Autism and Autistic Spectrum Disorders
Connection "shedding" failure?
Dr. Kovacevic is currently working on the hypothesis that a failure of "shedding" of supernumerary nerve connections normally expected to occur in the period between 12 - 15 months of age, may indeed be the main reason for the development of core symptoms in autism. The cause of this failure can be an infection (most likely), or an autoimmune reaction to an infection (very likely), but other causes (less likely) must be taken into consideration as well. If the fore said speculation can be proven, future treatment modalities may include antibiotics, IVIG, etc. Dr. Kovacevic is currently designing a pilot study on effectiveness of a prolonged (12 doses) IVIG treatment in autistic patients with a confirmed (or highly suspected) inflammatory component.
Brain inflammation link to autism. Dr. Carlos Pardo-Villamizar and his Johns Hopkins team report finding that certain immune system components (i.e. cytokines and chemokines) that promote inflammation are consistently activated in people with autism. Other scientists have also examined the possible connection between the immune system and autism. One study has linked the condition to the encephalitis, while another found raised levels of nitric oxide in the plasma of children with autism.
For more information, please contact Dr. Kovacevic by e-mai!
Is autism an "Efflux" Disease?
An interesting hypothesis has been recently brought forward by H. Vasken Aposhian, Ph. D. from the University of Arizona, Tuscon. Following his surprising findings of a decreased mercury levels in hair samples of children with autism (as compared to the healthy controls), Dr. Aposhian speculates that children with Autism may indeed have an impaired ability to rid their bodies of mercury, much the way children with Wilson's disease cannot metabolize copper. These observation have been independently confirmed by researchers at MIT as well. Further proof of this theory will require analysis of tissue rather than just hair and might be some time away.
If this hypothesis is confirmed, early mercury chelation would be the treatment of choice. In addition, a particular attention will have to be paid to possible mercury intake during the pregnancy (consumption of fish, use of mercury containing hair shampoos and conditioners, and yes, complete elimination of thimerosal from children's vaccines).
Review of attempted treatments for Autistic Spectrum Disorders
As a hormone involved in regulation of certain gastrointestinal functions, Secretin has been known for over a quarter of the Century. It has had no particular clinical application except as an aid in the evaluation of pancreatic functions. Following an anecdotal report in 1998 of an autistic child significantly improving following the administration the test dose of Secretin for an unrelated medical complaint the interest in Secretin has increased greatly. Since that time an unknown number of patients with autism has undergone this somewhat invasive and expensive treatment with various degrees of reported benefit. Scientifically sound study to determine the true benefits of administration of this compound to the children with autism was completed and published in 2001 by Dr. Conoglio of Emory University. Conclusions of this particular study were disappointing. Six weeks following the single dose of Secretin, only a small and statistically insignificant difference in symptoms between the group receiving Secretin and the group receiving the placebo was noticed.

Secretin might have had a positive impact in isolated cases of autism, but there have been no hard scientific evidences as of yet, that it really works. Dr. Conoglio's study is one of only few scientifically designed studies that have examined the use of Secretin in autism. The big drawback to this study is that only one dose of Secretin was used. In any case, Secretin's wider use in autism cannot be justified at this time. Even in those cases where an improvement attributable to Secretin has been noticed, it remains unclear how many treatments should patient receive, what is the necessary frequency of treatments and finally, how long would the reported benefit last.

IVIG therapy.
The rational for use of IVIG in children with autism has been (1) the assumption that bowel colonization with certain viruses (measles and rubella viruses) can result in an autoimmune reaction resulting in symptoms of autism (Wakefield, Gupta), and more recently (2) that PANDAS or PITAND-type pathophysiology can be responsible for the development of certain cases of autism. An additional boost for IVIG use in autism have been recent reports describing the appearance of classic autistic symptoms in patients following Herpes simplex encephalitis. Despite of the initial optimism generated with Gupta's reports, later experiences with IVIG therapy in autism have failed to duplicate his results.
Vitamin Mega doses.
Vitamins in doses far above doses recommended in the medical literature have become an answer to almost any medical problem that modern medical science has no other answer for.  It should come as no surprise that vitamins have been used in autism as well. Again, no solid scientific evidence exists to support use of Mega-doses of vitamins in patients with autism, however the antioxidant vitamins can be helpful to some extent.

Free radical damage of nervous tissues has been well documented in various other disorders and conditions, and one must assume that supplementation with antioxidants in autism would be of limited benefit in protecting the challenged nerve tissue. Since the benefits of antioxidants in autoimmune diseases have been reported as well, use of vitamins in autism cannot be outright discounted. One however has to be aware of the possibility of overdosing children with certain vitamins (particularly vitamin A). Use of pyridoxine (B6) and seligiline (B17) in autism has become more frequent and might have exhibited some benefits in these patients.

Vitamin B6 and Magnesium
Review of 12 published studies by Pfeiffer (1995) is enlightening but also sends a stern warning about how is the therapeutic research conducted and how results of such research can or should be interpreted.

Combination of mega-doses of Vitamin B6 and Magnesium might be beneficial in alleviating certain symptoms of autism, and the value of this combination in autistic patients with seizures must be explored further. Another possible benefit of this combination could be the prevention of further damage to the nervous system.

Dietary approaches to Autism: "leaky gut syndrome", GFCF (gluten-free, caseine-free) diet(s), carbohydrate elimination diet, ketogenic diet, probiotics
Since the associated gastrointestinal symptoms have been commonly reported in children with autism, it is not unexpected that many of the attempts to help these patients have targeted their gastrointestinal tract. What makes any serious assessment of the true effectiveness of dietary interventions in autism impossible, is the simple fact that the variety of suggested approaches is bewildering and the availability of supporting scientific scant at best. Anecdotal reports of improvements or outright cures of autism by certain dietary regimes should not be all discounted outright, since the scientific studies of their true value are lagging far behind.

"Leaky-gut syndrome" theory has been receiving some indirect help from the discovery of "Super-antigen" characteristics of some common microorganisms (Streptococcus Group A, Staphylococcus, Campylobacter, etc.). These properties enable these microorganisms to change the immune properties of the cells within the bowel wall, changing the resorptive behavior of these cells.

Ketogenic diet has been utilized in some patients with autism and seizures with good results. Even though the exact mechanism is not clearly understood, ketogenic diet should be tried in autistic patients with refractory (intractable) seizures.

Use of Lactobacillus acidophillus cultures to normalize the intestinal flora (the speculation about so-called "yeast overgrowth" aside) should be considered for an overall health of the child with autism. Stereotipic behavior frequently results in unhealthy stereotipic dietary habits, and here's where Lactobacillus can be of benefit.

New on the US market, but available in Europe since early 1900', Saccharomyces boulardii probiotic might be another important step forward in health applicability of probiotics.

Isolated attempts of antibiotic treatment for autism have been reported from some Mid-western medical centers. The rational for use of antibiotics has been the assumption of patient's bowel colonization by certain Super-antigen producing microorganisms (Group A Strept, certain strains of Staphylococcus, Campylobacter, etc.). In carefully chosen cases treatment with Vancomycin has been successful.
Chelation therapy is neither safe nor effective as Autism treatment
Based on, by now clearly rebuffed theories of heavy metal intoxication (mercury) being a cause of autism, this therapy has no place in its treatment and must be reserved for true heavy metal poisonings (lead, mercury, etc.). It is expensive and can be dangerous. Do not consider this option until more evidences are presented!
Addendum: recent study from University of Arizona, Tuscon (Aposhian) may force us to reexamine our current opinion about chelation and (possibly) reconsider it.
L-Carnitine use in patients with Rett syndrome has shown some promises, and needs to be studied further. Use and possible benefits of L-Carnitine in other disorders of the autistic spectrum are not known as of now.
Triptophan supplementation
Triptophan, a precursor of neurotransmitter serotonin, has been reported beneficial in patients with autism. To be specific, most of the recent studies have tested the Triptophan withdrawal in patients with autism, and found that the depletion of this compound in the diet of tested subjects has caused a significant clinical worsening of patients' core symptoms. This was successfully reverted upon reintroduction of triptophan into diet.

Triptophan dietary supplementation appears to benefit patients with autism. Word of caution: if patient is receiving SSRIs, tryptophan sypplementation is contraindicated (possibility of "Serotonin syndrome").

Chez et al. have reported a significant improvements in symptomatology of patients with autism receiving L-Carnosine therapy (dipeptide previously shown to enhance the frontal lobe function of the brain and considered to be neuroprotective). Follow-up studies are expected. In addition, reported benefits of L-Carnosine in patients diagnosed with ADD or ADHD might extend the usefulness of this supplement even further.
Review of pharmaceuticals currently used in Autism (targetting specific symptoms)
Patients with autism have become an unwilling polygon for testing of just about any new behavioral modification or psychotropic drug that comes to the market. Again, the target of all these pharmaceutical is NOT autism as a disease, but only its symptoms. Methylphenidate, Pemoline have been used to control symptoms of attention deficit and hyperactivity. Propranolol has been used for explosive behavior and aggressiveness. Serotonin-reuptake inhibitors and agonists, antidepressants (Fluoxetine, Fluvoxamine, Sertraline, Clomipramine) are being used to control some of the classic autistic symptoms: perserveration, obsessions, rigidity, aggressiveness) and haloperidol, thoridazine, chlorpromazine and pimozide for control of aggressiveness, destructiveness and self-injury.

Fluvoxamine and Risperidone appear to be overall effective in controlling some of the core symptoms of autism and repeated studies have confirmed their effectiveness. Risperidone has also shown promise in Asperger's syndrome.

Quetiapine, an atypical antipsychotic currently approved for treatment of schizophrenia, has shown some promise in Autistic Spectrum Disorders and mental retardation patients. 60 percent of patients with autism have responded favorably to the moderate to high doses of this medication.

Opiate agonists (Naltrexone)
One of more promising developments in autism research to date. Semisynthetic opiate-receptor antagonist might be the answer to the (speculated) endorphin "overload" in autistic patients, and could provide an important lead to the effective control of autistic symptoms. A small study has confirmed the potential of this treatment in autism, however larger, more scientific study is needed to assess the true clinical benefits of Naltrexone in children with autism.
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