Duffy Frank H, Als Heidelise
Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, USA.
Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Enders 107, Boston, MA, 02115, USA.
BMC Neurol. 2019 Feb 14;19(1):27. doi: 10.1186/s12883-019-1254-1.
Autism prevalence continues to grow, yet a universally agreed upon etiology is lacking despite manifold evidence of abnormalities especially in terms of genetics and epigenetics. The authors postulate that the broad definition of an omnibus 'spectrum disorder' may inhibit delineation of meaningful clinical correlations. This paper presents evidence that an objectively defined, EEG based brain measure may be helpful in illuminating the autism spectrum versus subgroups (clusters) question.
Forty objectively defined EEG coherence factors created in prior studies demonstrated reliable separation of neuro-typical controls from subjects with autism, and reliable separation of subjects with Asperger's syndrome from all other subjects within the autism spectrum and from neurotypical controls. In the current study, these forty previously defined EEG coherence factors were used prospectively within a large (N = 430) population of subjects with autism in order to determine quantitatively the potential existence of separate clusters within this population.
By use of a recently published software package, NbClust, the current investigation determined that the 40 EEG coherence factors reliably identified two distinct clusters within the larger population of subjects with autism. These two clusters demonstrated highly significant differences. Of interest, many more subjects with Asperger's syndrome fell into one rather than the other cluster.
EEG coherence factors provide evidence of two highly significant separate clusters within the subject population with autism. The establishment of a unitary "Autism Spectrum Disorder" does a disservice to patients and clinicians, hinders much needed scientific exploration, and likely leads to less than optimal educational and/or interventional efforts.
自闭症的患病率持续上升,然而尽管有大量证据表明存在异常,尤其是在遗传学和表观遗传学方面,但仍缺乏一个普遍认可的病因。作者推测,综合性“谱系障碍”的宽泛定义可能会阻碍有意义的临床关联的界定。本文提供证据表明,一种基于脑电图的客观定义的脑测量方法可能有助于阐明自闭症谱系与亚组(聚类)问题。
先前研究中创建的40个客观定义的脑电图相干因子证明,能够可靠地将神经典型对照组与自闭症患者区分开来,也能可靠地将阿斯伯格综合征患者与自闭症谱系中的所有其他患者以及神经典型对照组区分开来。在当前研究中,这40个先前定义的脑电图相干因子被前瞻性地用于一大群(N = 430)自闭症患者中,以定量确定该群体中是否存在不同的聚类。
通过使用最近发布的软件包NbClust,当前研究确定这40个脑电图相干因子可靠地识别出了较大自闭症患者群体中的两个不同聚类。这两个聚类显示出高度显著的差异。有趣的是,更多的阿斯伯格综合征患者属于其中一个聚类而非另一个聚类。
脑电图相干因子为自闭症患者群体中两个高度显著的不同聚类提供了证据。设立单一的“自闭症谱系障碍”对患者和临床医生并无益处,阻碍了急需的科学探索,并且可能导致教育和/或干预努力达不到最佳效果。