Academic journal article Indian Journal of Psychiatry

Childhood Autism in India: A Case-Control Study Using Tract-Based Spatial Statistics Analysis

Academic journal article Indian Journal of Psychiatry

Childhood Autism in India: A Case-Control Study Using Tract-Based Spatial Statistics Analysis

Article excerpt

Byline: Zarina. Assis, Bhavani. Bagepally, Jitender. Saini, Shoba. Srinath, Rose. Bharath, Purushotham. Naidu, Arun. Gupta

Context: Autism is a serious behavioral disorder among young children that now occurs at epidemic rates in developing countries like India. We have used tract-based spatial statistics (TBSS) of diffusion tensor imaging (DTI) measures to investigate the microstructure of primary neurocircuitry involved in autistic spectral disorders as compared to the typically developed children. Objective: To evaluate the various white matter tracts in Indian autistic children as compared to the controls using TBSS. Materials and Methods: Prospective, case-control, voxel-based, whole-brain DTI analysis using TBSS was performed. The study included 19 autistic children (mean age 8.7 years [+ or -] 3.84, 16 males and 3 females) and 34 controls (mean age 12.38 [+ or -] 3.76, all males). Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) values were used as outcome variables. Results: Compared to the control group, TBSS demonstrated multiple areas of markedly reduced FA involving multiple long white matter tracts, entire corpus callosum, bilateral posterior thalami, and bilateral optic tracts (OTs). Notably, there were no voxels where FA was significantly increased in the autism group. Increased RD was also noted in these regions, suggesting underlying myelination defect. The MD was elevated in many of the projections and association fibers and notably in the OTs. There were no significant changes in the AD in these regions, indicating no significant axonal injury. There was no significant correlation between the FA values and Childhood Autism Rating Scale. Conclusion: This is a first of a kind study evaluating DTI findings in autistic children in India. In our study, DTI has shown a significant fault with the underlying intricate brain wiring system in autism. OT abnormality is a novel finding and needs further research.

Introduction

Autism is a neurodevelopmental disorder with a range of clinical presentations, now classified in a broader class of disease called autism spectrum disorders (ASDs), which includes autism, Asperger syndrome, and pervasive developmental disorder-not otherwise specified (PDD-NOS). Impaired social interaction, associated with verbal and nonverbal communication deficits and stereotyped behaviors are the most common clinical sign.[sup][1]

Autism is a growing problem worldwide and possesses a greater healthcare and economic burden to the developing nations like India. Research is on rise in the last decade on understanding various aspects (e.g., pathophysiology, epidemiology etc.) of this condition. Clinicians and researchers worldwide are being challenged by the unique nature of this condition. India is no way behind, research is more focused in-silo in major institutions under various disciplines (e.g., neurology, psychiatry, neuroradiology, pediatrics, epidemiology etc.) across the country.

Neuroimaging plays an integral role in complimenting the clinical research, multiple studies have been conducted to correlate the association between the imaging and clinical findings which would in turn benefit the early diagnosis and treatment. To date, the most dramatic changes occur when the children receive early and intensive behavioral intervention.[sup][2]

Diffusion tensor imaging (DTI) is an advanced magnetic resonance imaging (MRI) technique which studies the microstructural integrity of white matter tracts in the brain. Although numerous studies have been published in the literature based on DTI analysis of autistic individuals worldwide, there is no path-breaking large scale study conducted on Indian population till date to study the nature of this entity in this ethnic group.

Our study is an attempt to analyze this complex entity affecting the Indian population. We hypothesized that white matter located between the brain regions known to be involved in social cognition would be structurally and functionally abnormal in autistic individuals. …

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