ORIGINAL ARTICLE

The effect of intraarterial heparin flushing to autism symptoms when used to treat the concomitant cerebral venous thrombosis: a case series

Erwin Setiawan , Ristaniah Soetikno, Nelly Amalia Risan, Shelly Shelly, Tugas Ratmono, Ardianto Pramono, Rachmanto Heryawan Surya Adiputra, Terawan Agus Putranto

Erwin Setiawan
Department of Neurology, faculty of medicine Universitas Padjajaran, Indonesia RSPAD Gatot Soebroto, Indonesia. Email: erwinsps2003@gmail.com

Ristaniah Soetikno
Department of Radiology, Faculty of Medicine Universitas Padjadjaran, Indonesia

Nelly Amalia Risan
Department of Child Health, Faculty of Medicine Universitas Padjadjaran, Indonesia

Shelly Shelly
Faculty of Medicine, Universitas Padjadjaran, Indonesia

Tugas Ratmono
RSPAD Gatot Soebroto, Indonesia

Ardianto Pramono
Department of Radiology, Faculty of Medicine Universitas Padjadjaran, Indonesia RSPAD Gatot Soebroto, Jakarta, Indonesia The Indonesia Army Medical Sciences Institute, Jakarta, Indonesia

Rachmanto Heryawan Surya Adiputra
RSPAD Gatot Soebroto, Jakarta, Indonesia

Terawan Agus Putranto
Department of Radiology, Faculty of Medicine Universitas Padjadjaran, Indonesia RSPAD Gatot Soebroto, Jakarta, Indonesia The Indonesia Army Medical Sciences Institute, Jakarta, Indonesia
Online First: December 01, 2019 | Cite this Article
Setiawan, E., Soetikno, R., Risan, N., Shelly, S., Ratmono, T., Pramono, A., Adiputra, R., Putranto, T. 2019. The effect of intraarterial heparin flushing to autism symptoms when used to treat the concomitant cerebral venous thrombosis: a case series. Bali Medical Journal 8(3). DOI:10.15562/bmj.v8i3.1609


Introduction. There are still no definite therapeutic strategies for Autism Spectrum Disorder (ASD) other than behavioural interventions and few FDA approved behaviour control drugs. In this study, we found a co-existence medical condition of ASD & Cerebral Vein Thrombosis (CVT) in the paediatric population. Based on these findings, a new therapeutic approach, a catheter-directed anticoagulant therapy termed as IAHF (Intra Arterial Heparin Flushing) was performed on this population of patients.

Methods. This paper aims to describe a series of 10 cases of IAHF procedure performed to treat CVT on children with ASD from 2018 through 2019 at Cerebrovascular Center RSPAD Gatot Soebroto Jakarta-Indonesia. The children diagnosed with ASD by the multidisciplinary team but also had CVT findings on their brain magnetic resonance imaging studies when performed as the series of comprehensive diagnostic examination. IAHF were conducted by delivering heparin through a modified DSA technique into the occluded vessels. Subject Autism status was assessed with the Childhood Autism Rating Scale (CARS) before and one month after IAHF procedures.

Results. The measurement of CARS Score after IAHF shows a relatively positive result. Eight patients showed a decreased in total CARS Score after the procedure, while only two patients had no improvement. One subject shows a decrease of nine points, the most significant changes, and improved the status from moderate to mild autism.

Conclusion. In children who have ASD and also accompanied by CVT findings in their imaging studies, IAHF treatment showed clinical improvement of the autism symptoms.

 

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