BIOMEDICAL

TREATMENT OF THE
YOUNG ADULT WITH
AUTISM SPECTRUM
DISCORDER
Presented by
Michael W. Elice, M.D. and
Barbara Fischkin

AutismOne, May 2009, Chicago, IL

What is ASD?
Aspergers

SOCIAL
Pervasive Developmental Delay

Autism
BEHAVIORAL LANGUAGE

Attention Deficit Disorders

DSM IV Diagnostic Criteria
for Autistic Disorder
Impairment in Social Interaction
-Impairment in the use of nonverbal behavior
-Lack of spontaneous sharing
-Lack of social/emotional reciprocity
-Failure to develop peer relationships
Impairment in Communication
-Delay in or lack of development of spoken language &
gestures
-Impairment in the ability to initiate or maintain
conversation
-Repetitive and idiosyncratic use of language
-Lack of pretend play
Restricted Repertoire of Activity and Interests
-Preoccupation with restricted patterns of interest
-Inflexible adherence to routines
 Increase in Autism Incidence
45
40
35
30
Incidence per 10,000

Autism
25
Epilepsy
20
Mental Retardation
15
10
5
0
1950 1965 1980 1994
Year of Birth
 Autism ---- rising
incidence
1/2000 prior to 1970
1/500 1996
1/166 2005
1/150 2007
And increasing.now
thought to be 1/80 1/100
What is Autism?
A complex array of gene-environment
interactions
This demands a rigorous evaluation to search
for the unique disease markers that help us
understand each childs individual needs
There is NO usual autism treatment
Only one FDA approved intervention for the
agitative, aggressive affects of autism
Risperadone
Beyond this, NOTHING ELSE!
Resources of mainstream medicine are
oriented to behavioral therapy, NOT
BIOMEDICAL
Disorders Associated
with ASD
Obsessive Compulsive Disorder
Oppositional Defiant Disorder
Tourettes Syndrome Tic
Disorder
PANDAS
Bi-Polar Disorder
Metabolic Disorders
Mitochondrial Disorders
Find the Source

Assess the Underlying Causes

Maldigestion/Malabsorption
Dysbiosis
Infection
Inflammation
Intestinal Permeability (leaky
gut)
Immune dysfunction
Food Intolerance/ Allergies
Albert Einstein:

If we knew
what we were
doing, it
wouldnt be
called research.
 BIOMEDICAL THERAPIES
3. ELIMINATION DIET

2. ALLERGY TESTING

3. ESSENTIAL FATTY ACID/COD LIVER OIL

4. VITAMINS/MINERALS

5. DIGESTIVE ENZYMES

6. METHYL COBALAMIN, FOLINIC ACID, TMG, NAC

7. AUTOIMMUNE THERAPY

8. CHELATION

9. ANTIFUNGALS AND ANTIANEROBICS

10. INTRAVENOUS GAMMA GLOBULIN

11. HYPERBARIC OXYGEN

Daniel Mulvaney, age
21 years
Lived in Mexico City and Hong Kong
with parents, Barbara and Jim,
journalists
Age 3 years febrile illness with
temp of 106 degrees, otitis
media. Hospitalized for
dehydration
Symptoms:
Loss of interest in other children
Chewing on clothes
Shredding
Loss of expressive language
Loss of interest in toys
Loss of toileting skills
Increase in temper tantrums
More Symptoms and
Interventions:
PICA ate glass in playground
Hearing test positive
Starts BOCES early childhood with
ABA, vitamin therapy
Luvox, Risperdal to control
violent behavior
2005 2 grand mal seizures, EEG
inconclusive, MRI - normal
Dan meets Dr. Elice,
November, 2007
Age 20 years
Mouthing pica, biting
Head pain requiring head compression
Hands move up and down, flapping
Ear flapping
Enjoys being upside down
Prefers to lie down to compress abdomen
Affectionate
Transitions well
Gets very close to people
Clomps feet
Lateral gaze
Occasional crooked smile
Obsesses on rope uses as a lariat
Dans Medical History
Product of Barbaras first
pregnancy
Pitocin induced labor failure to
progress
Born in Mexico City
Developmental milestones all on
target
Fully immunized without reactions
Dans Medical History
Diet craved vegetables, lettuce,
sushi and fish
BMs loose, frequent, foul
smelling,
greenish/brown color, 4-5
times/day
- Respiratory: frequent coughing
- Skin chicken skin red faced
- Sleep terrible!
Family History
Rosacea Aspergers
Urticaria Syndrome
Gout ADD
ADD Thyroiditis
Arthritis Colitis, ulcers
Alcoholism Seasonal allergies
Cardiovascular Colon cancer
disease Breast cancer
ADM
MS
Alzheimers Disease
Lab Investigation
Complete Blood Count w/ differential and platelet count,
ESR
Serum Metabolic Assay (Complete)
Thyroid Profile (T3, T4 and TSH), AutoAntibodies
Amino Acid Profile, Plasma
Methylenetetrahydrofolate Reductase (MTHFR)
Organic Acid Profile, Urine
Ammonia Level
Lactic Acid Level (Lactate)
Pyruvic Acid Level (Pyruvate)
Folic Acid, Homocysteine, Vit B1, B6, B12, D3 levels
Heavy Metal Profile (Lead, Mercury, Arsenic and
Cadmium), Blood
Antigliadin Antibodies and Transglutaminase (Celiac Panel)
Measles, Mumps and Rubella, all vaccine antibody titers
Chromosome Analysis (include Fragile X), genomic array
analysis
IgG, IgA, IgM, IgE levels
IGG Subclasses
B and T cell function tests
Myelin basic protein and neural axon filament antibodies
ASLO and Anti Dnase Antibodies
Dans Lab Results
NEGATIVE RESULTS
Folic acid: elevated
MTHFR: + mutation, A and
C sites
Ammonia: elevated
Herpes Simplex I: +
antibodies
Strep B: + antibodies; ASO
and antiDNAse B
Serologic immunity to
mumps and rubella BUT
NOT measles
Epstein Barr Virus: +
antibodies
POSITIVE RESULTS
LFTs: within normal
limits
B12, B6, B1: within
normal limits
Amino acids: within
normal limits
Plasma catecholamines:
normal
Pyruvate, lactate,
insulin, homocysteine:
normal
Antigliadin Antibodies:
negative
Laboratory Investigation
Hair analysis for metals
8 years old
Elevated:
- aluminum
- cadmium
- lead
- mercury
- silver
- uranium
- titanium
Association of MTHFR
Gene Variants with
Autism

Marvin Boris, M.D., Allan Goldblatt,

P.A.,
Joseph Galanko, PhD., S. Jill James,
PhD.

J. Of Physicians and Surgeons. 9:4.

Winter Edition, 2004
MTHFR
Methyl Cobalamin (B12)
Alterations in this pathway can induce chronic metabolic
imbalances. Data indicates that these alterations occur
frequently in ASD children.
Vitamin B12 is an essential cofactor for this pathway. B12
deficiency is well known to have neuropsychiatric
consequences in adults and adversely affect
neurodevelopment during infancy. Therefore, the abnormal
metabolic profile observed in a significant proportion of
autistic children suggests the possibility that the behavioral
features characteristic of these children could be a
manifestation of a genetically based systemic metabolic
derangement.
Methyl cobalamin inhibits the toxic effect of mercury on the
development of nerve fibers and glial cells. This explains
why the administration of injectible methyl cobalamin has
resulted in many of these children becoming more aware of
the environment, starting to speak and acting like other
children
MTHFR ASSOCIATED
DISEASES
NEURAL TUBE DEFECTS
CARDIOVASCULAR
CEREBRAL VASCULAR
INFLAMMATORY BOWEL DISEASE
CANCER- COLORECTAL, GI
LEUKEMIA
MULTIPLE PSYCHIATRIC
DISORDERS
Biomedical
Interventions
Dan starts on vitamin, mineral, antioxidants,
probiotics and essential fatty acids
Methyl cobalamin (B12) injections
Dan is allowed gluten, casein
Dan is told to avoid corn syrup,
preservatives, dyes and fast food, where
ingredients/preparation is unknown
Prescription medications:
Haldol
Luvox
Tenex
Zonisamide
Clinical Observations
Enuresis decreases
Bowel movements decrease in
frequency from 8 to 2 per day
Attention increases Dan goes
to the movies and sits for 1 hour
45 minutes
Dan plays ice hockey with
increased concentration
Next: more biomedical
Addition of folinic acid and N-acetyl
cysteine to methyl cobalamin
injections
PANDAS protocol, per NIMH studies
induction with 5 days of prednisone
followed by penicillin, 1 gram daily
Actos (PPAR gamma agonist)
Celebrex (COX-2 enzyme inhibitor)
Diamox (carbonic anhydrase inhibitor)
Clinical Observations
Increased concentration
Prompted use of words, says Hi without
prompt
GI now 1-2 bowel movements/day, formed
and normal appearance
Increased interaction with other adults
Sleep is uninterrupted by urination; he is dry
at night
No longer appearing to have headaches
Summer camp Dan gets raves staff
cannot believe how his behavior has changed
Who is Dan?

After 6 months of biomedical

intervention, his primary care
pediatrician says he looks like a
different person!
One year later

Increased concentration, now on Face Book

communicating with 130 friends
Health is excellent
GI and GU all functioning normally
Haldol is discontinued without psychotic
behavior or sleep disruption
Nemenda (glutamate receptor antagonist) is
added due to increase in bizarre motor
behavior, e.g. hands in mouth, walking with a
list to one side, strange finger movements
and inability to perform tasks previously
mastered
Plan for Dan
Continue the immune support
Heavy metal detoxification
(chelation)
Hyperbaric Oxygen Therapy
Intravenous Gamma Globulin
(IVIG)
WHY CHELATE?
 Mercury
Epidemic trends in ASD in the 1990s
Thimerosal an ethylmercury
compound
added to vaccines
Increase in the number of vaccines
given to infants and toddlers
All these vaccines add up to as much
as 200 micrograms in the first 6
months!
In 1999 AAP requires thimerosal to
be removed from all pediatric
vaccines ASAP
Remaining thimerosal containing
vaccines expired by 2003
Thimerosal still present, in very
Mercury: What can it
do?

Increases oxidative stress

Decreases glutathione production
Increases inflammatory cytokines
Causes cell death
Accumulates in brain, liver, and
other organs
What about Lead?
Lead is ubiquitous in our environment 4-5
million tons have been deposited in the
environment from car exhaust alone
It can be found in the water, air, soil and dust
Ingestion occurs by hand to mouth
transmission
80% of lead poisoned children can be
asymptomatic
Lead has a half life in the body of 20 years!
Lead exposure can result in neurological
damage, learning and behavioral problems
and lowered intelligence
Fetal exposure to lead affects
Symptoms of Metal
Poisoning
Emotional lability, irritability, behavioral changes
Poor focus and attention
Hyperactivity
Loss of developmental milestones, language delay
Learning delays
Criminal, delinquent behavior
Abdominal pain, loss of appetite, vomiting,
constipation
Headache, ataxia,
Lethargy, somnolence, seizures, stupor, coma
Muscle weakness
Impaired fine motor coordination
Visual-spatial impairment
Hearing defects, auditory processing problems
Delayed growth
Other Toxins:
Aluminum

- no physiologic need
- ability to cross blood brain barrier
enhanced by fluoride
- found in vaccines
- inhibitor of Magnesium, calcium and iron
- increases oxidative stress
- decreased glutathione
- increases lipid peroxidation
- synergistic with mercury to increase toxicity
exponentially
- deposited in brain, bone, muscle, kidney
Other Toxins:
Organic Pollutants
Phthalates, pesticides, herbicides, PCBs,
Bisphenols
Difficult to detox, stored in fat, cord blood,
breast milk
Tiny doses may interfere with hormonal
signals that regulate human organs,
development and metabolism
NO SAFE LEVELS!
DNA damage
Carcinogenic
Neurotoxic
Damage sperm
Allergies, asthma, diabetes, heart disease,
Vicious cycle of
toxicity

Increased damage Environmental

from toxins Toxins

Impaired
Detoxification
Heavy Metal
Detoxification
(the politically correct
term for Chelation)
Testing for toxic metal exposure
Chelation agents
- DMSA
- DMPS
- EDTA
- D-penicillamine
Maintain adequate levels of glutathione
Maintain adequate levels of vitamins and
minerals
Continue checking urine for metals until
excretion levels are significantly reduced
Clinical Response to
Chelation of Lead
Improved eye contact
Decreased hyperactivity
Emerging language; words and
sentences
Decreased scripted language,
echolalia
Improved GI function
Improved skin, hair, nails
Markedly improved learning abilities in
school
 HYPERBARIC
OXYGEN THERAPY
 Hyperbaric Oxygen Therapy
Dates back to 1662
Therapeutic uses:
- wound healing
- GI disease
- Infectious diseases
- Migraine syndromes
- Sleep disorders
- Peripheral vascular disease
- Stroke
- Brain injury
- Rheumatoid Arthritis
- Chronic fatigue syndrome
- Multiple sclerosis
- Parkinsons Disease
And
Hyperbaric Oxygen
Therapy
Autism
Autistic Spectrum Disorders
Hyperbaric oxygen therapy may improve symptoms in autistic children.
Med Hypotheses. 2006; 67(2):216-28 (ISSN: 0306-9877) Rossignol DA;
Rossignol LW

neuroinflammation and increased oxidative stress

decreased cerebral perfusion confirmed by SPECT and
PET scans
temporal regions of the brain related to speech, language
and auditory processing
HBOT is successful in known hypoperfusion syndromes
- cerebral palsy
- fetal alcohol syndrome
- closed head injury
- stroke
HBOT can normalize oxygen concentration in ischemic
tissues
HBOT has potent anti-inflammatory effects by reducing
oxidative stress
Hyperbaric Oxygen
Therapy
Oxygen is our primary source of
energy
Oxygen:
- promotes immune support
- destruction of toxins
- promotes new cell growth
- displaces harmful free radicals
- destroys harmful bacteria,
parasites
and other microbes
- enhances absorption of vitamins,
minerals, amino acids, and other
Hyperbaric Oxygen
Therapy
RESULTS
Statistically significant changes in
autistic symptoms, such as:
- language
- eye contact
- interactive play
- cognition
- improved GI function
- improved health and physical
behavior
Intravenous Gamma
Globulin (IVIG)
Therapy
Improvement in children with autism treated with
intravenous gamma globulin
Marvin Boris MD; Allan Goldblatt PA-C; Stephen M.
Edelson PhD
Journal of Nutritional & Environmental Medicine,
Volume 15, Issue 4 December 2005 , pages 169 - 176

Purpose. Immune dysfunction has been associated

with children with autism. One study found a
beneficial response of intravenous gamma globulin
(IVIG) therapy in autistic children. The present study
further evaluated the administration of IVIG to these
children.

Results. The participants' overall aberrant behaviors

decreased substantially soon after receiving their first
dose of IVIG. Further analysis of the total scores
revealed decreases in hyperactivity, inappropriate
 IVIG
Conclusions. Significant
improvement occurred in autistic
children receiving monthly IVIG.
There is a reasonable rationale
considering the risk/reward ratio
to utilize IVIG therapy in children
with autism. A well-controlled
placebo double-blind study would
be important to further clarify the
use of IVIG in autism and its
duration of benefits
Its not a sprint its a
MARATHON!
Do NOT sprint! Pace yourselves
Pace your bodies, your spirits, your finances
There will be hills and valleys
Never be complacent with what you achieve
Always celebrate the milestones achieved
As hard as it is for us, it is harder work for our
children.
Conclusions

Autistic Spectrum Disorders are

being diagnosed in epidemic
rates
They are not genetic disorders
They are medical disorders of the
immune system with genetic
predisposition
There are environmental triggers
that may initiate the symptoms
Biomedical intervention does help
Why Bother Doing This
With a 20 Year Old??
Why not??
You may have tried everything else!
Your child will enjoy life
You will enjoy life more
They may live up to their full potential
Less burden on support staff
Better residential placement
They may attain an independent
lifestyle!