The Connection Between ASD, Seizures/Epilepsy, And Cognitive Dysfunction - What IF THIS Is Not “Autism?”

Michael J. Goldberg, M.D., F.A.A.P.5620 WILBUR AVENUE, SUITE 318TARZANA, CALIFORNIA 91356TELEPHONE (818) 343 – 1010

www.neuroimmunedr.com

KANNER AUTISM – NOT!!!

Per Dr. Kanner himself, when asked what separated a child with this NEW idea of “Autism” from a child with Schizophrenia, he replied:

“The Child with Autism was NEVER Affectionate”

PAST MEDICAL HISTORY / “ILLNESS” PHOTOSENSITIVY Eczema or hives Frequent ear infections Thyroid or endocrine issues! Sensory processing difficulty Auditory processing difficulties Abnormal EEG or SEIZURE disorder Easily fatigued Wakes tired in AM OCD Fine / Gross motor abnormal

BODY SYSTEMS:

Endocrine Immune Hematology EENT Cardiovascular

Pulmonary GI GU Muscular - Skeletal Neuro

DISEASE MECHANISMS: Metabolic – Toxic

Genetic – Developmental

Tumor - Trauma – Insult

Psychogenic??

Infectious

Immunologic

FACTS vs. FICTION FICTION: “Autism” is NOT an epidemic

– FACT: “Autism” now 1:130 – some 1:88 males • POLIO – 1:1500 – 1:2000 in the 40s / 50s

FICTION: “Autism” is not preventable– FACT: NO recurrence in multiple high risk

families to date – PREVENTATIVE pediatrics FICTION: “Autism” cannot be treated

– FACT: Multiple previous Autism DSMIV 299.0 patients in regular or honor classes

• Oldest patients now in college FICTION: Viral IgG titers are meaningless

– FACT: While not “proving a diagnosis” – chronic elevation implies immune dysfunction or persistent viral infection of some type

 SCIENCE SAYS: An epidemic can NOT be due to a

developmental or genetic disorder – SCIENTIFICALLY IMPOSSIBLE!!!

ONE MUST have a disease process

ONLY probable CAUSE – immune and / or viral connection

FACTS vs. FICTION FICTION: “Autism” is NOT an epidemic

– FACT: “Autism” now 1:130 – some 1:88 males • POLIO – 1:1500 – 1:2000 in the 40s / 50s

FICTION: “Autism” is not preventable– FACT: NO recurrence in multiple high risk

families to date – PREVENTATIVE pediatrics FICTION: “Autism” cannot be treated

– FACT: Multiple previous Autism DSMIV 299.0 patients in regular or honor classes

• Oldest patients now in college FICTION: Viral IgG titers are meaningless

– FACT: While not “proving a diagnosis” – chronic elevation implies immune dysfunction or persistent viral infection of some type

“COMPLEX NEURO-IMMUNE,

COMPLEX VIRAL”RENO conf. June 2007

– Top researchers . . “Test tube scientists”• PhD’s / MD’s

– CONCLUSIVE STATEMENTS:• IF toxin, metal, OR “OTHER” specific issue or

trigger present to begin with, NO longer an issue. . .. LEFT WITH “COMPLEX NEURO-IMMUNE, COMPLEX VIRAL”

• NO OTHER FOCUS OF THERAPY EXPECTED TO BE SUCCESSFUL LONGER TERM BEYOND SPECIFIC SYMPTOMATIC TARGETS. . .

N.I.D.S. (Neuro –Immune Dysfunction Syndromes)

For whatever the reasons (genetic, environmental, a combination of viruses, vaccines, allergies, immune system “insults,” etc.), what is occurring appears to be an immune mediated, abnormal “shut down” of blood flow in the brain and therefore central nervous system function.

IMMUNE SYSTEM – ACTIVATED / SUPPRESSED vs. DYSFUNCTIONAL

“COMPLEX NEURO-IMMUNE, COMPLEX VIRAL” FICTION: MITOCHONDRIAL

DYSFUNCTION CAUSES THIS DISORDER

FACT: MITOCHONDRIAL DYSFUNCTION – AND MULTIPLE METABOLIC ABNORMALITIES ARE SECONDARY TO THE IMMUNE SYSTEM DYSFUNCTION (NOT PRIMARY – PATHO-PHYSIOLOGY)

“COMPLEX NEURO-IMMUNE, COMPLEX VIRAL” FICTION: YOU CAN STRENGTHEN

THE IMMUNE SYSTEM BY MULTIPLE SUPPLEMENTS OR MANINPULATIONS

FACT: SINCE THE IMMUNE SYSTEM IS DYSFUNCTIONAL, NOT BROKEN, ANY ATTEMPT TO PUSH IT ONE WAY, IS MORE LIKELY TO PUSH SOMETHING HARMFUL ALSO, THEN CREATE NET HELP

Microglial activation and TNFalpha production mediate altered CNS excitability following peripheral inflammation Riazi K, Galic MA, Kuzmiski JB, Ho W, Sharkey KA, Pittman QJ Proc Natl Acad Sci U S A. 2008 Nov 4;105(44):17151-6

Peripheral inflammation leads to a number of centrally mediated physiological and behavioral changes

We hypothesized that peripheral inflammation leads to increased neuronal excitability from a CNS immune response

Induced inflammation in the gut – To examine - excitability - brain - we administered

(PTZ); TNBS treated showed increased susceptibility to PTZ seizures - strongly correlated with the severity and progression of intestinal inflammation

– Hippocampal slices from inflamed, TNBS-treated - increased spontaneous interictal burst firing - increased intrinsic excitability

Brain

GutImmuneSystem

Neuroglial Activation and Neuroinflammation in the Brain of Patients with AutismDiana L. Vargas, MD, Caterina Nascimbene, MD,1Chitra Krishnan, MHS1Andrew W. Zimmerman, MD, and Carlos A. Pardo, MD Ann Neurol 2005;57:000–000

Active neuroinflammatory process – Past Neuropathological studies – little attention to

immune and neuroglial activity in autism

Responses resemble those seen in neurodegenerative disorders such as Alzheimer's disease (AD), Parkinson's disease (PD), and amyotropic lateral sclerosis, and are similar to those seen in dementia associated with human immunodeficiency virus (HIV) infection– In these conditions, chronic microglial activations

appears to be responsible for a sustained neuroinflammatory response

Supports view - innate immune response

INNATE IMMUNE SYSTEM: STEDMANS MEDICAL DICTIONARY:

– resistance manifested by a species (or by races, families, and individuals in a species) that has not been immunized (sensitized, allergized) by previous infection or vaccination; much of it results from body mechanisms that are poorly understood, but are different from those responsible for the altered reactivity associated with the specific nature of acquired immunity; in general, innate immunity is nonspecific and is not stimulated by specific antigens.

IT’S A COMBINATION OF STRESSES – NOT ONE FACTOR

Alzheimer’s

Anxiety

Adult ADHD

Fatigue

Schizophrenia

ADHD’S

DepressionLD’S

Panic AttacksAsperger

Autism

CFS

Bipolar

The “Real” Bell Curve

Epilepsy - Seizures

NEUR0-IMMUNE Related Disorders

FAMILY “CONNECTIONS”

Mother or Father with CFS or “other” immune mediated disorder

Older child (or two) with ADHD (or other learning disorder LD)

Younger child (or two) with Autism / PDD / Brain dysfunction / seizures

DIAGNOSIS: SPECT SCAN HIGHLIGHTS BLOOD FLOW TO THE BRAIN Once the problem

areas are identified, specific treatments can be implemented

Decreased Blood Flow = Decreased Function

Increased Blood Flow = Increased Function

Pink or green/blue indicates a problem area

SPECT Scan Output

DIAGNOSIS: NEUROSPECT SCAN PINPOINTS AREAS OF DYSFUNCTION – LEANING DIFFICULTIES Severe speech and

language difficulties (left temporal lobe)

Severe social difficulties (right temporal lobe)

Often some fine, not usually gross, motor difficulties (cerebellar involvement)

SPECT Scan Output

10 YR. OLD FEMALEEPILEPSY - ? AUTISM

NK cells 2.8%

sed rate 1

CHILD – DOING WELL/“NORMALIZING”

DOING OK – “BUT NOT GOOD ENOUGH”

CHILD – DOING POORLY:

DAN Protocol - CHELATION:

DAN – IV GLUTAHIONE, HBOT, CHELATION - SEIZURES

Implication: Potential For RecoveryAutism / NIDS If this is a “disease process” and NOT a

developmental disorder, then… Many children diagnosed with ASD were

born with normal brain function that has become dysfunctional

The disease can be addressed and the brain can work normally again - the brain appears to be more pliable than we thought

The importance of early detection and treatment cannot be underestimated . . but the brain IS PLIABLE

“PEDIATRIC” BASED TREATMENTS HAVE SHOWN SIGNIFICANT SUCCESS First: “DO NO HARM” / Hippocratic Oath

Focus on and “attack” the individual components (immune / viral) of the disorder – Food elimination regimens– Antivirals (if indicated)– Antifungals (if indicated)– SSRI’s (almost always indicated)– Antihistamines / allergy control

My clinical approach has been developed over 25 years as a pediatrician

GRADE DISTRIBUTION SHIFTS “UP THE SCALE” FROM INITIAL TO FINAL GRADE NUMBER

Data

Freq

uenc

y

12108642

25

20

15

10

5

0

9.035 1.845 1005.551 2.148 99

Mean StDev N

Initial NUMBERFinal NUMBER

Variable

Histogram of Initial NUMBER, Final NUMBERNormal

Lower GRADE Number (a shift to the LEFT) indicates improvement

ScaleA+ 1A 2A- 3B+ 4B 5B- 6C+ 7C 8C- 9D+ 10D 11D- 12

A

B C D

ADDITIONAL INFORMATION:

Link – Tarzana Hospital Talk – 3/18/09– http://www.tarzanacme.com/video.asp?VidID=

notautism

DVD – Tupelo Mississippi – Sept 2005– kmatthews@regionalrehabcenter.com

Website: neuroimmunedr.com

In progress – facebook site:

SHELBY

EMILY

RYAN

Ryan Now

ADDITIONAL INFORMATION:

Link – Tarzana Hospital Talk – 3/18/09– http://www.tarzanacme.com/video.asp?VidID=

notautism

DVD – Tupelo Mississippi – Sept 2005– kmatthews@regionalrehabcenter.com

Website: neuroimmunedr.com

In progress – facebook site: