Current status of biological treatment options in Autism Spectrum Disorder

Clinical Data on Canabinoids: Translational Research in the Treatment of Autism Spectrum Disorders

Translational research made with Cannabis sativa L. and its biocompounds provides data for some targeted diseases, as also symptoms associated with Autism Spectrum Disorders (ASDs). The main compounds ∆9-tetrahydrocannabinol (THC) and cannabidiol (CBD), are capable of modulating the endocannabinoid system since its dysregulation interferes with the pathophysiology of ASDs there are clinical evidence for its potential use in the treatment of the disease. Conventional therapy still has limitations, as it does not always treat the central symptoms, and there are many patients who do not respond to treatment, which demands more research on new therapies. Through the analysis of published literature on this topic, it is verified that cannabinoids, in particular CBD, improves symptoms associated with common comorbidities in ASDs. Some studies also demonstrate the therapeutic potential of these compounds in the treatment of central symptoms of autism. In addition, cannabinoid therapy to ASDs is associated with low adverse effects and a reduction in concomitant medication. Although it appears to be promising, it is essential to do the translation of this data into clinical research and some of its potential and critical gaps are discussed in this review pointing to large-scale and long-term clinical trials that should include more patients and homogeneous samples.

Early Prediction and Evaluation of Risk of Autism Spectrum Disorders

Autism is a neuro-developmental condition that first appears at less than three years of age. Autism spectrum disorders (ASD) include several symptoms, such as social communication impairment, stereotyping behaviors, speech abnormalities, and impairment of eye contact. Its prevalence has increased recently, and several factors play a role in increasing the risk of autism. Multiple studies and research explain the factors affecting the rate of autism, and in this article, we will review most of these factors. The aim of this review article is to increase awareness of the problem of autism and provide scientifically relevant information about the etiology, pathogenesis, risk factors, and management of ASD. Our perception of autism has evolved over time. A few years ago, the condition was nothing more than an unrecognized developmental delay, generally with intellectual disabilities. Today, it is recognized as a major public health issue and a topic of much research. Researchers have struggled to find a cause for ASD, and numerous treatments have been developed to maximize the potential to learn and become socially fluent, no matter how strong the impairments may be. Although there is no cure, there have been significant strides in identifying and developing treatments. Early prediction of autism is beneficial in an individual's treatment, which can be carried out by recognizing the risk factors of infants, thus leading to improved outcomes or even a complete cure. The prevalence of ASD has increased, and earlier prediction leads to the best outcomes.

Effects of CBD-Enriched Cannabis sativa Extract on Autism Spectrum Disorder Symptoms: An Observational Study of 18 Participants Undergoing Compassionate Use

Autism Spectrum Disorders comprise conditions that may affect cognitive development, motor skills, social interaction, communication, and behavior. This set of functional deficits often results in lack of independence for the diagnosed individuals, and severe distress for patients, families, and caregivers. There is a mounting body of evidence indicating the effectiveness of pure cannabidiol (CBD) and CBD-enriched Cannabis sativa extract (CE) for the treatment of autistic symptoms in refractory epilepsy patients. There is also increasing data support for the hypothesis that non-epileptic autism shares underlying etiological mechanisms with epilepsy. Here we report an observational study with a cohort of 18 autistic patients undergoing treatment with compassionate use of standardized CBD-enriched CE (with a CBD to THC ratio of 75/1). Among the 15 patients who adhered to the treatment (10 non-epileptic and five epileptic) only one patient showed lack of improvement in autistic symptoms. Due to adverse effects, three patients discontinued CE use before 1 month. After 6-9 months of treatment, most patients, including epileptic and non-epileptic, showed some level of improvement in more than one of the eight symptom categories evaluated: Attention Deficit/Hyperactivity Disorder; Behavioral Disorders; Motor Deficits; Autonomy Deficits; Communication and Social Interaction Deficits; Cognitive Deficits; Sleep Disorders and Seizures, with very infrequent and mild adverse effects. The strongest improvements were reported for Seizures, Attention Deficit/Hyperactivity Disorder, Sleep Disorders, and Communication and Social Interaction Deficits. This was especially true for the 10 non-epileptic patients, nine of which presented improvement equal to or above 30% in at least one of the eight categories, six presented improvement of 30% or more in at least two categories and four presented improvement equal to or above 30% in at least four symptom categories. Ten out of the 15 patients were using other medicines, and nine of these were able to keep the improvements even after reducing or withdrawing other medications. The results reported here are very promising and indicate that CBD-enriched CE may ameliorate multiple ASD symptoms even in non-epileptic patients, with substantial increase in life quality for both ASD patients and caretakers.

Trends in concept and nosology of autism spectrum disorder: A review

Autism Spectrum Disorder is a neurodevelopmental disorder characterized by persistent deficits in social communication, social interaction and restricted, repetitive patterns of behavior, interests or activities. The concept of autism has changed since its inception, from childhood schizophrenia to neuro-variation. These changes in concept have been accompanied by changes in the diagnostic threshold through which the 'case' of autism is identified. The occurrence of multiple changes in its diagnostic criteria over last 80 odd years opens up the possibility of challenges being posed to the existence of the disorder as it is today, with a possibility of newer conceptualization of autism coming up in the future. The potential consequences of the changes in its nosology and concept, such as those on the management and on prevalence estimation are some of the essential issues which need attention. In the current paper, we evaluate the evolution of the concept and nosology of autism with an overview of the accompanying impact of these changes.

Early childhood network alterations in severe autism

OBJECTIVE

To examine the differences in whole brain topology and connectivity in 17 children of the ages 3-8 years across severity of ASD, we performed resting state fMRI using a 3T MRI scanner and graph theoretical analysis of networks.

METHOD

Patients were partitioned into two cohorts based on the severity of ASD, determined using the Childhood Autism Rating Scale (CARS) scores (Mild, 30-36; Severe, 37+). Standard preprocessing pipeline was used, followed by independent component analysis (ICA) to identify regions of interest (ROIs) to construct subject-specific Z-correlation matrices representing the whole brain network. Following which, graph theory measures were calculated in the range of sparsity 6%-35% and statistically analyzed, and corrected for significance (FDR corrected, p < 0.05). Regional clustering coefficient that revealed significant between-group (mild vs. severe) differences were correlated against clinical scores (CARS).

RESULTS

Children with severe ASD revealed significantly increased clustering coefficient and small-worldness compared to those with mild or moderate ASD. Region of interest analysis revealed altered clustering in the Heschl's gyrus that significantly correlated with CARS scores.

CONCLUSION

The findings from the current study provide early stage evidence of aberrant brain connectivity appearing in severe ASD, prior to the effect of environmental bias and pruning mechanisms. The clustering of the Heschl's gyrus correlated to the severity of ASD symptoms and agrees with current literature on ASD-associated cortical changes, reflecting early changes to language processing regions.