N-ацетилцистеин как корректор раздражительности при детском аутизме

Background

This study examined the efficacy and safety of N-acetylcysteine (NAC) augmentation for treating irritability in children and adolescents with autism spectrum disorders (ASD).

Method

Forty children and adolescents met diagnostic criteria for ASD according to DSM-IV. They were randomly allocated into one of the two groups of NAC (1200mg/day)+risperidone or placebo+risperidone. NAC and placebo were administered in the form of effervescent and in two divided doses for 8 weeks. Irritability subscale score of Aberrant Behavior Checklist (ABC) was considered as the main outcome measure. Adverse effects were also checked.

Results

The mean score of irritability in the NAC+risperidone and placebo+risperidone groups at baseline was 13.2(5.3) and 16.7(7.8), respectively. The scores after 8 weeks were 9.7(4.1) and 15.1(7.8), respectively. Repeated measures of ANOVA showed that there was a significant difference between the two groups after 8 weeks. The most common adverse effects in the NAC+risperidone group were constipation (16.1%), increased appetite (16.1%), fatigue (12.9%), nervousness (12.9%), and daytime drowsiness (12.9%). There was no fatal adverse effect.

Conclusions

Risperidone plus NAC more than risperidone plus placebo decreased irritability in children and adolescents with ASD. Meanwhile, it did not change the core symptoms of autism. Adverse effects were not common and NAC was generally tolerated well.

A randomized double blind placebo controlled clinical trial of N-Acetylcysteine added to risperidone for treating autistic disorders

Исследования арбаклофена

The investigational γ-aminobutyric acid type B (GABA-B) agonist STX209 (arbaclofen, Seaside Therapeutics) may improve social function and behavior in patients with fragile X syndrome (FXS).

In a randomized, controlled phase 2 study of children and adults with FXS, investigators from Rush University Medical Center in Chicago found that treatment with arbaclofen was well tolerated and improved social avoidance and problem behaviors.

Drug Shows Promise in Fragile X and Possibly Autism 

N-ацетилцистеин в коррекции возбудимости у детей с аутизмом

Background
An imbalance in the excitatory/inhibitory systems with abnormalities in the glutamatergic pathways has been implicated in the pathophysiology of autism. Furthermore, chronic redox imbalance was also recently linked to this disorder. The goal of this pilot study was to assess the feasibility of using oral N-acetylcysteine (NAC), a glutamatergic modulator and an antioxidant, in the treatment of behavioral disturbance in children with autism.
Methods
This was a 12-week, double-blind, randomized, placebo-controlled study of NAC in children with autistic disorder. Subjects randomized to NAC were initiated at 900 mg daily for 4 weeks, then 900 mg twice daily for 4 weeks and 900 mg three times daily for 4 weeks. The primary behavioral measure (Aberrant Behavior Checklist [ABC] irritability subscale) and safety measures were performed at baseline and 4, 8, and 12 weeks. Secondary measures included the ABC stereotypy subscale, Repetitive Behavior Scale-Revised, and Social Responsiveness Scale.
Results
Thirty-three subjects (31 male subjects, 2 female subjects; aged 3.2–10.7 years) were randomized in the study. Follow-up data was available on 14 subjects in the NAC group and 15 in the placebo group. Oral NAC was well tolerated with limited side effects. Compared with placebo, NAC resulted in significant improvements on ABC irritability subscale (F = 6.80; p < .001; d = .96).
Conclusions
Data from this pilot investigation support the potential usefulness of NAC for treating irritability in children with autistic disorder. Large randomized controlled investigations are warranted.

 A Randomized Controlled Pilot Trial of Oral N-Acetylcysteine in Children with Autism

Лабораторная диагностика РДА

The urine test, which detects elevated levels of compounds called porphyrins, costs $50 to $100. Heyer said the test would become less expensive if used frequently as a way to screen babies.
James Woods, a researcher at the University of Washington who worked on the project with Battelle researchers, noted that everybody has the compounds in their urine, but the levels were clearly higher in certain children in the study. Also, although the study included only boys (who are much more likely to have autism than girls), Woods said that the test would likely work for both genders based on other research.
Heyer noted that although there’s been speculation that elevated porphyrin levels are related to mercury exposure in autistic children, the research team found no link to increased exposure to mercury. This leaves the question open of why the compounds are higher in some children with autism.

 Pilot Study: Urine Test Detects One-Third of Autism Cases

Исследование влияния диет без глютена или казеина на симптоматику расстройств аутистического спектра

For those children with GI and allergy symptoms, a gluten-free, casein-free diet was more effective in improving ASD behaviors, physiological symptoms and social behaviors compared to children without these symptoms.
Specifically, when a gluten-free, casein-free diet was strictly followed, parents witnessed an improvement in GI symptoms in their children as well as improvements in social behaviors, such as language production, eye contact, engagement, attention span, requesting behavior and social responsiveness.
Autism may be more than a neurological disease, says Laura Cousino Klein, associate professor of bio-behavioral health and human development and family studies—it may involve the GI tract and the immune system.
“There are strong connections between the immune system and the brain, which are mediated through multiple physiological symptoms,” Klein said. “A majority of the pain receptors in the body are located in the gut, so by adhering to a gluten-free, casein-free diet, you’re reducing inflammation and discomfort that may alter brain processing, making the body more receptive to ASD therapies.”
Furthermore, when all gluten and casein was removed from the diet, parents reported that a greater number of ASD behaviors, physiological symptoms and social behaviors improved in their children compared to those whose parents did not eliminate all gluten and casein. Also, parents who implemented the diet for six months or less reported that the diet was less effective in reducing ASD behaviors.
Some of the parents had eliminated only gluten or only casein from the diet, but survey results suggested that parents who completely eliminated both gluten and casein reported the most benefit.

Gluten-Free, Casein-Free Diet Shows Promise for Autism Symptoms

Циклосерин и аутизм

Researchers have launched a pilot clinical trial of a new medication aimed at relieving the sociability problems of adolescent and young adult patients with autism spectrum disorders (ASD).

The medication used, D-Cycloserine, originally was developed to treat tuberculosis, but previous studies showed, by chance, that it might change social behavior.

New Drug May Ease Social Impairment of Autism

Аутистическая симптоматика в результате вирусного поражения головного мозга

What happened to her? She suffered from herpes simplex encephalitis, a viral infection of the brain. X-rays at the age of 22 showed serious damage to the temporal lobes of the brain, extending to parts of the parietal lobes. (No pictures were provided, however.)

Can her case really be described as a "typical autistic syndrome"? Certainly, there are striking similarities, from the obsessive routines, to the echolalia (repeating what other people say), to the avoidance of eye contact, all classic symptoms of severe autism.

Of course it's always possible that the case report was written to accentuate these similarities, in order to make a nice publication. There have been a handful of other similar cases, though the same caveats apply. Still, if we do accept that these patients are indeed autistic, the implications for understanding the neurobiology of "normal" autism are obvious.

Autism Following Viral Infection

Детский аутизм и эпилепсия

Medscape: What is the risk for epilepsy in autism?

Dr. Chez: The risk for epilepsy in autism is 10%-30%, and it usually develops in the teenage or early adult years. Children with autism who are lower functioning, with mental retardation and cerebral palsy, for example, are more likely to develop epilepsy.

In addition, there are many children with autism who demonstrate epileptic spikes when monitored on 24-hour electroencephalography, but who do not manifest clinical epileptic seizures. These may be worth treating with antiepileptic drugs, as treatment may lead to improved behavior and receptive language. If the spikes are in the central temporal region, affecting the language area, I will usually try a trial of valproic acid. Valproic acid may also act as a mood stabilizer in these children, and also inhibits interleukin 1 cytokines, which may provide additional benefit. Other antiepileptic drugs may also be effective, although I have not seen good results with carbamazepine. There is also anecdotal evidence of improvement with the ketogenic diet.

Dr. Pellock: This is a controversial area. There are a few cases where treatment of epileptic spikes has resulted in improved behavior. However, without a clear manifestation of seizures, it is frequently difficult to know whether the short and long-term risks of the medications are really warranted. Clear goals need to be established to determine whether the treatment benefits the child. As a routine, I do not treat isolated spikes on the electroencephalogram, just as I would not treat isolated spikes in any child, with or without autism.

An Update on Autism -- Perspectives and Treatment: Autism and Epilepsy

СИОЗС не рекомендуются при аутизме

SSRIs Not Recommended for Autism in Children or Adults Based on Current Evidence