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Spilioti M, Evangeliou AE, Tramma D, Theodoridou Z, Metaxas S, Michailidi E, Bonti E, Frysira H, Haidopoulou A, Asprangathou D, Tsalkidis AJ, Kardaras P, Wevers RA, Jakobs C, Gibson KM. Evidence for treatable inborn errors of metabolism in a cohort of 187 Greek patients with autism spectrum disorder (ASD). Front Hum Neurosci 2013; 7:858. [PMID: 24399946 PMCID: PMC3871708 DOI: 10.3389/fnhum.2013.00858] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 11/25/2013] [Indexed: 12/27/2022] Open
Abstract
We screened for the presence of inborn errors of metabolism (IEM) in 187 children (105 males; 82 females, ages 4–14 years old) who presented with confirmed features of autism spectrum disorder (ASD). Twelve patients (7%) manifested increased 3-hydroxyisovaleric acid (3-OH-IVA) excretion in urine, and minor to significant improvement in autistic features was observed in seven patients following supplementation with biotin. Five diagnoses included: Lesch Nyhan syndrome (2), succinic semialdehyde dehydrogenase (SSADH) deficiency (2), and phenylketonuria (1) (2.7%). Additional metabolic disturbances suggestive of IEMs included two patients whose increased urine 3-OH-IVA was accompanied by elevated methylcitrate and lactate in sera, and 30 patients that showed abnormal glucose-loading tests. In the latter group, 16/30 patients manifested increased sera beta hydroxybutyrate (b-OH-b) production and 18/30 had a paradoxical increase of sera lactate. Six patients with elevated b-OH-b in sera showed improved autistic features following implementation of a ketogenic diet (KD). Five patients showed decreased serum ketone body production with glucose loading. Twelve of 187 patients demonstrated non-specific MRI pathology, while 25/187 had abnormal electroencephalogram (EEG) findings. Finally, family history was positive for 22/187 patients (1st or 2nd degree relative with comparable symptomatology) and consanguinity was documented for 12/187 patients. Our data provide evidence for a new biomarker (3-OH-IVA) and novel treatment approaches in ASD patients. Concise 1 sentence take-home message: Detailed metabolic screening in a Greek cohort of ASD patients revealed biomarkers (urine 3-hydroxyisovaleric acid and serum b-OH-b) in 7% (13/187) of patients for whom biotin supplementation or institution of a KD resulted in mild to significant clinical improvement in autistic features.
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Affiliation(s)
- Martha Spilioti
- First Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Athanasios E Evangeliou
- Fourth Department of Pediatrics, Papageorgiou Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Despoina Tramma
- Fourth Department of Pediatrics, Papageorgiou Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Zoe Theodoridou
- Department of Special Educational Needs, St. Luke's Hospital Thessaloniki, Greece
| | - Spyridon Metaxas
- Second ENT Department, Papageorgiou Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Eleni Michailidi
- Department of Pediatrics, Medical School, University of Crete Heraklion, Greece
| | - Eleni Bonti
- Department of Pediatrics, Papageorgiou Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Helen Frysira
- Department of Pediatrics, Athens University Medical School, Agia Sophia Children's Hospital Athens, Greece
| | - A Haidopoulou
- Fourth Department of Pediatrics, Papageorgiou Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Despoina Asprangathou
- Fourth Department of Pediatrics, Papageorgiou Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Aggelos J Tsalkidis
- Department of Pediatrics, Medical School, University of Thrace Alexandroupolis, Greece
| | - Panagiotis Kardaras
- Third Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Ron A Wevers
- Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine, RUNMC Nijmegen, Netherlands
| | - Cornelis Jakobs
- Metabolic Unit, Department of Clinical Chemistry, VU University Medical Center Amsterdam, Netherlands
| | - K Michael Gibson
- Section of Clinical Pharmacology, College of Pharmacy, Washington State University Spokane, WA, USA
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Bultas MW. The health care experiences of the preschool child with autism. J Pediatr Nurs 2012; 27:460-70. [PMID: 22920657 DOI: 10.1016/j.pedn.2011.05.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 05/11/2011] [Accepted: 05/15/2011] [Indexed: 11/30/2022]
Abstract
It is known that children with autism spectrum disorder (ASD) visit health care providers (HCPs) more frequently than typically developing peers, and mothers experience barriers in this process. The purpose of this interpretive phenomenological study was to gain a better understanding of a mother's experiences of taking her child with ASD to the HCP. Two themes related to the health care experience of the child surfaced from the study. These themes included feelings that HCPs do not "get" the complexity of caring for the child and marginalization of mothers by the HCP. The need for creation of child-specific profiles emerged from this study.
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Autism spectrum disorder in a child with propionic acidemia. JIMD Rep 2012; 7:63-6. [PMID: 23430497 DOI: 10.1007/8904_2012_143] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 03/01/2012] [Accepted: 03/12/2012] [Indexed: 02/07/2023] Open
Abstract
Autism is a neurodevelopmental disorder characterized by a combination of reciprocal social deficits, communication impairment, and rigid ritualistic interests. While autism does not have an identifying cause in most of the cases, it is associated with known medical conditions in at least 10% of cases. Although uncommon, cases of autism have also been reported in association with metabolic disorders. In this brief report, we describe the occurrence of autism in a 7-year-old girl with propionic acidemia (PA), a common form of organic aciduria resulting from the deficiency of propionyl-CoA carboxylase and characterized by frequent and potentially lethal episodes of metabolic acidosis often accompanied by hyperammonemia. It is particularly common in countries with high rates of consanguinity. Early diagnosis of autism in patients with metabolic disorders is important since autistic features are sometimes the most disruptive of all the child's problems. This facilitates providing the needed behavioral services not otherwise available for children with metabolic disorders.
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Bellando J, Lopez M. The school nurse's role in treatment of the student with autism spectrum disorders. J SPEC PEDIATR NURS 2009; 14:173-82. [PMID: 19614826 DOI: 10.1111/j.1744-6155.2009.00195.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE Some healthcare concerns have been found to be commonly associated with Autism Spectrum Disorders (ASD). Identification and treatment of these medical issues can improve the functioning of the child with ASD. This article will offer practical suggestions for the school nurse. CONCLUSIONS As a "front-line" medical professional in the schools, the school nurse is positioned to provide guidance on implementing interventions for the student with ASD. PRACTICE IMPLICATIONS By being knowledgeable about current research and treatment options for the various associated medical conditions, the school nurse can help the student achieve academic success in the school setting.
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Affiliation(s)
- Jayne Bellando
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
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Duby JC, Johnson CP. Universal screening for autism spectrum disorders: a snapshot within the big picture. Pediatr Ann 2009; 38:36-41. [PMID: 19213292 DOI: 10.3928/00904481-20090101-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- John C Duby
- The NeuroDevelopmental Center, Akron Children's Hospital, Akron, Ohio, USA.
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