کارآزمایی کنترل تصادفی استفاده از طب سوزنی زبان در اختلال طیف درخودماندگی Randomized control trial of using tongue acupuncture in autism spectrum disorder

Abstract Objective: The therapeutic approach of traditional chinese Medicine (TCM) in autism spectrum disorder (ASD) is a functional one. To study the efficacy, safety and functional brain change from the use of tongue acupuncture (TAC) on ASD children. Methods: 21 autistic boys (3e16 years old) were randomly assigned to TAC group (TAC: n Z 12; receiving daily TAC for 8 weeks) or control (C: n Z 9; no acupuncture). Primary outcome measures included Autism Treatment Evaluation Checklist (ATEC), Reynell Language Developmental Scale, Symbolic Play Test (SPT), Functional Independence Measure for Children (WeeFIM), Clinical Global Impression (CGI) Scale and Cerebral FDG Metabolism by PET. Results: There were significant improvement in speech domain of ATEC (p Z 0.030), Self-care domain of WeeFIM (p Z 0.021), cognition domain of WeeFIM (p Z 0.001) and Total score domain of WeeFIM (p Z 0.001) in TAC group compared to the C group. There were significant difference in positive clinical response between C and TAC group in language (p Z 0.0211), functional (p Z 0.0011), parental Impression criteria (p Z 0.0003) and overall cerebral glucose metabolism (p Z 0.0451) using ROC criteria. No significant association of PET Glucose Metabolism with Clinical response was found. None of the children developed any side-effects. Conclusion: A short course of TAC can improve specific functions in children with autism spectrum disorder, especially speech and cognition function. No statistical significant association of PET Glucose Metabolism with Clinical response. Larger scale with more sample size trial should be done for further investigation. Introduction Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder affecting language, communication, social interaction, and behavior.1 Autism is a heterogeneous disorder, commonly used therapies are a combination of specialized and supportive educational programming, communication training, psychosocial and behavioral and developmental interventions,2e8 however no consensus can yet be made for the best treatment as there is great variability in the strength of evidence, ranging from an absence of evidence to anecdotal and no validation to varying extent. In traditional Chinese acupuncture, nearly 400 acupoints on the body surface are interrelated to various functions. Acupuncture has been practiced in China for over 2 millennia. Specific acupoints in the tongue corresponding to various organs, and meridians were used for autism. The organ and meridian concept in the TCM model has been assumed as a fundamental basis to improve the behavior, cognition, and communicative ability in children with autism. We have demonstrated clinical efficacy of acupuncturing the surface or base of the tongue in specific acupoints in improving various functional modalities in patients with chronic neurological disorders such as ASD, cerebral palsy, stroke, and drooling problems.9e15 In our experience, the TCM approach for autism is more holistic. Autism is postulated as part of the spectrum of lower intelligence. Thus, the approach to autism is considered as lower intelligence due to “Heart-meridian and Kidney-meridian yin-yang imbalance” resulting in a communication problem and “Liver-meridian yin-yang imbalance” leading to behavioral problems.