A Randomised Controlled Trial of Bumetanide in the Treatment of Autism in Children

Gamma aminobutyric acid (GABA)-mediated synapses and the oscillations they orchestrate are altered in autism. GABA-acting benzodiazepines exert in some patients with autism paradoxical effects, raising the possibility that like in epilepsies, GABA excites neurons because of elevated intracellular concentrations of chloride. Following a successful pilot study, we have now performed a double-blind clinical trial using the diuretic, chloride-importer antagonist bumetanide that reduces intracellular chloride reinforcing GABAergic inhibition. Sixty children with autism or Asperger syndrome (3–11 years old) received for 3 months placebo or bumetanide (1 mg daily), followed by 1-month wash out. Determination of the severity of autism was made with video films at day 0 (D0) and D90 by blind, independent evaluators. Bumetanide reduced significantly the Childhood Autism Rating Scale (CARS) (D90−D0; P<0.004 treated vs placebo), Clinical Global Impressions (P<0.017 treated vs placebo) and Autism Diagnostic Observation Schedule values when the most severe cases (CARS values above the mean±s.d.; n=9) were removed (Wilcoxon test: P-value=0.031; Student's t-test: P-value=0.017). Side effects were restricted to an occasional mild hypokalaemia $(3.0–3.5 mM l^{−1} K^{+})$ that was treated with supplemental potassium. In a companion study, chronic bumetanide treatment significantly improved accuracy in facial emotional labelling, and increased brain activation in areas involved in social and emotional perception (Hadjikhani et al., submitted). Therefore, bumetanide is a promising novel therapeutic agent to treat autism. Larger trials are warranted to better determine the population best suited for this treatment

IMPLICATION DU PHARMACIEN D'OFFICINE DANS LE MAINTIEN ET LES SOINS A DOMICILE (ETUDE PROSPECTIVE SUR SIX MOIS AUPRES DE QUARANTE CINQ OFFICINES DE LA SARTHE)

ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Pronostiquer tôt les troubles du spectre autistique : Un défi ?

Les troubles du spectre de l’autisme (TSA) « naissent » in utero à la suite d’évènements pathologiques génétiques ou environnementaux. Le diagnostic des TSA n’est cependant effectué que vers l’âge de 3-5 ans en Europe et aux États-Unis. Un pronostic précoce permettrait pourtant d’atténuer la sévérité des atteintes cognitives, grâce à des approches psycho-éducatives. Une large panoplie d’approches a été suggérée pour établir un pronostic précoce des TSA, se fondant sur l’imagerie cérébrale, sur des enregistrements EEG, sur des biomarqueurs sanguins ou sur l’analyse des contacts visuels. Nous avons développé une approche fondée sur l’analyse par machine learning des données biologiques et échographiques recueillies en routine, du début de la grossesse au lendemain de la naissance, dans les maternités françaises. Ce programme qui permet d’identifier la presque totalité des bébés neurotypiques et la moitié des bébés qui auront un diagnostic de TSA quelques années plus tard, permet aussi d’identifier les paramètres ayant un impact sur le pronostic. Si quelques-uns d’entre eux étaient attendus, d’autres n’ont aucun lien avec les TSA. L’étude sans a priori des données de maternité devrait ainsi permettre un pronostic des TSA dès la naissance, ainsi que de mieux comprendre la pathogenèse de ces syndromes et de les traiter plus tôt

Motor anticipation in ASD children: the experience of a sequential pointing task

International audienceAutism Spectrum Disorder (ASD) is a neurodevelopmental psychiatric condition characterized by difficulties with social interactions and communication, repeated and stereotypical movements or restricted interests. Altered motor behaviours have also always been observed in ASD children (Kanner, 1943). But, to this day, they are still neglected during rehabilitation. Recent studies on animal models have suggested that ASD could be related with a cerebellum dysfunction (Jaber, 2017). Because the cerebellum is particularly involved in the control of anticipation, we proposed to compare the production of sequential pointing movements in ASD and neurotypical (NT) children. Precisely, we focused on motor anticipation of a second movement which occurs during the production of the first part of the sequence (first pointing).Using a digitizer, 34 NT (18 girls) and 27 ASD children (9 girls), 6-12 years divided into three age groups (6-7 years, 8-9 years, 10-11 years). They’ve had to point to a target first horizontally situated at a 10cm lenght and then, to another one vertically situated at a 17cm height. These two targets were presented ten times on each side. Concerning the second target, two target widths were used (0,5cm and 4cm). A movement endpoint tolerance was used (from the center of the target: radius +0,2mm). The analyses have been concerned with the velocity of the first movement (V P1). One subject of the ASD group was excluded because his results were at +- 2SD of the mean.Results show an effect of the age group (p = .05) and a margin interaction between age group and target width (F (1, 2) = 2.93, p = .06). No interaction effect exists between group, age group and target width (p = .64). Thereby, as NT do, during a sequential pointing task, ASD children can anticipate the difficulty incoming during the production of a current movement and this motor anticipation capacities increase with age. Although their developmental trajectory mimics that of NT children, they stay slower in each of the conditions. Consequently, motor anticipation capacities of ASD children seems preserved but they present global motor slowness. These results will be discussed with the cerebellum dysfunction theory in ASD

Discrete movements in ASD children: comparison between the isochrony principle and Fitts' law

International audienceRecent studies on animal models have suggested that Autism Spectrum Disorders (ASD) could be related with a cerebellum dysfunction (Jaber, 2017). Because the cerebellum is particularly involved in the control of fine motricity, we compared the production of handwriting and pointing discrete movements in ASD and neurotypical (NT) children. Because these two tasks follow two motor laws, the isochrony principle and Fitts’ law, we can have clear expectations in terms of tasks success criteria.Using a digitizer, 24 NT and 27 ASD children (6-12 years) had to produce five size of “e” letters in cursive mode and 16 pointing movements with 4 difficulty indexes. In the two tasks the results show that, although ASD children respect the motor laws which characterize the production of movements, they are significantly slower compared with NT. Thereby, ASD children seemed to manage differently the difficulty. These results will be discussed in the framework of the cerebellum dysfunction hypothesis of ASD

Dyadic coping and coparenting among couples after their child’s recent autism diagnosis

International audienceThis study explores how parenting couples use their relationship to support each other after their child’s autism diagnosis by assessing the role of dyadic coping and parenting sense of competence as predictors of their coparenting quality. Mothers and fathers raising a child on the spectrum (N = 70 couples) individually completed self-report questionnaires measuring stress appraisal, dyadic coping, parenting sense of competence, and coparenting. Parents were recruited 1–36 months after their child’s autism diagnosis and data were analyzed using the actor-partner interdependence model. Parents’ dyadic coping and sense of competence were related to their level of coparenting. Partner effects were found as mothers’ dyadic coping was positively linked to fathers’ coparenting and a higher sense of competence among fathers predicted mothers’ coparenting. Further research is needed to understand how these effects evolve throughout the child’s development stages. Lay abstract: We investigated how couples support each other after their child’s autism diagnosis and whether this affects the way they work together to raise their child. We recruited 70 couples raising a child on the autism spectrum. Both partners were asked to complete the same questionnaires measuring how they perceived the experience of having a child on the autism spectrum, how they used their relationship to support each other during stressful situations, how competent they felt completing their parenting tasks, and the coparenting relationship to explore how they worked together as a team when parenting their child. Parents participated in the study 1–36 months after their child’s autism diagnosis. We used statistical techniques that allowed us to see the impact mothers and fathers had on each other. Overall, parents who felt more competent and supported by their partner worked better as a team to raise their child on the spectrum. Fathers invested in the coparenting relationship more when mothers felt more supported by fathers. Mothers invested in the coparenting relationship more when fathers felt more competent parenting their child. Further research is needed to better understand how we can support couples as their child gets older

Diarrhée à Campylobacter jejuni chez le cheval. Premiers cas en France

Les auteurs décrivent deux cas de diarrhée à Campylobacter jejuni dans l'espèce équine en France, ayant atteint des poulains ou des adultes. L'affection a été sévère puisque 2 chevaux sont morts sur 6 animaux atteints, un en début d’affection, l'autre quelques semaines après en faisant une récidive. D'autres cas ont été diagnostiqués. Cette gastro-entérite aiguë s’accompagne de symptômes d’allure grippale. Son diagnostic est relativement facile si les excréments diarrhéiques sont traités très rapidement au laboratoire : examen direct, après ou non coloration, au microscope ; mise en culture sur milieu sélectif, dans les 24 h en général après leur émission.Vaissaire Josée, Pitre J., Régnier G., Lemonnier Jean-Paul, Plateau E., Guillou J.-P., Voisin G., Letot G. Diarrhée à Campylobacter jejuni chez le cheval. Premiers cas en France. In: Bulletin de l'Académie Vétérinaire de France tome 138 n°2, 1985. pp. 123-130

La fabrique du genre

Pourquoi un ouvrage sur le genre ? Pourquoi un de plus ? Comme le fait remarquer Philippe Lejeune dans l’interview figurant dans ce volume, les études sur le genre occupent une place importante dans la recherche anglo-saxonne, qui les conçoit comme un enjeu politique majeur. Il en va autrement en France. Les chercheurs dans le domaine des études anglophones ne peuvent ignorer cette question, ils lisent leurs consœurs et confrères outre-atlantique, s’en inspirent, mais ils font montre d’une attitude plus réservée. Sans doute est-ce un fait de culture, mais c’est aussi le produit d’un déplacement : alors que les études de genre sont issues des travaux des féministes de la génération des années soixante-dix, notamment Hélène Cixous, Julia Kristeva et Luce Irigaray, qui se positionnèrent en regard de la psychanalyse freudienne, les développements contemporains sont plus spécifiquement américains, bien que puisant leurs sources dans le poststructuralisme français, en particulier Foucault, Derrida, Lacan, l’on pense notamment à Judith Butler, Leo Bersani ou Eve Sedgwick. C’est de ce hiatus qu’est partie la recherche qui a donné lieu à cet ouvrage, avec pour perspective, à la fois de rendre compte de l’inspiration que la critique européenne puise dans la pensée anglo-saxonne, mais aussi de mettre en lumière la manière spécifique dont elle se l’approprie, voire dont elle s’en distingue. Pour charpenter ce travail, les articles qui constituent ce volume ont été placés en regard d’interviews de ceux qui inspirent leurs démarches critiques. Notre choix fut subjectif, partiel. Les personnes sollicitées n’ont pas toutes souhaité ou pu répondre à nos questions. Nous remercions ceux qui ont accepté de se plier au jeu: Eve Sedgwick, Luce Irigaray, Gérard Wajcman, Philippe Lejeune, Eric Laurent. L’ouvrage résulte des travaux du laboratoire de recherche « Lectures et languages critiques » de l’équipe ACE