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Open Access Highly Accessed Research article

Corticosteroid therapy in regressive autism: a retrospective study of effects on the Frequency Modulated Auditory Evoked Response (FMAER), language, and behavior

Frank H Duffy1*, Aditi Shankardass2, Gloria B McAnulty2, Yaman Z Eksioglu3, David Coulter1, Alexander Rotenberg1 and Heidelise Als2

Author Affiliations

1 Department of Neurology, Boston Children’s Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts 02115, USA

2 Department of Psychiatry (Psychology), Boston Children’s Hospital and Harvard Medical School, 320 Longwood Avenue, Boston, Massachusetts 02115, USA

3 Pediatric Neurology, Golisano Children’s Hospital and Upstate Medical University, 90 Presidential Plaza, Syracuse, New York 13292, USA

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BMC Neurology 2014, 14:70  doi:10.1186/1471-2377-14-70

Published: 15 May 2014

Abstract

Background

Up to a third of children with Autism Spectrum Disorder (ASD) manifest regressive autism (R-ASD).They show normal early development followed by loss of language and social skills. Absent evidence-based therapies, anecdotal evidence suggests improvement following use of corticosteroids. This study examined the effects of corticosteroids for R-ASD children upon the 4 Hz frequency modulated evoked response (FMAER) arising from language cortex of the superior temporal gyrus (STG) and upon EEG background activity, language, and behavior. An untreated clinical convenience sample of ASD children served as control sample.

Methods

Twenty steroid-treated R-ASD (STAR) and 24 not-treated ASD patients (NSA), aged 3 - 5 years, were retrospectively identified from a large database. All study participants had two sequential FMAER and EEG studies;Landau-Kleffner syndrome diagnosis was excluded. All subjects’ records contained clinical receptive and expressive language ratings based upon a priori developed metrics. The STAR group additionally was scored behaviorally regarding symptom severity as based on the Diagnostic and Statistical Manual IV (DSM-IV) ASD criteria list. EEGs were visually scored for abnormalities. FMAER responses were assessed quantitatively by spectral analysis. Treated and untreated group means and standard deviations for the FMAER, EEG, language, and behavior, were compared by paired t-test and Fisher’s exact tests.

Results

The STAR group showed a significant increase in the 4 Hz FMAER spectral response and a significant reduction in response distortion compared to the NSA group. Star group subjects’ language ratings were significantly improved and more STAR than NSA group subjects showed significant language improvement. Most STAR group children showed significant behavioral improvement after treatment. STAR group language and behavior improvement was retained one year after treatment. Groups did not differ in terms of minor EEG abnormalities. Steroid treatment produced no lasting morbidity.

Conclusions

Steroid treatment was associated with a significantly increased FMAER response magnitude, reduction of FMAER response distortion, and improvement in language and behavior scores. This was not observed in the non-treated group. These pilot findings warrant a prospective randomized validation trial of steroid treatment for R-ASD utilizing FMAER, EEG, and standardized ASD, language and behavior measures, and a longer follow-up period.

Please see related article http://www.biomedcentral.com/1741-7015/12/79 webcite

Keywords:
Autism; Behavior; Corticosteroids; Distortion; EEG; Electroencephalogram; Evoked potential; EP; Frequency modulated auditory evoked response; FMAER; Language; Regression; Spectral; Steroids; STG; Superior temporal gyrus; Treatment