Autistic Spectrum Disorders: Alternative Approaches To Help Our ...

1. Autistic Spectrum Disorders:Alternative Approaches To Help Our ChildrenDecember 15, 2008New York City, NY Nancy O�Hara, M.D. 150 Danbury Road Wilton, CT 06897 www.drohara.com

3. New Approaches for the Non-Responders Inflammation PANDAS Gut Proprionic acid Biofilm Multiple Treatment Options Oxidative Stress How To Measure 8OHG (urine) Cysteine (blood) Mitochondrial markers How To Treat Prevention Antioxidants (including Glutathione) Multiple other treatment options Seizures

4. PANDASPediatric Autoimmune Neurologic Disorder Associated with Strep Criteria for PANDAS Presence of OCD and/or tic disorder; neurologic abnormalities Prepubertal onset Episodic course of symptom severity (relapsing/remitting) Temporal relationship between strep and symptom exacerbation Symptoms of PANDAS Choreiform movements Emotional lability, depression and personality change Anxiety, irritability, compulsive rituals Cognitive and handwriting changes Aggression or self-injurious behavior Treatment of PANDAS (Sue Swedo) PCN or Zithromax prophylaxis (symptom improvement) Plasmaphoresis or IVIG (decreases titers, antineural antibodies) 1 gm over 2 days decreases symptoms by 45% in one month (no change with placebo) 

6. Mind the GUT Proprionic Acid How can gut bug control behavior? Bugs produce SCFA, like Proprionic acid Also common preservative in wheat and dairy Byproduct of bacterial metabolism Increased with B12 problems and biotin deficiencies Proprionic acidemia Carnitine depletion Mitochondrial problems Accumulation of SCFA Impaired methylation and sensitivity to metabolic stress Injecting Proprionic acid into brain of rats Causes reversible repetitive behavior Induces hyperactivity, ritual turning, object fixation and sterotypies Treat Clostridia with Flagyl (metronidazole)

7. Mind the GUT - Biofilm Collection of microbial communities enclosed in polysaccharide matrix of calcium, magnesium and iron Matrix protects against phagocytosis, antibiotics, immune modulation and antimicrobials Also outer membrane proteins of matrix not expressed on outer layer (but rather internalized into biofilm) and therefore not recognized by immune system Consider biofilm Recurrent or persistent dysbiosis, recurrent otitis, sinusitis, dental caries Children who initially do well with antifungals and then no response Stool and urine cultures negative but does well on antifungals or antibiotics Treatment includes probiotics and prebiotic (symbiotic), oral EDTA, iron chelating compounds, mucous degrading enzymes Lactoferrin retains motility in bacteria and does not allow it to form biofilm aggregates (especially pseudomonas � serratiopeptidase also helps) Fibrinolytic enzymes help to break down staph Chitosan (derived from shellfish) � has NAG and thins biofilm, especially strep

8. Mind the GUT - Biofilm Treatment protocol (very long process � may be years; average 4-6 months; improvements seen in weight gain, behavior (including PANDAS OCD and tics, conversationand stools) Step 1 � Lysis/detachment of biofilm (on empty stomach) Enzymes (lumbrokinase, nattokinase, serratiopeptidase, SPS30, papaya or pineapple) Oral DisodiumEDTA or Apple Cider Vinegar Lactoferrin (do not do if very sensitive to dairy); NAG (N-Acetyl Glucosamine) Step 2 � microbial killing (antifungals/antibiotics � give 15 minutes later with meds) Often start with herbals (agent varies with germ type) Die off often occurs at Day 21 (includes irritability, aggression, hyperactivity, sleeplessness, skin rash and fever) Step 3 � clean up (like a toothbrush � a few hours after step one) Charcoal, fiber, modified citrus pectin, alginates, brown algae Step 4 � rebuilding and nourishing gut lining Probiotics, prebiotics, fermented foods Diet � SCD or at least high antioxidant (high ORAC value- Acai, noni, goji), low sugar and low AGE (advanced glycation endproducts � browned, fried or heated at high temps like French fries, cake, dark sodas, donuts) Supporting nutrients include xylitol, aloe, EFAs, slippery elm, marshmallow, ginger, colostrum

9. You gain strength, courage and confidence by every experience in which you really stop to look fear in the face�. You must do the thing you think you cannot do.-Eleanor Roosevelt

10. What To Do Mucosal health=Promoting Immunity Remove stressors (e.g., allergenic foods, gluten, casein, yeast, bacteria, parasites, toxins) Supply nutrients (e.g., vitamin A,C,D,E, B vitamins, zinc, magnesium) Supply EFAs and immunoglobulin production (probiotics, saccharomyces boulardii) Anti-inflammatories (Ibuprofen, Mesalamine, Sulfasalazine, Curcumin, Spironolactone, Phosphatidylcholine, Galantamine, Minocycline, Steroids, HBOT)

11. Remove Stressors - Allergens Bioset Drug free, gentle means to eliminate food intolerances and environmental sensitivities First determines reactivity or �allergy� to substance Measures body�s energy flow using Electrodermal screening Muscle testing

12. Remove Stressors - Allergens Bioset Continued Find that body is �blocked� or reactive to substance Activate specific acupressure points Clear sensitivity Increase energy flow

13. TSO Ovamed.org Immune modulator Used in Crohn�s Disease Two month course of pig worms Expense

14. �Courage does not always roar. Sometimes it is the quiet voice at the end of the day saying, �I will try again tomorrow.�

15. Role of Vitamin D in Autism Vitamin D down-regulates inflammatory cytokine production in brain Vitamin D raises seizure threshold Deficiency < 40 ng/ml Vit D 25-OH levels Treatment Vit D3 to reach levels > 40-60 ng/ml Fat soluble vitamin (monitor routinely) Sunlight

16. Treating Inflammation Curcumin (turmeric) Anti-inflammatory Promotes stem cell proliferation 150 � 1500 mg orally Spironolactone Anti-androgen (testosterone) effects Anti-inflammatory (MS) Protective against mercury poisoning in rats 25 mg 1-3x/day

17. Treating Inflammation Phosphatidylcholine Anti-inflammatory Promotes detoxification 100 � 200 mg IV; 1800 - 2000 mg orally Galantamine Anti-inflammatory (helpful vs aggression) Nicotine (as effective as Ritalin vs inattention) � - 1 patch (7 mg patch) Synergistic effects on blocking microglial activation (which leads to neural inflammation)

18. Treating Inflammation Minocycline Anti-inflammatory (commonly used in Lyme) Dose � 100 bid Steroids Anti-inflammatory (asthma, allergic rhinitis) Studied in combination with antimicrobials for CNS infection (Fitch et al) Short course therapy diagnostic 1 mg/kg prednisone

20. Hyperbaric Oxygen Therapy Applies to increased oxygen concentration at increased pressure Mild HBOT � 28% oxygen; 1.3 ATA (4 psi) = diving to depth of 10 feet HBOT � 100% oxygen; 1.5 or greater ATA (> 8 psi) = diving to > 20 feet Clinical and research proven success with fetal alcohol syndrome, ischemic brain injury, cerebral palsy, head trauma, ASD

21. HBOT - Theory Increase oxygen content and delivery to tissues Allows oxygen gas to dissolve more easily into the surrounding liquids, such as the blood plasma and cerebrospinal fluids Overcomes hypoperfusion (temporal and frontal lobe cerebral artery resistance correlates with behavioral symptoms) Potent anti-inflammatory (treat lupus, arthritis, colitis, encephalitis) Reduces oxidative stress (give antioxidants) Mobilizes stem cells from bone marrow

22. HBOT - Practice Mild HBOT Minimum 40 sessions (some studies � 80) Each session = 1 hour (maximum 2 hours) Maximum in 30 days (90 sessions � two 1 � hour sessions each day) Breaks? Side effects � barotrauma (2%), claustrophobia, temporary dizziness, vision changes, headache or nausea, seizures (0.01%)

23. HBOT - Practice Hard Chamber HBOT Can obtain same pressures (1.3 ATA) or greater Can obtain 100% oxygen 1 hour session (maximum 2/day) Multiple studies showing benefit in Lyme disease, autoimmune disorders, injuries and now ASD

24. HBOT - contraindications Acute asthma attack High Fever Uncontrolled seizure disorder Optic Neuritis Pneumothorax Known ear infection or upper respiratory infection Aneurism Glaucoma Pregnancy Severe heart or lung disease

26. Treat inflammation - Diet Basic Fresh, unprocessed, protein, rotational Nonallergenic (crave that which most sensitive) GFCFSFYFCF Specific Carbohydrate Diet (SCD) Gut And Psychology Syndrome (GAPS) Body Ecology Diet (BED)

28. Oxidative Stress Measurements 8OHG (RNA) Cysteine Mitochondrial markers AST Carnitine Ammonia Lactic acid Creatinine kinase

29. Oxidative StressTreatment Options Prevention Diet � rotational, unprocessed, organic Remove and eliminate toxins Remove amalgams Alternative vaccination schedule Air and water filters Avoid large fish (shark, sea bass, tuna, swordfish) Checnet.org

30. Oxidative StressTreatment Options Antioxidants Decrease oxidative stress/free radical damage Promote detoxification Vitamins A, C, D, E Glutathione, N Acetyl Cysteine (NAC), PK Detoxifies heavy metals and chemicals Preserve mitochondrial integrity and promotes ATP production Protects lining of gut Promotes normal T cell function

31. Oxidation sounds like it should be a good thing, since we all know we need oxygen to breathe But from a cellular perspective, oxidation is akin to rusting. Look at some of the things that make you rust quicker:Oxidation sounds like it should be a good thing, since we all know we need oxygen to breathe But from a cellular perspective, oxidation is akin to rusting. Look at some of the things that make you rust quicker:

32. Oxidative StressTreatment Options Others Melatonin (promote sleep/antioxidant) Pycnogenol (pine bark) Sauna Namenda (Memantamine) Langauge Social and self-stimulatory behavior Antiglutamate Others � GABA, chamomile, pumpkin seeds

33. Now let�s see what happens to the same pathway under oxidative stress, when collular antioxidants fail to control production of reactive oxygen species. Some children with autism have a decrease in adenosine deaminase activity. Any metabolic derangement that interferes with removal of adenosine will drive the reaction back, and cause SAH (S-adenosylhomocysteine) to accumulate. That inhibits essential methyltransferase reactions, interfering with methylation of DNA and RNA, making abnormal membrane phospholipids and neurotransmitters. If methionine synthase does not work (and MS is shut down by minute amounts of thimerosal) the 5 methyl form will increase, the metabolically active form will decrease (tetrahydrofolate): a functional folate deficiency. If you aren�t making enough methionine, which supplies 50% of the body�s cysteine, you won�t be able to make glutathione. Consequences of decreased glutathione include: decreased antioxidant capabilities decreased ability to detoxify environmental toxins increased gut permeability and degeneration of gut epithelium autoimmunity with increased Th2 expression reduced cellular methylation capability, altered neurotransmitter signaling and altered membrane fluidity Now let�s see what happens to the same pathway under oxidative stress, when collular antioxidants fail to control production of reactive oxygen species. Some children with autism have a decrease in adenosine deaminase activity. Any metabolic derangement that interferes with removal of adenosine will drive the reaction back, and cause SAH (S-adenosylhomocysteine) to accumulate. That inhibits essential methyltransferase reactions, interfering with methylation of DNA and RNA, making abnormal membrane phospholipids and neurotransmitters. If methionine synthase does not work (and MS is shut down by minute amounts of thimerosal) the 5 methyl form will increase, the metabolically active form will decrease (tetrahydrofolate): a functional folate deficiency. If you aren�t making enough methionine, which supplies 50% of the body�s cysteine, you won�t be able to make glutathione. Consequences of decreased glutathione include: decreased antioxidant capabilities decreased ability to detoxify environmental toxins increased gut permeability and degeneration of gut epithelium autoimmunity with increased Th2 expression reduced cellular methylation capability, altered neurotransmitter signaling and altered membrane fluidity

34. Sauna (FIR) Non-Invasive therapy using safe energy (infrared heat) to penetrate the skin to depths of approximately 1 � to 2 inches for more effective cellular detoxification. Infrared heat increases temperature of objects without heating the surrounding air. This is similar to standing in the sun on a cold day and feeling warm. Infrared rays are NOT the same as the ultraviolet rays that can be harmful to the skin.

35. Sauna (FIR) Uses lower temperatures (100-120 degrees) with deeper penetration; more comfortable Decreases inflammation Boosts immune system Helps with detoxification Improves metabolic regulation Helps to neutralize abnormal germs and Prevent overgrowth Boosts skin healing/integrity (acne, eczema)

36. Sauna (FIR) Recommend 15-20 minutes 5x/week Most common possible side effect is dehydration Children�s core body temperature increases faster than adults Possible contraindications: Diseases with impaired perspiration � MS, Parkinson�s, IDDM Neuropathy Pregnant women Some prescription medications, such as diuretics, barbiturates, and beta-blockers Cardiovascular disorders Alcohol use Any surgical implants � need approval of surgeon Fever

38. What To DoAdditional Treatment Options 5-HTP Regulates self-stim, OCD, mood, sleep Secretin (Intranasal) Serotonin (self-regulatory), behavior, gut Oxytocin (Intranasal) Related to Prolactin Acts on amygdala Reduces anxiety, self-stimming Enhances word retrieval and memory Used in Alzheimer�s Disease

39. Seizures Up to 60% non-responding children with ASD had abnormal overnight EEG Associated with sleep problems Decreased sleep efficiency Prolonged latency to REM and decreased total REM time Consider EEG or Brain Mapping qEEG (without sedation) Maps areas of activity, deficiency, change

40. What To Do Neurofeedback Direct training of brain Brain exercise Change brain activity by rewarding shifts toward more stable brain state Self-regulation training

41. What To Do Neurofeedback � how is it done Apply electrodes to scalp Record brain activity through computer Extract info about key brainwave function Show child ebb and flow of brain waves through video game Effectively play video game with brain Shape brain wave activity by promoting certain frequencies and diminishing others

42. What To Do Neurofeedback Specific to each child and each problem Specific frequencies targeted Specific locations recorded Improves emotional control, physiologic stability and mental performance Helps regulate dysregulation � anxiety, sleep, attention and OCD

43. Don�t Forget The Basics Diet/Enzymes Probiotics At least 10 billion organisms More severe GI symptoms, doses > 50 billion Symptomatic (alkalinization) Activated charcoal (mop up toxins) Alka Seltzer Gold, Trisalts, HCO3 Nutrients (multivitamin) Essential Fatty Acids

44. What Is It That My Child Needs: To Get To Get Rid Of My Courage