Transcript biomedical treatment of the

BIOMEDICAL TREATMENT
OF THE YOUNG ADULT
WITH AUTISM SPECTRUM
DISCORDER
Presented by
Michael W. Elice, M.D. and
Barbara Fischkin
AutismOne, May 2009, Chicago, IL
What is ASD?
Asperger’s
SOCIAL
Pervasive Developmental Delay
Autism
BEHAVIORAL
LANGUAGE
Attention Deficit Disorders
DSM IV Diagnostic Criteria
for Autistic Disorder
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Impairment in Social Interaction
-Impairment in the use of nonverbal behavior
-Lack of spontaneous sharing
-Lack of social/emotional reciprocity
-Failure to develop peer relationships
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Impairment in Communication
-Delay in or lack of development of spoken language &
gestures
-Impairment in the ability to initiate or maintain conversation
-Repetitive and idiosyncratic use of language
-Lack of pretend play
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Restricted Repertoire of Activity and Interests
-Preoccupation with restricted patterns of interest
-Inflexible adherence to routines
-Repetitive movements
Incidence per 10,000
Increase in Autism Incidence
45
40
35
30
25
20
15
10
5
0
Autism
Epilepsy
Mental Retardation
1950
1965
1980
Year of Birth
1994
Autism ---- rising incidence
1/2000 prior to 1970
1/500 1996
1/166 2005
1/150 2007
And increasing…………….now thought
to be 1/80 – 1/100 children!!
What is Autism?
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A complex array of gene-environment interactions
This demands a rigorous evaluation to search for
the unique disease markers that help us understand
each child’s individual needs
There is NO usual autism treatment
Only one FDA approved intervention for the
agitative, aggressive affects of autism –
Risperadone
Beyond this, NOTHING ELSE!
Resources of mainstream medicine are oriented to
behavioral therapy, NOT BIOMEDICAL
Disorders Associated with
ASD
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Obsessive Compulsive Disorder
Oppositional Defiant Disorder
Tourette’s Syndrome – Tic Disorder
PANDAS
Bi-Polar Disorder
Metabolic Disorders
Mitochondrial Disorders
Find the Source
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Assess the Underlying Causes
Maldigestion/Malabsorption
Dysbiosis
Infection
Inflammation
Intestinal Permeability (leaky gut)
Immune dysfunction
Food Intolerance/ Allergies
Toxicity
Albert Einstein:
“If we knew what
we were doing, it
wouldn’t be called
research.”
BIOMEDICAL THERAPIES
1. ELIMINATION DIET
2. ALLERGY TESTING
3. ESSENTIAL FATTY ACID/COD LIVER OIL
4. VITAMINS/MINERALS
5. DIGESTIVE ENZYMES
6. METHYL COBALAMIN, FOLINIC ACID, TMG, NAC
7. AUTOIMMUNE THERAPY
8. CHELATION
9. ANTIFUNGALS AND ANTIANEROBICS
10. INTRAVENOUS GAMMA GLOBULIN
11. HYPERBARIC OXYGEN
Daniel Mulvaney, age 21
years
Lived in Mexico City and Hong Kong with
parents, Barbara and Jim, journalists
 Age 3 years – febrile illness with temp
of 106 degrees, otitis media.
Hospitalized for dehydration
Symptoms:
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Loss of interest in other children
Chewing on clothes
Shredding
Loss of expressive language
Loss of interest in toys
Loss of toileting skills
Increase in temper tantrums
More Symptoms and
Interventions:
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PICA – ate glass in playground
Hearing test – positive
Starts BOCES early childhood with
ABA, vitamin therapy
Luvox, Risperdal to control ‘violent
behavior’
2005 – 2 grand mal seizures, EEG
inconclusive, MRI - normal
Dan meets Dr. Elice,
November, 2007
Age 20 years
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Mouthing – pica, biting
Head pain requiring head compression
Hands move up and down, flapping
Ear flapping
Enjoys being upside down
Prefers to lie down to compress abdomen
Affectionate
Transitions well
Gets very close to people
Clomps feet
Lateral gaze
Occasional crooked smile
Obsesses on rope – uses as a lariat
Dan’s Medical History
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Product of Barbara’s first pregnancy
Pitocin induced labor – failure to
progress
Born in Mexico City
Developmental milestones all on target
Fully immunized without reactions
Dan’s Medical History
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Diet – craved vegetables, lettuce,
sushi and fish
BM’s – loose, frequent, foul smelling,
greenish/brown color, 4-5 times/day
Respiratory: frequent coughing
Skin – “chicken skin” red faced
Sleep – terrible!
Family History
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Rosacea
Urticaria
Gout
ADD
Arthritis
Alcoholism
Cardiovascular disease
ADM
MS
Alzheimers Disease
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Asperger’s Syndrome
ADD
Thyroiditis
Colitis, ulcers
Seasonal allergies
Colon cancer
Breast cancer
Lab Investigation
Complete Blood Count w/ differential and platelet count,
ESR
Serum Metabolic Assay (Complete)
Thyroid Profile (T3, T4 and TSH), AutoAntibodies
Amino Acid Profile, Plasma
Methylenetetrahydrofolate Reductase (MTHFR)
Organic Acid Profile, Urine
Ammonia Level
Lactic Acid Level (Lactate)
Pyruvic Acid Level (Pyruvate)
Folic Acid, Homocysteine, Vit B1, B6, B12, D3 levels
Heavy Metal Profile (Lead, Mercury, Arsenic and Cadmium),
Blood
Antigliadin Antibodies and Transglutaminase (Celiac Panel)
Measles, Mumps and Rubella, all vaccine antibody titers
Chromosome Analysis (include Fragile X), genomic array
analysis
IgG, IgA, IgM, IgE levels
IGG Subclasses
B and T cell function tests
Myelin basic protein and neural axon filament antibodies
ASLO and Anti Dnase Antibodies
Dan’s Lab Results
NEGATIVE RESULTS
Folic acid: elevated
MTHFR: + mutation, A and C
sites
Ammonia: elevated
Herpes Simplex I: + antibodies
Strep B: + antibodies; ASO
and antiDNAse B
Serologic immunity to mumps
and rubella BUT NOT
measles
Epstein Barr Virus: +
antibodies
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POSITIVE RESULTS
LFT’s: within normal limits
B12, B6, B1: within normal
limits
Amino acids: within normal
limits
Plasma catecholamines:
normal
Pyruvate, lactate, insulin,
homocysteine: normal
Antigliadin Antibodies:
negative
Laboratory Investigation
Hair analysis for metals
8 years old
Elevated:
- aluminum
- cadmium
- lead
- mercury
- silver
- uranium
- titanium
“Association of MTHFR Gene
Variants with Autism”
Marvin Boris, M.D., Allan Goldblatt, P.A.,
Joseph Galanko, PhD., S. Jill James,
PhD.
J. Of Physicians and Surgeons. 9:4.
Winter Edition, 2004
MTHFR
Methyl Cobalamin (B12)
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Alterations in this pathway can induce chronic metabolic imbalances.
Data indicates that these alterations occur frequently in ASD
children.
Vitamin B12 is an essential cofactor for this pathway. B12 deficiency
is well known to have neuropsychiatric consequences in adults and
adversely affect neurodevelopment during infancy. Therefore, the
abnormal metabolic profile observed in a significant proportion of
autistic children suggests the possibility that the behavioral features
characteristic of these children could be a manifestation of a
genetically based systemic metabolic derangement.
Methyl cobalamin inhibits the toxic effect of mercury on the
development of nerve fibers and glial cells. This explains why the
administration of injectible methyl cobalamin has resulted in many of
these children becoming more aware of the environment, starting to
speak and acting like other children
MTHFR ASSOCIATED
DISEASES
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NEURAL TUBE DEFECTS
CARDIOVASCULAR
CEREBRAL VASCULAR
INFLAMMATORY BOWEL DISEASE
CANCER- COLORECTAL, GI
LEUKEMIA
MULTIPLE PSYCHIATRIC DISORDERS
Biomedical Interventions
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Dan starts on vitamin, mineral, antioxidants,
probiotics and essential fatty acids
Methyl cobalamin (B12) injections
Dan is allowed gluten, casein
Dan is told to avoid corn syrup, preservatives, dyes
and fast food, where ingredients/preparation is
unknown
Prescription medications:
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Haldol
Luvox
Tenex
Zonisamide
Clinical Observations
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Enuresis – decreases
Bowel movements decrease in
frequency from 8 to 2 per day
Attention – increases – Dan goes to
the movies and sits for 1 hour 45
minutes
Dan plays ice hockey with increased
concentration
Next: more biomedical
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Addition of folinic acid and N-acetyl cysteine
to methyl cobalamin injections
PANDAS protocol, per NIMH studies –
induction with 5 days of prednisone followed
by penicillin, 1 gram daily
Actos (PPAR gamma agonist)
Celebrex (COX-2 enzyme inhibitor)
Diamox (carbonic anhydrase inhibitor)
Clinical Observations
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Increased concentration
Prompted use of words, says “Hi” without prompt
GI – now 1-2 bowel movements/day, formed and
normal appearance
Increased interaction with other adults
Sleep is uninterrupted by urination; he is dry at
night
No longer appearing to have headaches
Summer camp – Dan gets “raves” – staff cannot
believe how his behavior has changed
Who is Dan?
After 6 months of biomedical
intervention, his primary care
pediatrician says “he looks like a
different person!”
One year later………
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Increased concentration, now on Face Book
communicating with 130 “friends”
Health is excellent
GI and GU all functioning normally
Haldol is discontinued without psychotic behavior or
sleep disruption
Nemenda (glutamate receptor antagonist) is added
due to increase in bizarre motor behavior, e.g.
hands in mouth, walking with a list to one side,
strange finger movements and inability to perform
tasks previously mastered
Plan for Dan
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Continue the immune support
Heavy metal detoxification (chelation)
Hyperbaric Oxygen Therapy
Intravenous Gamma Globulin (IVIG)
WHY CHELATE?
Mercury
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Epidemic trends in ASD in the 1990’s
Thimerosal – an ethylmercury compound
added to vaccines
Increase in the number of vaccines given
to infants and toddlers
All these vaccines add up to as much as
200 micrograms in the first 6 months!
In 1999 AAP requires thimerosal to be
removed from all pediatric vaccines ASAP
Remaining thimerosal containing vaccines
expired by 2003
Thimerosal still present, in very small
amount in DT, Tetanus Toxoid, Menomune
and certain Flu vaccines
Mercury: What can it do?
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Increases oxidative stress
Decreases glutathione production
Increases inflammatory cytokines
Causes cell death
Accumulates in brain, liver, and other
organs
What about Lead?
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Lead is ubiquitous in our environment – 4-5 million
tons have been deposited in the environment from
car exhaust alone
It can be found in the water, air, soil and dust
Ingestion occurs by hand to mouth transmission
80% of lead poisoned children can be
asymptomatic
Lead has a half life in the body of 20 years!
Lead exposure can result in neurological damage,
learning and behavioral problems and lowered
intelligence
Fetal exposure to lead affects neurodevelopment
Symptoms of Metal
Poisoning
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Emotional lability, irritability, behavioral changes
Poor focus and attention
Hyperactivity
Loss of developmental milestones, language delay
Learning delays
Criminal, delinquent behavior
Abdominal pain, loss of appetite, vomiting, constipation
Headache, ataxia,
Lethargy, somnolence, seizures, stupor, coma
Muscle weakness
Impaired fine motor coordination
Visual-spatial impairment
Hearing defects, auditory processing problems
Delayed growth
Other Toxins:
Aluminum
- no physiologic need
- ability to cross blood brain barrier
enhanced by fluoride
- found in vaccines
- inhibitor of Magnesium, calcium and iron
- increases oxidative stress
- decreased glutathione
- increases lipid peroxidation
- synergistic with mercury to increase toxicity
exponentially
- deposited in brain, bone, muscle, kidney and liver
Other Toxins:
Organic Pollutants
– Phthalates, pesticides, herbicides, PCB’s,
Bisphenols
– Difficult to detox, stored in fat, cord blood,
breast milk
– Tiny doses may interfere with hormonal signals
that regulate human organs, development and
metabolism
– NO SAFE LEVELS!
– DNA damage
– Carcinogenic
– Neurotoxic
– Damage sperm
– Allergies, asthma, diabetes, heart disease,
Vicious cycle of toxicity
Increased damage
from toxins
Environmental
Toxins
Impaired
Detoxification
Heavy Metal Detoxification
(the politically correct term
for Chelation)
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Testing for toxic metal exposure
Chelation agents
- DMSA
- DMPS
- EDTA
- D-penicillamine
Maintain adequate levels of glutathione
Maintain adequate levels of vitamins and minerals
Continue checking urine for metals until excretion
levels are significantly reduced
Clinical Response to
Chelation of Lead
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Improved eye contact
Decreased hyperactivity
Emerging language; words and sentences
Decreased scripted language, echolalia
Improved GI function
Improved skin, hair, nails
Markedly improved learning abilities in
school
Increased social skills
HYPERBARIC OXYGEN
THERAPY
Hyperbaric Oxygen Therapy
Dates back to 1662
 Therapeutic uses:
- wound healing
- GI disease
- Infectious diseases
- Migraine syndromes
- Sleep disorders
- Peripheral vascular disease
- Stroke
- Brain injury
- Rheumatoid Arthritis
- Chronic fatigue syndrome
- Multiple sclerosis
- Parkinson’s Disease
And……………………………………………………………
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Hyperbaric Oxygen
Therapy
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Autism
Autistic Spectrum Disorders
Hyperbaric oxygen therapy may improve symptoms in autistic children.
Med Hypotheses. 2006; 67(2):216-28 (ISSN: 0306-9877) Rossignol DA;
Rossignol LW
• neuroinflammation and increased oxidative stress
• decreased cerebral perfusion confirmed by SPECT and
PET scans
• temporal regions of the brain related to speech, language
and auditory processing
• HBOT is successful in known hypoperfusion syndromes
- cerebral palsy
- fetal alcohol syndrome
- closed head injury
- stroke
• HBOT can normalize oxygen concentration in ischemic
tissues
• HBOT has potent anti-inflammatory effects by reducing
oxidative stress
Hyperbaric Oxygen
Therapy
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Oxygen is our primary source of energy
Oxygen:
- promotes immune support
- destruction of toxins
- promotes new cell growth
- displaces harmful free radicals
- destroys harmful bacteria, parasites
and other microbes
- enhances absorption of vitamins,
minerals, amino acids, and other
nutrients
Hyperbaric Oxygen
Therapy
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RESULTS
Statistically significant changes in autistic
symptoms, such as:
- language
- eye contact
- interactive play
- cognition
- improved GI function
- improved health and physical behavior
Intravenous Gamma
Globulin (IVIG) Therapy
Improvement in children with autism treated with
intravenous gamma globulin
Marvin Boris MD; Allan Goldblatt PA-C; Stephen M. Edelson
PhD
Journal of Nutritional & Environmental Medicine, Volume 15,
Issue 4 December 2005 , pages 169 - 176
Purpose. Immune dysfunction has been associated with
children with autism. One study found a beneficial response of
intravenous gamma globulin (IVIG) therapy in autistic
children. The present study further evaluated the
administration of IVIG to these children.
Results. The participants' overall aberrant behaviors decreased
substantially soon after receiving their first dose of IVIG.
Further analysis of the total scores revealed decreases in
hyperactivity, inappropriate speech, irritability, lethargy and
stereotypy. However, 22 of the 26 children regressed to their
IVIG
Conclusions. Significant improvement
occurred in autistic children receiving
monthly IVIG. There is a reasonable
rationale considering the risk/reward
ratio to utilize IVIG therapy in children
with autism. A well-controlled placebo
double-blind study would be important
to further clarify the use of IVIG in
autism and its duration of benefits
It’s not a sprint… it’s a
MARATHON!
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Do NOT sprint! Pace yourselves
Pace your bodies, your spirits, your finances
There will be hills and valleys
Never be complacent with what you achieve
Always celebrate the milestones achieved
As hard as it is for us, it is harder work for our
children.
Conclusions
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Autistic Spectrum Disorders are being
diagnosed in epidemic rates
They are not genetic disorders
They are medical disorders of the
immune system with genetic
predisposition
There are environmental triggers that
may initiate the symptoms
Biomedical intervention does help in
many cases
Why Bother Doing This
With a 20 Year Old??
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Why not??
You may have tried everything else!
Your child will enjoy life
You will enjoy life more
They may live up to their full potential
Less burden on support staff
Better residential placement
They may attain an independent lifestyle!