Study claims heavy metal removal does not help autism symptoms

Let's ring in the new year by dispelling some "neuro flapdoodle"! -  A study shows that removing heavy metals from the blood through a process called chelation does not help children who have autism. JR

Removing heavy metals from the body through a process traditionally used to treat mercury and lead poisoning doesn't help relieve autism symptoms, a new analysis suggests.

During chelation therapy, patients are given injections of a chemical that binds to heavy metals, lowering their concentration in the blood and ultimately allowing the metals to be excreted through urine.

Chelation gained traction as an alternative treatment for autism due to a theory that mercury poisoning might play a role in the developmental disorder. However, evidence hasn't supported that idea and it's been essentially discarded in the scientific community, researchers said.

The procedure also carries safety concerns, including risks of kidney damage and gastrointestinal problems.

Lead researcher Tonya Davis from Baylor University in Waco, Texas, said the study team's goal was not to tell parents which treatments they should or shouldn't seek for their children.

"I see that they want to try everything, and they are well intentioned," she told Reuters Health.

"But there are risks involved with any treatment choice, and some of those risks are very serious. So far science does not support (chelation) as being an effective treatment, and that's a big risk to take when you have limited resources and limited time."

The Centers for Disease Control and Prevention estimates that one in 88 kids in the U.S. has an autism spectrum disorder.

Davis and her colleagues found five studies that tested the effects of chelation in kids with autism. Those studies each had between one and 41 children, from age three to 14.

Researchers had given the kids chelation therapy - sometimes along with vitamin supplements or other treatments - between one and 12 times a week for up to seven months. They used tests and questionnaires or anecdotal reports from parents to see how symptoms changed over time.

The study with only one child, a four-year-old boy, found chelation had positive effects on autism symptoms based on a parent report. The other four studies all showed mixed results, with some kids improving on some symptom measures.

However, none of the studies provided any certainty that those benefits were due to chelation itself, and not another treatment or just kids getting older, the researchers wrote in the journal Research in Autism Spectrum Disorders.

Davis said she and her colleagues were surprised to find so few studies measuring the effects of chelation, given how many families they each knew that were using it. That lack of evidence was a concern, she said, along with the questionable study designs and conclusions.

"I just hope that parents get as much information as they can" before trying a new treatment, Davis said.

A typical package of chelation treatments runs for about $2,000 to $5,000. In addition to treating lead poisoning, chelation has also been used for cancer and heart disease.

But when it comes to autism, even calling chelation an alternative therapy is a stretch, said one autism researcher not involved in the new study.

"There's really no evidence that mercury causes autism or has a place in causing autism, and also we know that chelation can be dangerous as well. Even the underlying theories don't make sense," said Dr. Joyce Mauk, head of the Child Study Center, an organization that treats kids with developmental disabilities in Fort Worth, Texas.

"Most children with developmental disabilities, what gets them better is a really skilled therapist and lots of work," Mauk told Reuters Health.

"If you hear about something when all you do is inject something or take a pill, it's unlikely to work."

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Excess holiday eating has same effect as jet lag

This article discusses how excess holiday eating disturbs your "food clock" and has effects similar to jet lag or working the graveyard overnight shift at work. It also discusses how to reset your "food clock."

If the sinful excess of holiday eating sends your system into butter-slathered, brandy-soaked overload, you are not alone: People who are jet-lagged, people who work graveyard shifts and plain-old late-night snackers know just how you feel.

All these activities upset the body's "food clock," a collection of interacting genes and molecules known technically as the food-entrainable oscillator, which keeps the human body on a metabolic even keel. A new study by researchers at the University of California, San Francisco (UCSF) is helping to reveal how this clock works on a molecular level.

Published this month in the journalProceedings of the National Academy of Sciences, the UCSF team has shown that a protein called PKCγ is critical in resetting the food clock if our eating habits change.

The study showed that normal laboratory mice given food only during their regular sleeping hours will adjust their food clock over time and begin to wake up from their slumber, and run around in anticipation of their new mealtime. But mice lacking the PKCγ gene are not able to respond to changes in their meal time -- instead sleeping right through it.

The work has implications for understanding the molecular basis of diabetes, obesity and other metabolic syndromes because a desynchronized food clock may serve as part of the pathology underlying these disorders, said Louis Ptacek, MD, the John C. Coleman Distinguished Professor of Neurology at UCSF and a Howard Hughes Medical Institute Investigator.

It may also help explain why night owls are more likely to be obese than morning larks, Ptacek said.

"Understanding the molecular mechanism of how eating at the "wrong" time of the day desynchronizes the clocks in our body can facilitate the development of better treatments for disorders associated with night-eating syndrome, shift work and jet lag," he added.

Resetting the Food Clock

Look behind the face of a mechanical clock and you will see a dizzying array of cogs, flywheels, reciprocating counterbalances and other moving parts. Biological clocks are equally complex, composed of multiple interacting genes that turn on or off in an orchestrated way to keep time during the day.

In most organisms, biological clockworks are governed by a master clock, referred to as the "circadian oscillator," which keeps track of time and coordinates our biological processes with the rhythm of a 24-hour cycle of day and night.

Life forms as diverse as humans, mice and mustard greens all possess such master clocks. And in the last decade or so, scientists have uncovered many of their inner workings, uncovering many of the genes whose cycles are tied to the clock and discovering how in mammals it is controlled by a tiny spot in the brain known as the "superchiasmatic nucleus."

Scientists also know that in addition to the master clock, our bodies have other clocks operating in parallel throughout the day. One of these is the food clock, which is not tied to one specific spot in the brain but rather multiple sites throughout the body.

The food clock is there to help our bodies make the most of our nutritional intake. It controls genes that help in everything from the absorption of nutrients in our digestive tract to their dispersal through the bloodstream, and it is designed to anticipate our eating patterns. Even before we eat a meal, our bodies begin to turn on some of these genes and turn off others, preparing for the burst of sustenance -- which is why we feel the pangs of hunger just as the lunch hour arrives.

Scientist have known that the food clock can be reset over time if an organism changes its eating patterns, eating to excess or at odd times, since the timing of the food clock is pegged to feeding during the prime foraging and hunting hours in the day. But until now, very little was known about how the food clock works on a genetic level.

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Outcomes for Children with CP - Early Identification and Comprehensive Management are Important!

This important article starts with great observations that a) early diagnosis is beneficial and b) prognostic information is importance. My problem with the article is that all types of CP are blended together.  
See the bottom for prognostic information. JR

"Parents believe professionals withhold prognostic information in an attempt to protect them from bad news. Research, however, suggests that the absence of prognostic information makes it more difficult, not easier, for parents to cope.

Dissatisfaction with delayed receipt of diagnostic information has been linked to higher rates of parental depression. In qualitative studies, parents advise professionals that they want and need prognostic information to assist them with planning services.

In addition, parents recommend that medical information be presented in “parent-friendly” language to facilitate their understanding and acceptance of information.^"

Clinical prognostic messages from a systematic review on cerebral palsy.

Novak I, Hines M, Goldsmith S, Barclay R.

Source

MSc (Hons), BAppSc (OT), Head of Research, Cerebral Palsy Alliance Research Institute, PO Box 184, Brookvale NSW 2100, Australia. inovak@cerebralpalsy.org.au.

Abstract

OBJECTIVE:

To summarize evidence on the rates of co-occurring impairments, diseases, and functional limitations with cerebral palsy into succinct clinical messages.

METHODS:

A search was conducted of the databases PubMed, Medline, CINAHL, and PsycINFO, and the results were supplemented with hand searches. Two independent reviewers determined whether retrieved abstracts met the following inclusion criteria: human subjects; >90% were children or adults with cerebral palsy; published after 1999; and population-based data. Articles were appraised, analyzing design, participants, level of evidence, rates of impairments, and functional implications. Methodologic quality was rated by using a standardized checklist.

RESULTS:

A total of 1366 papers were identified in the search; 82 were appraised and 30 were included in the meta-analyses. High-level evidence existed, as rated on the Oxford 2011 Levels of Evidence: 97% of prevalence studies were level 1. The data were of a moderate to high quality grade (with the exception of sleep disorders), allowing plain English clinical messages to be developed.

CONCLUSIONS:

Among children with cerebral palsy, 3 in 4 were in pain; 1 in 2 had an intellectual disability; 1 in 3 could not walk; 1 in 3 had a hip displacement; 1 in 4 could not talk; 1 in 4 had epilepsy; 1 in 4 had a behavior disorder; 1 in 4 had bladder control problems; 1 in 5 had a sleep disorder; 1 in 5 dribbled; 1 in 10 were blind; 1 in 15 were tube-fed; and 1 in 25 were deaf.

PMID:

 

23045562

 

[PubMed - in process]

Pediatrics. 2012 Nov;130(5):e1285-312. doi: 10.1542/peds.2012-0924. Epub 2012 Oct 8.

Clinical Prognostic Messages 

From a Systematic Review on 

Cerebral Palsy

TABLE 3

Clinical Messages

Problem	How Common Is This Problem?	Who Is at Risk?	Long-term Implications?	Clinical Recommendations
Behavior	1 in 4 children with cerebral palsy have a behavior disorder (moderate-quality GRADE)	Children with cerebral palsy and an ID are more likely to have behavioral problems (high-quality GRADE)	Unknown	Thorough assessment of behavior is recommended. Also a pain assessment is essential in the presence of behavioral problems, even for children with mild physical impairments.
	The rate of abnormal behavior in children with cerebral palsy is 2 to 4 times higher than the population (moderate-quality GRADE)	Children with cerebral palsy and epilepsy are more likely to have behavioral problems; these children are also more likely to have an intellectual impairment (moderate-quality GRADE)		Pain control may remediate or minimize the behavioral problem.
		Children with cerebral palsy and severe pain are more likely to have behavioral problems (high-quality GRADE)		Standard psychometric IQ assessment is also recommended in the presence of behavioral problems to enable the family to understand the prognosis of the behavioral problem.
		Children with cerebral palsy and milder physical disability are more likely to have behavioral problems than children with severe physical disability (high-quality GRADE)
Bladder and bowel control	1 in 4 children with cerebral palsy do not have bladder control (moderate-quality GRADE)	The risk of bladder and bowel control problems increases with severity of physical disability (moderate-quality GRADE)	Unknown	Medical investigations are warranted as abnormal anatomic findings are common
	The rate of bladder control problems in children with cerebral palsy <4 2="2" 3="3" grade="grade" higher="higher" is="is" low-quality="low-quality" old="old" population="population" td="td" than="than" the="the" times="times" to="to" years="years">	Children with cerebral palsy who are unable to walk or have an ID are most at risk for bladder and bowel control problems (moderate-quality GRADE)		Children with cerebral palsy should be offered standard toilet training but over a longer period of time
	1 in 3 to 4 children with cerebral palsy have constipation (low-quality GRADE)			Prescription of incontinence aides will be required for 1 in 3-4 and this will be for longer periods of time that children without physical disabilities
Dribbling	1 in 5 children with cerebral palsy dribble (moderate-quality GRADE)	Children with severe physical disability are more likely to dribble (moderate-quality GRADE)	Unknown	Social stigma is a major problem arising from dribbling and effective treatments such as Botulinum toxin A or surgical interventions should be explored.
Eating	1 in 15 children with cerebral palsy are tube-fed (moderate-quality GRADE)	Children with a history of poor sucking during infancy are more likely to have feeding problems (moderate-quality GRADE)	Eating skills remain stable in adulthood (high-quality GRADE)	Infants with cerebral palsy and poor sucking should have their eating comprehensively monitored.
	Children with cerebral palsy are 3 times more likely to have feeding problems at 6 months of age (moderate-quality GRADE)	Children with severe physical disability are more likely to need someone to feed them (moderate-quality GRADE) and are more likely to need tube feeding (moderate-quality GRADE).		Swallowing safety should be comprehensively assessed if concerns are reported.
		Children who are nonverbal are more likely to have difficulty feeding (high-quality GRADE)		Weight should also be measured regularly as those with more severe physical disability have higher risk for malnutrition.
Epilepsy	1 in 4 children with cerebral palsy have active epilepsy (high-quality GRADE)	The risk of epilepsy with cerebral palsy increases with severity of physical disability (high-quality GRADE)	Adults with cerebral palsy and epilepsy are less likely to work (high-quality GRADE)	Anti-epileptic medications are usually effective for managing seizures and are considered standard practice for managing epilepsy in children with cerebral palsy
	1 in 3 children with cerebral palsy have had epilepsy at some time (high-quality GRADE)	Children with both sides of the body affected are more likely to have epilepsy (high-quality GRADE)	Children with cerebral palsy are less likely to become seizure-free (low-quality GRADE)
		Children with cerebral palsy and an ID are more likely to have epilepsy (high-quality GRADE)
Hearing	1 in 25 children with cerebral palsy have severe hearing impairment or are deaf (high-quality GRADE)	Children with more severe physical disability are more likely to have a hearing impairment (moderate-quality GRADE)	Unknown	Early screening, assessment, and accommodation for hearing impairment is recommended
Hips and spine	1 in 3 children with cerebral palsy have hip displacement (high-quality GRADE)	Children with both sides of the body affected and who cannot walk are at the greatest risk of hip problems (high-quality GRADE) and scoliosis (low-quality GRADE)	Long-term active hip surveillance reduces the likelihood of progression from hip displacement to hip dislocation (moderate-quality GRADE)	6- to 12-month hip surveillance is recommended and is effective for ensuring access to early treatment. Radiograph and clinical assessment should commence very early. For those who receive hip surveillance the rate of salvage orthopedic surgery is lower
	1 in 10 children with cerebral palsy have hip dislocation without hip surveillance (high- quality GRADE)	The risk of hip abnormalities with cerebral palsy increases with severity of physical disability (high-quality GRADE)
		The risk of associated spinal deformity increases with severity of physical disability (low-quality GRADE)
Intellect	1 in 2 children with cerebral palsy have an ID (moderate-quality GRADE)	Children with more severe physical disability are more likely to have an intellectual impairment (moderate-quality GRADE)	Unknown	Formal assessment and diagnosis of an ID is an important prognostic indicator for walking, bladder control, school performance, and likelihood of independent living
	1 in 4 children with cerebral palsy have a severe ID (moderate-quality GRADE)	Children with dyskinetic cerebral palsy who have an ID are more likely to have a severe ID than those with spastic cerebral palsy (moderate-quality GRADE)		If multiple impairments exist, psychometric screening of intelligence is highly recommended for intervention and school planning
Pain	3 in 4 children with cerebral palsy are in pain (moderate-quality GRADE)	Children and adults with cerebral palsy regardless of level of disability are at risk for pain (high-quality GRADE)	Pain is linked to higher rates of behavioral problems and lower participation (high-quality GRADE)	Parents and children report levels of pain differently and therefore the child’s perceptions should always be sought
		For those who can walk, neck, back, and feet are high-risk pain sites (low-quality GRADE)	Pain increases with age (moderate-quality GRADE)	Investigate a wide range of pain origins (eg, dental, gastrointestinal, muscular, neuropathic, rheumatology, skeletal, tonal)
		Children and adults with contracture are at higher risk of developing pain (moderate-quality GRADE)		Comprehensive pain management should be instigated to minimize the likelihood of secondary behavioral problems from developing
Sleeping	1 in 5 children with cerebral palsy have a sleep disorder (low-quality GRADE)	Children with cerebral palsy and active epilepsy are most at risk for sleep disorders (low-quality GRADE)	Unknown	Through and specialist assessment of sleep problems are recommended
	The rate of sleep disorders in children with cerebral palsy is 5 times higher than the population (low-quality GRADE)	Children with spastic quadriplegia or dyskinesia or a severe visual impairment are more likely to have difficulty initiating and maintaining sleep (low-quality GRADE)		Early treatment of sleep problems (both medical and behavioral) is advisable before secondary academic and behavioral problems emerge or are established
Talking	1 in 4 children with cerebral palsy cannot talk (high-quality GRADE)	Children with more severe physical disability/nonambulatory are more likely to have a speech impairment (high-quality GRADE)	Unknown	Early assessment and recommendations of augmentative and alternative communication options for speech impairment is recommended
	1 in 3 children with cerebral palsy have some speech impairment (high-quality GRADE)	Children with dyskinesia are more likely to have speech problems (high-quality GRADE)
Walking	1 in 3 children with cerebral palsy cannot walk (high-quality GRADE)	Children with cerebral palsy who have 4 limbs affected and/or ID and/or epilepsy and/or a vision impairment have a higher risk of being unable to walk (high-quality GRADE)	Children who walk using aids or cannot walk lose walking function during adolescence (moderate-quality GRADE)	Children who walk using aides and their families should be emotionally prepared for potential loss of motor function in adolescence
	1 in 6 children with cerebral palsy walk using aides (high-quality GRADE)	At age 2 years, children with cerebral palsy who are unable to roll, sit, or pull to stand have a very high risk of being unable to walk (high-quality GRADE)	Ability to walk further declines during later adulthood. (high-quality GRADE)	Children who walk using aides require mobility assessments at the commencement of adolescence to enable prescription of appropriate mobility devices to accommodate declining motor function
	1 in 2 children with cerebral palsy walk independently (high-quality GRADE)	A child’s walking ability at age 12 years is predictive of their walking ability as an adult. (high-quality GRADE)
Vision	1 in 10 children with cerebral palsy have a severe visual impairment or are blind (moderate-quality GRADE)	Children with severe physical disability are more likely to have a visual impairment (high-quality GRADE). Among those with severe physical disability, severe visual impairment occurs more frequently with spasticity than dyskinesia (high-quality GRADE)	Unknown	Early screening, assessment, and treatment of vision impairment is recommended
	1 in 4 children with cerebral palsy have a vision impairment (moderate-quality GRADE)	Children born prematurely with cerebral palsy are more likely than children without cerebral palsy to have visual impairments (high-quality GRADE)

• GRADE system (Guyatt et al [2008])²¹ was as follows: high-quality: further research is very unlikely to change our confidence in the estimate of effect; moderate-quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; low-quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; and very-low-quality: any estimate of effect is very uncertain.

MRIs Show Signs of Brain Injuries Missed in CT Scans

MRIs can show signs of traumatic brain injuries that cannot be seen in CT scans. 

The second best test is a history and exam by a specialist. 

The most sensitive test is a parent saying that their child is not right. JR

Hospital MRIs may be better at predicting long-term outcomes for people with mild traumatic brain injuries than CT scans, the standard technique for evaluating such injuries in the emergency room, according to a clinical trial led by researchers at the University of California, San Francisco (UCSF) and the San Francisco General Hospital and Trauma Center (SFGH).

Published this month in the journalAnnals of Neurology, the study was led by UCSF neuroradiologist Esther Yuh, MD, PhD and followed 135 people treated for mild traumatic brain injuries over the past two years at one of three urban hospitals with level-one trauma centers: SFGH, the University of Pittsburgh Medical Center and University Medical Center Brackenridge in Austin, Texas as part of a study called NIH-funded TRACK-TBI (Transforming Research and Clinical Knowledge in Traumatic Brain Injury).

All 135 patients with mild traumatic brain injuries received CT scans when they were first admitted, and all were given MRIs about a week later. Most of them (99) had no detectable signs of injury on a CT scan, but more than a quarter (27/99) who had a "normal" CT scans also had detectable spots on their MRI scans called "focal lesions," which are signs of microscopic bleeding in the brain.

Spotting these focal lesions helped the doctors predict whether the patients were likely to suffer persistent neurological problems. About 15 percent of people who have mild traumatic brain injuries do suffer long-term neurological consequences, but doctors currently have no definitive way of predicting whether any one patient will or not.

"This work raises questions of how we're currently managing patients via CT scan," said senior author on the study Geoff Manley, MD, PhD, the chief of neurosurgery at SFGH and vice-chair of the Department of Neurological Surgery at UCSF. "Having a normal CT scan doesn't, in fact, say you're normal," he added.

Better Precision Tools Needed for Head Injuries, Doctors Say

At least 1.7 million Americans seek medical attention every year for acute head injuries, and three quarters of them have mild traumatic brain injuries -- which generally do not involve skull fractures, comas or severe bleeding in the brain but have a variety of more mild symptoms, such as temporary loss of consciousness, vomiting or amnesia.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that far more mild traumatic brain injuries may occur each year in the United States but the true number is unknown because only injuries severe enough to bring someone to an emergency room are counted.

Most of those who do show up at emergency rooms are treated and released without being admitted to the hospital. In general, most people with mild traumatic brain injuries recover fully, but about one in six go on to develop persistent, sometimes permanent disability.

The problem, Manley said, is that there is no way to tell which patients are going to have the poor long-term outcomes. Some socioeconomic indicators can help predict prolonged disability, but until now there have been no proven imaging features, or blood tests for predicting how well or how fast a patient will recover. Nor is there a consensus on how to treat mild traumatic brain injuries.

"The treatment's all over the place -- if you're getting treatment at all," Manley said.

The new work is an important step towards defining a more quantitative way of assessing patients with mild traumatic brain injuries and developing more precision medical tools to detect, monitor and treat them, he added.

If doctors knew which patients were at risk of greater disabilities, they could be followed more closely. Being able to identify patients at risk of long-term consequences would also speed the development of new therapeutics because it would allow doctors to identify patients who would benefit the most from treatment and improve their ability to test potential new drugs in clinical trials.

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