Chiropractic Treatment (4)

Chiropractic Treatment (3)

Chiropractic Treatment (2)

Chiropractic Treatment

If you are reading this blog then you are either a chiropractic student, chiropractic patient or a CAM enthusiast, in any of the above cases your understanding of chiropractic can either be a grand in depth one or a minimal surface understanding.

Chiropractic is a whole body approach and treatment to neuromusculoskeletal system without the use of surgery or drugs. Adjuncts to chiropractic include nutritional supports, dietary counseling, physical therapies and rehabilitation.

Several case studies have been published on the efficacy of chiropractic care and the reduction of both the objective and subjective symptoms/clinical findings in autistic children.

Improvement in Autism in a Child Coupled with Reduction in Vertebral Subluxations: A Case Study & Selective Review of the Literature Journal of Pediatric, Maternal & Family Health - Chiropractic ~ Volume 2010 ~ Issue 3 ~ Pages 107 -115

Iprovement in a 3½-year-old autistic child following chiropractic intervention to reduce vertebral subluxation [case report]; J Vert Sublux Res. 2008 ;APR(7):Online access only pp. 1-4

Some chiropractic researchers have even gone as far as to compare techniques, such as atlas orthogonal versus a full spine adjusting technique like the study published in J Vert Sublux Res. 2006 ;MAR(9):Online access only 7 p.

Either way, more clinical studies are needed to prove the efficacy and physiological process behind the causation of the reduction of symptoms post-chiropractic adjustment.

As chiropractic care is a core CAM treatment, it is far less harmful than the use of prescriptions and can/should be used in the combination of dietary and nutritional supports (as previously blogged) and alongside some of the conventional therapies (also previously blogged).

Drug Therapies

The following is a link to a list of the conventional drug therapies used on autistic children:

http://www.child-autism-parent-cafe.com/autism-medication.html

When taking part in drug therapies for any disease, disorder or physiological condition it is important to know and understand any interactions and nutritional deficiencies that can be caused by the aforementioned drugs. The following information is searched via www.drugdigest.com

Via the list previously provided:

Amphetamine/Detroamphetamine: a stimulant commonly prescribed for ADHD creates the following symptoms:

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• anxiety, nervousness
• changes in mood or behavior
• chest pain
• fast, irregular heartbeat
• fever, or hot, dry skin
• high blood pressure
• muscle twitching
• uncontrollable head, mouth, neck, arm, or leg movements

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• difficulty sleeping
• dizziness or light headedness
• headache
• nausea, vomiting
• stomach cramps
• weight loss

Clomipramine: a tri-cyclic antidepressant m/c prescribed for obsessive compulsive disorder has the following side effects:

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• breast enlargement, milk
• breathing problems
• confusion, hallucinations
• fast, irregular heartbeat
• fever with increased sweating
• muscle stiffness, spasms
• pain or difficulty passing urine, loss of bladder control
• seizures
• suicidal thoughts or other mood changes
• swelling of the testicles
• tingling, pain, or numbness in the feet or hands
• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• change in sex drive or performance
• constipation, or diarrhea
• nausea, vomiting
• weight gain or loss

The list can go on and on, let's take a case example:

A 13 year old boy with autism that still wets the bed can commonly be found to be on the following medications:

Adderal, Anafranil, Tofranil, Hadol and Lithium citrate

Look at the interactions!!

Severe Interaction
SELECTED SYMPATHOMIMETICS/TRICYCLIC COMPOUNDS
amphetamine-dextroamphetamine Oral and imipramine HCl Oral may interact based on the potential interaction between SELECTED SYMPATHOMIMETICS and TRICYCLIC COMPOUNDS.
SELECTED SYMPATHOMIMETICS/TRICYCLIC COMPOUNDS
amphetamine-dextroamphetamine Oral and clomipramine Oral may interact based on the potential interaction between SELECTED SYMPATHOMIMETICS and TRICYCLIC COMPOUNDS.



Moderate Interaction
HALOPERIDOL/LITHIUM
haloperidol lactate Oral and lithium citrate Oral may interact based on the potential interaction between HALOPERIDOL and LITHIUM.



Selected Sympathomimetics/Tricyclic Compounds

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

MONOGRAPH TITLE: Selected Sympathomimetics/Tricyclic Compounds

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Unknown. However, it is speculated that direct-acting sympathomimetic amines have an enhanced effect due to tricyclic blockage of norepinephrine reuptake. Indirect-acting sympathomimetics would have decreased activity due to tricyclic blockage of their uptake into the adrenergic neuron.

CLINICAL EFFECTS: Increased effect of direct acting sympathomimetics. Decreased effect of indirect acting sympathomimetics. Mixed acting sympathomimetics will show effects based on the predominance of either direct or indirect activity.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Consider avoiding the concurrent use of direct-acting sympathomimetics and tricyclic compounds. If concurrent use of direct-acting sympathomimetics and tricyclic compounds is warranted, the initial dose of the sympathomimetic should be lowered and the patient should be monitored for adverse cardiovascular effects. Use of tricyclic compounds and other sympathomimetics should be approached with caution.

DISCUSSION: Epinephrine and other direct-acting sympathomimetic amines exert enhanced cardiovascular effects (e.g., arrhythmias, hypertension, and tachycardia) in individuals concurrently receiving or previously treated with tricyclic antidepressants.

Other direct and mixed acting sympathomimetic amines have also been reported to interact with tricyclic antidepressants. These include norepinephrine, phenylephrine, dopamine, and methoxamine. The pressor effects of the indirect-acting sympathomimetic amines (i.e., amphetamines, ephedrine, methylphenidate, pseudoephedrine, and tyramine) are antagonized by tricyclic antidepressants. Protriptyline, amitriptyline, and desipramine have also been reported to interact with direct-acting sympathomimetics.

Similarity between cyclobenzaprine and the tricyclic antidepressants consideration of tricyclic antidepressant interactions for cyclobenzaprine.

REFERENCES:

1.Boakes AJ, Laurence DR, Teoh PC, Barar FS, Benedikter LT, Prichard BN. Interactions between sympathomimetic amines and antidepressant agents in man. Br Med J 1973 Feb 10;1(5849):311-5.

2.Ghose K. Sympathomimetic amines and tricyclic antidepressant drugs. Neuropharmacology 1980 Dec;19(12):1251-4.

3.Svedmyr N. The influence of a tricyclic antidepressive agent (protriptyline) on some of the circulatory effects of noradrenaline and adrenaline in man. Life Sci 1968 Jan 1;7(1):77-84.

4.Bonaccorsi A, Garattini S. Effect of desipramine on directly or indirectly elicited catecholamine pressor responses in rats. J Pharm Pharmacol 1966 Jul;18(7):443-8.

5.Cairncross KD. On the peripheral pharmacology of amitriptyline. Arch Int Pharmacodyn Ther 1965 Apr;154(2):438-48.

6.Ghose K, Gifford LA, Turner P, Leighton M. Studies of the interaction of desmethylimipramine with tyramine in man after a single oral dose, and its correlation with plasma concentration. Br J Clin Pharmacol 1976 Apr; 3(2):334-7.

7.Jefferson JW. A review of the cardiovascular effects and toxicity of tricyclic antidepressants. Psychosom Med 1975 Mar-Apr;37(2):160-79.

8.Ragheb M. Drug interactions in psychiatric practice. Int Pharmacopsychiatry 1981;16(2):92-118.

9.Risch SC, Groom GP, Janowsky DS. Interfaces of psychopharmacology and cardiology--part one. J Clin Psychiatry 1981 Jan;42(1):23-34.

10.Maxwell RA, Keenan PD, Chaplin E, Roth B, Eckhardt SB. Molecular features affecting the potency of tricyclic antidepressants and structurally related compounds as inhibitors of the uptake of tritiated norepinephrine by rabbit aortic strips. J Pharmacol Exp Ther 1969 Apr;166(2):320-9.

Haloperidol/Lithium

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

MONOGRAPH TITLE: Haloperidol/Lithium

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Unknown.

CLINICAL EFFECTS: Extrapyramidal and neurotoxic effects have been reported.

PREDISPOSING FACTORS: Large doses of either drug, pre-existing brain damage, history of mania, history of drug-induced extrapyramidal symptoms or the existence of other disease states (e.g., infection, dehydration).

PATIENT MANAGEMENT: During the initiation of concurrent treatment with this drug combination, observe the patient closely for signs of neurotoxic or extrapyramidal effects.

DISCUSSION: Haloperidol and lithium have been used safely in the treatment of patients. However, numerous reports experiencing adverse effects during concurrent administration of these drugs have been reported. Signs and symptoms associated with concomitant use have included confusion, fever, lethargy, tremors, stupor, weakness, leukocytosis and increased blood urea nitrogen. Extrapyramidal effects, which in some cases were irreversible, and permanent brain damage have also been reported.

REFERENCES:

1.Cohen WJ, Cohen NH. Lithium carbonate, haloperidol, and irreversible brain damage. JAMA 1974 Dec 2;230(9):1283-7.

2.Thornton WE, Pray BJ. Lithium intoxication: a report of two cases. Can Psychiatr Assoc J 1975 Jun;20(4):281-2.

3.Loudon JB, Waring H. Toxic reactions to lithium and haloperidol. Lancet 1976 Nov 13;2(7994):1088.

4.Baastrup PC, Hollnagel P, Sorensen R, Schou M. Adverse reactions in treatment with lithium carbonate and haloperidol. JAMA 1976 Dec 6; 236(23):2645-6.

5.Juhl RP, Tsuang MT, Perry PJ. Concomitant administration of haloperidol and lithium carbonate in acute mania. Dis Nerv Syst 1977 Sep;38(9):675-6.

6.Thomas CJ. Brain damage with lithium/haloperidol. Br J Psychiatry 1979 May;134:552.

7.Biederman J, Lerner Y, Belmaker RH. Combination of lithium carbonate and haloperidol in schizo-affective disorder: a controlled study. Arch Gen Psychiatry 1979 Mar;36(3):327-33.

8.Thomas C, Tatham A, Jakubowski S. Lithium/haloperidol combinations and brain damage. Lancet 1982 Mar 13;1(8272):626.

9.Spring G, Frankel M. New data on lithium and haloperidol incompatibility. Am J Psychiatry 1981 Jun;138(6):818-21.

10.Addonizio G. Rapid induction of extrapyramidal side effects with combined use of lithium and neuroleptics. J Clin Psychopharmacol 1985 Oct; 5(5):296-8.

11.Goldney RD, Spence ND. Safety of the combination of lithium and neuroleptic drugs. Am J Psychiatry 1986 Jul;143(7):882-4.

12.Saran A, Addy O, Foliart RH, Schubert DS, Halaris A. Electroencephalographic changes and other indices of neurotoxicity with haloperidol-lithium therapy. Neuropsychobiology 1989;20(3):152-7.

Conventional Treatments

This blog focuses on the CAM treatments for autism, but in order to be fair to both sides of the treatment paradigms

Types of conventional treatment include but are not limited to the following:

1. Animal therapy
Animal therapy focus to improve in the inter action between the child and animal, thereby increasing the child confident in building relation ship as well as sensory and motor issues.

2. Auditory integration therapy
The program uses modified music and sound with an aim to correct the problems of child's in processing and understanding speech and sound.

3. Augmentative communication
Augmentative communication helps to support the child's communication output by acting as a bridge until speech develops or by providing an alternative if speech fails to develop. It includes picture exchange communication, picture and symbol displays, technological support for communication, sign language and body language.

4. Behaviour treatments
The aims of behaviour treatment is to help the autistic children to overcome the emotional , behavioural and cognitive dysfunction through a goal-oriented, systematic procedure. It is said that this types of treatment have proven to be successful in treating mood, anxiety, personality, eating, substance abuse, and psychotic disorders in some degrees.

5. Chelation
Since children with autism have a weakened secretion system, Cchelation helps to remove heavy metals accumulated in the brain through medication taken by IV or by mouth or rubbed on the skin. Although, it is a new treatment, but in theory, it decreases physical and behaviour problems.

6. Diet
Daily diet is always important for autistic or non autistic children. Since most autistic children have problem of weakened immune system and problem with toxic elimination, intake of foods which help to strengthen immune and improve toxin secretion will do no harm while avoiding intake of foods which may elevate the allergic and gastrointestinal problem are always essential. Choosing fresh and organic foods carefully will always help to reduce metabolic conditions for autistic children.

7. Discrete trial training
Discrete trial training is a program which helps to improve the basic skills for autistic children
a) Pre learning skills such as sit, attending, look at your class mate and teacher, etc.
b) Safe skills such as know their name, address, parent phone number, etc
Before the children can proceed the more complex language, academic and social skills by beginning of with a breaking off the skills into small part and taught in repetitive drills

Reference:

http://www.ehow.com/how_5464120_manage-treat-autism-conventional-perspective.html

Diagnosis via Brain Scans?

In order to identify the key systems that fail in autism, an understanding of the neural bases for typical language acquisition is needed. A study focused on this was conducted via sleep fMRI study of typical toddlers. In response to speech, typical toddlers in the study displayed extended networks of activation to complex speech information. Specifically, functional activity was prominent in a number of different frontal and cerebellar regions that are involved in social, emotional, attention, novelty detection or sequence tracking functions in adults, whereas activity in 3 year old typical children was prominent primarily in classic adult receptive language cortices. Reference: fMRI Studies, Autism Center of Excellence in a Redclay 2007 Study Autistic spectrum disorder is a lifelong condition caused by abnormalities in the development of the brain. The vast majority of these are male, and diagnosis usually involves a lengthy process of interviews and personal accounts from family and friends close to the patient.

Medical researchers compared the brain scans of 20 adults with autism against those of 20 adults without. They found significant differences in the thickness of tissue in parts of the grey matter in areas of the frontal and parietal lobes which are responsible for functions including behaviour and language.

In the experiment, Ecker showed that her imaging technique was able to detect which people in her group had autism, with 90% accuracy. "If we get a new case, we will also hopefully be 90% accurate," she said.

Reference:

Autism can be diagnosed with brain scan – study; Alok Jha,guardian.co.uk, Tuesday 10 August 2010

Another study focused on the cingulate gyrus in high-functioning autistic subjects. These subjects were studied under fMRI in simple social interactions. The task at hand was an iterated trust game in which two subjects take turns as investor or trustee. The investor chooses how much to money to invest. This chosen amount is tripled on its way to the trustee, and the trustee then chooses how much to repay to the investor.

Read Montague and his colleagues have studied this game extensively in large groups of volunteers and have observed a characteristic pattern of brain activity in the anterior cingulate cortex. When making an investment (self phase), transient increases in activity are seen in an area of mid cingulate cortex, the results suggest that the abnormality associated with autism is restricted to only one phase of the interactive game: the point where the autistic volunteer makes an investment, not the point where the autistic volunteer is told about the repayment made by their partner.

Additional results from Read Montague's group give further clues as to the implications of this result. First, the same pattern of activity in cingulate cortex is observed when volunteers are shown pictures of people engaged in athletic activities and asked to imagine themselves taking part. This is further evidence as to the nature of the cognitive process associated with this pattern of activity: it involves thinking about the self acting in a social context. Second, the characteristic patterns of activity in the cingulate cortex are only observed when the trust game is played with a human partner. No such distinct patterns emerge when the game is played in the absence of a responsive social partner...At least part of the imagining must involve thinking about how one would fit in with the group, and how other group members would evaluate one's performance. Actually, this is a question about the kind of reputation one might gain in the eyes of the others. Likewise, in the self phase of the trust game, the amount one invests can be seen as a measure of how much one trusts one's partner. It is not just giving an amount of money; it is giving a signal to the other person: “trust me” and “I trust you.

Reference:

Chiu P.H., Kayali M.A., Kishida K.T., Tomlin D., Klinger L.G., Klinger M.R., Montague P. .

Self Responses along Cingulate Cortex Reveal Quantitative Neural Phenotype for High-Functioning Autism

(2008) Neuron, 57 (3), pp. 463-473.

Dietary Interventions

Now more than ever, parents of autistic children are seeking alternative treatment methods for their children. One of these treatment methods include dietary interventions.

Dietary interventions are based upon two ideas:
1. Food allergies cause symptoms of autism (see previous post about GI tract and gluten)
2. An insufficiency of specific vitamins and minerals

In a 2007 research project, vitamin D deficiencies during gestation was linked to higher incidences of autistic children. Vitamin D is believed to have an effect on the regulation/dysregulation of protein development within the brain. The deficiency can either be genetic or iatrogenic in the form of advice from doctors to stay out of the sun.

Reference:
Autism and vitamin D
John Jacob Cannell
Medical Hypotheses - 2008 (Vol. 70, Issue 4, Pages 750-759, DOI: 10.1016/j.mehy.2007.08.016)

Iron deficiencies have also been shown to be prevalent in autistic children. Iron is an integral part of many proteins and enzymes that maintain good health. In humans, iron is an essential component of proteins involved in oxygen transport. It is also essential for the regulation of cell growth and differentiation. A deficiency of iron limits oxygen delivery to cells, resulting in fatigue, poor work performance, and decreased immunity. A 2004 English study, showed a very high prevalence of iron deficiency in children with autism, which could potentially compromise further their communication and behavioural impairments.

Reference:

Latif A., Heinz P., Cook R.

Iron deficiency in autism and Asperger syndrome

(2002) Autism, 6 (1), pp. 103-114.

Vaccines?

Autism & Nutrition

Autism and Acetaminophen?

Multiple theories currently exist over the possible enviromental triggers for autism including childhood vaccinations, mercury exposure and viral infections (all of these will eventually be discussed in this forum). Some more researched theories include the idea that the use of acetaminophen within the early years of childhood causes autism, hence the title and topic for this blog post.

Acetaminophen is metabolized via three pathways: glucuronidation (a process that makes any non-energy providing source available for excretion), sulfation (a process that decreases the toxological effects of the drug) and via the cytochrome P-450 system (a process that bioactivates the drug via a catalyzation of the oxidizing agents within the drug itself).

One study of children with autism indicated that they had a sulfonation deficit which, as previously described, decreases the toxicity of acetaminophen, allowing for higher, more toxic levels to remain within the circulatory pathway.

Source: Schultz, Stephen. Can autism be triggered by acetaminophen activation of the endocannabinoid system? Acta Neurobiol Exp 2010, 70:227-231

Gastrointestinal Disorders and Autism?

Although gastrointestinal (GI) disorders are not among the diagnostic criteria for autism, as many as 84% of children with autism present with GI issues. It's been long suggested that there is a correlation between the two:

1961: Asperger himself suggested a link between autism and celiac disease (an autoimmune digestive response to gluten intake).

1971: Goodwin noted malabsorption in autistic children.

1979: Panksepp described the neurochemistry of autism, suggesting that an incomplete breakdown and excessive absorption of dietary food peptides (gluten containing foods such as barley, rye, oats, etc) may exert central opioid-like effects.

1993: Murch suggested that a deficient in the phenol-sulfur-transferase systems in the GI wall may lead to increased GI permeability to food peptides leading to both intestinal inflammation and neuropsychiatric dysfunction.

In a 2009 journal article in Pediatrics (124;796-798) Ibrahim details a 18+ year study on the GI system and autism. In this study, participants from age 0-18 were followed and put into five different categories according to their GI symptoms: 1) Constipation 2) diarrhea 3) abdominal bloating, discomfort or irritability 4) gastroesophageal reflux or vomiting 5) feeding issues or food selectivity. The majority of the medical care throughout this study was conducted via the Mayo Clinic.

The study found that there were significant differences between cases with autism and controls in cumulative incidence of constipation and feeding issues/food selectivity. Relative risk ratios, however, determined no significant associations between cases with autism and controls in the overall incidence of diarrhea, reflux/vomiting, and bloating/irritability/discomfort.

The goal of this study was to compare the incidence of GI symptoms of autistic children to age and gender-matched controls. The studied concluded that the overall incidence of gastrointestinal symptoms "did not differ between cases of autism and controls. The areas of difference, such as constipation and food issues/food selectivity, they attribute to neurobehavioral characteristics in children with autism rather than being indicative of primary gastrointestinal pathology. Of importance, they do suggest that subgroups of children may have gastrointestinal disorders that contribute to their autistic behaviors." However, Ibrahim did note that there are sub-categories that need to be investigated further, in order to lay the gastrointestinal prevalence in autistic children to rest.

It is important to note that this study's participants came from the same county within Wisconsin, and were made up of 98% caucasian ethnicity and that a generalized statement cannot be made from this one study.

Different Forms of Autism

There are five different types of autism, it is important to understand the various types in order to understand possible causation and treatments.

1) Autistic Disorder: This is what everyone thinks of when they tend to hear the word autism. This form is found in children under the age of 3 and refers to those children who have problems with communication, social interaction and imaginative play.

2) Asperger's Syndrome: This is often called the high functioning form of autism, as these individuals have average to above average intellectual scores however, they still have the same social problems and interests problems as an autistic disorder child.

3) Rett Syndrome: This form is specific to females. These girls seem to develop normally but then start to developmentally decline from age 1-4, mainly noticed when purposeful hand motions are replaced with repetitive movements.

4) Childhood Integrative Disorder: These children develop normally for at least two years and then lose some or most of their communication and social skills.

5) Pervasive Developmental Disorder (PDD): This is a catch-all category for children who do not ideally fit into any of the other four previously mentioned autism forms.

Autism: What is it exactly?

"Autism is a developmental disorder that appears in the first three years of life, and effects the brain's normal development of social and communication skills."
-A.D.A.M.

Autism is a physical condition linked to biological and chemical abnormalities within the brain, while the causative agents are unknown, autism remains to be one of the most actively researched areas in medicine. This is a blog, created for Logan College of Chiropractic's Clinical Nutrition II class with Dr. Josephine Lee, that will provide further insight into the possible causes and clinically promising treatments of the various forms of autism, such as diet, vaccine sensitivity, mercury poisoning, digestive tract changes, and treatments via chiropractic, nutrition and acupuncture physicians.

We welcome your feedback and questions and invite you to learn along with us.