Abstract
The concept of “acquired autism” refers to the hypothesis that amongst the massive heterogeneity that encompasses autism spectrum disorder (ASD) there may be several phenotypes that are neither syndromic nor innate. Strong and consistent evidence has linked exposure to various pharmacological and infective agents with an elevated risk of a diagnosis of ASD including maternal valproate use, rubella and herpes encephalitis. Autoimmune encephalitis (AE) describes a group of conditions characterised by the body's immune system mounting an attack on healthy brain cells causing brain inflammation. The resultant cognitive, psychiatric and neurological symptoms that follow AE have also included ASD or autism-like traits and states. We review the current literature on AE and ASD. Drawing also on associated literature on autoimmune psychosis (AP) and preliminary evidence of a psychosis-linked subtype of ASD, we conclude that AE may either act as a potentially causative agent for ASD, and/or produce symptoms that could easily be mistaken for or misdiagnosed as autism. Further studies are required to discern the connection between AE and autism. Where autism is accompanied by regression and atypical onset patterns, it may be prudent to investigate whether a differential diagnosis of AE would be more appropriate.
Highlights
Defined by the core features of social communication issues and the presence of restricted and/or repetitive behaviours that variably but significantly impact on quality of life, autism spectrum disorder (ASD) represents a clinical diagnosis currently based solely on the observation of overt behaviours and developmental history [1]
Autoimmune encephalitis (AE) appears to more frequently manifest as agitation, temper tantrums and aggression, often coinciding with speech and language issues such as mutism and echolalia [52], sleep disorder, sensory issues and gait and movement disturbances [53, 54]. de Bruijn et al [55] discussed the various mimics of AE presentation in children. They noted that possible alternative clinical labels need to be considered when diagnosing paediatric AE, including Gilles de la Tourette syndrome and paediatric autoimmune neuropsychiatric disorders associated with Streptococcus infections (PANDAS) whose symptoms may overlap with AE
Multiple reports have described the presentation of ASD and/or autistic features in cases of diagnosed AE
Summary
Paul Whiteley 1*, Ben Marlow 2,3, Ritika R. Edited by: Ute Christiane Meier, Ludwig Maximilian University of Munich, Germany. Reviewed by: Karl Bechter, University of Ulm, Germany Karun K. Strong and consistent evidence has linked exposure to various pharmacological and infective agents with an elevated risk of a diagnosis of ASD including maternal valproate use, rubella and herpes encephalitis. The resultant cognitive, psychiatric and neurological symptoms that follow AE have included ASD or autism-like traits and states. We review the current literature on AE and ASD. Drawing on associated literature on autoimmune psychosis (AP) and preliminary evidence of a psychosis-linked subtype of ASD, we conclude that AE may either act as a potentially causative agent for ASD, and/or produce symptoms that could be mistaken for or misdiagnosed as autism.
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