Role of complementary & alternative medicine (CAM) using acupuncture (AC) for autism spectrum disorder (ASD)

Poster Sessions - 130 Treatment: 130.096: no. 117BACKGROUND: Parents of children with ASD sought for CAM treatment. (1) The approach in TCM is “holistic” with a philosophical background of balancing “Yin-and-Yang”. The pathophysiological basis aimed to improve “energy” or “body-flow” or “de-Qi”. Depending on the symptoms of ASD, clinical manifestations could be categorized into different TCM syndromes: “Delay in Development; Speech and Language problems; Hearing problems; or Emotion problems”. The sites of the pathological changes had been postulated to be in the ‘brain, heart, spleen, liver and kidney meridian”. In our experience, TCM approach for autism is postulated to be related to lower intelligence due to 'Heart-meridian and Kidney-meridian imbalance” resulting in communication problem and “Liver-meridian imbalance” leading to behavioral problem. (2, 10) OBJECTIVES: We adopted a different approach to assess …postprintThe 9th Annual International Meeting for Autism Research (IMFAR), Philadelphia, PA., 20-22 May 2010. In Abstract Book of the International Meeting for Autism Research, 2010, p. 574-57

Hong Kong childhood stroke registry (HKCSR) - a study of 50 cases (1991-2001)

BACKGROUND: A Hong Kong Childhood Stroke Registry (HKCSR) was established for Chinese children. OBJECTIVE: To study the clinical presentation, etiology, risk factors and outcome of Chinese children with stroke….published_or_final_versio

Risk factors associated with refractory epilepsy in children

Posters: no. P7BACKGROUND: There is a lack of consensus about the definition of intractable or refractory epilepsy in children. Medically intractable epilepsy occurred in 10 to 20% of epilepsy with childhood onset. Patients with medical intractability had immense resource implication and lifelong disability/disabilities. Early identification of risk factors for refractory epilepsy offers a chance of appropriate and timely treatment thus affecting prognosis. METHODS: A retrospective study was performed for our cohort of 505 children aged below 18 years with new-onset epilepsy, diagnosed between 1979 and 2006, and actively managed at the Comprehensive Epilepsy Clinic, Department of Paediatrics and Adolescent Medicine of the University of Hong Kong. We arbitrarily defined refractory epilepsy as those who had never been seizure-free for more than 12 months despite receiving anti-epileptic drug (AED) treatment. Responders were arbitrarily defined as those who had at least been seizure-free for consecutive 12 months. All patients had been on one or more AEDs and were followed up for at least 24 months after AED initiation. The demographic, clinical, diagnostic, investigative, management and seizure outcome at 2 years were analysed. RESULTS: At 2 years’ follow up, 42% (n=212) had refractory epilepsy. Risk factors significantly correlated with refractory epilepsy included history of status epilepticus (P<0.001), symptomatic aetiology (P<0.001), use of two or more AEDs (P=0.001), abnormal neurological co-morbidities including mental retardation (IQ<70) [P<0.001], learning disabilities (IQ=70-90) [P=0.009], cerebral palsy (P=0.011), abnormalities in EEG (P<0.001) and neuroimaging (P<0.001). CONCLUSIONS: Early identification of risk factors to predict possible medical intractability is important in improving treatment strategies especially in the selection of traditional versus newer AEDs, mono- versus poly-pharmacy or even earlier alternative epilepsy management decision plans including evaluation for possible surgical therapies.published_or_final_versionThe 1st Hong Kong Neurological Congress cum 22nd Annual Scientific Meeting of the Hong Kong Neurological Society, Hong Kong, 6-8 November 2009. In Hong Kong Medical Journal, 2009, v. 15 n. 6, suppl. 7, p. 42, abstract P

Use of Dysmorphology for Subgroup Classification on Autism Spectrum Disorder in Chinese Children

Data from 1,261 Chinese Autistic Spectrum Disorder (ASD) patients were evaluated and categorized into dysmorphic (10.79 %) and non-dysmorphic groups (89.21 %) upon physical examination by the presence of dysmorphic features. Abnormal MRI/CT result, IQ scores and epilepsy were significantly associated with the dysmorphic group of ASD children. However, gender, EEG abnormality and family history and recurrence of ASD were not found to be significantly different between group statuses. It is suggested that results collected from the Chinese population generally resembles that found in the Caucasians with ethnical differences still present. Current study supports the result shown in Miles' study (Miles et al. in Am J Med Genet 135A:171-180, 2005), in which heterogeneity subtypes of autism of different genetic origins which could be distinguished by presence of dysmorphic features on the patients.postprin

Randomized control trial of using tongue acupuncture in autism spectrum disorder

Objective The therapeutic approach of traditional chinese Medicine (TCM) in autism spectrum disorder (ASD) is a functional one. To study the efficacy, safety and functional brain change from the use of tongue acupuncture (TAC) on ASD children. Methods 21 autistic boys (3–16 years old) were randomly assigned to TAC group (TAC: n = 12; receiving daily TAC for 8 weeks) or control (C: n = 9; no acupuncture). Primary outcome measures included Autism Treatment Evaluation Checklist (ATEC), Reynell Language Developmental Scale, Symbolic Play Test (SPT), Functional Independence Measure for Children (WeeFIM), Clinical Global Impression (CGI) Scale and Cerebral FDG Metabolism by PET. Results There were significant improvement in speech domain of ATEC (p = 0.030), Self-care domain of WeeFIM (p = 0.021), cognition domain of WeeFIM (p = 0.001) and Total score domain of WeeFIM (p = 0.001) in TAC group compared to the C group. There were significant difference in positive clinical response between C and TAC group in language (p = 0.0211), functional (p = 0.0011), parental Impression criteria (p = 0.0003) and overall cerebral glucose metabolism (p = 0.0451) using ROC criteria. No significant association of PET Glucose Metabolism with Clinical response was found. None of the children developed any side-effects. Conclusion A short course of TAC can improve specific functions in children with autism spectrum disorder, especially speech and cognition function. No statistical significant association of PET Glucose Metabolism with Clinical response. Larger scale with more sample size trial should be done for further investigation.published_or_final_versio

Electroacupuncture for children with autism spectrum disorder: Pilot study of 2 cases

Objective: The objective of this study was to observe for efficacy, safety, and compliance of electroacupuncture for autism spectrum disorder (ASD). Methods: Two (2) children with ASD received electroacupuncture for 24 sessions over 8 weeks and were assessed pre- and postacupuncture. We defined a positive or negative change as an improvement or deterioration of 25%, respectively, in total score or any subscales of Aberrant Behavioral Checklist (ABC), Ritvo-Freeman Real Life Scale (RFRLS), WeeFIM,® and as a rating of much improved or much worse on the Clinical Global Impression-Improvement (CGI-I) scale. Results: For ABC, positive changes in "Irritability" and "Stereotypy" was noted in case 1 but no changes occurred for case 2. For RFRLS, positive changes were found for both cases in "Sensory motor," "Sensory response," and "Total score," although negative change was noted for case 2 in "Affectual response." For WeeFIM®, there were no positive or negative changes in both cases. For CGI-I, positive change in case 1 with much improved in "Social relatedness, Communication, and Stereotypy behavior" was reported. Conclusions: A short intensive course of electroacupuncture might improve some core features of children with ASD. © 2008 Mary Ann Liebert, Inc.published_or_final_versio

Double-blind randomized control trial of acupuncture for autistic spectrum disorder

Free Paper Presentations: no. FP3OBJECTIVE: To study the efficacy, safety, and compliance of short-term electro-acupuncture (EA) for children with autism spectrum disorder (ASD). METHODS: This was a randomised, double-blind, sham-controlled, clinical trial. Children with ASD were randomly assigned to EA group (n=30) or sham electro-acupuncture (SEA) group (n=25) matched by age and severity of autism. The EA group received EA for selected acupoints while SEA group received sham EA to sham acupoints. A total of 12 acupuncture sessions over 4 weeks were given. Primary outcome measures included WeeFIM, Pediatric Evaluation of Disability Inventory (PEDI), Leiter International Performance Scale–Revised (Leiter-R), Clinical Global Impression–Improvement (CGI-I) scale. Secondary outcome measures consisted of Aberrant Behavior Checklist (ABC), Ritvo-Freeman Real Life Scale (RFRLS), Reynell Developmental Language Scale (RDLS), and standardised parental report. Data were analysed by Mann-Whitney test. RESULTS: There was significant improvement in language comprehension domain of WeeFIM (P=0.02), self-care caregiver assistant domain of PEDI (P=0.028), and CGI-I (P=0.003) in the EA than SEA group. As for parental report, the EA group also showed significantly better social initiation (P=0.01), receptive language (P=0.006), motor skill (P=0.034), coordination (P=0.07), and attention span (P=0.003). More than 70% children with ASD adapted acupuncture easily, while 8% had poor acupuncture compliance. Mild side-effect with minor superficial bleeding or irritability during acupuncture was found. CONCLUSION: A short 4 weeks (12 sessions) course of EA is useful to improve the specific function in children with ASD, especially for language comprehension and self-care ability.published_or_final_versionThe 1st Hong Kong Neurological Congress cum 22nd Annual Scientific Meeting of the Hong Kong Neurological Society, Hong Kong, 6-8 November 2009. In Hong Kong Medical Journal, 2009, v. 15 n. 6, suppl. 7, p. 29, abstract FP

Outcome of children with first febrile seizure - a local cohort study of 565 cases

OBJECTIVE: To investigate the clinical profile and outcome of children admitted for first febrile seizure (FS) in Hong Kong. METHODS: A retrospective study was performed for all children admitted to Queen Mary Hospital with first episode of FS for during a 5 years period (March 1998 - March 2003) was conducted. FS is defined as “an event in a neurologically healthy infant or child aged 6 months to 5 years, associated with fever >38ΟC but without evidence of intracranial infection or a defined cause and with no …published_or_final_versio

Pilot study for subgroup classification for autism spectrum disorder based on dysmorphology and physical measurements in Chinese children

Poster Sessions: 157 - Comorbid Medical Conditions: abstract 157.058 58BACKGROUND: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder affecting individuals along a continuum of severity in communication, social interaction and behaviour. The impact of ASD significantly varies amongst individuals, and the cause of ASD can originate broadly between genetic and environmental factors. Objectives: Previous ASD researches indicate that early identification combined with a targeted treatment plan involving behavioural interventions and multidisciplinary therapies can provide substantial improvement for ASD patients. Currently there is no cure for ASD, and the clinical variability and uncertainty of the disorder still remains. Hence, the search to unravel heterogeneity within ASD by subgroup classification may provide clinicians with a better understanding of ASD and to work towards a more definitive course of action. METHODS: In this study, a norm of physical measurements including height, weight, head circumference, ear length, outer and inner canthi, interpupillary distance, philtrum, hand and foot length was collected from 658 Typical Developing (TD) Chinese children aged 1 to 7 years (mean age of 4.19 years). The norm collected was compared against 80 ASD Chinese children aged 1 to 12 years (mean age of 4.36 years). We then further attempted to find subgroups within ASD based on identifying physical abnormalities; individuals were classified as (non) dysmorphic with the Autism Dysmorphology Measure (ADM) from physical examinations of 12 body regions. RESULTS: Our results show that there were significant differences between ASD and TD children for measurements in: head circumference (p=0.009), outer (p=0.021) and inner (p=0.021) canthus, philtrum length (p=0.003), right (p=0.023) and left (p=0.20) foot length. Within the 80 ASD patients, 37(46%) were classified as dysmorphic (p=0.00). CONCLUSIONS: This study attempts to identify subgroups within ASD based on physical measurements and dysmorphology examinations. The information from this study seeks to benefit ASD community by identifying possible subtypes of ASD in Chinese population; in seek for a more definitive diagnosis, referral and treatment plan.published_or_final_versio