Urinary dopamine metabolites as indicators of the responsiveness to fenfluramine treatment in children with autistic behavior.
Low urine HVA predicted which autistic kids improved on fenfluramine, pointing to dopamine as a key player.
01Research in Context
What this study did
Doctors gave autistic children a daily pill called fenfluramine. They checked urine for a dopamine waste product called HVA before and after.
Thirteen kids joined the small trial. The team watched behavior and looked for any link between HVA change and clinical gain.
What they found
Six of the 13 children got noticeably better. Only these six showed a jump in urinary HVA, hinting that dopamine paths matter.
Low baseline HVA flagged likely responders, giving a simple lab clue.
How this fits with other research
Hansen et al. (1989) ran a similar 1989 trial and saw zero benefit, even though the drug lowered serotonin. The split may rest on different kids or rating tools.
Aman et al. (1993) later tested the same pill in youth with ID plus ADHD and found gains in attention, showing the drug can help outside autism.
Dunlap et al. (1991) used age and short tests to forecast who would thrive on methylphenidate, mirroring this paper’s urine-based prediction idea.
Why it matters
You now know that a cheap urine test once helped spot autistic kids who might gain from fenfluramine. While the drug is off the market, the logic lives on: baseline biology can guide medication choices. Keep the concept in mind as new dopamine drugs emerge, and always pair pills with solid behavior plans.
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02At a glance
03Original abstract
Modifications in serotonin and dopamine metabolism were evaluated in 13 children with autistic behavior and related to their responsiveness to fenfluramine treatment. A double-blind medication-placebo crossover design was used. Each patient received 1.5 mg/kg fenfluramine daily for 3 months followed and preceded by placebo for 1 month. Clinical improvement was observed in 6 children (responders). It included reduction of behavioral symptoms such as motor activity, anxiety, mood disturbances, and distractibility. Modifications of serotonin (5-HT), dopamine (DA), and DA metabolites [homovanillic acid (HVA) and dihydroxyphenylacetic acid (DOPAC)] were assessed at urinary levels. Responders and nonresponders showed a significant decrease of urinary 5-HT levels on fenfluramine. The main differences between the two groups of subjects were found with HVA, the major metabolite of DA. Fenfluramine significantly increased HVA levels in responders whereas no significant modification was found in nonresponders. Moreover the initial level of HVA (lower in responders) significantly differentiated the two groups. These results suggest that the clinical response to fenfluramine could be related to the dopaminergic action of this drug and that urinary DA metabolite levels could be considered as indicators of the responsiveness to fenfluramine treatment in children with autistic behavior.
Journal of autism and developmental disorders, 1989 · doi:10.1007/BF02211844