RESUMEN
Objectives: Inflammatory mechanisms are implicated in the aetiology of autism spectrum disorder (ASD), and use of the immunomodulator Trichuris suis Ova (TSO) is a novel treatment approach. This pilot study determined the effect sizes for TSO versus placebo on repetitive behaviours, irritability and global functioning in adults with ASD.Methods: A 28-week double-blind, randomised two-period crossover study of TSO versus placebo in ten ASD adults, aged 17-35, was completed, with a 4-week washout between each 12-week period at Montefiore Medical Center, Albert Einstein College of Medicine. Subjects with ASD, history of seasonal, medication or food allergies, Y-BOCS ≥6 and IQ ≥70 received 2,500 TSO ova or matching placebo every 2 weeks of each 12-week period.Results: Large effect sizes for improvement in repetitive behaviours (d = 1.0), restricted interests (d = 0.82), rigidity (d = 0.79) and irritability (d = 0.78) were observed after 12 weeks of treatment. No changes were observed in the social-communication domain. Differences between treatment groups did not reach statistical significance. TSO had only minimal, non-serious side effects.Conclusions: This proof-of-concept study demonstrates the feasibility of TSO for the treatment of ASD, including a favourable safety profile, and moderate to large effect sizes for reducing repetitive behaviours and irritability.Clinicaltrials.gov: NCT01040221.
Asunto(s)
Trastorno del Espectro Autista , Conducta , Genio Irritable , Terapia con Helmintos , Trichuris , Adolescente , Adulto , Animales , Trastorno del Espectro Autista/complicaciones , Trastorno del Espectro Autista/parasitología , Trastorno del Espectro Autista/terapia , Conducta/fisiología , Estudios Cruzados , Método Doble Ciego , Estudios de Factibilidad , Humanos , Hipersensibilidad/complicaciones , Hipersensibilidad/terapia , Genio Irritable/fisiología , Óvulo , Proyectos Piloto , Terapia con Helmintos/normas , Tricuriasis , Trichuris/fisiología , Adulto JovenRESUMEN
Neurodiversity, a term initially used mostly by civil and human rights movements since the 1990s, refers to the notion that cognitive as well as emotional properties characteristic of developmental disorders such as autism spectrum disorders (ASD) are not necessarily deficits, but fall within normal behavioural variations exhibited by humans. The purpose of the present article is to examine the relevance of this notion to scientific research on ASD. On the assumption that one crucial survival advantage of intelligent activity is vigilance toward dangers in the external world, and such vigilance must work in the social domain as well as in the non-social domain, the author argues that the pattern of operation of an individual person's mind can be categorized according to the domain toward which that individual is more oriented. Individuals with ASD, overall, do not rely upon their social relationships but rather are predisposed to process perceived non-social objects in more depth, which manifests itself as hyper-sensation and hyper-attention to detail. It can be assumed that underconnectivity among cortical areas and subcortical areas underlies such mental operation neurologically. One of the main predictions based on this assumption is that all facets of psychological function are susceptible to disruption in ASD. Indeed, it has traditionally been thought that there are such general deficits in this disorder. However, contrary to the prevalent belief that people with ASD lack empathy, in fact people with ASD are capable of empathizing with the minds of others if those others are people with ASD. Thus, the neurological underconnectivity in ASD certainly leads some processing of information in the mind to work with less coordination, but has in fact contributed to providing Homo sapiens with behavioural variants. Finally, the clinical implications of the advantages of viewing ASD as a variation in neurodiversity are discussed.