Increased blood lead level in many children is one of the health problems in Egypt which may be the reason, at least in part, for cognitive dysfunction with subsequent poor scholastic achievement. Thus, interventions to control lead exposure are mandatory.
Neuropsychiatric systemic lupus erythematosus (NPSLE) is one of the most difficult manifestations of lupus to diagnose. Measurement of serum brain autoantibodies and assessment of cognitive function by electroneurophysiological studies (electroencephalogram (EEG) and P300) have contributed to an earlier and a more specific diagnosis of NPSLE. Thus, we were stimulated to assess the value of serum antineuronal antibodies and electroneurophysiological studies in diagnosis and early prediction of NPSLE. To investigate this, assessment of serum antineuronal antibodies and cognitive function (clinically and by electroneurophysiological studies) was done in 30 lupus patients [14 (46.7%) with and 16 (53.3%) without clinical evidence of NPSLE] in comparison with 30 healthy matched subjects. Patients without clinical evidence of NPSLE were followed-up clinically by monthly neuropsychiatric evaluation for 18 months. Seropositivity for antineuronal antibodies and abnormalities of EEG and P300 (prolonged latency and/or low amplitude) were found in 60%, 50% and 70%, respectively of lupus patients. During follow-up, 8 out of the 16 patients without clinical evidence of NPSLE developed such evidence [six (75%) had antineuronal seropositivity, five (62.5%) had abnormal EEG, six (75%) had P300 abnormalities and all had at least one abnormal result of these parameters at the time of initial evaluation before clinical presentation of NPSLE]. In conclusion, serum antineuronal antibodies and electroneurophysiological studies may be reliable parameters for diagnosis and early prediction of NPSLE, especially when combined together, before clinical manifestations ensue. Further studies on a large scale are warranted to evaluate the predictive value of these parameters in NPSLE.
Etiology of autism has become an area of significant controversy. Allergy may play a role in the pathogenesis of autism wherein allergic immune responses to some proteins (e.g., dietary proteins and latex) may induce the production of brain autoantibodies, which are found in many autistic children. This study was conducted to investigate the frequency of allergic manifestations in autistic children. The relationship between allergy and disease characteristics in terms of disease severity, clinical findings and electroencephalography (EEG) abnormalities was also studied. Fifty autistic children (30 had mild to moderate autism and 20 had severe autism) were studied in comparison to 50 age-and sex-matched children without neuropsychiatric manifestations serving as controls. Clinical evaluation was done with special emphasis on neuropsychiatric assessment and clinical manifestations of allergy. Serum total immunoglobulin E was measured in all studied subjects. In addition, EEG and assessment of mental age were done for all autistic children. Allergic manifestations (bronchial asthma, atopic dermatitis and/or allergic rhinitis) were found in 52% of autistic patients. This frequency was significantly higher than that of controls (10%; P < 0.001). There was a significant positive association between the frequency of allergic manifestations and disease severity, important clinical findings elicited in some autistic children (gastrointestinal symptoms and neurological manifestations) and EEG abnormalities. In conclusion, the frequency of allergic manifestations is increased in autistic children. The significant positive association between these manifestations and important disease characteristics (disease severity, gastrointestinal symptoms, neurological findings and EEG abnormalities) may shed light on the possible causal role of allergy in some autistic children. Indeed, we need to know more about the links between allergy, immune system and brain in autism. This is important to determine whether therapeutic modulation of immune function and allergic diseases are legitimate avenues for novel therapy in selected cases of autism or even for attempted primary prevention in genetically at risk subgroups.
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