Kortikosteroid Tedavisi Sonrası Otizm Spektrum Bozukluğu Bulguları Düzelen Bir Landau-Kleffner Sendromu Olgusu

Abstract

Çok nadir rastlanan bir çocukluk-çağı hastalığı olan Landau-Kleffner Sendromu (LKS), elektroensefalogramdaki (EEG) epileptiform etkinlik ile ilişkili edinsel afazidir. Landau-Kleffner Sendromu’nun klinik görünümü bazı çocuklarda Otizm Spektrum Bozukluğu’na (OSB) benzeyebilir. Bu yazıda Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları (ÇRS) polikliniğine OSB belirtileri ile başvuran, ancak nörolojik tetkikler sonucunda LKS tanısı konulan, LKS medikal tedavisi sonrası nöropsikiyatrik semptomlarında belirgin düzelme gösteren bir vaka sunulmuştur. Dört yaş yedi aylık erkek çocuk, konuşmada gerileme, sosyal iletişimde azalma ve tekrarlayıcı davranış kalıpları şeklindeki yakınmaları ile ÇRS polikliniğine getirilmiştir. İlk olarak OSB tanısı konulmuş ve Çocuk Nöroloji’ye yönlendirilmiş olan vakanın yapılan nörolojik değerlendirmeleri sonrasında, hastaya LKS tanısı konulmuş ve antiepileptik tedavi başlanmıştır. Üç ay kadar kullanılan konvansiyonel antiepileptik tedaviden fayda görmeyen hastaya kortikosteroid tedavi başlanmış ve 1 ay içerisinde konuşma regresyonunda ve LKS’ye bağlı olan OSB belirtilerinde klinik olarak azalma görülmüştür, 3 ay içinde ise bu belirtilerde belirgin düzelme olduğu gözlenmiştir. Bu makalede, LKS’de konvansiyonel antiepileptik tedavi ile bilişsel ve dil fonksiyonlarında ve EEG patolojisinde düzelme olmayan vakalarda kortikosteroid tedavisiyle hem nöropsikiyatrik semptomlarında hem de EEG bulgularında hızlı düzelme sağlanabileceği bildirilmiştir. Alanyazında, LKS’de bilinen tedavilerin konuşma regresyonunu düzeltmede etkili olduğuna yönelik daha fazla bilgi olmakla birlikte, LKS’ye bağlı ortaya çıkan OSB belirtilerini azaltmasına yönelik çok az vaka bildirimi vardır.

Keywords

• Landau-Kleffner Sendromu
• otizm spektrum bozukluğu
• antiepileptik tedavi
• kortikosteroid tedavisi

A Case of Landau-Kleffner Syndrome with Autism Spectrum Disorder Symptoms Improved After Corticosteroid Treatment

Abstract

Landau-Kleffner Syndrome (LKS), a very rare childhood disease, is acquired aphasia associated with epileptiform activity on the electroencephalogram (EEG). The clinical presentation of Landau-Kleffner Syndrome may resemble Autism Spectrum Disorder (ASD) in some children. In this article, a case who applied to the Child and Adolescent Psychiatry (CAP) outpatient clinic with ASD symptoms, but was diagnosed with LKS as a result of neurological examinations, showed significant improvement in neuropsychiatric symptoms after LKS medical treatment. A four-year-seven-month-old boy was brought to the CAP outpatient clinic with symptoms of regression in speech, impairment in social communication, and rigid and repetitive patterns of behaviour. The patient was initially diagnosed with ASD and was referred to Pediatric Neurology. After the neurological evaluations, the patient was diagnosed with LKS and antiepileptic treatment was started. Corticosteroid treatment was initiated to the patient, who did not benefit from conventional antiepileptic therapy, which was used for about three months, and a clinical decrease was observed in speech regression and ASD symptoms associated with LKS within 1 month, and a significant improvement was observed in these symptoms within 3 months. In this article, it has been reported that in cases, where there is no improvement in cognitive and language functions and also EEG pathology with conventional antiepileptic treatment in LKS, rapid improvement can be achieved in both neuropsychiatric symptoms and EEG findings with corticosteroid treatment. Although there is more information in the literature that known treatments are effective in improving speech regression in LKS, there are few case reports on reducing the symptoms of ASD associated with LKS.

Keywords

• Landau-Kleffner syndrome
• autism spectrum disorders
• antiepileptic treatment
• corticosteroid treatment

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