Autism Spectrum Disorders and Seizures

I recently had a patient present to the office for a neurological consultation regarding a learning disability, ADHD or an issue relating to the autism spectrum. It appears that the little girl was spacing out and had difficulty concentrating. In my seminars, I always speak about patients on the autism spectrum not having any hard lesions. That is to say, their MRI is normal in regards to not having any tumors, infections, malformations etc. For example if the child has a tumor, then his diagnosis is not autism but would be whatever type of tumor was found. It is only when all these hard lesions are ruled out that the diagnosis of autism is considered. This type of screening ensures that we are then dealing with a functional lesion. This means that all the structures in the brain are present. It then becomes a question of the function of the brain, its connections and coherence. Another fairly common test that is  performed on a child suspected of being on the autism spectrum is an EEG. In this case, we would be looking for seizures. In the case above we would be concerned with absent seizures in which the patient seems to space out or be  “absent” consciously even though they are present physically. In my practice ,we have quite a few patients that have both a history of an autism diagnosis as well as a seizure disorder. Please be aware that a patient can have an autism spectrum disorder, a seizure disorder or they may have both. The patient’s treatment will of course be affected by the category into which they fall. for example functional neurologist often use light as a technique  to introduce a stimulus into the visual system. If the patient recently had an EEG in which the flashing of lights triggered a seizure, then that information certainly needs to be considered when developing a treatment plan for that particular patient. In any case, many patients being evaluated for these types of conditions will have an MRI and an EEG performed as part of their work up. Those tests should exclude other conditions being a cause of your child’s issues and your child not being part of the autism spectrum. A recent study in the Journal of  Brain Development found that 24.6% individuals in the study with infantile autism had at least one epilepsy diagnosis versus 1.5% in the comparison group. The take-home of this article is make sure your basics are covered so that  the most appropriate treatment plan can be instituted for your child.

Brain Dev. 2010 Jul 22. [Epub ahead of print]

Gluten Free Dieters: Check This Out

There is a new social networking web site for gluten free dieters that functions like face book. Share recipes, stories and frustration. The web site seems to be geared toward celiac disease but gluten free is gluten free. It has blogs and forums. It has events listed in different cities around the country. The emphasis doesn’t appear to be on the Autism Spectrum but I am sure you can find ideas here to make your life easier.It really looks like a good place to get some gluten free info. Here it is  http://www.glutenfreefaces.com/

My Frustration

I have a 9 year old autistic boy who on his first visit complained of chronic painful constipation as well as other symptoms commonly associated with autism. His abdomen was clearly bloated. He came to me after having previously been to various D.A.N. doctors including one with a very positive reputation. I asked the mom who wanted to pursue Hemispheric Integration Therapy if he had been worked up biomedically and if his issues had been addressed. She told me “Oh yes, I can bring in all his old lab work, he has no biomedical issues”. She said she provided me a list of the supplements he was taking. Finally, about 4 weeks later, after repeatedly asking for his lab work ( which she continuously said she forget to bring) I asked ” Are you sure he doesn’t have yeast?”  That day the 9 year old , still in diapers, was constipated, bloated and screaming from the pain. She responded ” Oh yeah, he has yeast.” I asked ” Are you giving him anything for it?”. She said ” I was but I got tired of giving it to him”.  Incidentally, she always came in handing the child a cookie. For those of you that don’t know, yeast love sugar. I then asked her what supplements he was taking at present. She responded that he wasn’t taking anything now. ” Then what was that list of supplements you wrote down on your intake sheet on his first day” I asked. “Oh, those are things he has taken in the past but he isn’t taking anything now” she said. FRUSTRATION!! We gave him some saccharomyces boulardii and he started feeling better by Monday. We also ordered some appropriate test to assess the child and be able to monitor his progress. I often say that Hemispheric Integration Therapy is like an exercise program for the brain. Before you begin an exercise program, you would want to make sure you did not have any serious health issues and make sure you eat enough protein to rebuild the muscles. Yeast and dysbiosis are what I call negative factors that should be addressed if you want to get the most out of the H.I.T. I think we will be stricter about bringing records prior to starting treatment. Every child I treat is an ambassador for H.I.T and this office.  I want to make sure that they all make the most progress that they can. This treatment approach is a great one but it is not a miracle.

Gluten Free Brownies Anyone?

In my opinion, the gluten free diet is brutal but it seems everyday it is getting easier with all the new sites and recipes.

http://tried-and-truecookingwithheidi.blogspot.com/2009/07/bodacious-sugar-free-gluten-free.html

Tourette’s Syndrome Beware

  Here is some interesting information from the site http://physician-assistant.advanceweb.com/editorial/content/editorial.aspx?CC=41662

The summary relates to those with ADHD and speaks to the effectiveness  of current medications as well as some contraindications. Often I must remind parents that these  are spectrum disorders and there is much overlap among conditions. That is, for example, one can have a child with OCD and ADHD or Asperger’s Syndrome with ADHD. In this case, the warning is to those with Tourettes Syndrome and ADHD. Be careful of the conditions that your child may have and the medications they are given. The paragraph below speaks to a contraindication for the ADHD medication group if you have tics or Tourettes. Just in the last 3 months we have had 2 patients  treating in our Hemisperic Integration therapy Program with that exact combination.

ADHD Drug Performed Well in StudyTreatment with once-daily Metadate CD (methylphenidate) Extended-Release Capsules by Celltech Pharma was more effective in children with attention deficit hyperactivity disorder (ADHD) than treatment with another frequently used drug, according to a study recently published in the online edition of the journal Pediatrics (Swanson JM, Wigal SB, Wigal T, et al. A comparison of once-daily methylphenidate formulations in children with attention-deficit/hyperactivity disorder in the laboratory school [the COMACS study.] 2004;113:e206-e216).

Metadate CD was more effective than the other drug during the morning hours and the two drugs performed similarly during afternoon hours, according to a company press release. Both formulations provide an initial dose of immediate-release methylphenidate. The initial dose is followed by an extended, controlled delivery of methylphenidate. The study included 184 children between the ages of 6 and 12 with ADHD.

Metadate CD Capsules are contraindicated in patients with marked anxiety, tension and/or agitation; in patients with glaucoma, tics or Tourette’s syndrome; and within 14 days of using monoamine oxidase inhibitors. Metadate CD Capsules should be used with caution in patients with a history of psychosis, drug or alcohol dependence, seizures, hypertension or cardiovascular disease.

The most common adverse reactions are headache, abdominal pain, decreased appetite and insomnia.