not account for the findings.
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Affiliation(s)
- I Carina Gillberg
- Department of Child and Adolescent Psychiatry, University of Göteborg, Göteborg, Sweden
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Gillberg CL. The Emanuel Miller Memorial Lecture 1991. Autism and autistic-like conditions: subclasses among disorders of empathy. J Child Psychol Psychiatry 1992; 33:813-42. [PMID: 1634591 DOI: 10.1111/j.1469-7610.1992.tb01959.x] [Citation(s) in RCA: 227] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent autism and autism-related research from Gothenburg is surveyed. In indigenous families, typical autism seems no more common now than 10 years ago. Genetic factors play a part in causing autism and Asperger syndrome. Certain medical syndromes carry a relatively high risk of concomitant autistic symptoms. Evidence for non-specific brain dysfunction is often found in autism and autistic-like conditions. The search for the underlying clue to the riddle of autism may be futile. Autism might be best conceptualized as a behavioural syndrome reflecting underlying brain dysfunction which shades into other clinical syndromes. A new class of disorders of empathy is proposed.
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Affiliation(s)
- C L Gillberg
- Department of Pediatrics and Child Psychiatry, Child Neuropsychiatry Centre, University of Göteborg, Sweden
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Affiliation(s)
- Lorna Wing
- National Autistic Society, 276 Willesden Lane, NW2 5RB, London, England
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