Autistic spectrum disorders affect one out of every 68 persons, with a 4:1 dominance in males. Since they are dysfunctions rather than irreversible injuries to the central nervous system, which can be attributed to deficits in the neuronal networks and synaptogenesis and are modifiable thanks to the plasticity of the brain, starting therapy as early as possible is essential for more favourable progress. Very few treatments are backed by solid scientific evidence. We will analyse the therapeutic approaches oriented towards improving autism spectrum disorders which showed a clinical improvement that can be related to neurophysiological or functional changes in the central nervous system. We will classify the behavioural educational treatments and those in the research phase into a hierarchy, highlighting the neurogenetic entities with a high prevalence of autism, in which their pathophysiology and molecular base are known, that attempt to modify the consequences of those alterations by means of pharmacological agents. These entities include fragile X syndrome (GABAergic and metabotropic glutamate receptor inhibitors), tuberous sclerosis (mTOR inhibitors), Phelan-McDermid syndrome and Rett syndrome (insulin-like growth factor 1 inhibitors). Oxytocin, which has been shown to improve social cognition in persons with autism spectrum disorders, is analysed separately.
Title: Abordajes terapeuticos en los trastornos del espectro autista.
Los trastornos del espectro autista afectan a una de cada 68 personas, con predominio de 4 a 1 en varones. Por tratarse de disfunciones y no lesiones irreversibles del sistema nervioso central, atribuibles a defectos en las redes neuronales y la sinaptogenesis, modificables gracias a la plasticidad cerebral, la precocidad en el inicio terapeutico es fundamental para una mejor evolucion. Son pocos los tratamientos que cuentan con clara evidencia cientifica. Analizaremos abordajes terapeuticos orientados a mejorar los trastornos del espectro autista que demostraron una mejoria clinica relacionable a cambios neurofisiologicos o funcionales en el sistema nervioso central. Jerarquizaremos los tratamientos educativos conductuales y aquellos en etapa de investigacion, puntualizando las entidades neurogeneticas con alta prevalencia de autismo, en las cuales se conoce su fisiopatologia y base molecular, que intentan modificar a traves de farmacos las consecuencias de dichas alteraciones, incluyendo el sindrome X fragil (gabergicos e inhibidores del receptor metabotropico del glutamato), la esclerosis tuberosa (inhibidores del mTOR), el sindrome de Phelan-McDermid y el sindrome de Rett (inhibidores del desarrollo insulinico-1). Separadamente se analiza la oxitocina, que ha demostrando una mejoria en la cognicion social en personas con trastornos del espectro autista.