INTRAVENOUS IMMUNOGLOBULIN TREATMENT OF CHILDREN WITH AUTISM

Since autism has been associated with immunologic abnormalities sugges ting an autoimmune cause of autistic symptoms in a subset of patients, this study was undertaken to investigate whether intravenous immunogl obulin (IVIg) would improve autistic symptoms. Ten autistic children w ith immunologic abnormalities, demonstrated on blood tests, were enrol led in this study. Their ages ranged from 4 to 17 years, with two girl s and eight boys. Eight children (1 female and 7 male) historically ha d undergone autistic regression. Intravenous immunoglobulin, 200 to 40 0 mg/kg, was administered every 6 weeks for an intended treatment prog ram of four infusions. In five children, there was no detectable chang e in behavior during the treatment program. In four children, there wa s a mild improvement noted in attention span and hyperactivity. In non e of these children did the parents feel that the improvement was suff icient to warrant further continuation of the infusions beyond the ter mination of the program. Only in one child was there a very significan t improvement, with almost total amelioration of autistic symptoms ove r the time period of the four infusions. Once the treatment program wa s completed, this child gradually deteriorated over a 5-month time per iod and fully reverted to his previous autistic state. In this treatme nt program, five children had no response to intravenous immunoglobuli n. In the four children who showed mild improvements, those improvemen ts may simply have been due to nonspecific effects of physician interv ention and parental expectation (ie, placebo effect). However, in one child there was a very significant amelioration of autistic symptoms. There were no distinguishing historic or laboratory features in this c hild who improved. Given a positive response rate of only 10% in this study, along with the high economic costs of the immunologic evaluatio ns and the intravenous immunoglobulin treatments, the use of intraveno us immunoglobulin to treat autistic children should be undertaken only with great caution, and only under formal research protocols.