Archive for the ‘Lyme’ Category

Processing Disorders and Autism

Sunday, September 18th, 2016

EEGleftThere are a number of newly-minted diagnoses that have been invented to explain many of the symptoms of the modern epidemic that covers autism.

They include:

 Sensory Processing Disorder
→ Visual Processing Disorder
→ Auditory Processing Disorder
→ Oppositional Defiance Disorder
→ Attention Deficit Disorder
→ Hyperactivity Disorder

→ Attention Deficit / Hyperactivity Disorder
→ Anxiety Disorder
→ Obsessive Compulsive Disorder
→ Explosive Disorder
→ Social Processing Disorder

Diagnosis:
These conditions frequently display such similar general patterns that, depending on a practitioner’s inclination to be a ‘splitter’ or a ‘lumper’, the available treatment regimens could vary widely. For example, AD and HD are usually treated as ADHD, with stimulant medications, even though inattention, poor focus, distractibility and hyperactivity may arise from a variety of physiological conditions.

Likewise, aggression, obsessive – compulsive behaviors, and opposition are usually prescribed anti-anxiety medications, such as Risperdone, Abilify, Intuniv, or even Prozac and Zoloft.

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Some are more or less related, and others may be merely due to immaturity, therefore patience and time will yield preferable results.

Treatments:
It is not difficult to imagine that processing difficulties in vision, hearing, touch, and the other senses, can lead to signs, such as repetitive behaviors or ‘stimming’, to alleviate the sensory overload. Supplements, such as magnesium, turmeric, epsom salt baths, essential oils and even HBOT could address those issues, in addition to traditional therapies. Most parents of children with ASD own at least one trampoline.

Restricted interests and repetitive behaviors are core problems in patients with autism. They are not OCD, and the usual medications are rarely effective, even though the diagnosis prompts traditional physicians to prescribe higher, more frequent doses, and/or a combination of pharmaceutical preparations.

The recognition that processing difficulties underly these unusual behaviors has engendered the protocols that include ABA, PT, OT and other specialty therapies. They require significant resources, but have demonstrated improved outcomes. Certainly this approach is not as risky or potentially harmful as potent medications.

Anxiety appears to be a result of a combination of the other processing difficulties, and social processing disorder is as real as any of the other contrived diagnoses. Early socialization is, therefore, a useful intervention. The fewer pharmacological interventions, the less chance that they will poison the growing brain.

On another hand, certain abnormalities seem to be a result of difficulties in other-than-CNS processing. Aggression, opposition, and explosive behaviors are frequently gut-related. The recognition that autistic behaviors can be ameliorated by restoring the gastrointestinal microbiome has assisted many patients who have been suffering for years.

Conclusions:
The biomedical approach is unique in the treatment of this myriad of medical conditions because the basic assumption is that they are due to a variety of upstream difficulties.

The recognition that, in patients with autism, some neural pathways proceed down the right path, others stumble upon an incorrect route, some thoughts don’t propagate at all, while other symptoms are emanating from elsewhere, goes a long way to assisting patients in their improvement.

Medical Academy of Pediatric Special Needs – Fall 2016

Sunday, September 11th, 2016

This week, the Medical Academy of Pediatric Special Needs held its semiannual conference in downtown Atlanta, GA. This is ‘Ground 0’ for practitioners, researchers and professors from all over the world to meet, learn, explore and discuss a myriad of relevant topics.

Members who have been returning for 100’s of lecture hours generally choose the advanced courses. For some, the conference has become a group of ~50 experienced and knowledgeable practitioners who meet to discuss ‘workups’, basic science, relevant research and treatment protocols for those who are most affected with ASD.

Notes and Observations
Day 1 – Tough Cases
I really enjoyed our lectures by the plain-speaking Dr. John Green, of Portland, OR. Dr. Green not only reviewed those who improved because of his medical expertise, but those who got better in spite of him, those who haven’t gotten better, those who got better but he can’t figure out why, and the most frustrating – patients who improve only to suffer frequent relapses.

Dr. Sid Baker, a pioneer of the biomedical movement, described his early medical experiences in Africa that morphed into his lifelong dedication to treating patients with ASD. He expressed his disappointment that so many conventional colleagues disagree with our practice.

Dr. Baker elucidated how he initiates care with new patients. He discussed increasingly resistant cases, covering topics from severe speech apraxia to the approach to children with injurious behaviors.

The first day was filled with the most frustrating and difficult cases you can imagine. Eminent practitioners Drs. James Neuenshwander, Michael Elice, and Julie Buckley challenged our diagnostic and therapeutic knowledge, attempting to navigate the complicated courses of those who improved and those who didn’t.

Day 2
Dr. Daniel Amen‘s morning lecture was entitled “3D Brain SPECT Imaging”. The takeaway message was that SPECT scans – technology – could/should/will become a mainstay for a multitude of CNS disorders. His manner and stories of research, technical evaluation, and clinical practice, were positively spellbinding and inspirational.

Dr. Theoharides presented his research and extensive knowledge about the important role of allergy in ASD. Dr. Theo continues to publish a mountain of monumental works, not only on the topics of autism and the role of mast cells, but treatments, as well.

Toxins were the subject of the afternoon’s lectures. We learned about the identification of substances in the environment that are dangerous, how they are measured, how damage is done, and the means to control and treat. For the skeptical reader, there was a plethora of supporting scientific evidence of the relationships to autism (and many other modern conditions).

As has become customary, Dr. Dan Rossignol rounded up the day with a roundup of all of the latest scientific research. Rapidly.

Day 3 – Advanced Clinical Cases
Severe behaviors and speech apraxia. For patients who are most resistant to conventional and alternative treatments, essential oils, acupuncture, and even worms were explored as possible solutions.

Throughout the afternoon, cases got even tougher! Lyme, Persistent Lyme, Non-Lyme Lyme, PANDAS, PANS, parasites… an increasing number of reasons to have signs and symptoms that are called autism. Such information extends our knowledge and leads to better diagnoses for our patients, and possibilities for treatment.

Dr. Green discussed biomarkers. Though these ‘labs’ are not specific to ASD, per se, this will become a necessary next step to document level of involvement and response to treatments.

A brand new treatment, repetitive Transcranial Magnetic Stimulation was presented by Dr. Arun Mukherjee. The jury is still out on this expensive intervention.

Conclusions
One important reason that I return to this meeting, is simply that I feel at home among like-thinking practitioners. Members don’t agree on every subject, but we are respectful and actually enjoy our practices.

In traditional medicine, conferences are basically show-and-tell affairs, where researchers report their data, previously published in medical journals. When doctors think outside the box, practitioners with diverse skills, who are scattered over the globe, discover improved results by networking in this fashion.

Patients, parents, and families can feel confident that progress is being made (slowly), as serious, dedicated doctors continue to try to unravel this modern mystery.

Finally, I am proud to report that, at this meeting, I was awarded Fellowship status in the Medical Academy of Pediatric Special Needs.

Lyme Disease and the Autism Spectrum

Sunday, October 25th, 2015

A disease described forty years ago due to a cluster of patients who appeared in the vicinity of Lyme, CT, has to be considered among the list of differential diagnoses when pediatric patients present with unusual developmental and other complaints.

Included on that list are PANDAS, specific neurologic disorders (e.g. seizures and cerebral palsy), chromosomal anomalies, mitochondrial disorders, and a myriad of systemic conditions, such as autoimmune ailments, G-I disease and skin rashes that ultimately may lead to symptoms and signs that fulfill criteria for ASD.

Cause
There is a complicated life cycle involving a deer tick that is infected with an unusual bacterial organism. When a human is bitten, those critters create problems throughout the human body.

Presentation
The variety of symptoms are due to effects in multiple organ systems, including skin, internal organs, muscles, and neurons throughout the body. Fatigue and various CNS complaints are the most obvious and serious signs. In patients with ASD, Lyme may appear as regression or progression of aggressive and disruptive behaviors.
Recent recognition of the havoc that this infection wreaks on the immune system points to signs and symptoms in a number of modern autoimmune maladies.

Testing
The most reliable diagnosis is made when a two step protocol is positive. Using the same sample, a positive or equivocal enzyme test will lead to testing for specific antibodies. According to one commercial laboratory, their PCR test has the advantages of correctly identifying Lyme in small measure, and in a variety of tissues. Costs are approximately $300 to $800.
Unless there is specific and adequate documentation, insurance companies balk at paying for even the less expensive labs.

According to the CDC, “Laboratory blood tests are helpful if used correctly and performed with validated methods. Laboratory tests are not recommended for patients who do not have symptoms typical of Lyme disease. Just as it is important to correctly diagnose Lyme disease when a patient has it, it is important to avoid misdiagnosis and treatment of Lyme disease when the true cause of the illness is something else.”

Treatment
Patients treated with appropriate common oral, or intravenous antibiotics in the early stages of Lyme disease usually recover. There is a controversy concerning the proper diagnosis of patients who fail to respond after 6 months.
The CDC prefers “Post-treatment Lyme Disease Syndrome” to the term, ‘Chronic Lyme Disease‘. There is also “Conventional medicine and the NIH have taken a particularly strong position, researching various treatment protocols with little evidence of value. However, those who continue to suffer seek additional relief.

Conclusion
When faced with the enigmatic and vague diagnosis of ‘Spectrum Disorder’, parents sometimes seek a more specific, treatable disorder, such as Lyme. Clinicians should elicit a history of possible exposure to infected blacklegged ticks. Though ASD patients are as likely as anyone to become infected, symptoms that begin in infancy and very early childhood are much less likely due to Borrelia.

The history, a particular rash, and an unrelenting deterioration of neurologic function should alert the astute physician to perform the appropriate laboratory testing.

Importantly, the information we learn from studying and treating Lyme disease has many similarities to our better understanding of autism, as well.

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