Hakan ERDOĞAN, Bilal KELTEN, Osman AKDEMİR, Alper KARAOĞLAN, Erol TAŞDEMİROĞLU

Otizm ve serebellar mutizm: Nöroanatomik bulguların bir derlemesi

Otistik Spektrum Bozukluğu OSB , atipik sosyal etkileşim, bozulmuş sözel ve sözel olmayan iletişim, ilgi azlığı ve yaratıcı oyunun sınırlanması ile karakterize, davranışsal olarak tanımlanmış bir sendromdur. OSB'nin prevalansının yaklaşık olarak binde 4-5 arasında olduğu düşünülmektedir ama sayılar uygulanan tanı kriterlerine göre değişmektedir 1 . OSB'li olan bireyler 3 temel özelliğe sahiptirler; 1. Karşılıklı etkileşimlerin bozuklukları; 2. Gelişmede ve dil kullanımında anormallik; ve, 3. Tekrarlayıcı ve ritüelize edilmiş davranışlar ve ilgi alanlarının daralmış olması. Otizmin temel özelliklerine ek olarak, tabloyu ağırlaştıran yaygın nörolojik bozukluklar mevcuttur. Otizm spektrumunda mental geriliğin prevalansı yaklaşık olarak %30'dur. Otizm ile ilişkili epilepsinin prevalansı %5 ile %44 arasında değişmektedir. Anksiyete ve duygu durum bozuklukları da otizmde oldukça yaygındır. Otizmin ortaya çıkışında bir heterojenlik mevcuttur. Bazı çocuklar, 0-18 ay arasında gelişme geriliği bulguları gösterirken, OSB'si olanların %40'a kadarı 18-24'üncü aylara kadar normale yakın gelişme gösterirler. Brunelle ve arkadaşlarının belirttiği gibi: Tüm sonuçlar “sosyal beyin” denilen bölgelerin anatomik ve fonksiyonel anormalilerin açıklanmasında birleşmektedirler 2 . Süperior temporal korteks, parietal korteks ve amigdala gibi bazı beyin bölgeleri sosyal davranışla ilişkilidir. Ama son gelişmeler, OSB'de serebellumun rolünü daha fazla düşünmemize yol açmaktadır. Bu derleme OSB dâhilinde görülen nöroanatomik anormalliklerin gözden geçirilmesini sunmaktadır. Burada OSB'de serebellar organizasyonu anlamamıza katkıda bulunan bulguları tartışacağız.

Anahtar Kelimeler:

otistik spektrum bozukluğu, serebellum, serebellar mutizm

Autism and cerebellar mutism: A review of the neuroanatomical findings

Autistic Spectrum Disorder ASD is behaviorally defined syndrome characterized by atypical social interaction, disordered verbal and non-verbal communication, restricted areas of interest and limited imaginative play. The prevalence of ASD is considered to be approximately 4 to 5 per 1000, but numbers differ according to criteria used for diagnosis 1 . Individuals with ASD have three core features; 1. İmpairments of reciprocal social interactions; 2. Abnormal development and use of language; and, 3. Repetitive and ritualized behaviors and a narrow range of interests. In addition to the core features of autism, there are common co-morbid neurological disorders. The prevalence of mental retardation in the autism spectrum is approximately 30%. Epilepsy prevalence associated with autism varies from 5% to 44%. Anxiety and mood disorders are also very common in autism. There is a heterogeneity in the onset of autism. Although some children have signs of development delays between 0-18 months of life, up to 40% of children with ASD initially demonstrate the near-normal developemnt until 18-24 months. As Brunelle et al. says: All the results are converging toward the description of anatomical and functional anomalies in the regions of the so-called “social brain” 2 . Several brain regions such as frontal lobe, the superior temporal cortex, the parietal cortex, and amygdala have been implicated in social behavior. But the recent developments make us think more about the role of cerebellum in ASD. This review presents an overview of the neuroanatomical abnormalities that occur within ASD. We discuss the findings that have advanced our understanding of cerebellar organization in ASD.

Keywords:

autistic spectrum disorder, cerebellum, cerebellar mutism,

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