Diagnostic of cognitive epileptiform disintegration with autism spectrum disorders in children of early ages
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Controversial issues in comorbidity between epilepsy and autism: subclinical epileptiform activity and autistic epileptiform regression
Early childhood autism, or autism spectrum disorders, is an extremely heterogeneous group of conditions that share similar symptoms of dysontogenesis. The most significant comorbidity in patients with autism is epilepsy, which is still associated with a variety of controversies. The present article covers the most controversial aspects of comorbidity between autism and epilepsy, including the impact of psychopharmacotherapy on the risk of epilepsy, clinical significance of epileptiform activity on the electroencephalogram in patients without epilepsy, and criteria for and prevalence of autistic epileptiform regression syndrome. We found that there is still a lack of reliable evidence for the majority of issues related to the combination of autism and epilepsy. We emphasize the need for further studies. We also provide a detailed description of the history, criteria, prevalence, and clinical examples of autistic epileptiform regression syndrome.
Controversial issues in comorbidity between epilepsy and autism: subclinical epileptiform activity and autistic epileptiform regression
Early childhood autism, or autism spectrum disorders, is an extremely heterogeneous group of conditions that share similar symptoms of dysontogenesis. The most significant comorbidity in patients with autism is epilepsy, which is still associated with a variety of controversies. The present article covers the most controversial aspects of comorbidity between autism and epilepsy, including the impact of psychopharmacotherapy on the risk of epilepsy, clinical significance of epileptiform activity on the electroencephalogram in patients without epilepsy, and criteria for and prevalence of autistic epileptiform regression syndrome. We found that there is still a lack of reliable evidence for the majority of issues related to the combination of autism and epilepsy. We emphasize the need for further studies. We also provide a detailed description of the history, criteria, prevalence, and clinical examples of autistic epileptiform regression syndrome.
Введение. В статье рассмотрены проблемы диагностики когнитивной дезинтеграции при расстройствах аутистического спектра у детей раннего возраста, в основе которых лежат эпилептические энцефалопатии. Проанализировано современное состояние научной проблемы относительно этиологии и патогенеза, а также классификации когнитивной дезинтеграции. Впервые показана роль препаратов нейроадаптогенного действия в коррекции симптомов когнитивной дезинтеграции у детей.Цель. Оценка эффективности влияния препаратов нейроадаптогенного действия «Когивис» и «Силента» на проявления когнитивной дезинтеграции у детей с расстройствами аутистического спектра.Материалы и методы. Было обследовано 36 детей с когнитивной дезинтеграцией в возрасте от 3 до 7 лет (средний возраст составил 45,5±8,23 мес.), в том числе 20 мальчиков и 16 девочек. Всем детям был проведен общеклинический и неврологический осмотр, обследование с помощью опросников M-CHAT (модифицированный скрининговый тест на аутизм для детей раннего возраста) и СARS (рейтинговая шкала аутизма у детей), электроэнцефалография (ЭЭГ), видео-ЭЭГ мониторинг ночного сна, магнитно-резонансная томография (МРТ) и трактография головного мозга. Все дети были разделены на 2 группы в зависимости от клинических особенностей:1-я группа (n=19) – дети с преобладанием в клинической картине тревоги, раздражительности, гиперактивности, стереотипного поведения, нарушений ночного сна;2-я группа (n=17) – дети с преобладанием повышенной утомляемости, снижением концентрации внимания и запоминания, задержкой развития речи и когнитивных функций, астено-невротическим синдромом. Детям 1-й группы назначался препарат нейроадаптогенного действия «Силента» по 2,5 мл 3 раза в день в течение 21 дня. Дети 2-й группы получали сироп «Когивис» 2,5 мл 2 раза в день в течение 21 дня. Результаты лечения оценивались с использованием теста АТЕС и проведения МР-трактографии через 1 мес. после окончания курса лечения.Результаты. Показано, что после окончания курса лечения у 78,9% детей 1-й группы отмечалось выраженное улучшение по субшкале IV теста АТЕС (физические функции, поведение), в то же время более 73,6% детей имели положительные результаты по субшкале III (сенсорные и когнитивные функции). У детей данной группы мы отмечали выраженное уменьшение тревоги, раздражительности, эмоциональной лабильности, гиперактивности и стереотипного поведения, нормализацию засыпания и ночного сна.У детей 2-й группы наибольший процент положительных ответов отмечался по субшкалам I – язык и коммуникативные функции (88,2%) и IV – физические функции, поведение (82,3%). У детей данной группы отмечалось снижение утомляемости, увеличение интереса к занятиям, улучшение памяти и концентрации внимания, языковых и когнитивных функций.По результатам проведенной МР-трактографии у детей в обеих группах выявлено статистически достоверное повышение средних показателей фракционной анизотропии и коэффициента диффузии в передних и задних отделах дугообразного тракта доминантного полушария, правого и левого крючкообразных трактов, а также в колене и валике мозолистого тела (p<0,01).Заключение. Показано, что в основе развития когнитивной дезинтеграции у детей раннего возраста преимущественно лежат бессудорожные эпилептические энцефалопатии, проявляющиеся субклиническими приступами и персистирующей эпилептиформной активностью на ЭЭГ. Установлено, что включение в состав терапии препаратов нейроадаптогенного действия «Когивис» и «Силента» улучшает социальное, речевое и когнитивное развитие детей с когнитивной дезинтеграцией. С помощью МР-трактографии установлено, что после курса лечения происходит увеличение показателей фракционной анизотропии в основных трактах головного мозга, что свидетельствует об увеличении толщины и длины указанных трактов, а повышение показателя диффузии указывает на увеличение насыщенности проводящих путей молекулами воды, содержащейся в основном в миелиновых оболочках. Introduction. In the article, there are considered the problems of diagnosis of cognitive disintegration (CD) in autism spectrum disorders in young children that are based on epileptic encephalopathy. The current state of the scientific problem regarding the etiology and pathogenesis, as well as the classification of cognitive disintegration is analyzed. For the first time, the role of neuroadaptogenic drugs in the correction of symptoms of cognitive disintegration in children was showed.Purpose. Evaluation of the effectiveness of the influence of neuroadaptogenic drugs “Cogivis” and “Silenta” on the manifestations of cognitive disintegration in children with autism spectrum disorders.Materials and methods. There were examined 36 children with CD aged from 3 to 7 years (mean age – 45.5±8.23 months), including 20 boys and 16 girls. All children underwent general clinical and neurological examination, examination with the help of M-CHAT questionnaires (modified screening test for autism for young children) and CARS (rating scale for autism in children), electroencephalography (EEG), video-EEG monitoring, including during night sleep, magnetic resonance imaging (MRI), and magnetic resonance tractography of the brain. All children were divided into 2 groups depending on clinical features: the 1st group (19 children) – children with the predominance of anxiety, irritability, hyperactivity, stereotyped behavior, sleep disorders in theclinical picture; the 2nd group (17 children) – children with the predominance of increased fatigue, decreased concentration and memory, delayed speech and cognitive functions, astheno-neurotic syndrome. Children from the 1st group were prescribed the drug of neuroadaptogenic action “Silenta” 2.5 ml 3 times a day for 21 days. Children from the group 2 received “Kogivis” syrup 2.5 ml twice a day for 21 days. The results of treatment were evaluated using the APEC test and MR tractography in 1 month after the end of treatment.Results. It was revealed that after the end of the course of treatment, 78.9% of children from the 1st group showed a marked improvement in the subscale of the IV APEC test (physical functions, behavior), while more than 73.6% of children had positive results in the subscale III (sensory and cognitive functions). In children of this group, we noted a marked decrease of anxiety, irritability, emotional lability, hyperactivity and stereotyped behavior, normalization of sleep and night sleep. In children of the 2nd group, the highest percentage of positive responses was observed on the subscales I – language and communicative functions (88.2%) and IV – physical functions, behavior (82.3%). In children of this group, there was a decrease of fatigue, increased interest in classes, improved memory and concentration, language and cognitive functions. According to the results of MR tractography, in children of both groups, there was revealed a statistically significant increase of the average fractional anisotropy and diffusion coefficient in the anterior and posterior arcuate tract of the dominant hemisphere, right and left hook-shaped tracts, as well as in the knee and body. Conclusion. It was showed that the development of cognitive disintegration in young children is mainly based on non-convulsive epileptic encephalopathy, manifested by subclinical seizures and persistent epileptiform activity on the EEG. It was revealed that the inclusion of neuroadaptogenic drugs “Kogivis” and “Silenta” in the therapy improves the social, speech and cognitive development of the child. MR tractography showed that after the course of treatment, there is the increase of fractional anisotropy in the main tracts of the brain, indicating the increase of the thickness and length of these tracts, and the increase of diffusion, which indicates the increase of saturation of conductive pathways with water molecules in myelin sheaths. Thus, the increase of FA reflects the increase of the thickness of the tract, and the increase of ADA – the increase of myelin content.
SYSTEM OF INTENSIVE NEUROPHYSIOLOGY REHABILITATION IN THE COMPLEX REHABILITATION OF CHILDREN WITH AUTISTIC SPECTRUM DISORDERS: APPLICATION EXPERIENCE AND EVALUATION OF EFFICIENCY Yurii G. Antipkin, Liudmyla G. Kyrylova, Oleksandr O. Miroshnikov State University «Academician O. M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the National Academy of Medical Sciences of Ukraine», Platona Maiborody Str., 8, Kyiv 04050, Ukraine Introduction. Today, autistic spectrum disorders (ASD) remain one of the most important and complex problems of modern neuropediatrics and rehabilitation, due to their increasing prevalence in all countries of the world, the complexity of early diagnosis, and the ambiguity of treatment strategies. In separate studies, the positive impact of the system of intensive neurophysiological rehabilitation (INR) according to the method of prof. V.I. Kozyavkin on motor and coordination functions of children with autism spectrum disorders was proved. The aim of the work is to determine the effectiveness of the system of intensive neurophysiological rehabilitation in children with ASD, as well as to study its influence on the dynamics of language, social and communicative functions in this group of children. Materials and methods. We observed 55 children with ASD aged 2-6 years (average age 3.80 ± 1.22 years), among them 32 boys and 23 girls. All children had an established diagnosis of ASD, according to the DSM-V criteria and the results of the M-CHAT questionnaire. A comprehensive examination of the state of the children's nervous system was carried out using a generally accepted neurological examination, video-EEG monitoring, brain MRI and MR-tractography. Results. In most children of the main group, after the end of the treatment course, improvement in all subscales of APEC was noted. On all four scales, the children of the main group managed to achieve higher positive results of treatment compared to the control group. However, compared to the indicators of children in the control group, statistically significant differences were found only on scales I (language, communicative functions) and IV (physical functions, behavior). In the children of the main group, there was a decrease in hyperactivity, improvement in self-control, a decrease in the level of aggression and self-aggression, normalization of muscle tone, improvement in gross and fine motor skills, gait, balance, and posture correction. Conclusions. The results of our study show that among 55 children with ASD who received treatment using the system of intensive neurophysiological rehabilitation, the majority of patients showed improvement in language, cognitive, and social functions, increased range of motion, and improvement in gross and fine motor skills. Thus, the results of the conducted study showed a positive impact of the INR on the physical, communicative and cognitive functions of children with ASD. Keywords: system of intensive neurophysiological rehabilitation, V. I. Kozyavkin's method, autistic spectrum disorders, magnetic resonance tractography, rehabilitation.
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