Dear Colleagues:

Welcome to the September–October 2015 issue of Innovations in Clinical Neuroscience. We start this issue with an intriguing review by Yarlagadda et al titled,“Placental Barrier and Autism Spectrum Disorders: The Role of Prolactin and Dopamine on the Developing Fetal Brain.” Here the authors explore a possible link between in-utero exposure to a high maternal prolactin/dopamine ratio and subsequent development of autism spectrum disorder (ASD). The authors hypothesize that a comprehensive, biologically oriented approach to the use of psychotropics in the regulation of neurotransmission during pre- and postpartum periods may result in better outcomes in this population.

Next, in their prospective study, “The Effect of Carnitine Supplementation on Hyperammonemia and Carnitine Deficiency Treated with Valproic Acid in a Psychiatric Setting,” Nakamura and Nagamine investigate the effect of levocarnitine supplementation on serum ammonia and carnitine levels simultaneously, and their clinical outcomes in patients treated with valproic acid. The authors found that in valproic acid-treated psychiatric patients who received carnitine supplementation an overall improvement was seen in their mental status, which may be related to mitochondrial function.

Following this, Narang et al present their review article, “Electroconvulsive Therapy Intervention for Parkinson’s Disease.” The authors explore the available literature to determine if use of electroconvulsive therapy (ECT) is supported as a safe and effective treatment option for patients with treatment-refractory Parkinson’s disease. The authors found that use of ECT for acute and maintenance treatment of Parkinson’s disease in select patients, particularly for treatment of motor function, is supported by the literature; however, the inability to predict how long the beneficial effects of ECT therapy will last and unclear or undocumented parameters for optimal application may deter clinicians from considering this evidence-based treatment option for their patients with treatment-resistant Parkinson’s disease. The authors note the need for further research to determine optimal application parameters and how long the effects can last.

Next, Brown and Rais present their case report, “Autism in the Son of a Woman with Mitochondrial Myopathy and Dysautonomia: A Case Report.” The authors report the case of a 15-year-old boy with a history of autism spectrum disorder (ASD) and neurocardiogenic syncope who was admitted to the inpatient unit for self-injury. His young mother was discovered to suffer from mitochondrial myopathy, dysautonomia, neurocardiogenic syncope, Ehler-Danlos syndrome, and other uncommon multisystem pathologies likely related to mitochondrial dysfunction. The authors review and discuss the ongoing research into the relationship between ASD and mitochondrial dysfunction, including mitochondrial myopathies and other mitochondrial diseases. Research has shown that although only a small minority of patients with ASD has a mitochondrial disease, many patients with mitochondrial myopathies have ASD symptoms, which can pose diagnostic challenges for clinicians. The authors use their case to illustrate the need for a high index of suspicion for mitochondrial disease in patients with ASD, as they have two orders of magnitude greater risk for such diseases than the general population.

Following this, Monga and Padala present their case report, “Aripiprazole for Treatment of Apathy,” which describes a 42-year-old man with depression and seizure disorder who had significant apathy that did not respond to carbamazepine, sertraline, and topiramate but showed significant improvement in apathy six weeks after initiation of aripiprazole. The authors review and discuss the symptoms, presentation, and treatment options of apathy as well as how apathy is different from depression. The authors also review the recent evidence that suggests that dopamine receptor agonists can be helpful in treatment of apathy.
As always, we hope you enjoy this issue, and we welcome your comments and submissions.

Amir Kalali, MD
Editor, Innovations in Clinical Neuroscience