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Canitano R, Bozzi Y. Autism Spectrum Disorder with Epilepsy: A Research Protocol for a Clinical and Genetic Study. Genes (Basel) 2023; 15:61. [PMID: 38254951 PMCID: PMC10815607 DOI: 10.3390/genes15010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental condition affecting ~1% of people worldwide. Core ASD features present with impaired social communication abilities, repetitive and stereotyped behaviors, and atypical sensory responses and are often associated with a series of comorbidities. Among these, epilepsy is frequently observed. The co-occurrence of ASD and epilepsy is currently thought to result from common abnormal neurodevelopmental pathways, including an imbalanced excitation/inhibition ratio. However, the pathological mechanisms involved in ASD-epilepsy co-morbidity are still largely unknown. Here, we propose a research protocol aiming to investigate electrophysiological and genetic features in subjects with ASD and epilepsy. This study will include a detailed electroencephalographic (EEG) and blood transcriptomic characterization of subjects with ASD with and without epilepsy. The combined approach of EEG and transcriptomic studies in the same subjects will contribute to a novel stratification paradigm of the heterogeneous ASD population based on quantitative gene expression and neurophysiological biomarkers. In addition, our protocol has the potential to indicate new therapeutic options, thus amending the current condition of absence of data and guidelines for the treatment of ASD with epilepsy.
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Affiliation(s)
- Roberto Canitano
- Division of Child and Adolescent Neuropsychiatry, University Hospital of Siena, 53100 Siena, Italy
| | - Yuri Bozzi
- Center for Mind/Brain Sciences (CIMeC), University of Trento, 38068 Rovereto, Italy;
- CNR Institute of Neuroscience, 56124 Pisa, Italy
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赵 亚, 范 慧, 王 翔, 罗 雅, 张 嵘, 郑 晓. [Early death and causes of death of patients with autism spectrum disorders: A systematic review]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2023; 55:375-383. [PMID: 37042154 PMCID: PMC10091241 DOI: 10.19723/j.issn.1671-167x.2023.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Indexed: 06/20/2023]
Abstract
To study of premature/early death of autistic patients from the perspective of life course can help families, medical institutions and policy makers better deal with the adverse effects of autism. Several studies have shown that autistic patients have a high risk of death, however, the results are still inconsistent. To assess the risk of mortality among the autistic patients, we undertook a comprehensive search of MEDLINE, Web of Science and EMBASE databases. This paper reviewed the studies on the negative disease outcomes of autism spectrum disorders, including the risk of death, causes of death and several research hotspots in this field. Strict inclusion/exclusion criteria were used. Information was extracted from selected papers, tabulated and synthesized. In the study, 15 studies were included, with a total of 216 045 individuals. The main outcome was all-cause mortality in association with autism and the secondary outcome was cause-specific mortality. The results showed that all-cause mortality was higher for the autistic patients (RR=2.32, 95%CI: 1.98-2.72, I2=87.1%, P < 0.001). Risk ratio showed a greater inequality for female than male (male: RR=2.00, 95%CI: 1.57-2.55, I2=93.2%, P < 0.001; female: RR=4.66, 95%CI: 3.30-6.58, I2=92.0%, P < 0.001). Compared with the unnatural death, the risk of natural death was higher (RR=3.44, 95%CI: 1.27-9.26, I2=80.2%, P=0.025). As autism had many comorbidities, which would bring more health risks and natural deaths possibilities. There were some structural differences in unnatural death. Accidental injury death and suicide were two kinds of causes. Lacking social skills would weaken the ability to ask for help when encountering injuries. This paper put forward some suggestions for futures. First, to well study the comorbidity can reduce the risk of death from a medical point of view. Second, the scientists and policymakers should pay attention to the social environment and provide a safer environment for the autistic patients. Third, for women and for adolescents without cognitive impairment, due to their high risk of suicide, the society should provide them with more supportive social networks and improve their life satisfaction. Fourth, it is necessary to balance the rehabilitation resources in various regions in China and provide more high-quality lifelong rehabilitation monitoring and care services.
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Affiliation(s)
- 亚楠 赵
- 中国医学科学院, 北京协和医学院群医学与公共卫生学院, 北京 100730School of Population Medicine and Public Health, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
- 北京大学中国卫生发展研究中心, 北京 100191China Center for Health Development Studies, Peking University, Beijing 100191, China
- 北京大学亚太经合组织健康科学研究院, 北京 100871Peking University Asia Pacific Economic Cooperation Health Sciences Academy, Beijing 100871, China
| | - 慧芸 范
- 北京大学亚太经合组织健康科学研究院, 北京 100871Peking University Asia Pacific Economic Cooperation Health Sciences Academy, Beijing 100871, China
- 北京大学人口研究所, 北京 100871Institute of Population Research, Peking University, Beijing 100871, China
| | - 翔宇 王
- 北京大学亚太经合组织健康科学研究院, 北京 100871Peking University Asia Pacific Economic Cooperation Health Sciences Academy, Beijing 100871, China
- 北京大学人口研究所, 北京 100871Institute of Population Research, Peking University, Beijing 100871, China
| | - 雅楠 罗
- 北京大学亚太经合组织健康科学研究院, 北京 100871Peking University Asia Pacific Economic Cooperation Health Sciences Academy, Beijing 100871, China
- 北京大学公共卫生学院全球卫生学系, 北京 100191Department of Global Health, Peking University School of Public Health, Beijing 100191, China
| | - 嵘 张
- 北京大学神经科学研究所, 北京大学基础医学院神经生物学系, 神经科学教育部重点实验室, 卫生部神经科学重点实验室, 北京 100191Neuroscience Research Institute, Peking University; Department of Neurobiology, Peking University School of Basic Medical Sciences; Key Laboratory for Neuroscience of the Ministry of Education; Key Laboratory for Neuroscience of the Ministry of National Health Commission; Beijing 100191, China
- 北京大学医学部孤独症研究中心, 北京 100191Autism Research Centre, Peking University Health Science Centre, Beijing 100191, China
| | - 晓瑛 郑
- 中国医学科学院, 北京协和医学院群医学与公共卫生学院, 北京 100730School of Population Medicine and Public Health, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
- 北京大学亚太经合组织健康科学研究院, 北京 100871Peking University Asia Pacific Economic Cooperation Health Sciences Academy, Beijing 100871, China
- 北京大学医学部孤独症研究中心, 北京 100191Autism Research Centre, Peking University Health Science Centre, Beijing 100191, China
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Cano-Villagrasa A, Moya-Faz FJ, López-Zamora M. Relationship of epilepsy on the linguistic-cognitive profile of children with ASD: A systematic review of the literature. Front Psychol 2023; 14:1101535. [PMID: 37063523 PMCID: PMC10092355 DOI: 10.3389/fpsyg.2023.1101535] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/17/2023] [Indexed: 03/31/2023] Open
Abstract
IntroductionThe prevalence of comorbidity between epilepsy and Autism Spectrum Disorder (ASD) in the pediatric age increased significantly in recent years. The onset of epilepsy negatively influences the abilities of the user with ASD. Thus, epilepsy will be a disabling factor that will reduce the cognitive-linguistic skills of users with ASD. The main objective of this work is to review the current scientific literature and to compare the relationship of epilepsy on the development of cognitive and linguistic skills of children with ASD.MethodsIn this regard, a systematic search was carried out in the main sources (Medline, PubMed, WOS, ResearchGate and Google Scholar). 481 articles were identified, from which, after meeting the different inclusion and exclusion criteria, a total of 18 studies of relevance to the objectives of this work were selected.ResultsThe results reflect that, at a global level, epilepsy significantly influences the performance of cognitive- linguistic skills in people with ASD.DiscussionIn conclusion, epilepsy in the ASD population leads to a reduction in cognitive and linguistic abilities, which respond to the different types of epilepsy and their location, significantly impacting the quality of life and basic activities of daily living of the user with ASD.
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Affiliation(s)
- Alejandro Cano-Villagrasa
- Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Campus de los Jerónimos, Murcia, Spain
- Facultad de Ciencias de la Salud, Valencian International University, Valencia, Spain
- *Correspondence: Alejandro Cano-Villagrasa
| | - Francisco José Moya-Faz
- Facultad de Ciencias de la Salud, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
- Francisco José Moya-Faz
| | - Miguel López-Zamora
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología y Logopedia, Universidad de Málaga, Málaga, Spain
- Miguel López-Zamora
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Sundelin H, Söderling J, Bang P, Bolk J. Risk of Autism After Pediatric Ischemic Stroke: A Nationwide Cohort Study. Neurology 2022; 98:e1953-e1963. [PMID: 35314504 PMCID: PMC9141625 DOI: 10.1212/wnl.0000000000200253] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/04/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Ischemic stroke increases the risk of neurodevelopmental disorders; however, the risk of autism is not thoroughly explored. Our aim was to evaluate risk of autism and risk factors for autism in children with pediatric ischemic stroke and in their first-degree relatives. METHODS In this cohort study, individuals with ischemic stroke from 1969 to 2016, <18 years of age, alive 1 week after stroke, and without prior autism were identified in Swedish national registers. Ten matched controls per index individual and all first-degree relatives of index individuals and controls were identified. Conditional Cox regression was used to calculate the risk of autism. Unconditional logistic regression was performed to analyze sex, gestational age, age at stroke diagnoses, comorbid adverse motor outcome, comorbid epilepsy, and a sibling with autism as risk factors for autism in children with ischemic stroke. RESULTS Of the 1,322 index individuals, 46 (3.5%) were diagnosed with autism compared to 161 (1.2%) controls (adjusted hazard ratio [aHR] 3.02, 95% CI 2.15-4.25). There was no significant difference in risk of autism according to age at stroke: perinatal (aHR 2.69, 95% CI 1.44-5.03) and childhood stroke (aHR 3.18, 95% CI 2.12-4.78). The increased risk remained after exclusion of children born preterm or small for gestational age (aHR 3.78, 95% CI 2.55-5.60) and when children with stroke diagnosed from 1997 to 2014 were analyzed (aHR 2.91, 95% CI = 1.95-4.35). Compared to controls, the risk of autism was increased in individuals with ischemic stroke and comorbid epilepsy (aHR 7.05, 95% CI 3.74-13.30), as well as adverse motor outcome (aHR 4.28, 95% CI 2.44-7.51). When individuals with adverse motor outcome and epilepsy were censored, the risk of autism was still increased (aHR 2.37, 95% CI 1.45-3.85). Sex, gestational age, and having a sibling with autism were not associated with autism in individuals with pediatric ischemic stroke. DISCUSSION An increased risk of autism was seen after pediatric ischemic stroke, particularly in individuals with comorbid epilepsy, and could not be explained by being born preterm or small for gestational age. The risk was increased also in individuals free from epilepsy and adverse motor outcome, implying that all children with ischemic stroke should be readily screened for autism if the disorder is suspected.
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Affiliation(s)
- Heléne Sundelin
- From the Department of Women's and Children's Health (H.S.), Neuropediatric Unit, Karolinska University Hospital; Department of Medicine Solna (J.S., J.B.), Clinical Epidemiology Division, Karolinska Institutet, Stockholm; Department of Biomedical and Clinical Sciences (H.S., P.B.), Division of Children's and Women's Health, Linköping University; Department of Clinical Science and Education Södersjukhuset (J.B.); and Sachs' Children and Youth Hospital (J.B.), Stockholm, Sweden
| | - Jonas Söderling
- From the Department of Women's and Children's Health (H.S.), Neuropediatric Unit, Karolinska University Hospital; Department of Medicine Solna (J.S., J.B.), Clinical Epidemiology Division, Karolinska Institutet, Stockholm; Department of Biomedical and Clinical Sciences (H.S., P.B.), Division of Children's and Women's Health, Linköping University; Department of Clinical Science and Education Södersjukhuset (J.B.); and Sachs' Children and Youth Hospital (J.B.), Stockholm, Sweden
| | - Peter Bang
- From the Department of Women's and Children's Health (H.S.), Neuropediatric Unit, Karolinska University Hospital; Department of Medicine Solna (J.S., J.B.), Clinical Epidemiology Division, Karolinska Institutet, Stockholm; Department of Biomedical and Clinical Sciences (H.S., P.B.), Division of Children's and Women's Health, Linköping University; Department of Clinical Science and Education Södersjukhuset (J.B.); and Sachs' Children and Youth Hospital (J.B.), Stockholm, Sweden
| | - Jenny Bolk
- From the Department of Women's and Children's Health (H.S.), Neuropediatric Unit, Karolinska University Hospital; Department of Medicine Solna (J.S., J.B.), Clinical Epidemiology Division, Karolinska Institutet, Stockholm; Department of Biomedical and Clinical Sciences (H.S., P.B.), Division of Children's and Women's Health, Linköping University; Department of Clinical Science and Education Södersjukhuset (J.B.); and Sachs' Children and Youth Hospital (J.B.), Stockholm, Sweden
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Galli J, Loi E, Visconti LM, Mattei P, Eusebi A, Calza S, Fazzi E. Sleep Disturbances in Children Affected by Autism Spectrum Disorder. Front Psychiatry 2022; 13:736696. [PMID: 35250655 PMCID: PMC8891952 DOI: 10.3389/fpsyt.2022.736696] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/24/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Sleep disturbances are common in children affected by Autism Spectrum Disorder (ASD). The aim of our study was to describe sleep characteristics and disturbances in children with ASD, to evaluate possible related factors, and to assess parental stress. METHODS Hundred children with a diagnosis of ASD (mean age: 66.7 months, SD: 27.4, range: 24.7-152.1 months, n = 79 males) were included in the study. We collected data on sociodemographic, clinical, genetic and instrumental variables as well as comorbid conditions. Parents filled out the Questionnaire on sleep behavior in the first years of life, the BEARS questionnaire, and the Parenting Stress Index Short Form. From the analysis on sleep characteristics, we excluded 25 children treated with melatonin. RESULTS Fifty-seven (57%) out of 100 children met the criteria for insomnia. Sleep disorders were associated with developmental or cognitive delay, emotional and behavioral problems (such as anxiety problems and aggressive behaviors) and absence of strategies for inducing sleep after nocturnal awakenings. From parents' reports, sleep disorders had diurnal repercussions on their offspring; however, we found no statistical correlation between disturbances and family stress. Also, no significant correlation was found between sleep disturbances and epilepsy. Finally, a statistical correlation was found between the regular intake of melatonin and the resolution of insomnia. CONCLUSIONS Multifactorial variables may be associated to insomnia that could have an impact on the children' behavior. Clinicians need to be aware of the value of screening for sleep disturbance in children with ASD to integrate sleep interventions in the treatment plan.
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Affiliation(s)
- Jessica Galli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Erika Loi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | - Paola Mattei
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Anna Eusebi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Stefano Calza
- BDbiomed, BODaI Lab, University of Brescia, Brescia, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
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Braun CM, Elie-Fortier J. Epilepsy and autism: How does age at seizure onset factor in? JOURNAL OF EPILEPTOLOGY 2021. [DOI: 10.21307/jepil-2021-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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7
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Priol AC, Denis L, Boulanger G, Thépaut M, Geoffray MM, Tordjman S. Detection of Morphological Abnormalities in Schizophrenia: An Important Step to Identify Associated Genetic Disorders or Etiologic Subtypes. Int J Mol Sci 2021; 22:ijms22179464. [PMID: 34502372 PMCID: PMC8430486 DOI: 10.3390/ijms22179464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/06/2021] [Indexed: 12/20/2022] Open
Abstract
Current research suggests that alterations in neurodevelopmental processes, involving gene X environment interactions during key stages of brain development (prenatal period and adolescence), are a major risk for schizophrenia. First, epidemiological studies supporting a genetic contribution to schizophrenia are presented in this article, including family, twin, and adoption studies. Then, an extensive literature review on genetic disorders associated with schizophrenia is reviewed. These epidemiological findings and clinical observations led researchers to conduct studies on genetic associations in schizophrenia, and more specifically on genomics (CNV: copy-number variant, and SNP: single nucleotide polymorphism). The main structural (CNV) and sequence (SNP) variants found in individuals with schizophrenia are reported here. Evidence of genetic contributions to schizophrenia and current knowledge on genetic syndromes associated with this psychiatric disorder highlight the importance of a clinical genetic examination to detect minor physical anomalies in individuals with ultra-high risk of schizophrenia. Several dysmorphic features have been described in schizophrenia, especially in early onset schizophrenia, and can be viewed as neurodevelopmental markers of vulnerability. Early detection of individuals with neurodevelopmental abnormalities is a fundamental issue to develop prevention and diagnostic strategies, therapeutic intervention and follow-up, and to ascertain better the underlying mechanisms involved in the pathophysiology of schizophrenia.
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Affiliation(s)
- Anne-Clémence Priol
- Pôle Hospitalo-Universitaire de Psychiatrie de l’Enfant et de l’Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, University of Rennes 1, 35000 Rennes, France; (L.D.); (G.B.); (M.T.)
- Correspondence: (A.-C.P.); (S.T.); Tel.: +33-2-99-51-06-04 (A.-C.P. & S.T.); Fax: +33-2-99-32-46-98 (A.-C.P. & S.T.)
| | - Laure Denis
- Pôle Hospitalo-Universitaire de Psychiatrie de l’Enfant et de l’Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, University of Rennes 1, 35000 Rennes, France; (L.D.); (G.B.); (M.T.)
| | - Gaella Boulanger
- Pôle Hospitalo-Universitaire de Psychiatrie de l’Enfant et de l’Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, University of Rennes 1, 35000 Rennes, France; (L.D.); (G.B.); (M.T.)
| | - Mathieu Thépaut
- Pôle Hospitalo-Universitaire de Psychiatrie de l’Enfant et de l’Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, University of Rennes 1, 35000 Rennes, France; (L.D.); (G.B.); (M.T.)
| | - Marie-Maude Geoffray
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Le Vinatier, 69500 Bron, France;
| | - Sylvie Tordjman
- Pôle Hospitalo-Universitaire de Psychiatrie de l’Enfant et de l’Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, University of Rennes 1, 35000 Rennes, France; (L.D.); (G.B.); (M.T.)
- CIC (Clinical Investigation Center) 1414 Inserm, Centre Hospitalier Universitaire (CHU) de Rennes, University of Rennes 1, 35033 Rennes, France
- Integrative Neuroscience and Cognition Center (INCC), CNRS UMR 8002, University of Paris, 75006 Paris, France
- Correspondence: (A.-C.P.); (S.T.); Tel.: +33-2-99-51-06-04 (A.-C.P. & S.T.); Fax: +33-2-99-32-46-98 (A.-C.P. & S.T.)
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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: 28] [Impact Index Per Article: 7.0] [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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Suzuki T, Suzuki T, Raveau M, Miyake N, Sudo G, Tsurusaki Y, Watanabe T, Sugaya Y, Tatsukawa T, Mazaki E, Shimohata A, Kushima I, Aleksic B, Shiino T, Toyota T, Iwayama Y, Nakaoka K, Ohmori I, Sasaki A, Watanabe K, Hirose S, Kaneko S, Inoue Y, Yoshikawa T, Ozaki N, Kano M, Shimoji T, Matsumoto N, Yamakawa K. A recurrent PJA1 variant in trigonocephaly and neurodevelopmental disorders. Ann Clin Transl Neurol 2020; 7:1117-1131. [PMID: 32530565 PMCID: PMC7359110 DOI: 10.1002/acn3.51093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/10/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Neurodevelopmental disorders (NDDs) often associate with epilepsy or craniofacial malformations. Recent large-scale DNA analyses identified hundreds of candidate genes for NDDs, but a large portion of the cases still remain unexplained. We aimed to identify novel candidate genes for NDDs. METHODS We performed exome sequencing of 95 patients with NDDs including 51 with trigonocephaly and subsequent targeted sequencing of additional 463 NDD patients, functional analyses of variant in vitro, and evaluations of autism spectrum disorder (ASD)-like phenotypes and seizure-related phenotypes in vivo. RESULTS We identified de novo truncation variants in nine novel genes; CYP1A1, C14orf119, FLI1, CYB5R4, SEL1L2, RAB11FIP2, ZMYND8, ZNF143, and MSX2. MSX2 variants have been described in patients with cranial malformations, and our present patient with the MSX2 de novo truncation variant showed cranial meningocele and partial epilepsy. MSX2 protein is known to be ubiquitinated by an E3 ubiquitin ligase PJA1, and interestingly we found a PJA1 hemizygous p.Arg376Cys variant recurrently in seven Japanese NDD patients; five with trigonocephaly and one with partial epilepsy, and the variant was absent in 886 Japanese control individuals. Pja1 knock-in mice carrying p.Arg365Cys, which is equivalent to p.Arg376Cys in human, showed a significant decrease in PJA1 protein amount, suggesting a loss-of-function effect of the variant. Pja1 knockout mice displayed moderate deficits in isolation-induced ultrasonic vocalizations and increased seizure susceptibility to pentylenetetrazole. INTERPRETATION These findings propose novel candidate genes including PJA1 and MSX2 for NDDs associated with craniofacial abnormalities and/or epilepsy.
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Affiliation(s)
- Toshimitsu Suzuki
- Department of Neurodevelopmental Disorder Genetics, Institute of Brain Science, Nagoya City University Graduate School of Medical Science, Nagoya, Aichi, 467-8601, Japan.,Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama, 351-0198, Japan
| | - Toshifumi Suzuki
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan.,Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, 113-8421, Japan
| | - Matthieu Raveau
- Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama, 351-0198, Japan
| | - Noriko Miyake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Genki Sudo
- Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama, 351-0198, Japan
| | - Yoshinori Tsurusaki
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan.,Faculty of Nutritional Science, Sagami Women's University, Sagamihara, Kanagawa, 252-0383, Japan
| | - Takaki Watanabe
- Department of Neurophysiology, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Yuki Sugaya
- Department of Neurophysiology, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Tetsuya Tatsukawa
- Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama, 351-0198, Japan
| | - Emi Mazaki
- Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama, 351-0198, Japan
| | - Atsushi Shimohata
- Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama, 351-0198, Japan
| | - Itaru Kushima
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8550, Japan.,Medical Genomics Center, Nagoya University Hospital, Nagoya, Aichi, 466-8560, Japan
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8550, Japan
| | - Tomoko Shiino
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8550, Japan
| | - Tomoko Toyota
- Laboratory for Molecular Psychiatry, RIKEN Center for Brain Science, Wako, Saitama, 351-0198, Japan
| | - Yoshimi Iwayama
- Laboratory for Molecular Psychiatry, RIKEN Center for Brain Science, Wako, Saitama, 351-0198, Japan
| | - Kentaro Nakaoka
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Aoi-ku, Shizuoka, 420-8688, Japan
| | - Iori Ohmori
- Department of Special Needs Education, Okayama University Graduate School of Education, Okayama, 700-8530, Japan
| | - Aya Sasaki
- Department of Pathology and Laboratory Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, 272-8513, Japan
| | - Ken Watanabe
- Section of Bone Function, Department of Bone and Joint Diseases, National Center for Geriatrics and Gerontology (NCGG), Obu, Aichi, 474-8511, Japan
| | - Shinichi Hirose
- Department of Pediatrics, School of Medicine and Research Institute for the Molecular Pathomechanisms of Epilepsy, Fukuoka University, Fukuoka, Fukuoka, 814-0180, Japan
| | - Sunao Kaneko
- Department of Neuropsychiatry, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, 036-8562, Japan.,North Tohoku Epilepsy Center, Minato Hospital, Hachinohe, 031-0813, Japan
| | - Yushi Inoue
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Aoi-ku, Shizuoka, 420-8688, Japan
| | - Takeo Yoshikawa
- Laboratory for Molecular Psychiatry, RIKEN Center for Brain Science, Wako, Saitama, 351-0198, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8550, Japan
| | - Masanobu Kano
- Department of Neurophysiology, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Takeyoshi Shimoji
- Department of Neurosurgery, Okinawa Pref. Nanbu Medical Center and Children's Medical Center, Arakawa Haebaru, Okinawa, 901-1193, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Kazuhiro Yamakawa
- Department of Neurodevelopmental Disorder Genetics, Institute of Brain Science, Nagoya City University Graduate School of Medical Science, Nagoya, Aichi, 467-8601, Japan.,Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama, 351-0198, Japan
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10
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Rothärmel M, Moulier V, Vasse M, Isaac C, Faerber M, Bendib B, Mirea-Grivel I, Opolczynski G, Rosier A, Guillin O. A Prospective Open-Label Pilot Study of Transcranial Direct Current Stimulation in High-Functioning Autistic Patients with a Dysexecutive Syndrome. Neuropsychobiology 2020; 78:189-199. [PMID: 31266030 DOI: 10.1159/000501025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Executive functions (EF) are often impaired in autism spectrum disorder (ASD). Such dysfunctions are associated with anxiety, depression, and a lack of autonomy. Transcranial direct current stimulation (tDCS) has been shown to enhance EF in healthy adults and clinical populations and to improve working memory - a component of the EF - in adults with high-functioning ASD (HF-ASD). We hypothesized that tDCS could improve the EF of HF-ASD patients. Such enhancement could improve their adaptive behaviors. METHOD Eight patients with HF-ASD received 10 consecutive cathodal tDCS sessions (2 mA) over the left dorsolateral prefrontal cortex (F3) for 15 min each in an open trial. EF (with the Stroop test, Trail Making Test [TMT] A and B, Modified Wisconsin Card Sorting Test [mWCST], and Verbal Fluency Test) and behavioral dysexecutive syndrome (with the Behavioral Dysexecutive Syndrome Inventory and the Repetitive and Restricted Behaviour scale) were assessed before and 10 days after treatment. RESULTS This study showed significant improvement in initiation (TMT-A time: p = 0.018) and cognitive flexibility (TMT-B time: p = 0.009; letter Verbal Fluency Test: p = 0.017; mWCST total errors: p = 0.028) after tDCS. Regarding behavior, the hypoactivity of the patients improved, as well as their repetitive and restrictive behaviors. In addition, this noninvasive neurostimulation technique was well tolerated. CONCLUSIONS Flexibility and initiation are the most impaired EF in autism. These are promising results which justify a randomized and placebo-controlled study in a wider population. If these results were confirmed by a randomized controlled trial, tDCS could be an easy and well-tolerated adjunctive treatment aiming to improve the quality of life and the autonomy of ASD patients.
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Affiliation(s)
- Maud Rothärmel
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France,
| | - Virginie Moulier
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France.,EPS Ville Evrard, Unité de Recherche Clinique, Neuilly-sur-Marne, France
| | - Marianne Vasse
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Clémence Isaac
- EPS Ville Evrard, Unité de Recherche Clinique, Neuilly-sur-Marne, France
| | - Mathieu Faerber
- Centre Ressource Autisme Normandie Seine Eure, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Bilal Bendib
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Iris Mirea-Grivel
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Gaëlle Opolczynski
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Antoine Rosier
- Centre Ressource Autisme Normandie Seine Eure, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Olivier Guillin
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France.,Centre Ressource Autisme Normandie Seine Eure, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France.,CHU de Rouen, Rouen, France.,Faculté de Médecine, Normandy University, Rouen, France
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11
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Clinical Management of Children and Adolescents with Neurofibromatosis Type 1 Like Phenotypes and Complex Behavioural Manifestations: A Multidisciplinary and Dimensional Approach. Case Rep Psychiatry 2020; 2019:4764031. [PMID: 32089936 PMCID: PMC7011498 DOI: 10.1155/2019/4764031] [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: 05/23/2019] [Accepted: 11/27/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction. Cognitive and behavioural problems associated with Neurofibromatosis type 1 (NF1) are common sources of distress and the reasons behind seeking help. Here we describe patients with NF1 or NF1-like phenotypes referred to a Tier 3 Child and Adolescent Psychiatry Department and highlight the benefits of a multidisciplinary assessment.
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12
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Capkova Z, Capkova P, Srovnal J, Staffova K, Becvarova V, Trkova M, Adamova K, Santava A, Curtisova V, Hajduch M, Prochazka M. Differences in the importance of microcephaly, dysmorphism, and epilepsy in the detection of pathogenic CNVs in ID and ASD patients. PeerJ 2019; 7:e7979. [PMID: 31741789 PMCID: PMC6859875 DOI: 10.7717/peerj.7979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 10/02/2019] [Indexed: 01/06/2023] Open
Abstract
Background Autism spectrum disorders (ASD) and intellectual disabilities (ID) are heterogeneous and complex developmental diseases with significant genetic backgrounds and overlaps of genetic susceptibility loci. Copy number variants (CNVs) are known to be frequent causes of these impairments. However, the clinical heterogeneity of both disorders causes the diagnostic efficacy of CNV analysis to be modest. This could be resolved by stratifying patients according to their clinical features. Aim First, we sought to assess the significance of particular clinical features for the detection of pathogenic CNVs in separate groups of ID and ASD patients and determine whether and how these groups differ from each other in the significance of these variables. Second, we aimed to create a statistical model showing how particular clinical features affect the probability of pathogenic CNV findings. Method We tested a cohort of 204 patients with ID (N = 90) and ASD (N = 114) for the presence of pathogenic CNVs. We stratified both groups according to their clinical features. Fisher’s exact test was used to determine the significance of these variables for pathogenic CNV findings. Logistic regression was used to create a statistical model of pathogenic CNV findings. Results The frequency of pathogenic CNV was significantly higher in the ID group than in the ASD group: 18 (19.78%) versus 8 (7%) (p < 0.004). Microcephaly showed a significant association with pathogenic findings in ID patients (p < 0.01) according to Fisher’s exact test, whereas epilepsy showed a significant association with pathogenic findings in ASD patients (p < 0.01). The probability of pathogenic CNV findings when epilepsy occurred in ASD patients was more than two times higher than if epilepsy co-occurred with ID (29.6%/14.0%). Facial dysmorphism was a significant variable for detecting pathogenic CNVs in both groups (ID p = 0.05, ASD p = 0.01). However, dysmorphism increased the probability of pathogenic CNV detection in the ID group nearly twofold compared to the ASD group (44.4%/23.7%). The presence of macrocephaly in the ASD group showed a 25% probability of pathogenic CNV findings by logistic regression, but this was insignificant according to Fisher’s exact test. The probability of detecting pathogenic CNVs decreases up to 1% in the absence of dysmorphism, macrocephaly, and epilepsy in the ASD group. Conclusion Dysmorphism, microcephaly, and epilepsy increase the probability of pathogenic CNV findings in ID and ASD patients. The significance of each feature as a predictor for pathogenic CNV detection differs depending on whether the patient has only ASD or ID. The probability of pathogenic CNV findings without dysmorphism, macrocephaly, or epilepsy in ASD patients is low. Therefore the efficacy of CNV analysis is limited in these patients.
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Affiliation(s)
- Zuzana Capkova
- Department of Medical Genetics, University Hospital Olomouc, Olomouc, Czech Republic.,Department of Medical Genetics/Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Pavlina Capkova
- Department of Medical Genetics, University Hospital Olomouc, Olomouc, Czech Republic.,Department of Medical Genetics/Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Josef Srovnal
- Department of Medical Genetics, University Hospital Olomouc, Olomouc, Czech Republic.,Institute of Molecular and Translational Medicine/Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Katerina Staffova
- Institute of Molecular and Translational Medicine/Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | | | | | - Katerina Adamova
- Department of Medical Genetics, University Hospital Olomouc, Olomouc, Czech Republic.,Department of Medical Genetics/Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Alena Santava
- Department of Medical Genetics, University Hospital Olomouc, Olomouc, Czech Republic.,Department of Medical Genetics/Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Vaclava Curtisova
- Department of Medical Genetics, University Hospital Olomouc, Olomouc, Czech Republic.,Department of Medical Genetics/Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Marian Hajduch
- Institute of Molecular and Translational Medicine/Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Martin Prochazka
- Department of Medical Genetics, University Hospital Olomouc, Olomouc, Czech Republic.,Department of Medical Genetics/Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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13
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Lombardo MV, Lai MC, Baron-Cohen S. Big data approaches to decomposing heterogeneity across the autism spectrum. Mol Psychiatry 2019; 24:1435-1450. [PMID: 30617272 PMCID: PMC6754748 DOI: 10.1038/s41380-018-0321-0] [Citation(s) in RCA: 225] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 10/30/2018] [Accepted: 11/12/2018] [Indexed: 12/27/2022]
Abstract
Autism is a diagnostic label based on behavior. While the diagnostic criteria attempt to maximize clinical consensus, it also masks a wide degree of heterogeneity between and within individuals at multiple levels of analysis. Understanding this multi-level heterogeneity is of high clinical and translational importance. Here we present organizing principles to frame research examining multi-level heterogeneity in autism. Theoretical concepts such as 'spectrum' or 'autisms' reflect non-mutually exclusive explanations regarding continuous/dimensional or categorical/qualitative variation between and within individuals. However, common practices of small sample size studies and case-control models are suboptimal for tackling heterogeneity. Big data are an important ingredient for furthering our understanding of heterogeneity in autism. In addition to being 'feature-rich', big data should be both 'broad' (i.e., large sample size) and 'deep' (i.e., multiple levels of data collected on the same individuals). These characteristics increase the likelihood that the study results are more generalizable and facilitate evaluation of the utility of different models of heterogeneity. A model's utility can be measured by its ability to explain clinically or mechanistically important phenomena, and also by explaining how variability manifests across different levels of analysis. The directionality for explaining variability across levels can be bottom-up or top-down, and should include the importance of development for characterizing changes within individuals. While progress can be made with 'supervised' models built upon a priori or theoretically predicted distinctions or dimensions of importance, it will become increasingly important to complement such work with unsupervised data-driven discoveries that leverage unknown and multivariate distinctions within big data. A better understanding of how to model heterogeneity between autistic people will facilitate progress towards precision medicine for symptoms that cause suffering, and person-centered support.
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Affiliation(s)
- Michael V Lombardo
- Department of Psychology, University of Cyprus, Nicosia, Cyprus.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
| | - Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Centre for Addiction and Mental Health and The Hospital for Sick Children, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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14
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Tordjman S, Cohen D, Anderson G, Botbol M, Canitano R, Coulon N, Roubertoux P. Repint of “Reframing autism as a behavioral syndrome and not a specific mental disorder: Implications of genetic and phenotypic heterogeneity”. Neurosci Biobehav Rev 2018; 89:132-150. [DOI: 10.1016/j.neubiorev.2018.01.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/18/2016] [Accepted: 01/23/2017] [Indexed: 12/22/2022]
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15
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Meguid NA, Nashaat NH, Hashem HS, Khalil MM. Frequency of risk factors and coexisting abnormalities in a population of Egyptian children with autism spectrum disorder. Asian J Psychiatr 2018; 32:54-58. [PMID: 29216607 DOI: 10.1016/j.ajp.2017.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many risk factors interact together during the critical period of development and govern the future phenotype of autism spectrum disorder (ASD). Furthermore, co-occurring abnormalities among individuals with ASD vary a lot so as their abilities. AIM OF WORK To investigate possible risk factors and to determine the prevalence of coexisting abnormalities in a sample of Egyptian ASD children and their influence on the severity and their communication performance. METHODS The diagnosis and severity of ASD for participants (N=80) was performed by DSM-5, ADIR and CARS. They were investigated regarding the possible risk factors and coexisting abnormalities. A detailed history taking, clinical examination, the Arabic preschool language scale, cognitive abilities assessment and other additional instrumental measures such as EEG were used. RESULTS Caesarian section and neonatal jaundice were the most common risk factors. The severity of ASD was positively related to maternal and paternal ages. Developmental language disorder, intellectual disability, attention deficit hyperactivity disorder, sleep disorder and EEG changes were more frequently detected among studied cases. The CARS scores were significantly higher in ADHD and EEG changes groups. The most severely affected CARS items in the groups with these disorders were determined. CONCLUSION High parental ages has an impact on the severity of ASD. ADHD, sleep disorder, and EEG changes seem to have an impact on certain elements of the adaptive behavior especially the communicative performance of ASD individuals. We recommend to seriously investigate co-morbid abnormalities and consider them during the process of management of ASD for proper intervention plans.
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Affiliation(s)
- Nagwa Abdel Meguid
- Research on Children with Special Needs Department, Medical research division, National Research Centre, Cairo, Egypt; CONEM Egypt Child Brain Research Group, National Research Centre, Cairo, Egypt
| | - Neveen Hassan Nashaat
- Research on Children with Special Needs Department, Medical research division, National Research Centre, Cairo, Egypt.
| | - Heba S Hashem
- Research on Children with Special Needs Department, Medical research division, National Research Centre, Cairo, Egypt
| | - Mai M Khalil
- Research on Children with Special Needs Department, Medical research division, National Research Centre, Cairo, Egypt
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16
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Bakke KA, Howlin P, Retterstøl L, Kanavin ØJ, Heiberg A, Nærland T. Effect of epilepsy on autism symptoms in Angelman syndrome. Mol Autism 2018; 9:2. [PMID: 29340132 PMCID: PMC5759870 DOI: 10.1186/s13229-017-0185-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 12/25/2017] [Indexed: 12/02/2022] Open
Abstract
Background Autism spectrum disorder and epilepsy often co-occur; however, the extent to which the association between autism symptoms and epilepsy is due to shared aetiology or to the direct effects of seizures is a topic of ongoing debate. Angelman syndrome (AS) is presented as a suitable disease model to explore this association. Methods Data from medical records and questionnaires were used to examine the association between age of epilepsy onset, autism symptoms, genetic aberration and communication level. Forty-eight participants had genetically verified AS (median age 14.5 years; range 1–57 years). A measure of autism symptoms (the Social Communication Questionnaire; SCQ) was completed for 38 individuals aged ≥ 4 years. Genetic cause was subgrouped into deletion and other genetic aberrations of the 15q11-q13 area. The number of signs used to communicate (< 20 sign and ≥ 20 signs) was used as a measure of nonverbal communication. Results Mean age of epilepsy onset was 3.0 years (range 3 months–7.8 years). Mean SCQ score for individuals without epilepsy was 13.6 (SD = 6.7) and with epilepsy 17.0 (SD = 5.6; p = 0.17); 58% used fewer than 20 signs to communicate. There were no age differences between groups according to presence of epilepsy, level of nonverbal communication or type of genetic aberration. SCQ scores were higher in individuals with the deletion than in those with other genetic aberrations (18.7 vs 10.8 p = 0.008) and higher in the group who used < 20 signs to communicate (19.4 vs 14.1 p = 0.007). Age of epilepsy onset was correlated with SCQ (r = − 0.61, p < 0.001). Multiple regression showed that age of seizure onset was significantly related to SCQ score (β = − 0.90; p = 0.006), even when the type of genetic abnormality was controlled (R2 = 0.53; F = 10.7; p = 0.001). Conclusions The study provides support for the notion that seizures themselves contribute more to autism symptoms than expected from the underlying genetic pathology alone. The study demonstrates how a rare genetic syndrome such as Angelman syndrome may be used to study the relation between epilepsy and autism symptomatology.
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Affiliation(s)
- Kristin A Bakke
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Faculty of Health Sciences, University of Sydney, Sydney, NSW Australia
| | - Lars Retterstøl
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Øivind J Kanavin
- Frambu National Resource Center for Rare Disorders, Siggerud, Norway
| | - Arvid Heiberg
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Terje Nærland
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway.,NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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17
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Strasser L, Downes M, Kung J, Cross JH, De Haan M. Prevalence and risk factors for autism spectrum disorder in epilepsy: a systematic review and meta-analysis. Dev Med Child Neurol 2018; 60:19-29. [PMID: 29119560 DOI: 10.1111/dmcn.13598] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 12/17/2022]
Abstract
AIM To assess the prevalence and risk factors for autism spectrum disorder (ASD) in epilepsy, and to better understand the relationship and comorbidity between these disorders. METHOD PsychINFO and PubMed were searched for articles published in the past 15 years that examined the prevalence of ASD in individuals with epilepsy. RESULTS A total of 19 studies were found with a pooled ASD prevalence of 6.3% in epilepsy. When divided by type, the risks of ASD for general epilepsy, infantile spasms, focal seizures, and Dravet syndrome were 4.7%, 19.9%, 41.9%, and 47.4% respectively. Studies with populations under 18 years showed a 13.2 times greater risk of ASD than study populations over 18 years, and samples with most (>50%) individuals with intellectual disability showed a greater risk 4.9 times higher than study populations with a minority of individuals with intellectual disability. The main risk factors for ASD reported in the 19 studies included presence of intellectual disability, sex, age, and symptomatic aetiology of epilepsy. INTERPRETATION Current research supports a high prevalence of ASD in epilepsy. This study helps to define the clinical profile of patients with epilepsy who are at risk for ASD, which may help clinicians in early screening and diagnosis of ASD in this population. WHAT THIS PAPER ADDS Critical evaluation of previous studies examining the prevalence of autism spectrum disorder (ASD) in individuals with epilepsy. A meta-analysis of 19 studies showed a pooled ASD prevalence of 6.3% in individuals with epilepsy. Studies that included a majority of individuals with intellectual disability or younger population age had a higher prevalence of autism. Risk factors reported in studies included presence of intellectual disability, sex, age, and symptomatic epilepsy origin.
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Affiliation(s)
- Lauren Strasser
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Michelle Downes
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jane Kung
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - J Helen Cross
- UCL Great Ormond Street Institute of Child Health, London, UK
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18
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Richard AE, Scheffer IE, Wilson SJ. Features of the broader autism phenotype in people with epilepsy support shared mechanisms between epilepsy and autism spectrum disorder. Neurosci Biobehav Rev 2017; 75:203-233. [DOI: 10.1016/j.neubiorev.2016.12.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 12/29/2022]
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19
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Camfield P, Camfield C, Busiah K, Cohen D, Pack A, Nabbout R. The transition from pediatric to adult care for youth with epilepsy: Basic biological, sociological, and psychological issues. Epilepsy Behav 2017; 69:170-176. [PMID: 28089368 DOI: 10.1016/j.yebeh.2016.11.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 01/03/2023]
Abstract
Transition from pediatric to adult health care for adolescents with epilepsy is challenging for the patient, family, and health care workers. This paper is the first of three that summarize the main findings from the 2nd Symposium on Transition in Epilepsies, held in Paris from June 14-25, 2016. In this paper we describe five basic themes that have an important effect on transition. First, there are important brain changes in adolescence that leave an imbalance between risk taking and pleasure seeking behaviors and frontal executive function compared with adults. Second, puberty is a major change during the transition age. The three most important but separate neuroendocrine axes involved in puberty are gonadarche (activation of the gonads), adrenarche (activation of adrenal androgen production), and activation of the growth hormone-insulin like growth factor. Third, sexual debut occurs during the transition years, and at an earlier age in adolescents with epilepsy than controls. Adult sexual performance is often unsatisfactory. Although AED-induced alterations in sexual hormones and temporal lobe epilepsy may play a role in hyposexuality, depression, anxiety, and other social factors appear most important. Fourth, psychological development is very important with an evolution from an early stage (ages 10-13years) with concrete thinking, to a middle stage (ages 14-17) with analytic and more abstract introspective thinking, and then to a late stage (ages 18-21) with at least the beginnings of adult reasoning. Epilepsy may derail this relatively orderly progression. Adolescents with autistic spectrum disorder may present with severe behavior problems that are sometimes related to undiagnosed epilepsy. Fifth, bone health in adolescence is critical to establish adequate mineralization for all of adult life. While AED interference with Vitamin D metabolism is important, there is evidence that the effects of AEDs on bone are more complex and involve changes in remodeling. Hence, some non-inducing AEDs may have a significant effect on bone health. All five of these themes lead to recommendations for how to approach adolescents and young adults during transition and some specific interventions to achieve maximum long-term adult independence and quality of life.
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Affiliation(s)
- Peter Camfield
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada; Pediatric Department, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Carol Camfield
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada; Pediatric Department, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Kanetee Busiah
- Trousseau Hospital and Necker-Enfants Malades Hospital, APHP, Paris, France
| | - David Cohen
- Université Pierre et Marie Curie and Pitié-Salpétrière, Paris, France
| | - Alison Pack
- Columbia University Medical Center, New York, NY, United States
| | - Rima Nabbout
- Reference centre for rare epilepsies, Pediatric Neurology, Necker-Enfants Malades University Hospital, APHP, University of Paris Descartes, Inserm U1129, Paris, France
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20
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Robert C, Pasquier L, Cohen D, Fradin M, Canitano R, Damaj L, Odent S, Tordjman S. Role of Genetics in the Etiology of Autistic Spectrum Disorder: Towards a Hierarchical Diagnostic Strategy. Int J Mol Sci 2017; 18:E618. [PMID: 28287497 PMCID: PMC5372633 DOI: 10.3390/ijms18030618] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 12/27/2022] Open
Abstract
Progress in epidemiological, molecular and clinical genetics with the development of new techniques has improved knowledge on genetic syndromes associated with autism spectrum disorder (ASD). The objective of this article is to show the diversity of genetic disorders associated with ASD (based on an extensive review of single-gene disorders, copy number variants, and other chromosomal disorders), and consequently to propose a hierarchical diagnostic strategy with a stepwise evaluation, helping general practitioners/pediatricians and child psychiatrists to collaborate with geneticists and neuropediatricians, in order to search for genetic disorders associated with ASD. The first step is a clinical investigation involving: (i) a child psychiatric and psychological evaluation confirming autism diagnosis from different observational sources and assessing autism severity; (ii) a neuropediatric evaluation examining neurological symptoms and developmental milestones; and (iii) a genetic evaluation searching for dysmorphic features and malformations. The second step involves laboratory and if necessary neuroimaging and EEG studies oriented by clinical results based on clinical genetic and neuropediatric examinations. The identification of genetic disorders associated with ASD has practical implications for diagnostic strategies, early detection or prevention of co-morbidity, specific treatment and follow up, and genetic counseling.
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Affiliation(s)
- Cyrille Robert
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (PHUPEA), University of Rennes 1 and Centre Hospitalier Guillaume Régnier, 35200 Rennes, France.
- Service de Génétique Clinique, Centre de Référence Maladies Rares Anomalies du Développement (Centre Labellisé pour les Anomalies du Développement de l'Ouest: CLAD Ouest), Hôpital Sud, Centre Hospitalier Universitaire de Rennes, 35200 Rennes, France.
| | - Laurent Pasquier
- Service de Génétique Clinique, Centre de Référence Maladies Rares Anomalies du Développement (Centre Labellisé pour les Anomalies du Développement de l'Ouest: CLAD Ouest), Hôpital Sud, Centre Hospitalier Universitaire de Rennes, 35200 Rennes, France.
| | - David Cohen
- Hospital-University Department of Child and Adolescent Psychiatry, Pitié-Salpétrière Hospital, Paris 6 University, 75013 Paris, France.
| | - Mélanie Fradin
- Service de Génétique Clinique, Centre de Référence Maladies Rares Anomalies du Développement (Centre Labellisé pour les Anomalies du Développement de l'Ouest: CLAD Ouest), Hôpital Sud, Centre Hospitalier Universitaire de Rennes, 35200 Rennes, France.
| | - Roberto Canitano
- Division of Child and Adolescent Neuropsychiatry, University Hospital of Siena, 53100 Siena, Italy.
| | - Léna Damaj
- Service de Génétique Clinique, Centre de Référence Maladies Rares Anomalies du Développement (Centre Labellisé pour les Anomalies du Développement de l'Ouest: CLAD Ouest), Hôpital Sud, Centre Hospitalier Universitaire de Rennes, 35200 Rennes, France.
| | - Sylvie Odent
- Service de Génétique Clinique, Centre de Référence Maladies Rares Anomalies du Développement (Centre Labellisé pour les Anomalies du Développement de l'Ouest: CLAD Ouest), Hôpital Sud, Centre Hospitalier Universitaire de Rennes, 35200 Rennes, France.
| | - Sylvie Tordjman
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (PHUPEA), University of Rennes 1 and Centre Hospitalier Guillaume Régnier, 35200 Rennes, France.
- Laboratory of Psychology of Perception, University Paris Descartes, 75270 Paris, France.
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Tordjman S, Cohen D, Coulon N, Anderson GM, Botbol M, Canitano R, Roubertoux PL. Reframing autism as a behavioral syndrome and not a specific mental disorder: Implications of genetic and phenotypic heterogeneity. Neurosci Biobehav Rev 2017; 80:210. [PMID: 28153685 DOI: 10.1016/j.neubiorev.2017.01.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/18/2016] [Accepted: 01/23/2017] [Indexed: 12/13/2022]
Abstract
Clinical and molecular genetics have advanced current knowledge on genetic disorders associated with autism. A review of diverse genetic disorders associated with autism is presented and for the first time discussed extensively with regard to possible common underlying mechanisms leading to a similar cognitive-behavioral phenotype of autism. The possible role of interactions between genetic and environmental factors, including epigenetic mechanisms, is in particular examined. Finally, the pertinence of distinguishing non-syndromic autism (isolated autism) from syndromic autism (autism associated with genetic disorders) will be reconsidered. Given the high genetic and etiological heterogeneity of autism, autism can be viewed as a behavioral syndrome related to known genetic disorders (syndromic autism) or currently unknown disorders (apparent non-syndromic autism), rather than a specific categorical mental disorder. It highlights the need to study autism phenotype and developmental trajectory through a multidimensional, non-categorical approach with multivariate analyses within autism spectrum disorder but also across mental disorders, and to conduct systematically clinical genetic examination searching for genetic disorders in all individuals (children but also adults) with autism.
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Affiliation(s)
- S Tordjman
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Université de Rennes 1 and Centre Hospitalier Guillaume Régnier, 154 rue de Châtillon, 35200 Rennes, France; Laboratoire Psychologie de la Perception, Université Paris Descartes and CNRS UMR 8158, Paris, France.
| | - D Cohen
- Department of Child and Adolescent Psychiatry, AP-HP, GH Pitié-Salpétrière, CNRS FRE 2987, Université Pierre et Marie Curie, Paris, France
| | - N Coulon
- Laboratoire Psychologie de la Perception, Université Paris Descartes and CNRS UMR 8158, Paris, France
| | - G M Anderson
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - M Botbol
- Departement Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Université de Bretagne Occidentale, Brest, France
| | - R Canitano
- Division of Child and Adolescent Neuropsychiatry, University Hospital of Siena, Siena, Italy
| | - P L Roubertoux
- Aix Marseille Université, GMGF, Inserm, UMR_S 910, 13385, Marseille, France
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22
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McCue LM, Flick LH, Twyman KA, Xian H, Conturo TE. Prevalence of non-febrile seizures in children with idiopathic autism spectrum disorder and their unaffected siblings: a retrospective cohort study. BMC Neurol 2016; 16:245. [PMID: 27894273 PMCID: PMC5126876 DOI: 10.1186/s12883-016-0764-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 11/15/2016] [Indexed: 01/27/2023] Open
Abstract
Background Autism spectrum disorder (ASD) is a heterogeneous disorder characterized not only by deficits in communication and social interactions but also a high rate of co-occurring disorders, including metabolic abnormalities, gastrointestinal and sleep disorders, and seizures. Seizures, when present, interfere with cognitive development and are associated with a higher mortality rate in the ASD population. Methods To determine the relative prevalence of non-febrile seizures in children with idiopathic ASD from multiplex and simplex families compared with the unaffected siblings in a cohort of 610 children with idiopathic ASD and their 160 unaffected siblings, participating in the Autism Genetic Resource Exchange project, the secondary analysis was performed comparing the life-time prevalence of non-febrile seizures. Statistical models to account for non-independence of observations, inherent with the data from multiplex families, were used in assessing potential confounding effects of age, gender, and history of febrile seizures on odds of having non-febrile seizures. Results The life-time prevalence of non-febrile seizures was 8.2% among children with ASD and 2.5% among their unaffected siblings. In a logistic regression analysis that adjusted for familial clustering, children with ASD had 5.27 (95%CI: 1.51–18.35) times higher odds of having non-febrile seizures compared to their unaffected siblings. In this comparison, age, presence of gastrointestinal dysfunction, and history of febrile seizures were significantly associated with the prevalence of non-febrile seizures. Conclusion Children with idiopathic ASD are significantly more likely to have non-febrile seizures than their unaffected siblings, suggesting that non-febrile seizures may be ASD-specific. Further studies are needed to determine modifiable risk factors for non-febrile seizures in ASD.
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Affiliation(s)
- Lena M McCue
- Division of Biostatistics, Washington University in St. Louis, School of Medicine, 660 Euclid Ave., St. Louis, MO, 63110, USA.
| | - Louise H Flick
- Epidemiology Department, Saint Louis University, College for Public Health and Social Justice, 3545 Lafayette Ave., St. Louis, MO, 63104, USA
| | - Kimberly A Twyman
- Department of Pediatrics, Saint Louis University School of Medicine, 1465 S Grand Blvd., St Louis, MO, 63104, USA
| | - Hong Xian
- Department of Biostatistics, Saint Louis University, College for Public Health and Social Justice, 3545 Lafayette Ave., St. Louis, MO, 63104, USA
| | - Thomas E Conturo
- Department of Radiology, Washington University School of Medicine, 4525 Scott Ave., St Louis, MO, 63110, USA
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Ruskin DN, Fortin JA, Bisnauth SN, Masino SA. Ketogenic diets improve behaviors associated with autism spectrum disorder in a sex-specific manner in the EL mouse. Physiol Behav 2016; 168:138-145. [PMID: 27836684 PMCID: PMC5135580 DOI: 10.1016/j.physbeh.2016.10.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/08/2016] [Accepted: 10/14/2016] [Indexed: 12/17/2022]
Abstract
The core symptoms of autism spectrum disorder are poorly treated with current medications. Symptoms of autism spectrum disorder are frequently comorbid with a diagnosis of epilepsy and vice versa. Medically-supervised ketogenic diets are remarkably effective nonpharmacological treatments for epilepsy, even in drug-refractory cases. There is accumulating evidence that supports the efficacy of ketogenic diets in treating the core symptoms of autism spectrum disorders in animal models as well as limited reports of benefits in patients. This study tests the behavioral effects of ketogenic diet feeding in the EL mouse, a model with behavioral characteristics of autism spectrum disorder and comorbid epilepsy. Male and female EL mice were fed control diet or one of two ketogenic diet formulas ad libitum starting at 5 weeks of age. Beginning at 8 weeks of age, diet protocols continued and performance of each group on tests of sociability and repetitive behavior was assessed. A ketogenic diet improved behavioral characteristics of autism spectrum disorder in a sex- and test-specific manner; ketogenic diet never worsened relevant behaviors. Ketogenic diet feeding improved multiple measures of sociability and reduced repetitive behavior in female mice, with limited effects in males. Additional experiments in female mice showed that a less strict, more clinically-relevant diet formula was equally effective in improving sociability and reducing repetitive behavior. Taken together these results add to the growing number of studies suggesting that ketogenic and related diets may provide significant relief from the core symptoms of autism spectrum disorder, and suggest that in some cases there may be increased efficacy in females.
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Affiliation(s)
- David N Ruskin
- Department of Psychology, Neuroscience Program, Trinity College, Hartford, CT, United States.
| | - Jessica A Fortin
- Department of Psychology, Neuroscience Program, Trinity College, Hartford, CT, United States.
| | - Subrina N Bisnauth
- Department of Psychology, Neuroscience Program, Trinity College, Hartford, CT, United States.
| | - Susan A Masino
- Department of Psychology, Neuroscience Program, Trinity College, Hartford, CT, United States.
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Tanet A, Hubert-Barthelemy A, Crespin GC, Bodeau N, Cohen D, Saint-Georges C. A Developmental and Sequenced One-to-One Educational Intervention for Autism Spectrum Disorder: A Randomized Single-Blind Controlled Trial. Front Pediatr 2016; 4:99. [PMID: 27725927 PMCID: PMC5035746 DOI: 10.3389/fped.2016.00099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/05/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Individuals with autism spectrum disorder (ASD) who also exhibit severe-to-moderate ranges of intellectual disability (ID) still face many challenges (i.e., less evidence-based trials, less inclusion in school with peers). METHODS We implemented a novel model called the "Developmental and Sequenced One-to-One Educational Intervention" (DS1-EI) in 5- to 9-year-old children with co-occurring ASD and ID. The treatment protocol was adapted for school implementation by designing it using an educational agenda. The intervention was based on intensity, regular assessments, updating objectives, encouraging spontaneous communication, promoting skills through play with peers, supporting positive behaviors, providing supervision, capitalizing on teachers' unique skills, and providing developmental and sequenced learning. Developmental learning implies that the focus of training is what is close to the developmental expectations given a child's development in a specific domain. Sequenced learning means that the teacher changes the learning activities every 10-15 min to maintain the child's attention in the context of an anticipated time agenda. We selected 11 French institutions in which we implemented the model in small classrooms. Each institution recruited participants per dyads matched by age, sex, and developmental quotient. Patients from each dyad were then randomized to a DS1-EI group or a Treatment as usual (TAU) group for 36 months. The primary variables - the Childhood Autism Rating scale (CARS) and the psychoeducational profile (PEP-3) - will be blindly assessed by independent raters at the 18-month and 36-month follow-up. DISCUSSION AND BASELINE DESCRIPTION We enrolled 75 participants: 38 were randomized to the DS1-EI and 37 to the TAU groups. At enrollment, we found no significant differences in participants' characteristics between groups. As expected, exposure to school was the only significant difference [9.4 (±4.1) h/week in the DS1-EI group vs. 3.4 (±4.5) h/week in the TAU group, Student's t-test, t = 5.83, p < 0.001]. ETHICS AND DISSEMINATION The protocol was authorized by the competent national regulatory authority (Agence nationale de sécurité du médicament et des produits de santé) and approved by the local Ethics Committee (Comité de Protection des Personnes) at the University Hospital Saint-Antoine (May 7, 2013). The findings will be disseminated through peer-reviewed journals and national and international conferences. TRIAL REGISTRATION NUMBERS ANSM130282B-31 (April 16 2013) and ACTRN12616000592448 (May 6 2016).
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Affiliation(s)
- Antoine Tanet
- Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie Curie, Paris, France
- Departement de Psychiatrie de l’Enfant et de l’Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie, Paris, France
- Croix Rouge Française, Paris, France
| | | | | | - Nicolas Bodeau
- Departement de Psychiatrie de l’Enfant et de l’Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie, Paris, France
| | - David Cohen
- Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie Curie, Paris, France
- Departement de Psychiatrie de l’Enfant et de l’Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie, Paris, France
| | - Catherine Saint-Georges
- Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie Curie, Paris, France
- Departement de Psychiatrie de l’Enfant et de l’Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie, Paris, France
- Hôpital de jour Centre André Boulloche, Paris, France
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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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Abstract
Abstract
ASD research is at an important crossroads. The ASD diagnosis is important for assigning a child to early behavioral intervention and explaining a child’s condition. But ASD research has not provided a diagnosis-specific medical treatment, or a consistent early predictor, or a unified life course. If the ASD diagnosis also lacks biological and construct validity, a shift away from studying ASD-defined samples would be warranted. Consequently, this paper reviews recent findings for the neurobiological validity of ASD, the construct validity of ASD diagnostic criteria, and the construct validity of ASD spectrum features. The findings reviewed indicate that the ASD diagnosis lacks biological and construct validity. The paper concludes with proposals for research going forward.
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Cohen IL, Liu X, Hudson M, Gillis J, Cavalari RNS, Romanczyk RG, Karmel BZ, Gardner JM. Using the PDD Behavior Inventory as a Level 2 Screener: A Classification and Regression Trees Analysis. J Autism Dev Disord 2016; 46:3006-22. [DOI: 10.1007/s10803-016-2843-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sundelin HEK, Larsson H, Lichtenstein P, Almqvist C, Hultman CM, Tomson T, Ludvigsson JF. Autism and epilepsy: A population-based nationwide cohort study. Neurology 2016; 87:192-7. [PMID: 27306624 DOI: 10.1212/wnl.0000000000002836] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/03/2016] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate the risk of autism spectrum disorder (ASD) in individuals with epilepsy and in their first-degree relatives to determine shared etiology. METHODS Through the Swedish Patient Register, we identified 85,201 individuals with epilepsy, as well as all their siblings (n = 80,511) and offspring (n = 98,534). Each individual with epilepsy was compared with 5 controls, matched for age, sex, calendar period, and county, while siblings and offspring were compared with siblings and offspring of controls. We excluded siblings and offspring with epilepsy. Using Cox regression, we calculated hazard ratios (HRs) for future diagnosis of ASD. Logistic regression was applied to calculate odds ratios (ORs) for prior diagnosis of ASD. RESULTS During follow-up, 1,381 (1.6%) individuals with epilepsy and 700 (0.2%) controls were diagnosed with ASD. Individuals with epilepsy were therefore at increased risk of future ASD (HR 10.49, 95% confidence interval [CI] 9.55-11.53), with the highest risk seen in individuals diagnosed with epilepsy in childhood. Both siblings (HR 1.62, 95% CI 1.43-1.83) and offspring (HR 1.64, 95% CI 1.46-1.84) of epilepsy patients were at increased risk of ASD. The risk in the offspring was particularly high in mothers with epilepsy (HR 1.91; 95% CI 1.63-2.23). Epilepsy was also associated with a prior diagnosis of ASD (OR 4.56, 95% CI 4.02-5.18). CONCLUSIONS Individuals with epilepsy are at increased risk of ASD, especially if epilepsy appears in childhood. Further, ASD is more common in the siblings and offspring of individuals with epilepsy, suggesting shared etiology.
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Affiliation(s)
- Heléne E K Sundelin
- From the Department of Pediatrics (H.E.K.S.), University Hospital, Linköping; Departments of Medical Epidemiology and Biostatistics (H.L., P.L., C.A., C.M.H., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), University Hospital, Örebro, Sweden; and Division of Epidemiology and Public Health (J.F.L.), School of Medicine, University of Nottingham, UK.
| | - Henrik Larsson
- From the Department of Pediatrics (H.E.K.S.), University Hospital, Linköping; Departments of Medical Epidemiology and Biostatistics (H.L., P.L., C.A., C.M.H., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), University Hospital, Örebro, Sweden; and Division of Epidemiology and Public Health (J.F.L.), School of Medicine, University of Nottingham, UK
| | - Paul Lichtenstein
- From the Department of Pediatrics (H.E.K.S.), University Hospital, Linköping; Departments of Medical Epidemiology and Biostatistics (H.L., P.L., C.A., C.M.H., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), University Hospital, Örebro, Sweden; and Division of Epidemiology and Public Health (J.F.L.), School of Medicine, University of Nottingham, UK
| | - Catarina Almqvist
- From the Department of Pediatrics (H.E.K.S.), University Hospital, Linköping; Departments of Medical Epidemiology and Biostatistics (H.L., P.L., C.A., C.M.H., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), University Hospital, Örebro, Sweden; and Division of Epidemiology and Public Health (J.F.L.), School of Medicine, University of Nottingham, UK
| | - Christina M Hultman
- From the Department of Pediatrics (H.E.K.S.), University Hospital, Linköping; Departments of Medical Epidemiology and Biostatistics (H.L., P.L., C.A., C.M.H., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), University Hospital, Örebro, Sweden; and Division of Epidemiology and Public Health (J.F.L.), School of Medicine, University of Nottingham, UK
| | - Torbjörn Tomson
- From the Department of Pediatrics (H.E.K.S.), University Hospital, Linköping; Departments of Medical Epidemiology and Biostatistics (H.L., P.L., C.A., C.M.H., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), University Hospital, Örebro, Sweden; and Division of Epidemiology and Public Health (J.F.L.), School of Medicine, University of Nottingham, UK
| | - Jonas F Ludvigsson
- From the Department of Pediatrics (H.E.K.S.), University Hospital, Linköping; Departments of Medical Epidemiology and Biostatistics (H.L., P.L., C.A., C.M.H., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), University Hospital, Örebro, Sweden; and Division of Epidemiology and Public Health (J.F.L.), School of Medicine, University of Nottingham, UK
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Abstract
Previous findings have shown that individuals with autism spectrum disorder (ASD) evince greater intra-individual variability (IIV) in their sensory-evoked fMRI responses compared to typical control participants. We explore the robustness of this finding with a new sample of high-functioning adults with autism. Participants were presented with visual, somatosensory and auditory stimuli in the scanner whilst they completed a one-back task. While ASD and control participants were statistically indistinguishable with respect to behavioral responses, the new ASD group exhibited greater IIV relative to controls. We also show that the IIV was equivalent across hemispheres and remained stable over the duration of the experiment. This suggests that greater cortical IIV may be a replicable characteristic of sensory systems in autism.
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Clinical characteristics of children and young adults with co-occurring autism spectrum disorder and epilepsy. Epilepsy Behav 2015; 47:183-90. [PMID: 25599987 DOI: 10.1016/j.yebeh.2014.12.022] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 11/23/2022]
Abstract
The association between autism spectrum disorder (ASD) and epilepsy has been described for decades, and yet we still lack the full understanding of this relationship both clinically and at the pathophysiologic level. This review evaluates the available data in the literature pertaining to the clinical characteristics of patients with autism spectrum disorder who develop epilepsy and, conversely, patients with epilepsy who develop autism spectrum disorder. Many studies demonstrate an increased risk of epilepsy in individuals with ASD, but rates vary widely. This variability is likely secondary to the different study methods employed, including the study population and definitions of the disorders. Established risk factors for an increased risk of epilepsy in patients with ASD include intellectual disability and female gender. There is some evidence of an increased risk of epilepsy associated with other factors such as ASD etiology (syndromic), severity of autistic features, developmental regression, and family history. No one epilepsy syndrome or seizure type has been associated, although focal or localization-related seizures are often reported. The age at seizure onset can vary from infancy to adulthood with some evidence of a bimodal age distribution. The severity and intractability of epilepsy in populations with ASD have not been well studied, and there is very little investigation of the role that epilepsy plays in the autism behavioral phenotype. There is evidence of abnormal EEGs (especially epileptiform abnormalities) in children with ASD even in the absence of clinical seizures, but very little is known about this phenomenon and what it means. The development of autism spectrum disorder in patients with epilepsy is less well studied, but there is evidence that the ASD risk is greater in those with epilepsy than in the general population. One of the risk factors is intellectual disability, and there is some evidence that the presence of a particular seizure type, infantile spasms, may increase risk, but some of the data are conflicting. We believe that one of the reasons that so little is known about this phenomenon is the lack of cross talk between researchers and clinicians alike in the two fields. We conclude that large systematic studies that employ strict ascertainment of samples using standardized definitions of both disorders, validated data collection tools, and appropriate longitudinal follow-up are needed to better shed light on certain clinical aspects of the comorbidity of ASD and epilepsy. Ideally, we could provide the optimal diagnostic and treatment services to these patients in a multidisciplinary setting with both epilepsy and neurobehavioral specialists. This article is part of a Special Issue entitled "Autism and Epilepsy".
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Guinchat V, Cravero C, Diaz L, Périsse D, Xavier J, Amiet C, Gourfinkel-An I, Bodeau N, Wachtel L, Cohen D, Consoli A. Acute behavioral crises in psychiatric inpatients with autism spectrum disorder (ASD): recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 38:242-255. [PMID: 25575287 DOI: 10.1016/j.ridd.2014.12.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 06/04/2023]
Abstract
During adolescence, some individuals with autism spectrum disorder (ASD) engage in severe challenging behaviors, such as aggression, self-injury, disruption, agitation and tantrums. We aimed to assess risk factors associated with very acute behavioral crises in adolescents with ASD admitted to a dedicated neurobehavioral unit. We included retrospectively in 2008 and 2009 29 adolescents and young adults with ASD hospitalized for severe challenging behaviors and proposed a guideline (Perisse et al., 2010) that we applied prospectively for 29 patients recruited for the same indications between 2010 and 2012. In total, 58 patients were admitted (n=70 hospitalizations, mean age=15.66 (±4.07) years, 76% male). We systematically collected data describing socio-demographic characteristics, clinical variables (severity, presence of language, cognitive level), comorbid organic conditions, etiologic diagnosis of the episode, and treatments. We explored predictors of Global Assessment Functioning Scale (GAFS) score and duration of hospitalization at discharge. All but 2 patients exhibited severe autistic symptoms and intellectual disability (ID), and two-thirds had no functional verbal language. During the inpatient stay (mean=84.3 (±94.9) days), patients doubled on average their GAFS scores (mean=17.66 (±9.05) at admission vs. mean=31.4 (±9.48) at discharge). Most common etiologies for acute behavioral crises were organic causes [n=20 (28%), including epilepsy: n=10 (14%) and painful medical conditions: n=10 (14%)], environmental causes [n=17 (25%) including lack of treatment: n=11 (16%) and adjustment disorder: n=6 (9%)], and non-ASD psychiatric condition [n=33 (48%) including catatonia: n=5 (7%), major depressive episode: n=6 (9%), bipolar disorder: n=4 (6%), schizophrenia: n=6 (9%), other/unknown diagnosis: n=12 (17%)]. We found no influence of age, gender, socio-economic status, migration, level of ID, or history of seizure on improvement of GAFS score at discharge. Severity of autism at admission was the only negative predictor (p<.001). Painful medical conditions (p=.04), non-ASD psychiatric diagnoses (p=.001), prior usage of specialized ASD care programs (p=.004), functional language (p=.007), as well as a higher number of challenging behaviors upon admission (p=.001) were associated with higher GAFS scores at discharge. Clinical severity at admission, based on the number of challenging behaviors (r=.35, p=.003) and GAFS score (r=-.32, p=.008) was correlated with a longer inpatient stay. Longer hospitalization was however correlated (r=.27, p=.03) with higher GAFS score at discharge even after adjustment for confounding factors. Challenging behaviors among adolescents with ASD may stem from diverse risk factors, including environmental problems, comorbid acute psychiatric conditions, or somatic illness such as epilepsy or acute pain. The management of these behavioral challenges requires a unified, multidisciplinary approach.
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Affiliation(s)
- Vincent Guinchat
- Department of Child and Adolescent Psychiatry, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, 47 bd de l'Hôpital, 75013 Paris, France
| | - Cora Cravero
- Department of Child and Adolescent Psychiatry, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, 47 bd de l'Hôpital, 75013 Paris, France
| | - Lautaro Diaz
- Department of Child and Adolescent Psychiatry, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, 47 bd de l'Hôpital, 75013 Paris, France
| | - Didier Périsse
- Department of Child and Adolescent Psychiatry, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, 47 bd de l'Hôpital, 75013 Paris, France
| | - Jean Xavier
- Department of Child and Adolescent Psychiatry, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, 47 bd de l'Hôpital, 75013 Paris, France
| | - Claire Amiet
- Department of Child and Adolescent Psychiatry, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, 47 bd de l'Hôpital, 75013 Paris, France
| | - Isabelle Gourfinkel-An
- Center of Epileptology, Reference Center for Rare Epilepsies and Department of Genetics, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, 47 bd de l'Hôpital, 75013 Paris, France
| | - Nicolas Bodeau
- Department of Child and Adolescent Psychiatry, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, 47 bd de l'Hôpital, 75013 Paris, France
| | - Lee Wachtel
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, 707 North Broadway Street, Baltimore, MD 21205, USA
| | - David Cohen
- Department of Child and Adolescent Psychiatry, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, 47 bd de l'Hôpital, 75013 Paris, France; Institut des Systèmes Intelligents et Robotiques, CNRS UMR 7222, Université Pierre et Marie Curie, 1 Place Jussieu, 75005 Paris, France.
| | - Angèle Consoli
- Department of Child and Adolescent Psychiatry, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, 47 bd de l'Hôpital, 75013 Paris, France; INSERM U669, Maison de Solenn, 97 bd de Port Royal, 75014 Paris, France
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Du X, An Y, Yu L, Liu R, Qin Y, Guo X, Sun D, Zhou S, Wu B, Jiang YH, Wang Y. A genomic copy number variant analysis implicates the MBD5 and HNRNPU genes in Chinese children with infantile spasms and expands the clinical spectrum of 2q23.1 deletion. BMC MEDICAL GENETICS 2014; 15:62. [PMID: 24885232 PMCID: PMC4061518 DOI: 10.1186/1471-2350-15-62] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/13/2014] [Indexed: 02/06/2023]
Abstract
Background Infantile spasms (IS) is a specific type of epileptic encephalopathy associated with severe developmental disabilities. Genetic factors are strongly implicated in IS, however, the exact genetic defects remain unknown in the majority of cases. Rare mutations in a single gene or in copy number variants (CNVs) have been implicated in IS of children in Western countries. The objective of this study was to dissect the role of copy number variations in Chinese children with infantile spasms. Methods We used the Agilent Human Genome CGH microarray 180 K for genome-wide detection of CNVs. Real-time qPCR was used to validate the CNVs. We performed genomic and medical annotations for individual CNVs to determine the pathogenicity of CNVs related to IS. Results We report herein the first genome-wide CNV analysis in children with IS, detecting a total of 14 CNVs in a cohort of 47 Chinese children with IS. Four CNVs (4/47 = 8.5%) (1q21.1 gain; 1q44, 2q31.1, and 17p13 loss) are considered to be pathogenic. The CNV loss at 17p13.3 contains PAFAH1B1 (LIS1), a causative gene for lissencephaly. Although the CNVs at 1q21.1, 1q44, and 2q23.1 have been previously implicated in a wide spectrum of clinical features including autism spectrum disorders (ASD) and generalized seizure, our study is the first report identifying them in individuals with a primary diagnosis of IS. The CNV loss in the 1q44 region contains HNRNPU, a strong candidate gene recently suggested in IS by the whole exome sequencing of children with IS. The CNV loss at 2q23.1 includes MBD5, a methyl-DNA binding protein that is a causative gene of ASD and a candidate gene for epileptic encephalopathy. We also report a distinct clinical presentation of IS, microcephaly, intellectual disability, and absent hallux in a case with the 2q23.1 deletion. Conclusion Our findings strongly support the role of CNVs in infantile spasms and expand the clinical spectrum associate with 2q23.1 deletion. In particular, our study implicates the HNRNPU and MBD5 genes in Chinese children with IS. Our study also supports that the molecular mechanisms of infantile spasms appear conserved among different ethnic backgrounds.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yong-Hui Jiang
- Division of Neurology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai 201102, China.
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