ALGORITHM FOR PROVIDING MEDICAL CARE TO CHILDREN WITH AUTISM SPECTRUM DISORDERS ASSOCIATED WITH GENETIC DEFICIENCY OF THE FOLATE CYCLE

Abstract

Formulation of the problem. The regulation of medical care for children with mental disorders of the autism spectrum, which are associated with mutations / polymorphisms of genes of folic acid cycle enzymes, required the development of an appropriate algorithm for medical care. Analysis of recent research and publications. Genetic deficiency of the folate cycle – a common genetic disorder in the population, associated with disruption of DNA methylation and hyperhomocysteinemia, has different clinical manifestations during different periods of ontogenesis, leading to the development of autism in young children. The data contained in this protocol are based on the results of meta- analyzes and systematic reviews of randomized controlled trials, actually randomized controlled clinical trials and non-randomized controlled trials published in international scientometric databases of peer-reviewed periodicals PubMUS, Embase, SCOP. The information provided in the protocol is largely based on the data presented and systematized in a scientific monograph (Maltsev DV Disorders of the autism spectrum in children with folate deficiency, 2016). Formulating the purpose of the article. The purpose of medical care is to ensure progress in mental development and eliminate the manifestations of autism in children by providing neuroprotective and neuroregenerative effects of therapeutic interventions. The presentation of the main material. The neuroprotective effect is to eliminate or suppress the mechanisms of CNS damage – mostly immunedependent processes (systemic inflammation, opportunistic and opportunistic infections, antineuronal autoimmunity, etc.). Neuroregeneration is a consequence of activation of metabolism in the CNS due to nootropic drug therapy and stimulation of remyelination during immunoglobulin therapy. Medical care is provided in stages, in stages, according to the modern understanding of the pathogenesis of the disease. The main drug is intravenous human immunoglobulin, which has a complex positive effect on the CNS of children with autism spectrum disorders due to anti- inflammatory, immunomodulatory, antimicrobial and remyelinating effects. During the course of therapy, this drug is combined with antimicrobial, nootropic, hepato- and immunotropic drugs, detoxification and metabolic support in a certain sequence in accordance with the current understanding of the pathogenesis of the disease and the results of paraclinical laboratory studies obtained by follow-up. Conclusions and prospects for further research. When assessing the effectiveness of treatment and determining the need for further therapy according to the protocol, take into account a range of factors, including the dynamics of mental disorders on the scales for assessing the severity of autism spectrum disorders, the dynamics of reduction of myelinated areas on MR images of the brain, changes in bioelectrical activity EEG, restoration of gastrointestinal function according to clinical data and coprogram results, results of laboratory paraclinical tests, including signs of normalization of immune status su, suppression of autoimmunity to neurons and reduction / elimination of abnormal microbial load on the child's body.