BORRELIOOSI/AUTISMI

[Bb]

Lähettäjä: Soijuv Lähetetty: 26.9.2004 9:56

Käynnissä tutkimus borrelioosin yhteydestä lasten autismiin:


http://www.columbia-lyme.org/dept/nyspi ... tud-n.html

Developmental Delay and Lyme Disease
in Children: An epidemiologic study

Participants: Children with Lyme Disease & Autism from New Jersey and Connecticut

Goals:To understand more about the association between LD and developmental delay and developmental regression

Status of study :Underway. As this is a population-based study, we are not recruiting individual patients.

Principal Investigator :Brian A. Fallon, MD

Design of the Study : This study is supported by the Wilton Lyme Disease Task Force. Based on the hypothesis that the prevalence of autism may be increased in Lyme endemic areas, the prevalence statistics for autism in the school districts of known hyperendemic areas in New Jersey and Connecticut will be compared to the prevalence statistics for autism in the school districts of areas without much Lyme Disease. The hyperendemic and non-endemic areas will be identified by categorizing rates of Lyme disease (in each area) into quantiles. Once the data has been collected and prevalence rates have been calculated for both autism and Lyme disease, an expected rate of autism will be calculated based on areas that have a low prevalence of Lyme Disease. From this rate, an expected number of cases will be determined (based on population size) and a calculation of the observed number of autism cases minus the expected number of autism cases will be made. From this calculation, graphical comparisons will be made to determine if observed values of autism more dramatically deviate from expected values in areas that have high rates of Lyme Disease. Prevalence rates will then be mapped in overlays to determine if Lyme hyperendemic areas overlap with high rates of autism. Arcview, a Geographic Information System (GIS) of which Columbia University is already in possession, will be used for all mapping purposes.

Contact :This is an epidemiologic study. No contact by subjects is needed at this time.

Screening Questionnaire :This is an epidemiologic study. No contact by subjects is needed at this time.

Frequently asked questions

Why is this study needed? Lyme disease has been associated with a broad array of neuropsychiatric disorders. Undoubtedly, the most common are headaches and stiff neck in early neurologic Lyme Disease and mild to moderate cognitive problems in later neurologic Lyme Disease. This latter syndrome has been termed encephalopathy. Lyme Disease may also cause considerable irritability, particularly in the acute phase of the illness, as well as less common symptoms such as paranoia, obsessive compulsive behaviors, or mania. Autism is classically considered to be a neurodevelopmental disorder, the cause of which is unknown. In our work with children who have developed Lyme disease, we have encountered a few children who had developed autistic-like disorders which were eventually also diagnosed as having Lyme Disease due to other concomitant symptoms; when the child received intensive antibiotic therapy, the autistic syndromes dramatically improved and, in some cases, resolved. We hypothesize: a) that a small subpopulation of children with autism in Lyme endemic areas may have an antibiotic responsive disorder due to a spirochete-induced autistic syndrome; and b) that areas with very high rates of Lyme Disease would show higher than expected rates of autism. The latter hypothesis will be tested using geographic mapping.

What are some questions to ask if a child presents with new onset autistic behaviors?

Certainly if a child was well until age 4 and then develops significant abnormalities in social interaction, language, or imaginative play, this would not be typical of autism which is a disorder that shows signs and symptoms prior to age 3. Autistic behaviors that emerge after age 3 would be diagnosed as either Asperger.s or possibly childhood disintegrative disorder. Childhood disintegrative disorder in particular may be associated with various general medical conditions, such as Addison-Schilder.s disease or subacute sclerosing panencephalitis. Medical conditions need to be ruled out in children who develop these disorders after age 3. Lyme Disease should be suspected if the child has been exposed to a Lyme Endemic area, if the child has been bitten by ticks or experienced unusual round rashes, or if the child has had a bad bout of flu-like symptoms, or the child has been complaining of joint pains, headaches, or fatigue. In the child younger than age 3, the diagnosis of a Lyme-induced autistic syndrome would be harder to make, as the age of abnormal behaviors would be consistent with the typical onset for non-Lyme autistic-like disorders. The work-up should include blood tests and a spinal tap to look for evidence of increased intracranial pressure, elevated protein or white cells, and/or elevated levels of antibodies to borrelia burgdorferi.

How often would Lyme Disease cause an autistic-like disorder?

This is probably a rare occurrence.

If Lyme Disease has induced an autistic-spectrum disorder, is it reversible? Based on our knowledge of Lyme Disease, we would expect that appropriately intensive intravenous antibiotic therapy would result in a marked improvement in the autistic-spectrum behaviors. We do not know how long such a treatment should last, but our experience with other patients suggests that, if six weeks of therapy do not result in significant change, a longer course of therapy may be warranted and ultimately effective.