Trastornos neuropsiquiátricos autoinmunes asociados a infecciónestreptocócica en la edad pediátrica / Autoimmune neuropsychiatric disorders associated with streptococcal infection in the pediatric age

Objetivo: Identificar los aspectos clínicos de pacientes pediátricos con trastornos neuropsiquiátricos autoinmunes, asociados a infección estreptocócica.Métodos: Se realizó un estudio descriptivo. Se tomó la información de las historias clínicas de todos los pacientes cubanos con trastornos neuropsiquiátricos autoinmunesasociados a infección estreptocócica en edad pediátrica, atendidos en el CentroInternacional de Restauración Neurológica de La Habana, entre enero de 2001 y agosto de 2018. Hubo 56 pacientes que cumplieron con los criterios diagnósticos de dicho trastorno, y todos fueron incluidos en el estudio. Entre las variables más relevantesanalizadas estuvieron la edad de inicio de los síntomas, la historia de infecciones recurrentes y los síntomas clínicos. Para el análisis de los datos se utilizaron métodos de la estadística descriptiva, como la media aritmética, la moda, la proporción y los porcentajes.Resultados: La edad promedio de inicio del cuadro fue de 6,7 ± 2,7 años (desviación estándar). Refirieron alguna infección a repetición 36 pacientes (64,29 Por ciento). Los síntomasclínicos más frecuentes fueron tics y trastornos de conducta en 52 casos (92,86 Por ciento), seguido por trastorno de déficit de atención con hiperactividad en 41 (73,21 Por ciento) y deterioro en el rendimiento escolar en 27 (48,21 Por ciento).Conclusiones: Los trastornos neuropsiquiátricos autoinmunes asociados a infección estreptocócica en la edad pediátrica fueron más frecuentes en los pacientes del sexomasculino. Están relacionados con la presencia de infecciones a repetición, sobre todo de las vías respiratorias alta. No está claro su carácter hereditario. Los síntomas pueden ser disímiles y, en algunos casos, difíciles de definir. El motivo de consulta más frecuente de estos pacientes fue las tics(AU)

Objective: To identify the clinical aspects of pediatric patients with autoimmune neuropsychiatric disorders associated with streptococcal infection.Methods: A descriptive study was carried out. Information was taken from the medical records of all Cuban pediatric patients with autoimmune neuropsychiatric disorders associated with streptococcal infection, treated at the International NeurologicalRestoration Center of Havana, from January 2001 to August 2018. Fifty-six (56) patients met the diagnostic criteria for this disorder, and all were included in this study.The most relevant variables analyzed were age of the onset of symptoms, history of recurrent infections and clinical symptoms. Descriptive statistics methods were used for data analysis, such as the arithmetic mean, mode, proportion and percentages.Results: The age average of the onset of symptoms was of 6, 7 ± 2,7 years (standard deviation). Thirty-six patients referred some repeated infection (64,29 Per cent). The clinical most frequent symptoms were tics and behavior dysfunctions in 52 cases (92,86 Per cent), followed by dysfunction of deficit of attention with hyperactivity in 41 (73,21 Per cent) and poor school performance in 27 (48,21 Per cent).Conclusions: Autoimmune neuropsychiatric disorders associated with streptococcal infection in the pediatric age were more frequent in male patients. They are related tothe presence of repeated infections, especially of the upper respiratory tract. Its hereditary character is not clear. The symptoms can be dissimilar and, in some cases, difficult to define. The most frequent reason for consultation of these patients was tics(AU)

Conectividad funcional derivada del electroencefalograma durante el sueño no REM en los trastornos del espectro autista / Functional connectivity derived from an electroencephalogram during non-REM sleep in autism spectrum disorders

Objetivo. Conocer las diferencias en los patrones de conectividad funcional, las características topológicas de la red y la relación de éstas con las anomalías epileptiformes interictales en niños con trastorno del espectro autista (TEA) primario y secundario. Pacientes y métodos. Se realizó un estudio retrospectivo con 27 niños de 3-13 años diagnosticados con TEA, a los que se les realizó un electroencefalograma en estado funcional de sueño espontáneo. Se analizó la conectividad funcional y las propiedades de la red a partir de los datos obtenidos del electroencefalograma durante la etapa N2 del sueño no REM. Se determinó la frecuencia de descarga de la actividad epileptiforme interictal (FDAEI) y se correlacionó con las propiedades topológicas de la red. Resultados. Los pacientes con TEA secundario tenían una disminución de la sincronización para la frecuencia alfa y un incremento para la frecuencia theta y delta en comparación con los pacientes con TEA primario. La eficiencia local alfa fue mayor en los pacientes que presentaban actividad epileptiforme interictal. Además, en los pacientes con TEA secundario, existía una correlación positiva y negativa estadísticamente significativa entre la FDAEI y las propiedades topológicas de red. Conclusiones. Los pacientes con TEA secundario muestran patrones de conectividad funcional más débiles para la frecuencia alfa y más fuerte para la theta y delta que los pacientes con TEA primario. En pacientes con TEA secundario, la actividad epileptiforme interictal se relaciona con la conectividad local y global de la red para las bandas de frecuencia alfa y beta durante el sueño no REM

Aim. To know the differences in the patterns of functional connectivity, the topological characteristics of the network and the relationship between these latter and the interictal epileptiform anomalies in children with primary and secondary autism spectrum disorder (ASD). Patients and methods. A retrospective study was conducted with 27 children aged between 3 and 13 years diagnosed with ASD. Subjects were submitted to an electroencephalogram in a functional state of spontaneous sleep. Functional connectivity and the properties of the network were analysed using data obtained from the electroencephalogram during the N2 stage of non-REM sleep. The frequency of discharge of the interictal epileptiform activity (FDIEA) was determined and was correlated with the topological properties of the network. Results. Synchronisation was diminished in patients with secondary ASD for the alpha frequency and increased for the theta and delta frequency compared with patients with primary ASD. Local alpha efficiency was higher in patients who presented interictal epileptiform activity. Additionally, in patients with secondary ASD there was a statistically significant positive and negative correlation between FDIEA and the topological properties of the network. Conclusions. Patients with secondary ASD display patterns of functional connectivity that are weaker for the alpha frequency and stronger for theta and delta than patients with primary ASD. In patients with secondary ASD, the interictal epileptiform activity is related to local and global connectivity of the network for the alpha and beta bands during non-REM sleep

Non-Invasive Brain Stimulation for Children with Autism Spectrum Disorders: A Short-Term Outcome Study.

Non-Invasive Brain Stimulation (NIBS) is a relatively new therapeutic approach that has shown beneficial effects in Autism Spectrum Disorder (ASD). One question to be answered is how enduring its neuromodulatory effect could be. Twenty-four patients with ASD (mean age: 12.2 years) received 20 sessions of NIBS over the left dorsolateral prefrontal cortex (L-DLPFC). They were randomized into two groups with two (G1) or three (G2) clinical evaluations before NIBS. Both groups had a complete follow-up at six months after the intervention, with the aim of determining the short-term outcome using the total score on the Autism Behavior Checklist, Autism Treatment Evaluation Checklist, and the Autism Diagnostic Interview. Transcranial Direct Current Stimulation (tDCS) was used in ASD patients aged <11 years, and repetitive Transcranial Magnetic Stimulation (rTMS) for 11-13-year-olds. Observation points were at one, three, and six months after completing all the sessions of NIBS. A significant reduction in the total score on the three clinical scales was observed and maintained during the first six months after treatment, with a slight and non-significant tendency to increase the scores in the last evaluation. Twenty sessions of NIBS over the L-DLPFC improves autistic symptoms in ASD children, with a lasting effect of six months.

Peripheral Inflammatory Markers Contributing to Comorbidities in Autism.

This study evaluates the contribution of peripheral biomarkers to comorbidities and clinical findings in autism. Seventeen autistic children and age-matched typically developing (AMTD), between three to nine years old were evaluated. The diagnostic followed the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DMS-IV) and the Childhood Autism Rating Scale (CARS) was applied to classify the severity. Cytokine profile was evaluated in plasma using a sandwich type ELISA. Paraclinical events included electroencephalography (EEG) record. Statistical analysis was done to explore significant differences in cytokine profile between autism and AMTD groups and respect clinical and paraclinical parameters. Significant differences were found to IL-1ß, IL-6, IL-17, IL-12p40, and IL-12p70 cytokines in individuals with autism compared with AMTD (p < 0.05). All autistic patients showed interictalepileptiform activity at EEG, however, only 37.5% suffered epilepsy. There was not a regional focalization of the abnormalities that were detectable with EEG in autistic patients with history of epilepsy. A higher IL-6 level was observed in patients without history of epilepsy with interictalepileptiform activity in the frontal brain region, p < 0.05. In conclusion, peripheral inflammatory markers might be useful as potential biomarkers to predict comorbidities in autism as well as reinforce and aid informed decision-making related to EEG findings in children with Autism spectrum disorders (ASD).