Síndrome de Landau-Kleffner e regressão autística: a importância do diagnóstico diferencial

Early Intervention in Autism Spectrum Disorder

Abstract. Early intervention in autism has become possible with the identification of this disorder at earlier ages, but the scientific production on this subject is still very incipient. The present study aimed to characterize scientific production in Brazil regarding early intervention in the Autism Spectrum Disorder (ASD), resorting to the database of the Capes Journal Platform ( Plataforma de Periódicos Capes). The procedure used for the theoretical search was an integrative literature review. The discussion on the analysis of the review occurred with the inclusion of articles published in Portuguese, between 2001 and 2020, with the keywords: “intervention”, “early” and “autism.” As a result, a total of 83 texts were found. Of this total, 65 articles were published in peer-reviewed journals and made available as an online resource on the Capes Journal Platform. In the next phase of data analysis, we decided to categorize the articles included in the search process ( N = 25), based on the following categories: “autism” (19) and “early autism intervention” (6). A very low percentage of publications related to this topic were identified in the search universe, although an increase in studies has been observed in recent years. Nonetheless, we concluded that the six articles on early intervention agree that the sooner the disorder is diagnosed and the child is stimulated, the greater the effectiveness in the development of communication and language, as well as social interaction.

Landau-Kleffner syndrome: a rare auditory processing disorder series of cases and review of the literature

OBJECTIVE

To describe the clinical presentation and treatment of 3 children with an Auditory Processing Disorder with an identifiable neurological cause: Landau-Kleffner syndrome. This classical syndrome is well recognized in pediatric neurology but the diagnosis is less well known to Pediatric Otolaryngology, Speech Language Pathology and Audiology services.

METHODS

Retrospective chart review of three patients with Landau-Kleffner syndrome.

RESULTS

In all cases, pharmacological intervention led to clinical and electroencephalographic improvement, but all patients had long-term difficulty with understanding sounds in a noisy environment. Magnetic Resonance Imaging (MRI) of the brain was normal in all three patients. Their language disturbance improved over time. Speech language intervention was helpful in addressing communication difficulties arising from the auditory processing/receptive and expressive language disorder.

CONCLUSION

A multidisciplinary assessment is the key for early diagnosis, treatment and follow-up in patients with this syndrome.

Early-onset acquired epileptic aphasia (Landau-Kleffner syndrome, LKS) and regressive autistic disorders with epileptic EEG abnormalities: the continuing debate

Early-onset acquired epileptic aphasia (Landau-Kleffner syndrome) may present as a developmental language disturbance and the affected child may also exhibit autistic features. Landau-Kleffner is now seen as the rare and severe end of a spectrum of cognitive-behavioural symptoms that can be seen in idiopathic (genetic) focal epilepsies of childhood, the benign end being the more frequent typical rolandic epilepsy. Several recent studies show that many children with rolandic epilepsy have minor developmental cognitive and behavioural problems and that some undergo a deterioration (usually temporary) in these domains, the so-called "atypical" forms of the syndrome. The severity and type of deterioration correlate with the site and spread of the epileptic spikes recorded on the electroencephalogram within the perisylvian region, and continuous spike-waves during sleep (CSWS) frequently occur during this period of the epileptic disorder. Some of these children have more severe preexisting communicative and language developmental disorders. If early stagnation or regression occurs in these domains, it presumably reflects epileptic activity in networks outside the perisylvian area, i.e. those involved in social cognition and emotions. Longitudinal studies will be necessary to find out if and how much the bioelectrical abnormalities play a causal role in these subgroup of children with both various degrees of language and autistic regression and features of idiopathic focal epilepsy. One has to remember that it took nearly 40 years to fully acknowledge the epileptic origin of aphasia in Landau-Kleffner syndrome and the milder acquired cognitive problems in rolandic epilepsies.