epilepsy in autism: an overview

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Autism One Conference Toronto, Canada Oct. – Nov. 2009 www.hardyhealthcare.com drhardy@hardyhealthcare.com 781-740-8300. Epilepsy in Autism: An Overview. A Time for Optimism. 32 year perspective Back wards of a 1300 bed state school for the MR Began to suspect complex partial szs - PowerPoint PPT Presentation

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  • Epilepsy in Autism: An OverviewAutism One ConferenceToronto, CanadaOct. Nov. 2009

    www.hardyhealthcare.comdrhardy@hardyhealthcare.com781-740-8300Nov. 09*HHA

    HHA

  • A Time for Optimism32 year perspectiveBack wards of a 1300 bed state school for the MRBegan to suspect complex partial szsIf not on EEG, do not rx.Rigidity of thinking is changing.Nov. 09*HHA

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  • An Integrative Approach

    Attention to diets and nutritionAttention to environmental factorsVaccinesMercuryAttention to allergies, oxidative stress, inflammation, and detoxificationNov. 09*HHA

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  • Epidemiology is Different in AutismIncidence of epilepsy is higher in autism M. Rutter in 1970 stated @ one third20% to 40% is current estimate Abnormal EEGs up to 84%Higher incidence of vaccination-induced seizures: Pertussis, etc.Higher incidence of temporal lobe seizure (TLE or CPS)Nov. 09*HHA

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  • Morbidity is IncreasedImpaired or delayed languageImpaired or delayed cognitionSecondary emotional symptomsAnxiety, fear, obsessionalismSocial impairmentsHelmets, unable to swim at timesAnxiety in parents and staff of programs

    Nov. 09*HHA

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  • Look for ComorbidityCo-morbid diseasesTuberous SclerosisFragile-X syndromeMesial-temporal sclerosisRubellaNeruo-inflammatory conditions?Mitochondrial disordersUnrecognized nutritional or metabolic issues: functional folic acid deficiencyNeuro-toxins: heavy metals?, etc.Nov. 09*HHA

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  • Mortality: IncreasedFew studies on this subject (? avoidance)SIDS Sudden Unexplained Death in Epilepsy (SUDEP)Cardio-respiratory eventEarly morning nocturnal seizuresAspirationTraumaDrowningNov. 09*HHA

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  • Diagnosis: More DifficultOften non-verbal or limited ability to express symptom, especially emotional feelingsOften unable to cooperate for EEGs, BEAMs, QEEGs, MEGsSeizure vs: inattention, tics, Sydenhams chorea, stereotypy of autism, PANDASSubclinical discharges & occult szs

    Nov. 09*HHA

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  • Clinical History is Key!Temporal and paroxysmal patternsHistory, history, historyLocation, location, locationTrauma: birth or other head traumasMesial-temporal sclerosisConstellation of symptoms and signsFamily history of variable importanceMyoclonic epilepsyMitochondrial disordersNov. 09*HHA

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  • ExaminationNeurocutaneous disordersDysmorphic features suggestive of chromosomal disorder or genetic disorderFetal alcohol syndromeValproate syndromeNov. 09*HHA

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  • Laboratory TestingNeurophysiologicSensitivity and specificityImaging studiesGeneticMetabolicToxicologicalOxidative stress, sulfation, methylationThe Therapeutic TrialNov. 09*HHA

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  • Basic AdageIf you do not know the diagnosis after taking the history and doing the exam, go back and take the history over again.Robert Joynt, MD, PhD.Nov. 09*HHA

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  • Epilepsy Classification

    Generalized (both hemispheres involved)Tonic-clonic (Grand Mal, major motor)Petite Mal (Absence seizure)PartialSimple: one modality of brain functionComplex: two or moreTemporal Lobe EpilepsySecondary GeneralizationMyoclonic Epilepsy.Nov. 09*HHA

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  • Special Syndromes in ASDTLE: + Panic Disorder +/- OCDLandau-Kleffner Syndrome (epileptic aphasia): role of inflammation or oxidative stress?Post Vaccination EpilepsyCerebral Folate Deficiency

    Nov. 09*HHA

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  • Nov. 09*HHA

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  • Travolta CaseKawasakis Disease mucocutaneous lymph node syndrome not associated with either autism or epilepsy.BUT note the signs and symptoms of KD:High fever lasting for five days or longerPinkeye in both eyes Redness of lips, tongue, and lining of mouthSwollen cervical lymph node > 1.5 mm in diameterRed rash on the body, which may be flat or bumpy and that may have variable patternSwollen hands and feet with redness of palm and soles. In second week there may be peeling of the skin starting around the fingernails and moving up the arms

    Nov. 09*HHA

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  • Kawasakis Disease, Acrodynia, and MercuryMercury may play a pathogenic roleHigh urine mercuryOverlap of symptoms in two syndromesGenetic depletion of glutathione S-transferaseOnset often within days of vaccination1985 1997 20x in incidence, paralleling use of thimerosalMutter J & Yeter D. Curr Med Chem. 2008; 15(28):3000-10.Nov. 09*HHA

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  • Pre-ictalThe build up of tension/agitationDeepening of mood or depressionIncrease of anxietyHeightening of mania or obsessions and compulsionsExacerbation of psychosisTherapeutic effect of seizuresNov. 09*HHA

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  • Partial Ictal PhenomenaMotor SymptomsFocal motor activity anywhere on bodySpeech arrestSomato-sensory and Special Sensory HallucinationsSomato-sensoryUnformed visualOlfactoryGustatoryVertiginous-vestibularNov. 09*HHA

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  • Partial Ictal Phenomena, ContinuedPsychic-Cognitive SymptomsFear, Anxiety, PanicDepressionAngerIrritabilityPleasureDysphasiaDeja vuJamais vu

    DerealizationSpeeding thoughtsIncoherence of thoughtDistortions of:TimeBody ImageOdorSoundColorSize, shape, distanceHallucinationsMystical experienceNov. 09*HHA

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  • Partial Ictal Phenomena, ContinuedAutonomic SymptomsAbdominal: nauseaChest Unusual headHyper-salivationDiaphoresisTemperature Pallor or flushingPiloerectionPalpitationsNov. 09*HHA

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  • Post-ictalAggressionSelf-injuryConfusion, DeliriumLethargy, Anergy, SomulenceNov. 09*HHA

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  • InterictalAggressionPsychosis (Schizophreniform)Sexual DysfunctionReligiosity and Philosophic InterestsHypergraphiaCircumstantiality and Viscosity (stickiness)Nov. 09*HHA

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  • Interictal Period The Epileptic PersonalityObsessivenessViscosityEmotionalityCircumstantialityParanoiaDepressionAltered Sexual Interest

    AngerAggressionDependenceReligiosityHypermoralityIncreased philosophic Concerns

    Nov. 09*HHA

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  • TLE & Panic Attacks & SIBNov. 09*HHA

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  • HHATLE & Panic and SIBNov. 09*HHA

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  • Biomedical InterventionsNUTRICEUTICAL HORMONALNatural progesteronBe careful of synthetic progestins & ProveraPHARMACEUTICALNEUROFEEDBACKDETOXIFICATION: +/- CHELATIONVAGUS NERVE STIMULATION NEUROSURGERYNov. 09*HHA

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  • Treatment Should Be IterativeTrial and ErrorWilling to stick ones neck out - to be inventiveNov. 09*HHA

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  • Coups in Boston 7 y/o girl with spikes on EEG, absent AER, probable regressive autism, side effects from Depakote (sedation) and Lamictal (rash), and fear of trying prednisone due to side effects: I told her (mother) that I am more inclined to think that the treatments which Dr. Hardy may prescribe might actually do more for her and be safer in the long run. Thus, I thought it made a lot more sense to pursue that route first.

    David L. Coulter, M. D., Harvard Medical School, December 2008Nov. 09*HHA

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  • Nutritional/Natural Treatments IDietsKetogenic (since 1921)Atkins Diet?Casein-free and/or gluten-freeHormonalNatural progesteronePills Lozenge Creams (ProGest)Nov. 09*HHA

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  • Nutritional/Natural Treatments IIL-Carnitine (to prevent valproate toxicity)Magnesium (pre-eclampsia)ZincOmega-3 EFAsVitamin B6 as P-5-PL-methylfolinic acid: Deplin & CerefolinNAC

    Nov. 09*HHA

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  • Nutritional/Natural Treatments IIIMitochondrial cocktailsVitamins D, E, thiamine, biotin, B12Manganese DMG and/or TMGSulfur as ALA, glutathione, MSM, DMSA

    Nov. 09*HHA

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  • Antiepileptic Medication IFirst Generation (1930 1980) all associated with side effects (especially folate deficiency) and adverse drug-drug interactionsBromidesBarbituatesPhenytoinCarbamazepineValproic acidsACTH & steroidsNov. 09*HHA

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  • Antiepileptic Medication IISecond generation (1990 2002) - fewer side effectsNeurontinLamictalTopamaxGabatrilZonagranKeppra The B6 discovery!Lyrica

    Nov. 09*HHA

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  • The B6 Discovery Vit B6 found to reduce behavioral side effects from KeppraNov. 09*HHA

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  • Antiepileptic Medication III

    Third generation in phase 3 Trials (2009 ?)CarisbamateRetigabineEslicarbazepineLacosamide

    Nov. 09*HHA

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  • Vagal Nerve StimulationNov. 09*HHA

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  • Vagal Nerve StimulationNov. 09*HHA

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  • QuestionsNov. 09*HHA

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