DSM - IV

• 299.00 Autistic Disorder
• 299.80 Asperger’s Disorder
• 299.80 Pervasive Developmental Disorder NOS
• 314.XX Attention-deficit / Hyperactivity Disorder
  .01 Combined type
  .00 Predominately inattentive type
  .01 Predominately hyperactive impulsive type
• 314.9 Attention-Deficit / Hyperactivity Disorder NOS

Neurological Disorders

• Encephalopathy
  • Static
  • Regressive
  • Toxic
  • Vaccination
• Hypotonia
• Seizure disorder
• Neuroimmune Disorder
  

AUTISM EPIDEMIC

• Autism ---- rising incidence
• 1/2000 prior to 1970
• 1/500 1996
• 1/150 2000
• Better diagnostic techniques?

AUTISM EPIDEMIC

Recent California study shows epidemic of Autism NOT due to:

• Better diagnosis
• Migration to certain communities

WHY?

Multifactorial Etiology of Autism

• Genetics
• Environmental
  • Toxic
    • Heavy Metals
    • Chemicals
• Abnormal liver detoxification
  • Impaired sulfation
  • GSH depletion
• Gastrointestinal
  • Maldigestion
    • Opioid peptides
• Dysbiosis
  • Fungal
  • Bacterial
    • Anaerobic
  • Parasites
  • Viral
• Food Allergies / Sensitivity

Multifactorial Etiology of Autism

• Biochemical
  • Vitamins
  • Minerals
  • Fatty Acids
  • Amino Acids
• Neural
  • Neurochemical
• Metabolic
  • Mitochondrial Dysfunction
  • Impaired Methylation
• Infections
  • Viral
  • Bacterial
  • Fungal
  • Parasitic
• Immune
  • Immune Deficiency
  • Autoimmunity
    

IMMUNIZATIONS
The epidemic of autism has escalated in the past decade.
The Hepatitis B vaccine was introduced in 1991 --- given on the day of birth.
This vaccine contains thimerosal--a mercury compound as a preservative.

EXPOSURE TO MERCURY

• Mother
  • Heavy metal burden
    • Fish consumption
      • Tuna
      • Swordfish
    • Amalgams
    • Flu vaccines
    • Rhogam
• Infant
  • Vaccinations

• Children
  • Vaccinations
  • Amalgams

Mercury Exposure from VaccinesBirth to 6 months

1950 - 50 mcg
1970 - 75 mcg
1992 - 187.5 mcg

Infant Mercury Exposure Via VaccinationCBER, 1999*

• By age 6 months, a fully vaccinated infant has received:
  • 3 DPT 75 mcg mercury
  • 3 Hib 75 mcg
  • 3 Hep B 37.5 mcg
  • TOTAL 187.5 mcg mercury *FDA Center for Biologics Evaluation and Research

MERCURY TOXICITY
Effects of mercury are highly variable (1,000 -10,000 fold) in its effects on the individual
Acrodynia / Pink Disease
Afflicted 1 in 500 children with similar low Hg exposures
More adverse effects on genotypes with a higher propensity to autoimmunity
Low-dose Hg exposure damages more boys than girls

MERCURY
Uncoupling of oxidative phosphorylation
Impaired mitochondrial energy generation
Increased oxyradical formation

Glutathione and Mercury
Mercury decreases the GSH concentration of lymphocytes and monocytes

The sensitivity of human lymphocytes and monocytes to the toxic effects of mercury are related to the endogenous levels of GSH ie.- cells with high endogenous levels of GSH were relatively resistant to both the immunotoxic and cytotoxic effects of mercury

GLUTATHIONE
Tripeptide
? – glutamylcysteinylglycine
Potent molecular antioxidant
Conjugation cofactor for the liver P450 system
Essential cofactor for the glutathione peroxidase family of antioxidant enzymes
Metabolic roles: anti-inflammatory, antitoxin and metabolic regulator
Maintenance of GSH levels are essential for healthy and functional cells

CONTRIBUTORS TO GLUTATHIONE DEPLETION

Genetic propensity
Poor diet
Pharmaceutical Rx (i.e. acetaminophen)
Aging
Heavy metals (i.e. Hg, Pb, Cu)
?ROS ? ? requirement for GPx ? consumption of GSH

ENHANCE GLUTATHIONE
NAC
Alpha Lipoic Acid
Vitamin C
Vitamin E
Silymarin
IV Glutathione
Most direct and effective way

Gastrointestinal Abnormalities in Children with Autistic Spectrum Disorders

• Gastrointestinal abnormalities
  • Impaired digestion
  • Inflammation
  • Increased intestinal permeability
  • Altered bowel flora
    • Fungal overgrowth / hypersensitivity
    • Bacterial
    • Parasites
    • Viral
  • Food allergies / sensitivities
    

FUNGAL DYSBIOSIS

• Clinical Clues
  • Recurrent infections
  • Recurrent antibiotics
  • Chronic diarrhea
  • Constipation
  • Gas / bloating / abdominal discomfort
  • Systemic complaints
    • Energy
    • Cognitive
    • Behavioral
  • Worsen with DMSA and/or ALA and/or NAC

Autistic Enterocolitis

• Abdominal pain with constipation or diarrhea
• Ileal lymphoid nodular hyperplasia
• Lymphocytic colitis (less severe than classical IBD)
• Marked epithelial pathology
  • Increased CD8+ T-cells
  • Increased mucosal gamma delta T-cell density
  • Increased basement membrane thickness
  • Focal reduction in sulfated GAG’s in basement membrane and epithelium
  • Th2 skewed response
• Evidence of gut epithelial dysfunction in autism
• Suggestive of an atypical autoimmune condition with a gut-brain connection

Immune System Abnormalities in Autism

• Abnormal cell-mediated immunity
  • Abnormal T-cell subsets
    • Decreased total CD4+ cells
    • Decreased Tsi – CD4+ cells
      • Alteration in this subset may contribute to the development of autoimmune mechanisms
  • Abnormal T-cell activation
    • Decreased lymphocyte proliferative response
  • Decreased NKCA
• Autoantibodies to neural antigens
• MBP
• NAFP
  • May be related to viral agents (measles, HHV6)

Immune System Abnormalities in Autism

• IgA deficiency; IgG(and subclass) deficiency
• Partial complement deficiency
  • Increased frequency of the null allele for the complement component 4-binding protein (C46p)
• Abnormal cytokine profiles
  • Th2 skewing
• High prevalence of allergic disorders
  • Food allergy

Autoimmunity andHeavy Metals

• Evidence that mercury can induce autoimmune disease, both in humans and experimental animals

Autoimmunity and Autism

• Immune factors such as autoimmunity may play a causal role in autism
• Autistic children have significantly higher levels of MV and MMR antibodies
  Related to MV-HA of MMR
• >90% of MMR antibody-positive autistic sera were also positive for MBP autoantibodies
• Suggests a causal relationship between MMR and brain autoimmunity in autism
• Suggests an “atypical” measles infection (neurological symptoms, no rash) might be etiologically linked to autoimmunity in autism

Measles Virus and Developmental Disorders

Persistent measles virus detected in the intestinal tissue of 75 of 91 patients with developmental disorders (i.e., autism) who also exhibited severe bowel disease.

MMR and Autism
There is an epidemic of autism among children in the United States. Ulmann et al. focus their research on a cohort of autistic children who develop what is known as regressive autism. Children with regressive autism meet normal developmental thresholds, but shortly after receiving the MMR (12 – 15 months of age) they begin to regress. Many public health officials have stated that the timing is simply a coincidence. However, Ulmann’s discovery of measles in the inflamed intestines of 75 of 91 children in this recent study gives serious cause for concern.

MMR and Autism
It is believed that persistent measles virus in the intestines of these children may be the cause of the severe bowel disease (lymphoid hyperplasia and ileocolitis). Bowel disease is believed to result in the neurological disorders in these children. It has been established by other researchers that developmental disorders are associated with severe bowel disease. Last year the Institute of Medicine urged further study of this issue and the Congress has included language urging the National Institutes of Health to support research in this area. Additionally, a research paper published in Adverse Drug Reactions in January 2001, showed flaws in the pre-licensing studies of the MMR vaccine.

MMR and Autism

I am very disturbed by these findings and believe it is critical that we give children’s health the highest priority. While the verdict is still out on whether the MMR vaccine causes regressive autism, an association has been demonstrated in this study and others. I call upon the AAP to urge pediatricians to give parents all the facts about this safety concern and allow parents to make an informed decision about whether or not they want to separate the MMR vaccine for their children.”

MMR and Autism

“Vaccines have saved millions of lives. However, there are growing concerns about the safety of the MMR vaccine that must be independently studied. These clinical laboratory findings cannot be dismissed with epidemiological studies. The Centers for Disease Control and National Institutes of Health must apply vigorous, independent tests to evaluate the concerns over the MMR.”

Use with other Vaccines
M-M-R®II should be given one
month before or after administration
of other vaccines

CONTRAINDICATIONS

Primary immunodeficiency states, including
Cellular immune deficiencies,
Hypogammaglobulinemic and dysgammaglobulinemic
States.

Treatment Protocol Modalities

Dietary elimination of:

• Casein
• Gluten
• Refined foods
• Chemicals
• Additives
• Food allergens / sensitivities
• Yeast

Treatment Protocol Modalities

Gastrointestinal abnormalities

• Treat dysbiosis(fungal,anaerobic)
• Restore bowel flora
• Maintain intestinal wall integrity
• Digestive enzymes

Treatment Protocol Modalities

• Detoxification
  • Heavy metals
  • Xenobiotics
  • Gastrointestinal
  • Liver
  • Sauna (far infrared)
• Essential to deal with constipation (if it is present)

Treatment Protocol Modalities

• Heavy Metal Detoxification
  • DMSA
  • Nutritional
• Zinc
• Magnesium
• Taurine
• Methionine
• Buffered Vitamin C
• Allithiamine
• Lipoic Acid
• NAC
• Essential to deal with GI abnormalities prior to the initiation of DMSA treatment

Treatment Protocol Modalities

• Targeted nutritional supplementation
  • Correct deficiencies/dependencies

Nutritional Deficiencies/Dependencies

Includes

• Magnesium
• Vitamin B6
• Vitamin B12
• Folic Acid
• Vitamin A
• Zinc
• Sulfate
• EFA’s
• Molybdenum
• Glutathione

Treatment Protocol Modalities

• Targeted nutritional supplementation
  • Correct deficiencies/dependencies
• Enhance function
  • IV Glutathione
  • Methylobalamin
  • TD TTFD
• Secretin therapy
• Immune system modulation
  • Allergy treatment
  • Transfer factor
  • IV IgG

<< Regresar