Tuesday, October 30, 2012

Early Autism Treatment Benefits Kids' Brains

Early, intensive autism treatment improves children's brain development, a new study shows.
The treatment, dubbed Early Start Denver Model or ESDM, offers a child 20 hours a week of one-on-one treatment with a trained therapist. It also calls for many more hours of the treatment, in the form of structured play, with a parent trained in the technique.

By age 4, children given the treatment had higher IQ scores, more adaptive behavior, better coordination, and a less severe autism diagnosis than kids given the standard autism treatments offered in their communities. But that's not all, researchers Geraldine Dawson, PhD, and colleagues report.

"We jump-started and improved the responses of children's brains to social information," says Dawson, professor of psychiatry at the University of North Carolina and chief science officer at Autism Speaks.

Normal child development depends on interactions with parents and other people. Without such interactions, language and social skills do not develop.

As measured by an electroencephalogram (EEG), small children's brains show a specific pattern of activity when they look at a picture of a human face. This doesn't happen when they look at pictures of inanimate objects.

Just the reverse happens in children with autism. Their brains light up when they look at pictures of objects, but not when they look at faces. This changed dramatically in the children treated with ESDM.

"The [brains of] children who received the ESDM looked virtually identical to typical 4-year-olds," Dawson says. "The children that received the interventions normal in their communities continued to show the reversed pattern."

Changing Brain Development

The treated children weren't cured. They still had autism, Dawson says. But they are continuing to improve.
"These interventions not only alter the trajectory of behavioral development in a child with autism, but also brain development," Dawson says.

Brain development in children given a behavioral autism treatment likely means these children are learning to "work around" their autism, suggests Arthur L. Beaudet, MD, professor of molecular and human genetics, pediatrics, and molecular and cellular biology at Baylor College of Medicine, Houston.

"To the extent early intervention helps brain development, it is more likely to help by letting the brain compensate and get around the problems rather than reverse them," Beaudet says. "We do know if you damage the brain of a young child, like in an accident, the infant brain has a tremendous ability to recover and get around the problem."

Key to Autism Treatment: Start Early

Although she and her colleagues developed the ESDM treatment, Dawson is quick to point out that it's not the only effective autism treatment. The key, she says, isn't the treatment -- it's the timing.

"The important point is early diagnosis," she stresses. "By starting early, we have the best chance of providing these kids with the best possible outcomes."

One key to early diagnosis might be the EEG test used to evaluate outcomes in this study.

"There has already been published data showing these early EEG measures are detecting babies at risk of autism at 12 months of age. They have this unusual pattern of not showing a normal response to social stimuli," she says.

'Brain-dead' definition flawed, says ethicist

PATIENTS in intensive care are being declared brain dead for organ donation when they may still be legally alive, the Melbourne bioethicist Nicholas Tonti-Filippini says in a new book.

He says medical practice has moved ahead of the law by accepting a lesser standard of brain death than the law prescribes: the irreversible loss of all brain function.

A new standard has taken hold in intensive care units in which the crucial aspect is absence of consciousness, Professor Tonti-Filippini said.

''They are diagnosing brain death while there is still some mid-brain function. They say 'so what?', because the person is not conscious,'' he said.
If the mid-brain was functioning, then the brain would still control some bodily functions such as hormone production and blood pressure control. The only way to be certain was an imaging test that showed there was no blood flow to the brain, he said, but most Victorian hospitals used a clinical test for brain-stem function instead.

A spokesman for the intensive care society that establishes the brain death criteria (ANZICS), Associate Professor Bill Silvester, said Professor Tonti-Filippini was wrong, and potentially putting at risk the lives of critically ill people awaiting organ donation.

Professor Silvester, of the Austin Hospital, said a recent World Health Organisation forum on brain death explicitly regarded the ANZICS criteria as ''an exemplar of rigour''.

He said clinical testing, such as breathing, was the main way to determine death, including the mid-brain. The only need for extra testing, such as blood flow, was when clinical criteria could not be resolved. No patient had ever recovered when the clinical determination of brain death had been conducted correctly.
''ANZICS believes these unsubstantiated claims by Professor Tonti-Filippini risk damaging public confidence in a very rigorous process,'' he said.

But Professor James Tibbals, deputy director of intensive care at the Royal Children's Hospital and its medical director of organ donation, has endorsed Professor Tonti-Filippini, arguing that the current ANZICS test for brain death is neither legal nor ethical, and that most donors cannot be proven to be truly dead when organs are removed.

He said in a 2008 scientific paper that the blood-flow test was the only safe and reliable one, and was relatively simple and cheap.

The clinical tests used in most Victorian hospitals, such as testing breathing, could be misleading, as well as harmful or fatal for the patient. All the experts agreed that the absence of blood flowing in the brain meant irreversible loss of all brain function and therefore the patient was definitely dead. But requiring this stricter understanding meant organs could not be transplanted in some circumstances when they were now, which is why the donor community disliked Professor Tibbals' stance.

Professor Tonti-Filippini said the new definition, which had crept in gradually with no watershed moment, was of particular concern to religious people.

''It's enormously significant to the church because people are being diagnosed as dead and their organs are being taken when, as a matter of faith, you'd say they were alive,'' he said.

Most religious people understood death as the separation of soul and body, and accepted that had occurred with the irreversible loss of all brain function. But under the consciousness model a person could be declared dead while the hormones still worked and blood pressure was still controlled by the brain.

''I would say such a person is severely disabled, but you can't say dead,'' he said. ''We have moved from wanting to be absolutely certain that this person is dead to saying, 'This person is in such a state they might as well be dead'.''

He said religious people should insist on further tests showing there was no blood supply before endorsing organ donation.

Time Magazine on ‘How Cannabinoids May Slow Brain Aging’

Time Magazine‘s Maia Szalavitz does good work Monday with a piece reviewing some clinical evidence on cannabinoids – the molecules in marijuana – and aging. The brain’s own cannabinoid system is responsible for stopping inflammation, and “a sort of anti-oxidant cleanse, removing damaged cells and improving the efficiency of the mitochrondria, the energy source that powers cells, ultimately leading to a more robustly functioning brain.” Stimulating it with cannabinoids increase brain-derived neurotrophic factor which protects brain cells and promotes neuron growth, and – bucking the stereotype – maintains normal cognitive function in old age.

But politics keeps scientists from exploring pot for cures to Alzheimer’s and Parkinson’s Disease, researchers say. Gary Wenk, professor of neuroscience, immunology and medical genetics at Ohio State University wrote: “In my experience, working in this area is like touching the third rail. … I get hate and love mails that are bizarre and phone messages from people too high to talk. Some of my colleagues have left the area after seeing their names in the National Enquirer… I do not blame a war on marijuana but rather the public’s prejudice and extreme bias. I’ve now discontinued my research on this system.”

“He and others in the field are not completely pessimistic, however,” Szalavitz writes. “He says, ‘I’ve been trying to find a drug that will reduce brain inflammation and restore cognitive function in rats for over 25 years; cannabinoids are the first and only class of drugs that have ever been effective. I think that the perception about this drug is changing and in the future people will be less fearful.’”

Awareness about infection caused by ‘brain-eating amoeba’ urged

Like many water-borne bacterial and viral diseases, Naegleria fowleri, an amoebic infection, has emerged as a health threat across Pakistan.

Though the infection is not highly prevalent but reporting of its recent cases in various areas of Pakistan, particularly Karachi, has necessitated the need for specific attention of the concerned authorities.

So far, there is no specific treatment available for Naegleria fowleri infection nor any vaccine is available to prevent it. Many health experts believe that the only way to avoid the deadly infection is preventive measures. It is believed that over 95 per cent of the confirmed cases of the infection have to face death despite treatment.

The amoeba that causes the infection is also called as ‘brain-eating amoeba’, named after the most common complication produced by this infection, primary amoebic meningoencephalitis (PAM), which is usually a fatal complication. This condition directly involves the spread of infection to the brain substance itself causing high mortality rate, said Assistant Professor of Microbiology Dr. Humaira Zafar while talking to ‘The News’ in connection with precautionary measures needed to avoid the infection.

She added that the presentations of infection after the entry of ameba into body through nasal cavity can range from changes in taste and smell, nausea, vomiting, headache, fever, and stiff neck. “In severe cases when disease progresses, confusion, hallucinations, lack of attention, and coordination in body movements can easily be manifested ultimately leading to seizures/fits and death within 14 days of the infection.”

She said that the case fatality rate of the infection is estimated at 98 per cent and the symptoms of the infection start about five days (range is from one to seven days) after exposure.

Dr. Humaira explained that Naegleria fowleri is a free-living amoeba and typically found in contaminated stagnant and contaminated water, such as ponds, lakes, rivers, and hot springs. It is also found in soil especially near the warm water discharges of industrial plants, and non-chlorinated or poorly chlorinated swimming pools. Rarely, it can appear in inadequately treated samples of home-based tap water that is not treated enough to be entirely potable, though this is not the usual method of contracting the illness unless the water is very deeply inhaled, usually deliberately, she said.

She further explained that the predisposing factors for the transformation of inactive to active form of Naegleria fowleri induces food deprivation, crowding, desiccation, accumulation of waste products, and cold temperatures. “The ideal temperature is the changing temperatures ranging from 25°C to 42°C.”

She said that no specific treatment options and vaccine is available for the infection while the prognosis for infected patients is also very poor. “More than 95% of infections are fatal despite treatment. Survivors may have residual neurological problems, such as seizure disorders.”

She said that the only way to reduce the spread of infection is avoiding contact with contaminated sources. This is only possible if access to safe and chlorinated water sources be ensured, she said.

Dr. Humaira said that apart from preventive measures, there needs adoption of proper diagnostic approaches by the examination of Brain Fluid (Cerebro spial fluid) culture and PCR studies are the mainstay of diagnostic approaches. She said that awareness among public should be created on the subject and patients of the infection should fully cooperate with the doctors on the subject of collection of brain fluid so that their management can be started soon.