Recent advances in autism treatment
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Transcript of Recent advances in autism treatment
Recent Advances in the treatment of Autistic Spectrum Disorders
By the end of 7 monthsSmile back at another personRespond to sound with soundsEnjoy social play
Red Flags• No big smiles or other warm, joyful
expressions by six months or thereafter
• No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter
By the end of 12 monthsUse simple gestures Imitate actions in their play Respond when told “no”
Red Flags• No back-and-forth gestures, such as
pointing, showing, reaching, or waving bye
• Not answering to one’s name when called
• No babbling – mama, dada, baba
By the end of 18 monthsDo simple pretend play Point to interesting objectsUse several single words
unpromptedRed Flags• No single words by 18 months• No simple pretend play
By the end of 2 years (24 months)
Use 2- to 4-word phrasesFollow simple instructionsBecome more interested in other childrenPoint to object or picture when named
Red Flags• No two-word meaningful phrases
(without imitating or repeating)• Lack of interest in other children
Red Flag: Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
The emergence of anew autism model
Older model• Genetically determined• Brain based• Hard-wired• Treatable but not
curable
Is autism a BRAINDISORDER?
Newer model• Environmentally triggered• Genetically influenced• Both brain and body• Metabolic abnormalities
play big role• Treatable and recovery
possible
OR is itA DISORDER THATAFFECTS THE BRAIN?
Topics
AUTISM is A Medical condition .It is not a mental DisorderAs such it is preventableTreatable .
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TreatmentGoals
Minimize core features and associated deficits Maximize functional independence and QOLAlleviate family stress
Educational interventionDevelopmental Therapies
CommunicationSensory, fine motor, gross motor
Behaviorally Based treatmentsCore and associated symptomsSocial skills
Medical or biologic treatmentsSupport family in home and community
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behaviorAll of our parents used it!
Involves the A, B, C’sNot airway, breathing circulation
Antecedent Behavior Consequence
Speech/Language TherapyBehaviorally based/ intensive structured
teaching E.g., Verbal Behavior
Augmentative strategiesSign languagePECSAided augmentative/ alternative system(s)
Decrease non-communicative languageDevelopmental-pragmatic approaches
appropriate use of language in social situationse.g., SCERTSSocial skills training
Adjunct to educational, developmental & behavioral treatmentsSo far no evidence of impact on core symptomsEvidence supporting is variable
Toolkit – handouts for MD & families
Treat target symptomsStereotypiesWithdrawalObsessionsIrritabilityHyperactivityattention spanself-injurious behavior Aggressionsleep
Mind-body Medicine
YogaMusic Therapy
Manipulative and Body-based
ChiropracticMassage/Therapeutic
TouchAuditory IntegrationEnergy Medicine
Transcranial & magnetic stimulation
Biologically Based
Most commonly used~ 50% - biologically based30% - mind body25% - manipulation/ body based
** Most use > 1 modality
SupplementsB6/Magnesium, B12DMG/ TMG Vitamin A, Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein/ gluten free
Off-label medications
Secretin
ImmuneAntifungal therapy Immunotherapy, steroidsAntibiotics/AntiviralsStem cell
transplantation
Immunization-relatedWith-hold immunizationChelation
Hyperbaric oxygen therapy (HBOT)
Always others coming along…
One of most commonly used CAM treatments
Hypothesis : Exogenous opiate-like peptides = false
neurotransmittersEvidence – most non-blinded; few RCT emerging, no
differences
Requires elimination of ALL dairy products (not “GFCF except for ice cream…”) & elimination of barley, rye, oats &
wheat products
Potential deficienciesInherently deficient in calcium, vitamin D
B vits, Iodine, others may be lower in substitute products
Weight typically adequate, monitor Fe status
Another approach to therapy
Dealing with the yeast overgrowth.Dealing with the leaky gut.Heavy metals and their effects.Chelation.Methylcobalamin.
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GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1. Yeast Overgrowth
2. Leaky gut
3. Heavy Metal Accumulation
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Yeast Overgrowth
Yeast overgrowth leads to poor absorption of necessary vitamins, minerals & esssential nutrients.
It is normal to have a small amount of yeast in the GI tract. Autistic children however have abnormal amounts, usually leading to poor absorption of essential nutrients and the leakage of toxic substances into the bloodstream which should not be absorbed.
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How do we treat the Yeast overgrowth & Leaky gut syndrome
Nutrition/Antioxidants in food and metabolised in the body Vitamins A, B Complex, C, E, B12 , B6, Folic Acid,
Niacin Essential Fatty Acids These are extremely important.
They are a most powerful anti-inflammatory agent. Co-Enzyme Q10,DMG Trace elements – Magnesium, Selenium, Chromium,
Zinc Probiotics Reduced L glutathione,N Acetyl cysteine, Alpha-
Lipoic Acid Anti-fungals medications. Herbal Products,
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Heavy Metals – what are they and where do they come from
Lead – petrol, paint, batteries, certain water mainsMercury – fillings in teeth, fish, paint, numerous
appliances such as mercury thermometers, nasal sprays and eye drops, certain vaccines.
Cadmium – Cigarettes, tyres, metal platingsArsenic – Pesticides, chicken feeds, rice, treated
wood
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Heavy Metals – what are they and where do they come from
Aluminum – Cooking wares, aluminum foil, antacids, certain vaccines, canned drinks/foods
Antimony – Carpets, flame retardant clothes
IronCopper
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Heavy Metals – how are we protected against these free radicals
Diet /nutrition– “let food be your medicine and let medicine be your food”- Hippocrates
Supplementation Skin release Good kidney eliminations Good bowel eliminations Exercise Healthy lifestyle
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What are the effects of these toxic metals overloadThey are oxidised to form free radicals
resulting in the destruction of cells, They affect organs ,interfere with enzyme
systems, inhibit prostaglandin formation. Weaken the immune system, inhibit the proper functioning of cells, contribute to gastrointestinal problems, and are carcinogenic.
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What Chelation agents are there1. EDTA-Ethylene diamine tetra acetic acid
2. DMSA(dimercocaptosuccinic acid)
3. DMPS(dimercaptopropanesulfonic acid)
4. TTFD Transdermal Allithiamine
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How are they used EDTA is effective only intravenously.It is used
in adults in the form of MG EDTA for Heart Disease,Circulatory disorders,neurological disorders, and the chronic degenerative diseases.
DMSA (dimercocaptosuccinic acid)DMPS(Dimercaptopropanesulfonic acid)TTFD/allathiamine (active form of B1)
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EDTA and its safetyGiven according to ACAM protocol millions of
chelations in past 30 years no recorded death.Doctors licensed in western Canada since
1997 No serious ADRS NIH conducting $30 million clinical trial on
2,300 patients no serious adrsNIH 800,000 I.V EDTA chelations in U.S.
alone no serious ADRSNot suitable for ASD children 3 hour i.v.
inneffective in chelating mercuryPowerful chelator of all other toxic heavy
metals
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Metal Dertoxification in Auistic childrenDMSA is the most widely used , convenient,
safe , and given orally. It is a good chelator of Mercury, Lead and Cadmium.
Dmps May be given intravenously. A good chelator of mercury,often used as a provovative agent, usually given in oral form
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Chelating With the oral chelators DMSA is given orally according to the Dan protocol 10mg/kg
body weight/3times daily for three days on and 11 days off.
Repeat Full Blood Count and Blood chemistry tests at 3 to 4 month intervals.
Mobilization and excretion of the heavy metals produces a shift in the equilibrium between the various compartments of the body. This exerts an almost magnetic effect on metals in depots which are not directly accessible to the chelating agent. The body attempts to restore an equilibrium between the depots again. The heavy metals will then migrate partially into compartmenst where it is accessible to the chelating agent.
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Advantages of DMSA over DMPSDMSA more widley used therefore greater experience with
its use and well established safety profile.
Well established in the DAN protocol.
No well established oral DMPS protocol.
DMPS used more in acute poisoning with Lead, Mercury, Arsenic etc.
DMSA is more effective in removing Mercury from the brain, particularly when combined with Alpha Lipoic Acid.
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Disadvantages of DMSA oral therpayDMSA may feed into the yeast/leaky gut/Gastrointestinal
problems.
DMPS is not as severe on the gastrointestinal problems
DMPS used by some physiciansina once weekly dosage of 100 mg per week
Is over 50 % absorbed
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Methylcobalamin and pharmacology Metylathion is the process by which a single
Carbon atom is transferred from a Methyl donor to another molecule.This process is essential to life itself.
Dr. Richard Deth of Boston believes that Thiomersail interferes with the Metylathion process in converting Vitamin B12 to Metylcobalamin.
In many cases Autsim can be treated effectively by the Administration of Metyl B12 to augment the Metylathion capacity.
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Biosynthesis of Active Methylcobalamin
The low levels of Glutathione in autistic children will adversely affect their ability to detoxify and protect against heavy metals such as Thiomersal.
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Impaired MethylationAs impaired Methylation is important in
Autism, the administration of Methylcobalamin should bring about an improvement.
Dr. James Neubrander has found significant improvement with injections of Methylcobalamin by giving the Methylcobalamin every 3 days.
Improvements were noted in Attention, language ability and social skills.
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How is Methylcobalamin given?Dosage recommendation is 65 micrograms
per Kilogram Bodyweight every 3 days.This means that as much as 1250 micrograms
is present in 0.05mlThe needle 30 gauge 3/10 Ultrafine BD
insulin. It may be given by the parent while the child is sleeping.
It is inserted into the buttock at a 30 – 45 degree angle just under the skin.
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Adverse effects1. Stimming
2. Hyperactivity
Should these effects occur one does not necessarily stop the treatment.
If Adverse effects are tolerable the treatment should continue
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Concentrated Metylcobalamin by InjectionMetylcobalamin is the active Co-enzyme
element of B12
B12 is present in the brain and central nervous system as Metylcobalamin & is Non toxic.
It is known that Metylcobalamin metabolism is impaired in the Autistic child.
Much information on this is available for Dr. Neubrander.
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Typical NaturopathicTreatment Plan
Heavy Metal ToxicityAsses presence of heavy metalsInvestigate heavy metal exposureUndergo chelation therapy for removal of heavy metals
Brain ChemistyEvaluate levels of Glutamate/GABA, serotonin and dopamine
Gastrointestinal HealthWheat (gluten) and milk (casein) free dietCandida diet (sugar, arabinose, tartaric acid)Hypoallergic diet to prevent autoimmunityAnti-inflammatory diet to control inflammationSupplements including EFA, probiotics, glutamine, MCT
NutritionWhy does food matter?
Opium, gluten and milk in AutismBreakdown of gluten and casein by secretions of the pancreas
and the intestines create peptides (small proteins) that are similar in structure to endorphins (the body’s natural pain killer). These peptides have opiate-like qualities.
Normally, these peptides are degraded and excreted with little effect.
In autistic patients, these peptides can lead to reduced brain electrical activity and thus altered behavioural changes.
This activity is improved by naltrexone administration (an opioid antagonist) therefore proving opioid action.
Much anecdotal evidence exists of significant improvement in autistic symptoms when milk and wheat are eliminated from the diet.
A study using 15 autistic children correlated significantly increased urine exorphin level with autistic spectrum patients. Elimination of milk and gluten from the diet resulted in improvement of social, cognitive and communications sills, commensurate with reduction of urinary exorphin level. Knivsberg et al, 1990
Treatment Atypical antipsychotic,
Abilify (Aripiprazole) oral formulation was approved November 24, 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years.
Data based on two 8 week, randomized, placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I).
Multi dimensional approachIt should be remembered that improving
Methylation capacity is only one component of the multi dimensional approach in the treatment of Autism.
Gluten Casein free dietNutritional supplementationChelatingBehavioural therapiesPharmacotherapy
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