Comorbidities in Autism and the Curious Cleaning Lady

Regular readers will know that I believe in the value of investigating the comorbidities of autism. 

We have a cleaning lady who comes each week to help keep our house in order.  She also understands the value of comorbidities. She is one of my independent observers, in changes in the behaviour of Monty, aged 10 with ASD.  She has a friend, whose husband was diagnosed with early-onset Alzheimer’s.

Alzheimer’s is not autism, but they are both examples of brain damage.

Still in his early 50s, the husband does not recognize his children and cannot leave home.  The expert Professor, treating him privately, was not halting the rapid decline.

So the cleaning lady asks me about all my investigations and decides that she might as well tell her friend.  She decided to suggest the antioxidant NAC and the cholinergic stimulant nicotine.

Well, after NAC, the husband was able to make it to the WC and do his business.  A small step forward.

After a day with the nicotine patch, things really changed so much that the family decided that they should seek a second opinion, this time from a doctor, yet to publish a book.

Doctor number two decided that it is not Alzheimer’s after all, and the prescribed medicines of the last three years were only making things worse.  And the new therapy? Nicotine patches.

Conclusion

The conclusion is self-evident. 

The next related conditions I will be investigating are cluster headaches, febrile seizures and absence seizures.

 

 

Epilepsy, Autism & EEGs

It is widely known that autism and epilepsy are comorbid with each other. Statistics are not very consistent, but it appears that up to 35% of people with autism will develop epilepsy and something like 30% of people with epilepsy already have autism.

My interest in epilepsy is currently just as a comorbidity, since Monty, aged 10 with ASD, has not exhibited any signs of it.  I will refer back to epilepsy in later posts when I attempt to “validate” potential autism interventions.  My logic is that if something has a positive effect across the majority of comorbidities, then I may be on to something.  For example, I found it insightful to read in a small study that nicotine patches reduced the incidence of epileptic attacks by 50%.

I recently came across an excellent, highly readable, paper that I think all parents interested in ASD should read.  It is written by an Israeli lady who is also doing some other very thoughtful research into treating autism.  The research itself is a retrospective study of EEG (Electroencephalography) tests on 56 children done in the US.

Autism and epilepsy: Cause,consequence, comorbidity, or coincidence?

EEG testing is known to be very insightful, but due to cost and availability, is rarely used in autism.  Some children, diagnosed with autism, turn out to have something different.

 Here are some highlights:

·        About 10% of children given a diagnosis of autism are found to have either a paroxysmal EEG pattern, as seen in acquired epileptic aphasia (Landau–Kleffner syndrome), or electrical status epilepticus during sleep, as seen in some children with childhood disintegrative disorder. 

·        None of the children who presented with ‘‘unlikely symptoms,’’ such as febrile convulsions, breath holding spells, and rage episodes, were diagnosed with epilepsy  

·        As many as 40% of the total group with autism had epilepsy, which was symptomatic in most children. Half of the children presented with convulsions, and they all had abnormal electroencephalograms (EEG) and were diagnosed with epilepsy.  

·        About one-quarter of the children presented with staring episodes, half of whom had epilepsy. 

·        None of the children with episodes of rage or breath holding spells had epilepsy 

o   This is the opposite of what many experts assume 

·       Our results, which indicate that clinical suspicion for epilepsy should be high if there is a history of convulsion and staring episodes, are in agreement with other studies showing that nearly all autistic children with seizures also exhibit epileptiform activity on electroencephalograms

 

A short film

Here is a parent-made film, showing the EEG procedure.

Conclusion

If you live in an area where EEGs are on offer, (California seems to be one good place to live) then it looks like a very smart test to have done.  If you were thinking your child’s tantrums and raging were indicative of future epilepsy, you can breathe again. 

 

Autism Drug Effectiveness in Comorbidities

The three autism comorbidities that I have chosen to investigate are asthma, high cholesterol and various types of seizure.

 

Phase 1

The first phase is the easy one.  I just need to see if my autism drugs are proven to be effective in the each comorbidity.  The results really surprised me.

With the exception of bumetanide and asthma, there is a perfect overlap.  Even more surprising, is that another loop diuretic, called furosemide, which is very similar to bumetanide, has been showed to be effective in asthma when given in the inhaled form.

In the case of cholesterol, I am looking at elevated levels in cardiology.  The use of bumetanide in people with heart problems associated with high cholesterol is to reduce blood pressure (anti-hypertensive).

 

 
You can check use of my autism drugs in each comorbidity using Google, or just look at the links I selected below.

 

Asthma/COPD

NAC improves effectiveness of the conventional corticosteroid therapy, particularly in hard to treat cases like current or past smokers. In COPD a severe form of asthma, read:  The role for N-acetylcysteine in the management of COPD

Do statins improve outcomesin patients with asthma on inhaled corticosteroid therapy?

Effect of inhaled furosemide and bumetanide on adenosine5'-monophosphate- and sodium metabisulfite-induced bronchoconstriction in asthmatic subjects

  

High Cholesterol (cardiac treatment)

NAC raises your good HDL cholesterol level, so lowering your overall cholesterol risk factor.

Dose-Related Increase of HDL-cholesterol Levels after N-acetylcysteine in Man

Statins were primarily developed to lower cholesterol as part of cardiac treatment.

 

Bumetanide is a loop diuretic and anti-hypertensive drug primarily marketed as a cardiac drug.

 

Seizures

 Glutathione peroxidase deficiency and childhood seizures

Treatment off our siblings with progressive myoclonus epilepsy of the Unverricht-Lundborg type with N-acetylcysteine

 

Role of Oxidative Stress in Refractory Epilepsy: Evidencein Patients and Experimental Models

 (then click for full version)

Can Statins Lower the Risk for Epilepsy?

Blocking seizures with the diuretic Bumetanide: Promises and pitfalls

 

Phase 2

The second phase involves understanding each comorbidity and seeing if any of their established treatments can be effective in treating autism.

This will also produce some surprises in the following posts.






 

Learning from Comorbidities in Autism

You might have been wondering why there has been a pause in my blog posts; rather than post nonsense, I have been exploring some new directions.

The current combination of bumetanide + NAC + atorvastatin does continue to be effective, but clearly there can be more.

I recently read a paper by a researcher who concluded that he thought autism was so heterogeneous there might well never be a drug therapy for autism.  I certainly see where he is coming from, but I think this tells us two things:-

 

1.      Do not expect conventional medical research to come up with an autism drug any time soon.

 

2.      It would be wise to read up on the medical research outside the realm of autism, where perhaps a more can-do approach and better resourcing might be evident.

This brings me to comorbidities.  In case you are not familiar with this term, in medicine, comorbidity is the presence of one or more disorders (or diseases) in addition to a primary disease.

In the case of autism frequent comorbidities include asthma, high cholesterol and seizures/epilepsy.

I decided to start with asthma, since Monty, aged 9 and with ASD, has mild asthma and I am already familiar with the range of treatments.

I somewhat fancifully hypothesized that there would be an overlap in effective drug therapies for autism and asthma; in other words what works for core autism treatment would be effective in asthma and vice versa.  Having been able to validate my hypothesis, I moved on to look at other comorbidities.  I am currently looking at three areas.

 

1.       Asthma and COPD

Asthma affects 300 million people worldwide and kills about 250,000 people ayear.  COPD (Chronic Obstructive Pulmonary Disease) is a more severe form of asthma and is the third leading cause of death in the US.

I figured that since these conditions are life threatening and widespread in developed counties, they would be well researched and drug therapies actively sought.

2.       High Cholesterol

The effects of high cholesterol are very well studied in cardiology, though not in autism.   The emerging understanding from cardiology is the causal link between cholesterol formation and neuroinflammation.  A little known fact is that elevated cholesterol is the norm in autism; people have asked me why, now I know and soon so will you.

 

3.       Seizures and epilepsy

 It is well known that many people with autism also have epilepsy.  There are many kinds of epilepsy and seizure; two types particularly interested me - absence seizures and non-convulsive seizures.  More of this later.

 

Subequent posts will present what I have learnt.

 

But now for a change of subject  and an interesting link ...

 

Common autism drug therapy in the US

If you do not live in the US, you may be unaware just how many drugs and supplements some autistic children receive.  It seems that in the US, 70% of autistic children take at least 10 different potions.  Not surprising, many of these can interact with each other.

If you are curious to see what some of these drugs are and what the common interactions are, you will find the following paper very interesting.  Its author, Theoharis C. Theoharides, has already appeared on this blog and he will appear again when we look at asthma and immunomodulation.

Unwanted interactions among most common treatment regimes in autism