La stimulation du nerf vague pour le traitement de la dépression réfractaire : les résultats après un an de suivi

La stimulation du nerf vague (SNV) a reçu l’approbation de Santé Canada en 2001, comme en Europe, pour le traitement de la dépression réfractaire et en 2005 aux États-Unis. Les études européennes et américaines rapportent un taux de réponse de 50% et de rémission de 30% après un an de traitement. La sélection des patients, encadrée par la recherche de marqueurs biologiques et des critères de résistance, pourrait contribuer à améliorer les taux de réponse. Cette étude décrit le suivi des patients ambulatoires souffrant de dépression réfractaire, d’un spectre unipolaire ou bipolaire (n=13) sous SNV. Une révision exhaustive de l’histoire médicale et thérapeutique précède une évaluation clinique intensive. Si un consensus d’équipe est obtenu, une investigation clinique à la recherche des marqueurs biologiques est effectuée. Ceci inclut une tomographie par émission de photons simples (SPECT), une tomographie par émission de positrons (TEP), une formule sanguine complète, un test de suppression à la dexaméthasone (DST), une collecte d’urine 24h (catécholamines et cortisol), une polysomnographie et une évaluation neuropsychologique abrégée. Après 1 an de traitement, 61,5% (8/13) des patients ont atteint le seuil de réponse (diminution de 50% des symptômes), dont 87.5% (7/8) en rémission. Les patients diagnostiqués d’un trouble bipolaire, présentant un DST anormal et/ou avec déficits cognitifs ont répondu au traitement et poursuivent leur rémission après 2 ans. Une sélection minutieuse des patients pour le SNV serait une méthode efficace pour traiter les dépressions réfractaires, notamment pour prévenir les rechutes, amenant un état euthymique durable pour la plupart des patients.

Une signature du polymorphisme structural d’acides ribonucléiques non-codants permettant de comparer leurs niveaux d’activités biochimiques

Des évidences expérimentales récentes indiquent que les ARN changent de structures au fil du temps, parfois très rapidement, et que ces changements sont nécessaires à leurs activités biochimiques. La structure de ces ARN est donc dynamique. Ces mêmes évidences notent également que les structures clés impliquées sont prédites par le logiciel de prédiction de structure secondaire MC-Fold. En comparant les prédictions de structures du logiciel MC-Fold, nous avons constaté un lien clair entre les structures presque optimales (en termes de stabilité prédites par ce logiciel) et les variations d’activités biochimiques conséquentes à des changements ponctuels dans la séquence. Nous avons comparé les séquences d’ARN du point de vue de leurs structures dynamiques afin d’investiguer la similarité de leurs fonctions biologiques. Ceci a nécessité une accélération notable du logiciel MC-Fold. L’approche algorithmique est décrite au chapitre 1. Au chapitre 2 nous classons les impacts de légères variations de séquences des microARN sur la fonction naturelle de ceux-ci. Au chapitre 3 nous identifions des fenêtres dans de longs ARN dont les structures dynamiques occupent possiblement des rôles dans les désordres du spectre autistique et dans la polarisation des œufs de certains batraciens (Xenopus spp.).

Eficacia de las intervenciones psicoeducativas en pacientes con esquizofrenia: una revisión sistemática

Introducción: La esquizofrenia es una enfermedad crónica que genera deterioro cognitivo y diversos grados de discapacidad. Dentro del tratamiento no solo debe considerarse el abordaje farmacológico sino también un enfoque psicoterapéutico. La psicoeducación es una intervención terapéutica con alto potencial en el manejo de pacientes con esquizofrenia, tiene importantes resultados especialmente en el área cognitiva. Métodos: Revisión sistemática de la literatura de artículos de bases de datos y búsqueda manual de revistas relacionadas que aportaran la mejor evidencia. Se evaluó calidad metodológica de los estudios y estos se organizaron en tablas de evidencia. Resultados: De 34 artículos potenciales, se seleccionaron finalmente dos para ser incluidos en la revisión. Se clasificaron como nivel de evidencia I. A pesar de la ambigüedad de las comparaciones, en general, las intervenciones psicoeducativas aportan beneficios con disminución de recaídas y reingresos hospitalarios. Discusión: La amplia gama de comparaciones aportó complejidad en el momento de incluir estudios para la presente revisión, la falta de detalle sobre aspectos propios de la intervención utilizada en cada estudio, generó limitaciones al momento de realizar comparaciones. La psicoeducación aporta beneficios, sin embargo debe tenerse en cuenta el compromiso cognitivo propio de la enfermedad, al momento de evaluar los desenlaces de este tipo de intervenciones. Conclusión: Las intervenciones psicoeducativas juegan un importante papel en el tratamiento de los pacientes con esquizofrenia. Es necesaria la realización de más estudios que consoliden con mayor firmeza la evidencia científica en éste área en particular.

Efectividad del tratamiento con neurofeedback en trastornos del estado del ánimo, ansiedad y fibromialgia: una revisión de literatura

El neurofeedback es una técnica no invasiva en la que se pretende corregir, mediante condicionamiento operante, ondas cerebrales que se encuentren alteradas en el electroencefalograma. Desde 1967, se han conducido numerosas investigaciones relacionadas con los efectos de la técnica en el tratamiento de alteraciones psicológicas. Sin embargo, a la fecha no existen revisiones sistemáticas que reúnan los temas que serán aquí tratados. El aporte de este trabajo es la revisión de 56 artículos, publicados entre los años 1995 y 2013 y la evaluación metodológica de 29 estudios incluidos en la revisión. La búsqueda fue acotada a la efectividad del neurofeedback en el tratamiento de depresión, ansiedad, trastorno obsesivo compulsivo (TOC), ira y fibromialgia. Los hallazgos demuestran que el neurofeedback ha tenido resultados positivos en el tratamiento de estos trastornos, sin embargo, es una técnica que aún está en desarrollo, con unas bases teóricas no muy bien establecidas y cuyos resultados necesitan de diseños metodológicamente más sólidos que ratifiquen su validez.

Corticosteroides vs dosis bajas de adrenocorticotropina en el tratamiento de espasmos infantiles. Revisión sistemática de la literatura

Antecedentes: El tratamiento de los espasmos infantiles generalmente se realiza con ACTH a pesar de perfil de efectos secundarios y el alto costo financiero. Se ha propuesto el uso de los corticoides como primera línea de tratamiento para la enfermedad, no obstante no existe certeza sobre la eficacia de este esquema. Objetivos: Evaluar la eficacia del uso de los corticoides comparados con la ACTH como primera línea de tratamiento en el manejo de pacientes con espasmos infantiles. Metodología: Se realizó una revisión sistemática de la literatura. La búsqueda se efectuó en las bases de datos Pubmed, Embase, Ovid, LiLaCs y en el registro de ensayos clínicos de Estados Unidos. Se incluyeron estudios en portugués, ingles y español, no se fijo límite de tiempo para la publicación. Se realizó un análisis de riesgo de sesgo y de calidad de la evidencia utilizando el programa GRADEPRO. Se estimaron OR y sus respectivos intervalos de confianza al 95%. Resultados: Se incluyeron 4 estudios, un ensayo clínico y tres estudios de cohorte retrospectiva. Dos estudios aportaron evidencia de calidad moderada y alta. No se encontraron diferencias en la eficacia a corto plazo entre el uso de los corticoides y la ACTH sobre desenlaces clínicos o electroencefalográficos. No se encontraron estudios de seguridad a largo plazo. La seguridad a corto plazo no mostró diferencias. Conclusiones: Es muy probable que el uso de los corticoides como primera línea de tratamiento puedan reemplazar el uso de la ACTH, se requiere estudios de seguridad a largo plazo. La decisión de su uso rutinario debería estar basada en un análisis de costo efectividad y bajo la mirada del balance riesgo/beneficio.

Eficacia y seguridad del aripiprazol en trastornos del espectro autista en población infanto-juvenil: revisión sistemática de la literatura

Aunque han pasado cinco años desde su aprobación en Estados Unidos para el manejo de los Trastornos del Espectro Autista (TEA), en Colombia el uso de aripiprazol para esta indicación continúa siendo off-label. En este contexto, se ha propuesto la ejecución de una revisión sistemática de la literatura con el fin de conocer la eficacia y seguridad de esta estrategia terapéutica a la luz de la evidencia disponible en el manejo de niños y adolescentes con TEA

Alunos com autismo : grau de aceitação por parte dos pares

As crianças com perturbações do Espectro do Autismo revelam acentuadas limitações ao nível das interacções sociais, tanto pela ausência de iniciação interativa com os seus pares, como pela falta de resposta às atitudes afetivas dos mesmos. Esta incapacidade para estabelecer relações sociais dificulta o convívio, mesmo quando os seus pares demonstram interesse em brincar. Ao longo da realização deste trabalho, através das leituras, vários autores referiram a importância da promoção das competências sociais nestas crianças. Com este estudo procura-se saber como são aceites os alunos com perturbações do Espectro do Autismo pelos seus pares sem Necessidades Educativas Especiais em contexto escolar. Propõe-se, assim, recolher as opiniões de vários alunos que frequentam o mesmo centro escolar face à presença de um colega com perturbações do Espectro do Autismo, de modo a fazer uma análise dos dados obtidos, bem como a elaboração de um plano de intervenção para uma melhoria da situação problema. Com base na análise das entrevistas realizadas no âmbito do estudo pode-se afirmar que os resultados da investigação revelam um contexto escolar positivo e empenhado no apoio aos alunos com perturbações do Espectro do Autismo. De acordo com os inquiridos e com os investigadores estudados na revisão da literatura é possível afirmar que o desenvolvimento das atividades lúdicas e um acompanhamento personalizado por um professor especializado, bem como a integração na turma, são fatores fundamentais para um melhor desenvolvimento global dos alunos em questão e para a prevenção de atitudes discriminatórias entre pares.

Ao encontro da inclusão: Uma tentativa de promover a autonomia e o sucesso de uma aluna com autismo, na disciplina de Matemática, através de estratégias de aprendizagem cooperativa

A Escola Inclusiva é a conquista recente de uma sociedade culta e democrática que vê na educação um campo de luta pelo cumprimento dos direitos à igualdade de todos os cidadãos independentemente das suas características individuais, exigindo uma escola que não discrimine e aceite a diferença. O trabalho apresentado é decorrente do Projeto de Intervenção, fundamentado na investigação-ação, realizado no âmbito do Curso de 2º ciclo em Educação Especial. Com este projeto quisemos minimizar dificuldades apresentadas por uma aluna com características do espectro do autismo, na área curricular disciplinar de Matemática e da socialização, numa perspectiva inclusiva. O enquadramento teórico abordou a Educação Inclusiva, a Escola Inclusiva, a Aprendizagem Cooperativa e as Perturbações do Espectro do Autismo. Como instrumentos, utilizámos a pesquisa documental, a entrevista semi-directiva à professora de Educação Espacial, a observação naturalista e a sociometria. A planificação global da intervenção, equacionada numa perspectiva de escola inclusiva, foi elaborada a partir do relacionamento/ cruzamento dos dados que resultaram da análise da informação recolhida, avaliados ao longo de todo o processo. A intervenção permitiu-nos constatar que a aluna fez aprendizagens significativas na área académica e social. Assim, nesta intervenção, confrontámo-nos com o desafio de práticas educativas, diferenciadas e inclusivas. Estas práticas, por sua vez, contribuíram para que os colegas e pais a olhassem de forma mais optimista e com um maior respeito face à sua problemática.

Variation in the human Cannabinoid Receptor (CNR1) gene modulates gaze duration for happy faces

BACKGROUND: Humans from an early age look longer at preferred stimuli, and also typically look longer at facial expressions of emotion, particularly happy faces. Atypical gaze patterns towards social stimuli are common in Autism Spectrum Conditions (ASC). However, it is unknown if gaze fixation patterns have any genetic basis. In this study, we tested if variations in the cannabinoid receptor 1 (CNR1) gene are associated with gaze duration towards happy faces. This gene was selected because CNR1 is a key component of the endocannabinoid system, involved in processing reward, and in our previous fMRI study we found variations in CNR1 modulates the striatal response to happy (but not disgust) faces. The striatum is involved in guiding gaze to rewarding aspects of a visual scene. We aimed to validate and extend this result in another sample using a different technique (gaze tracking). METHODS: 30 volunteers (13 males, 17 females) from the general population observed dynamic emotion expressions on a screen while their eye movements were recorded. They were genotyped for the identical four SNPs in the CNR1 gene tested in our earlier fMRI study. RESULTS: Two SNPs (rs806377 and rs806380) were associated with differential gaze duration for happy (but not disgust) faces. Importantly, the allelic groups associated with greater striatal response to happy faces in the fMRI study were associated with longer gaze duration for happy faces. CONCLUSIONS: These results suggest CNR1 variations modulate striatal function that underlies the perception of signals of social reward such as happy faces. This suggests CNR1 is a key element in the molecular architecture of perception of certain basic emotions. This may have implications for understanding neurodevelopmental conditions marked by atypical eye contact and facial emotion processing, such as ASC.

Research review: reading comprehension in developmental disorders of language and communication

Background: Deficits in reading airment (SLI), Down syndrome (DS) and autism spectrum disorders (ASD). Methods: In this review (based on a search of the ISI Web of Knowledge database to 2011), the Simple View of Reading is used as a framework for considering reading comprehension in these groups. Conclusions: There is substantial evidence for reading comprehension impairments in SLI and growing evidence that weaknesses in this domain are common in DS and ASD. Further, in these groups reading comprehension is typically more impaired than word recognition. However, there is also evidence that some children and adolescents with DS, ASD and a history of SLI develop reading comprehension and word recognition skills at or above the age appropriate level. This review of the literature indicates that factors including word recognition, oral language, nonverbal ability and working memory may explain reading comprehension difficulties in SLI, DS and ASD. In addition, it highlights methodological issues, implications of poor reading comprehension and fruitful areas for future research.

Beta event-related desynchronization as an index of individual differences in processing human facial expression: further investigations of autistic traits in typically developing adults

The human mirror neuron system (hMNS) has been associated with various forms of social cognition and affective processing including vicarious experience. It has also been proposed that a faulty hMNS may underlie some of the deficits seen in the autism spectrum disorders (ASDs). In the present study we set out to investigate whether emotional facial expressions could modulate a putative EEG index of hMNS activation (mu suppression) and if so, would this differ according to the individual level of autistic traits [high versus low Autism Spectrum Quotient (AQ) score]. Participants were presented with 3 s films of actors opening and closing their hands (classic hMNS mu-suppression protocol) while simultaneously wearing happy, angry, or neutral expressions. Mu-suppression was measured in the alpha and low beta bands. The low AQ group displayed greater low beta event-related desynchronization (ERD) to both angry and neutral expressions. The high AQ group displayed greater low beta ERD to angry than to happy expressions. There was also significantly more low beta ERD to happy faces for the low than for the high AQ group. In conclusion, an interesting interaction between AQ group and emotional expression revealed that hMNS activation can be modulated by emotional facial expressions and that this is differentiated according to individual differences in the level of autistic traits. The EEG index of hMNS activation (mu suppression) seems to be a sensitive measure of the variability in facial processing in typically developing individuals with high and low self-reported traits of autism.

Autistic traits modulate mimicry of social but not nonsocial rewards

Autism Spectrum Conditions (ASC) are associated with diminished responsiveness to social stimuli, and especially to social rewards such as smiles. Atypical responsiveness to social rewards, which reinforce socially appropriate behavior in children, can potentially lead to a cascade of deficits in social behavior. Individuals with ASC often show diminished spontaneous mimicry of social stimuli in a natural setting. In the general population, mimicry is modulated both by the reward value and the sociality of the stimulus (i.e., whether the stimulus is perceived to belong to a conspecific or an inanimate object). Since empathy and autistic traits are distributed continuously in the general population, this study aimed to test if and how these traits modulated automatic mimicry of rewarded social and nonsocial stimuli. High and low rewards were associated with human and robot hands using a conditioned learning paradigm. Thirty-six participants from the general population then completed a mimicry task involving performing a prespecified hand movement which was either compatible or incompatible with a hand movement presented to the participant. High autistic traits (measured using the Autism Spectrum Quotient, AQ) predicted lesser mimicry of high-reward than low-reward conditioned human hands, whereas trait empathy showed an opposite pattern of correlations. No such relations were observed for high-reward vs. low-reward conditioned robot hands. These results demonstrate how autistic traits and empathy modulate the effects of reward on mimicry of social compared to nonsocial stimuli. This evidence suggests a potential role for the reward system in underlying the atypical social behavior in individuals with ASC, who constitute the extreme end of the spectrum of autistic traits.

STX1A and Asperger syndrome: a replication study

Background Autism spectrum conditions (ASC) are a group of conditions characterized by difficulties in communication and social interaction, alongside unusually narrow interests and repetitive, stereotyped behaviour. Genetic association and expression studies have suggested an important role for the GABAergic circuits in ASC. Syntaxin 1A (STX1A) encodes a protein involved in regulation of serotonergic and GABAergic systems and its expression is altered in autism. Methods In this study, the association between three single nucleotide polymorphisms (SNPs) (rs4717806, rs941298 and rs6951030) in STX1A gene and Asperger syndrome (AS) were tested in 650 controls and 479 individuals with AS, all of Caucasian ancestry. Results rs4717806 (P=0.00334) and rs941298 (P=0.01741) showed a significant association with AS, replicating previous results. Both SNPs putatively alter transcription factor binding sites both directly and through other variants in high linkage disequilibrium. Conclusions The current study confirms the role of STX1A as an important candidate gene in ASC. The exact molecular mechanisms through which STX1A contributes to the etiology remain to be elucidated.

Single nucleotide polymorphism rs6716901 in SLC25A12 gene is associated with Asperger syndrome

BACKGROUND: Autism Spectrum Conditions (ASC) are a group of developmental conditions which affect communication, social interactions and behaviour. Mitochondrial oxidative dysfunction has been suggested as a mechanism of autism based on the results of multiple genetic association and expression studies. SLC25A12 is a gene encoding a calcium-binding carrier protein that localizes to the mitochondria and is involved in the exchange of aspartate for glutamate in the inner membrane of the mitochondria regulating the cytosolic redox state. rs2056202 SNP in this gene has previously been associated with ASC. SNPs rs6716901 and rs3765166 analysed in this study have not been previously explored in association with AS. METHODS: We genotyped three SNPs (rs2056202, rs3765166, and rs6716901) in SLC25A12 in n?=?117 individuals with Asperger syndrome (AS) and n?=?426 controls, all of Caucasian ancestry. RESULTS: rs6716901 showed significant association with AS (P?=?0.008) after correcting for multiple testing. We did not replicate the previously identified association between rs2056202 and AS in our sample. Similarly, rs3765166 (P?=?0.11) showed no significant association with AS. CONCLUSION: The present study, in combination with previous studies, provides evidence for SLC25A12 as involved in the etiology of AS. Further cellular and molecular studies are required to elucidate the role of this gene in ASC.

Genetic variation in the oxytocin receptor (OXTR) gene is associated with Asperger Syndrome

Background Autism Spectrum Conditions (ASC) are a group of neurodevelopmental conditions characterized by impairments in communication and social interaction, alongside unusually repetitive behaviors and narrow interests. ASC are highly heritable and have complex patterns of inheritance where multiple genes are involved, alongside environmental and epigenetic factors. Asperger Syndrome (AS) is a subgroup of these conditions, where there is no history of language or cognitive delay. Animal models suggest a role for oxytocin (OXT) and oxytocin receptor (OXTR) genes in social-emotional behaviors, and several studies indicate that the oxytocin/oxytocin receptor system is altered in individuals with ASC. Previous studies have reported associations between genetic variations in the OXTR gene and ASC. Methods The present study tested for an association between nine single nucleotide polymorphisms (SNPs) in the OXTR gene and AS in 530 individuals of Caucasian origin, using SNP association test and haplotype analysis. Results There was a significant association between rs2268493 in OXTR and AS. Multiple haplotypes that include this SNP (rs2268493-rs2254298, rs2268490-rs2268493-rs2254298, rs2268493-rs2254298-rs53576, rs237885-rs2268490-rs2268493-rs2254298, rs2268490-rs2268493-rs2254298-rs53576) were also associated with AS. rs2268493 has been previously associated with ASC and putatively alters several transcription factor-binding sites and regulates chromatin states, either directly or through other variants in linkage disequilibrium (LD). Conclusions This study reports a significant association of the sequence variant rs2268493 in the OXTR gene and associated haplotypes with AS.