Perfil clínico epidemiológico e avaliação sérica de estresse oxidativo em pacientes com Transtorno de Espectro Autista sob o tratamento de Metilfenidato

Abstract

Autistic Spectrum Disorder (ASD) is characterized by changes in neurological development and impairments in social interaction and communication, with the presence of repetitive and stereotyped behaviors. The use of methylphenidate in children diagnosed with ASD has contradictory results and there is no generalized benefit. Therefore, this study aimed to draw a clinical and epidemiological profile, to evaluate behavioral changes and levels of oxidative stress in the blood of patients with Autistic Spectrum Disorder. The study included 124 children and adolescents aged up to 17 years old, registered at the Center for Child Psychosocial Care (CAPSi) of the municipal health network of Fortaleza, from September 2017 to February 2019, where an interview was conducted with parents and the CARS (Childhood Autism Rating Scale) scale for the assessment. After behavioral assessment for 12 weeks, an educational booklet was applied; previously validated, directed to parents with information about the pathology, treatment and frequent doubts. After the behavioral evaluation stage, the biological material (blood) was obtained from all participants in each group for oxidative stress analysis. The sample of 124 participants showed that 39 (31.4%) were classified as non-autistic, 45 (36.2%) moderate autistic, 40 (32.2%) severe autistic, and had an average age of 5 years. for children with moderate autism and 3 years when diagnosed with the disorder. It was also possible to identify aspects related to the severity of patients diagnosed with ASD, with a predominance of moderate degree in males with 39 cases (34.8 ± 0.42) and among females, more severe records were observed, with 30 cases (48.9 ± 0.90), in addition to the percentages of mothers with viral infection evidenced during the completion of the clinical chart, which was applied to a total of 83 mothers surveyed. The number of patients exposed to drug abuse during the gestational period corresponded to 81 (65%) of the total of 124 individuals. Only 43 (53%) had moderate ASD and 38 (47%) out of 81 children. There were 28 male patients with moderate autism and 15 (34%) of a total of 43 female individuals. The number of patients with the highest severity of the disorder totaled 38 individuals, 30 of whom were male and 8 female. The application of CARS in children with ASD who started drug support with Risperidone, methylphenidate or both in combination with no other alternative therapy within 30 to 90 days. The results show that the group with severe ASD that used methylphenidate alone showed a reduction in CARS score (40.6 ± 0.79) when compared to the group without ASD (51.6 ± 0.97), In addition to the continued use of methylphenidate alone or in combination with Risperidone, it causes a reduction in reactive oxygen and nitrogen species and increases serum GSH levels. It is concluded that the use of methylphenidate after 12 weeks of evaluation has reduced CARS score and reduces reactive oxygen and nitrogen species and improves an antioxidant system pathway that corresponds to glutathione-related extrinsic pathway.