Autism and MMR (More Measles Rubbish)
June 8th, 2009
A reader sent me a comment from a parent of an autistic child. This parent had been told that their child’s “measles titre” was “five times normal”, which was offered as an explanation of why this child had autism.
I assume that this information was provided by some form of “health care practitioner”, most likely of the “alternative” genre. The parent’s comments made it clear that they had also been told that this “elevated titre” was due to the MMR vaccine.
Let’s deconstruct that argument.
Measles Titres - what are they?:
The “old school” way of doing measles antibody titres is the plaque reduction neutralisation (PRN) test. This involves adding serial dilutions of the patient’s serum to a virus solution and then putting the mixture on a lawn of cells. The greatest dilution (titre) that still gives a specified reduction in plaques (areas of viral infection) on the cell culture is the “antibody titre”. Previously, this was reported as the dilution itself (e.g. 1:64), but now the trend is to reference the results to the international standard anti-measles serum and report it as milli-International Units per milliliter (mIU/ml).
An easier (not to mention cheaper and faster) method is to use an enzyme-linked immunosorbent assay (ELISA) to measure the anti-measles antibody. This is a test that can be done in almost any clinical lab and requires no finicky cell cultures. Although the test is usually set up to give results as “immune”, “not immune” and “equivocal”, it can be quantified by using dilutions of the standard serum to set up a calibration curve.
The PRN test has been shown to be more sensitive to low levels of antibody (Cohen 2008) and it is probably more accurate, but both tests are “good enough” to give the answer most clinicians want: “Is this person immune to measles?”
The “normal value” of anti-measles antibody:
The whole idea of an anti-measles antibody titre being “five times normal” is a little weird. You see, the report from the lab will give the titre (if it is quantified - often it is not) and then state the level at which immunity is assured. What value the lab uses depends on which level of certainty they have chosen.
Studies have shown that an antibody level (titre) of 120 mIU/ml is sufficient to prevent clinical illness. This is often used by labs as the “rock-bottom” level for immunity. At this level, the patient will show some laboratory signs of measles infection (e.g. rising antibody levels) and may be able to transmit the disease to others (for a brief period) but won’t generally feel ill or develop a rash. Generally.
Because there is some debate about whether people at 120 mIU/ml are truly protected from measles, most labs set their “immune” point somewhere between 200 and 300 mIU/ml. This gives some margin for error.
However, these are not “normal values” except in the sense that anything below these levels is abnormal (if you want to be protected from measles). There is no upper “normal value”.
Let me say that again:
There is no upper value of “normal” for measles titres.
Baird et al (2008) should be an interesting read for those clinicians telling parents that their autistic children’s anti-measles antibody titre is “five times normal”. Not only did Baird et al show that there is no relationship between measles antibody titre and autism, but their data show the extreme range of antibody titres in both the “normal” and “autistic” population.
Baird et al looked at 90 “neurotypical” children born between 1 July 1990 and 31 December 1991 (average age 12 yrs at the time of the study) as their control group. The measles titres they measured in this group ranged from 25 to 6,300 mIU/ml (geometric mean - 890 mIU/ml). Even using a “normal” value of 300 mIU/ml, the highest of these “neurotypical” children was “twenty-one times normal”.
The antibody titres of the autistic children in the Baird et al study were not statistically different from the “neurotypical” controls (geometric mean - 870 mIU/ml).
Just to show that this wasn’t a fluke, LeBaron et al (2007) looked at measles antibody levels in kindergerten children (4 - 6 years) and at middle school children (10 - 12 years) before and after their second MMR vaccination. They found that the kndergarten children had a geometric mean antibody level of 1559 mIU/ml (over “five times normal”). The middle school children had a geometric mean of 757 mIU/ml prior to their “booster” MMR and 1672 mIU/ml after the second MMR.
The significance of “elevated” serum anti-measles antibody titres:
None.
Why do practitioners get quantitative anti-measles antibody titres for autistic children?:
I have no way of knowing for certain. All plausible explanations involve a “belief” that measles vaccine - more specifically, the MMR vaccine - can cause autism. This is a “belief” that is not, currently, supported by any credible data (Dr. Wakefield’s work having passed into the category of “non-credible” some time past). From talking with parents in my area, I have discovered that it is still a common practice (among the “alternative” autism practitioners) to obtain (and even follow) anti-measles antibody levels.
If the antibody levels are HIGH (which, as I have shown above is nonsense), the parents are told that the child has a “persistent vaccine-strain measles infection” (without, I might add, ever doing any testing to show that it was a vaccine strain). In my area, the common “treatments” are intravenous immunoglobulin (puzzling, since it has only moderate levels of anti-measles antibody - the child’s level is, presumably, much higher than normal), valcyclovir (puzzling, since it is absolutely ineffective against measles virus) and/or chelation (again, no possible effect against the measles vaccine). The “treatments”, I have found, vary from region to region, practitioner to practitioner and - apparently - day to day.
If the anti-measles antibody levels are LOW, a few parents have been told that the measles virus is suppressing the immune system and that “treatment” is indicated. In the few instances I have come across, the only treatment consistently not used was intravenous immunoglobulin - the only treatment that might have worked, were the diagnosis correct (which I doubt).
Summary:
The anti-measles antibody titre is being used in a nonsensical way to convince parents that their autistic children have persistent measles infections. This is nonsensical for two reasons - first, there is no indication that high anti-measles antibody titres are even associated with autism. And, secondly, the claim that a child’s anti-measles antibody titre is “five times normal” (or even “fifty times normal”) is nonsensical on its face, as there is no upper “normal” limit.
Parents who are told by a doctor that their child’s anti-measles antibody titre is “five times normal” should thank the doctor, firmly grasp their child’s hand and walk briskly from the office. This doctor does not understand how the anti-measles antibody titre works and should not be trusted with your child’s health care.
Prometheus
References:
Baird G, Pickles A, Simonof E, et al. Measles vaccination and antibody response in autism spectrum disorders. Arch. Dis. Child. 2008 Oct;93(10):832-7.
Cohen BJ, Doblas D, Andrews N. Comparison of plaque reduction neutralisation test (PRNT) and measles virus-specific IgG ELISA for assessing immunogenicity of measles vaccination. Vaccine 2008 Nov 25;26(50):6392-7.
LeBaron CW, Beeler J, Sullivan BJ, et al. Persistence of measles antibodies after 2 doses of measles vaccine in a postelimination environment. Arch. Pediatr. Adolesc. Med. 2007 Mar;161(3):294-301.
Filed under: Autism Practitioners, Autism Science, Critical Thinking
June 8th, 2009 at 6:43 pm
“If the anti-measles antibody levels are LOW,” … wouldn’t the proper treatment be vaccination?
June 8th, 2009 at 6:55 pm
Just out of curiosity, how would a person’s measles antibodies and by relation their titre be affected if they did have an active measles infection?
June 9th, 2009 at 1:31 pm
LW,
You are correct - although the presumption in these “cases” is that the child has already been vaccinated (that’s why the “practitioner” is blaming the MMR vaccine for the low titre).
If you had a situation where a patient had a low anti-measles antibody titre AND evidence of an on-going (possibly chronic) measles infection, one possible treatment would be to use immune globulin.
MJ,
Not much work has been done recently on antibody titres in acute wild-type measles. What has been done in the past indicates that the antibody levels after wild-type infection are initially about the same as with the Edmonston vaccine strain (i.e. 1,000 - 20,000 mIU/ml), but don’t drop quite as quickly.
Antibody titres in chronic measles infections - such as sub-acute sclerosing pan-encephalitis (SSPE) - are generally reported as being persistently high (thousands), but there are also case reports where the antibody titres were low or non-existent (for example see: Chung et al 2004, Acute fulminant subacute sclerosing panencephalitis with absent measles and PCR studies in cerebrospinal fluid. Pediatr Neurol 2004 Sep;31(3):222-4.)
(See also: http://iai.asm.org/cgi/reprint/33/1/34?view=long&pmid=6973545 )
If there is a persistent measles infection of the brain (persistent measles infections in other tissues have not been shown), the level of anti-measles antibody in the cerebro-spinal fluid (CSF) will be around 1 - 5% of that in the serum. People with high titres from acute measles or vaccination have CSF levels of anti-measles antibody that are much lower than that, although this is far from diagnostic.
Currently, anti-measles antibody is just one part of the evaluation for possible SSPE, which includes MRI and rt-PCR of the CSF for measles virus RNA.
Prometheus
June 9th, 2009 at 2:56 pm
Prometheus,
I thought “SSPE without CSF measles antibodies” was MIBE (measles inclusion body encephalitis) due to immune problems? The long period between measles and onset of neurological problems speaks against that, but the authors did not look at the immune system at all.
June 9th, 2009 at 4:21 pm
MJ asked: “Just out of curiosity, how would a person’s measles antibodies and by relation their titre be affected if they did have an active measles infection?”
Depends on when you measure them. Typically the antibody level is undetectable the first few days and then starts rising as the immune system gears up production.
The cells are single-purpose and extremely long-lived … when the antigen they were primed with shows up, they immediately start multiplying and spewing out antibodies. In some diseases one kind of immune system cells grab a bacteria or virus and drag it to the lymph nodes and sorta wave it around yelling “anybody recognize this guy?” If not, non-sensitized cells start antibody production. After the infection is over, most of them die off, but a few turn into long-lived cells that “remember” how to make that antibody.
The advantage of immunizations is not that there is enough circulating antibody to fend off infections, but that cells to produce that specific antibody are primed and sitting around waiting for a call to action. In an immunized individual, the antibody production is within the first few hours, not days.
June 9th, 2009 at 4:59 pm
Catherina,
It is true that the article I cited did not include a thorough evaluation of the immune system. However, there was no reason to suspect, a priori, that the subject was immuno-compromised. Most modern cases of measles inclusion body encephalitis (MIBE) are in immunocompromised patients, but some have no evidence of immune system problems. There are also other case reports of SSPE with low antibody titres.
There are data suggesting that MIBE and SSPE are extreme ends of a spectrum. And while MIBE is more common in immuno-suppressed patients, it could be the reason it shows up earlier than SSPE is that the patients are immuno-compromised, not that there is any difference in the diseases. Since both show poorly constrained replication of the measles virus (as opposed to ADEM, for instance), there may be good reason to consider them as a group.
From the perspective of a virologist, the “hallmark” of SSPE is a mutation in the matrix (M) gene of the measles virus, leading to large-scale intracellular replication of the virus in isolation from the immune system.
MIBE is supposed to be due to impaired host immune system and unconstrained replication of the virus for that reason. It also appears that this mutation is also present in the measles virus isolated from MIBE victims.
This is not an easy thing to test, as MIBE and SSPE are rare and currently occur most often in regions far from molecular biology laboratories. Perhaps the current anti-vaccination mood in the West will change that and we’ll be able to test this hypothesis more thoroughly close to home.
Prometheus
June 9th, 2009 at 5:11 pm
Prometheus,
Perhaps the current anti-vaccination mood in the West will change that and we’ll be able to test this hypothesis more thoroughly close to home.
you scare me - Germany still gets 7 or so cases of SSPE per year and had a MIBE case after the measles outbreak in 2007 - I will see what they found…
June 9th, 2009 at 6:34 pm
Prometheus I had two additional questions for you, if you don’t mind.
First, when you are talking about vaccinating because of a low (or not-immune) titre result, what happens for those individuals who fail to develop antibodies even after repeated booster shots? Obviously it does not mean that the person has measles but it seems to indicate that their bodies are having some sort of abnormal response.
Second, if I am understanding you correctly, a person’s titre level, in both the case of a vaccination or an actual infection, will start out at a somewhat high level and gradually fade over the following years. The length of time required for the titres to fade depends on the original source and the rate of fade seems to fit the pattern of an exponetial decay (or at least appears that way from quickly looking over the studies you are citing). If I am incorrect in these assumptions, please let me know.
Given the above what would it indicate if your titre level starts out at a relatively normal level, say 1500 mIU/ml, but stays the same and does not decrease over the following X years.
The follow up to the above is what would it mean if it started out at a higher level, perhaps this mythical “five times normal” level and stayed there over a number of years.
June 9th, 2009 at 8:01 pm
MJ,
There are people who don’t develop detectable anti-measles antibody even after vaccination - even after repeated vaccination. I happen to be one of them.
There are a number of possibilities:
[1] The person cannot mount an adequate immune response - they may have a primary immune deficiency or some sort of secondary immune deficiency.
[2] The person may be making an antibody that the ELISA test cannot detect. This can be seen by doing a PRN test, which uses actual inhibition of the measles virus.
[3] The person may not respond to the vaccine strain because they lack the proper cell receptor the virus needs to enter their cells. The receptor may be absent or mutated. (This is my situation - my CD46 protein is mutated and I am invulnerable to measles).
Only the first one is an “abnormal” response.
Antibody titres generally decay if the person is not re-exposed to the virus (either wild-type or vaccine strain). However, the levels almost never decline to pre-vaccination levels unless there is absolutely no exposure to the virus. And even if you don’t have any detectable antibody, you will probably not have “full-blown” measles.
Your “memory” B-cells that react to measles multiplied prodigiously in response to the vaccine (or the disease) and will respond much quicker than those of a person seeing measles for the first time. Unless you have developed an immune disorder, you will suffer from - at worst - a very mild case of measles.
A number of studies have shown that measles titres can remain fairly steady for long periods of time (years) if there is some level of exposure to the virus (or a similar virus), periodically “pumping up” the antibody level.
This is what is currently seen in the community, with most people showing a slow, gradual decline in their antibody levels but staying in the “immune” range, a few people maintaining relatively high antibody levels for a prolonged time and a few people having their antibody levels decay to sub-immune over time.
The key phrase here is “over time” - it takes years for the measles antibody levels to decline. In one of the studies I cited, it took ten years for the antibody level to fall by one half - in children.
If someone is “checking” their child every year, they will see the antibody levels drop only 7% in the first year, and only 6% in the second year. In your hypothetical scenario, the titre would be 1500 mIU/ml the first time, 1400 mIU/ml the next year and 1305 mIU/ml the next year. Go look up the equations for half-life and “run the numbers” for yourself.
The problem is that the year-to-year variation and lab error are larger than the expected natural decline in antibody levels. And if there was an exposure to the wild-type or vaccine-strain measles (or distemper or rinderpest or other morbilliviruses) in that period….well, the antibody levels will probably be even higher.
That’s why nobody in the real world follows anti-measles antibody levels except to determine an acute exposure. Once you’re immune, the “signal” is drowned out by the “noise”.
Prometheus
June 9th, 2009 at 8:34 pm
Prometheus, thanks for taking the time to answer my questions, I appreciate it.
June 9th, 2009 at 9:52 pm
Interesting stuff for this layman, particularly since your last comment may have explained why I never developed varicella (AFAIK) despite numerous exposures in childhood, and my pre-natal titres indicated I was not immune, despite several (pre-conception) rounds of vaccination. I always chalked it up to a combination of obscene good luck and a relatively ineffective vaccine.
June 10th, 2009 at 1:22 pm
Squillo,
Among the people who never develop antibodies to certain live-virus vaccines there are bound to be a few - at least - who are inherently resistant to the virus (both vaccine-strain and wild-type, we hope).
In my case, repeated vaccinations with MMR failed to produce an adequate antibody level. At the time, CD46 was thought to be the primary receptor for measles viruses, so (since I was in a molecular genetics lab) I sequenced my CD46 genes and found that it was missing a critical (for measles) domain.
More recently, the CD150 (SLAM) cell surface protein has been shown to be a (the?) critical protein for measles cell entry, so I have no idea why I can’t mount an immune response - it may be that I also have a mutation in CD150. I seem to have sufficient protection, however, as I was exposed to wild-type measles on a number of occasions and never came down with the disease.
Varicella zoster (chicken pox) virus has a more complex cell entry process, but there are certain cell surface proteins it uses (most importantly IDE - insulin degrading enzyme) that, if mutated in the correct place, could prevent infection.
Prometheus
July 2nd, 2009 at 3:26 pm
Prometheus,
Thank you for another great post.
I have a slightly off topic question, but I don’t know who else to ask. I keep running into the argument (or at least implication) that because “‘antigen-specific titers do not always correlate with protection’ ” this somehow means that certain vaccines are not proven to actually prevent disease. I imagine that quote, taken from a 2001 paper [Del Guidice, et al. Vaccine. 2001 Oct 15;20 Suppl 1:S38-41] is being used wildly out of context. Is this the case? Is there a difference between “effective”(meaning you have measurable titres) and “protective” (meaning you don’t actually get the disease) as people like Sherri Tenpenny repeatedly claim?
How else do researchers measure a given vaccine’s effectiveness at preventing disease if antibody titres are not a good indicator? (I hope these questions aren’t too incredibly naïve, and I apologize if they are. I’m new here.)
Thanks again.
July 3rd, 2009 at 12:17 am
This is an absolutely fabulous explanation, way better than mine when faced with the titer question! Thank you for another great post!
July 5th, 2009 at 4:05 pm
MDP,
The Del Guidice et al article did not specifically refer to their source for this “fact”, nor did it explain it. This is probably because vaccine researchers understand that people can occasionally have low antibody titres and yet have good immunity. However, it is generally true that if someone has an adequate antibody titre (whether manufactured by their own plasma cells or injected in the form of immune globulin), they will be immune.
The converse, however is not true. People with low antibody titres can be immune. The reason that people with low antibody titre can be immune is the cellular immunity (antibodies are referred to as humoral immunity). In fact, if a person has cellular immunity to a disease-causing organism, they may not be able to generate an “adequate” antibody titre, especially to live-virus vaccines. Their cellular immunity will “knock down” the vaccine strain before the humoral immune system has a chance to react.
Researchers and doctors measure the antibody titres because there is no good (or easy) way to measure cellular immunity. Fortunately, antibody titre works well for most people and most (or all) vaccines. To my knowledge, there are no vaccines that target cellular immunity specifically, so the antibody titre “works” for all but a very small percentage of people.
In short, the reason that “antigen-specific titers do not always correlate with protection” is that some people have good immunity but low antibody titres, not that people with adequate antibody titres have poor immunity.
Ms. Tenpenny’s use of “effective” titres as being different from “protective” titres strikes me as a distinction without a difference. It appears that she has made up her own definitions.
In common usage, the two terms - “effective” and “protective” - are used interchangeably. On the only occasion where I have heard a distinction made, an “effective” titre was defined as a titre adquate to prevent any clinical signs of disease, but low enough that the immune system reacts by producing more antibody - which can be seen as a rise in antibody titre after exposure. “Protective” titres - in this context - were defined as sufficient to prevent any immune system reaction. In the end, there is little or no practical difference from the patient’s point of view.
A few other points: individual antibody response to vaccines varies all over the place. Antibody titres after the first vaccination with - for example - measles vaccine vary a thousand-fold between the highest and lowest. That’s why we get “booster” vaccinations.
Some people may develop adequate immunity after a single vaccination, others may not develop adequate antibody protection after many vaccinations. That’s why we vaccinate the whole population - to “cover” those people who cannot develop an adequate immunity (or cannot be vaccinated).
Vaccine researchers look at both the production of “protective” antibody levels and resistance to the disease (if possible). For many vaccine-preventable diseases (e.g. measles), there are not enough cases in Western countries to use “absence of infection” as a criteria to test vaccines. However, when the vaccines were first introduced, their impact on infection rates were dramatic (which is why we can’t use prevention of infection as a practical metric for vaccine effectiveness in many cases).
I hope that helps.
Prometheus
July 6th, 2009 at 4:27 am
Hi Prometheus-
First off- thank you for putting so much thought and research into your posts. There is such a glut of unscientific, illogical static on the internet about autism and vaccines that it can make your head spin. I’m an autism parent, and I would love to be able to share your link with other parents who are confused about the vaccine issue. I’d be really grateful if you could take some pity on we, the un-medically trained parents, and include more such ‘translations’ in your blogs-
“Let me say that again:
There is no upper value of “normal” for measles titres.”
Your blog is awesome, and thanks again for all the thought and hard work you put into it.
Peace-
Abez
July 7th, 2009 at 1:01 am
We have a child with extremely high measle titres - we used an herb called LDM (about 60 drops per day) and the measles appeared all over his body for about a week but we saw no behavioral changes/improvemnts. Does this mean we didn’t stay on LDM long enough to eliminate the virus completly?
July 7th, 2009 at 2:55 pm
Abez,
If you ever need a “translation”, please post it in a comment and I’ll try to adress it ASAP.
Peaches,
Since most people haven’t seen measles, it may be that you mistook a rash due to the “herb” for measles. There is no indication that LDM has any anti-viral activity.
LDM (also known as Lomatium dissectum) is in the parsley family. There are concerns that the harvesting of Lomatium is leading to its extinction, since it is not commercially grown.
My suggestion would be to avoid using “herbal” medications, as they are not tested or regulated in any meaningful fashion. The “traditional” claims that Lomatium dissectum is “useful” for infections have never been tested.
Other Lomatium species have been tested with preliminary results showing some small effect against HIV and rotavirus, but their efficacy againt measles virus has not been tested. It should be noted that these are cell-culture studies and no toxicity studies have yet been done. Lomatium species are known to be toxic to insects.
With “herbs” harvested in the wild - and especially with “herbs” like Lomatium dissectum, which look like many other members of the “low-growing weed family” - there is also a very real chance that an inexperienced or unscrupulous (or just plain careless) harvester could be gathering the wrong plant. This could - at best - lead to you spending your hard-earned money on worthless ditch weeds. At worst, the substitution could be fatal.
Prometheus
July 11th, 2009 at 5:39 am
we used an herb called LDM (about 60 drops per day) and the measles appeared all over his body for about a week but we saw no behavioral changes/improvemnts.
Peaches, up to 10% of people who take Lomatium get a rash and/or hives. It is an adverse effect of taking the herb. It has nothing to do with “measles coming out”. The rash must have been unpleasant for your child. It is not surprising that this didn’t lead to an improvement in behaviour.
July 14th, 2009 at 2:48 pm
As a parent of an autistic boy, I need to comment on this. While there is no scientific evidence that proves that vaccines cause autism, there IS anecdotal evidence that supports this. MY SON IS AN EXAMPLE OF THIS.
After receiving his MMR vaccines at 15 months old, my son lost all language, wouldn’t maintain eye contact, started flapping his arms and walking on his toes, and his whole personality changed. He is now 7 years old, still doesn’t talk and has not grasped toilet-training. Autism is an exhausting, heartbreaking road that never really ends.
My advice is this: Get your child vaccinated, but wait until his/her immune system can handle it — at 3 or 4 years old. Statistically, the chances of contracting measles, mumps and rubella are very low. If I had it to do all over again, this is what I would do.
Sincerely,
Lisa U.
[Editor's note: There are also a large number of parents who have experienced exactly what Lisa's child went through without receiving the MMR vaccine. This is also "anecdotal evidence".
While it is true that the current chance of contracting measles, mumps and rubella is low - in the US - delaying vaccination will put your child at risk of contracting these diseases at an age when they typically do the most damage. If enough people in the US follow these practices - delayed vaccination - the chance of contracting measles, mumps and rubella will no longer be "very low".]
July 24th, 2009 at 6:41 am
Sheesh, sorry for not proofreading my own comment! This is what happens when you surf the internet with a baby in your lap. Please don’t post the other question, it’s embarrasingly riddled with typos! Here’s the version that makes sense:
Hi Prometheus- on an off-topic question, I talked to another Autism parent last week who saw Dr. James Bradstreet for their three year old son’s ‘BioMedical’ treatment- and they had been prescribed 24 ml of Ibuprophen syrup daily for him. They recently stopped, because after a few weeks of treatment he stopped talking and became lethargic.
I was wondering if you knew: What is the rationale behind giving the Ibuprophen, and isn’t that a dangerously high dose for a 3 year old?
Thanks!
July 24th, 2009 at 6:12 pm
Abez,
The recommended dose for ibuprofen is 5 - 10 mg/kg every 6 - 8 hours with a maximum daily dose of 40 mg/kg.
Ibuprofen comes in liquid form in concentrations of either 40 mg/ml (”drops” - for infants) or 20 mg/ml (suspension). Assuming that the recommendation was for the suspension, 24 ml a day would be 480 mg.
At age three years, a boy should be between 12 and 17 kg - at age four years, boys should be between 13 and 19 kg. If we assume that this “3 year old” is in the middle for both age and weight, he would weigh about 15 kilos.
This means that the maximum daily dose of ibuprofen would be about 600 mg - well above the 480 mg he is getting per day. At the lowest weight (12 kilos), he would be right at the daily maximum dose.
That said, there is concern about giving ibuprofen at such high doses for a prolonged period. Renal (kidney) problems can result from prolonged use of any non-steroidal anti-inflammatory drug (like ibuprofen).
As for the rationale behind Dr. Bradstreet’s use of ibuprofen - that requires a bit of guesswork. I know that Dr. Bradstreet is currently very……..excited about the idea that autism is a chronic inflammatory condition of the brain - perhaps he was using the ibuprofen to treat that. Other than that, I have no real idea what Dr. Bradstreet might be using the ibuprofen for.
Prometheus
July 29th, 2009 at 3:52 pm
Thanks Prometheus. Is there any truth to the ‘chronically inflammed brain’ theory?
July 30th, 2009 at 1:48 am
Abez,
The hypothesis of autism being due to “neuroinflammation” (chronically inflamed brain) is based on a few studies finding markers of inflammation in the blood and cerebrospinal fluid (CSF) of autistic children. One study found markers of inflammation in the brains of deceased autistic people.
Many people - including a few who periodically comment on this ‘blog - are convinced that these data “prove” that autism is caused by neuroinflammation. I’m not convinced yet. Here’s why:
[1] Until the findings of neuroinflammation are replicated by another research team (almost all the work has been done by one lab), it remains possible that they are not “real”. In fact, there are only a handful of studies that show neuroinflammation in autism at all.
[2] Even if we accept that the data do show that autistic children have neuroinflammation, this still doesn’t tell us if the neuroinflammation is the cause of autism or an effect of autism. It could be that whatever causes autism also increases these markers of inflammation.
[3] Even if autism is caused by neuroinflammation, it remains unclear if it is treatable. Given the developmental nature of autism, it is entirely possible that - again, if autism is caused by neuroinflammation - treatment would be futile.
It seems likely that whatever does cause autism causes a “missed step” in the developmental “program”. If this is the case, all subsequent steps will affected by the “missed step”. Correcting the problem that led to the “missed step” is cannot reverse the process because the “program” has already “moved on” by the time you even see the effects. And the developmental “program” doesn’t go back to make up lost steps.
[4] Given all of the work that needs to be done before we can say with any degree of confidence that autism is accompanied by neuroinflammation - let alone caused by it - there is no justification for treating autistic children with ibuprofen, pioglitazone (Actos) or whatever to reduce “neuroinflammation” that may not be there and may not be causing their autism.
All real medical treatments have risks. The decision to use any treatment has to include a reckoning of the risk:benefit ratio. If the is no benefit - as may be the case with treatment of “neuroinflammation” - a small (or even negligible) risk cannot be justified.
As frustrating as it may be, the best thing to do is wait for science to generate the necessary data. True, if it does turn out that treating neuroinflammation with pioglitazone can help autism, then those people who treated their children with it will have been shown to be right - even though they will have been right by accident (sometimes it’s better to be lucky than skillful).
On the other hand, if it turns out that autism is not due to neuroinflammation or that treating neuroinflammation is ineffective or that the “alternative” treatments used are not effective for neuroinflammtion (all of which are highly likely at this point), these children will have been exposed to real risks without any real chance for improvement.
Prometheus
December 6th, 2009 at 7:21 am
Due to paperwork issues, my daughter received an extra dose of the MMR vaccine. She received her 1st at age 2, 2nd (Proquad) at age 5 and 3rd at age 8. Is this something that could be harmful to her? All of her teachers have reported that she does not behave as “typical” for her her age and that she should be checked medically because she tends to “glass over” in class. Her pediatrician suggested counseling and did not offer any medical assistance. Her teacher at that time did not think this warranted a counselor and therefore I did not pursue it. Her grades are very good but she struggles with friendships and acts inappropriately much of the time (blows spit bubbles at the lunch table, runs around the classroom pretending to be a horse, lays on the ground and kicks in class, etc). She says she can’t control herself. My question is, what medical tests should I ask for since my Dr. is not offering any advice OR should I listen to my pediatrician (and not the teacher)and go to the counselor? I don’t want to put my daughter through unnecessary tests and would like to pursue the most relevant possibilities first. Thank you!
December 6th, 2009 at 2:21 pm
Ms. Schwartz,
Your daughter’s MMR history is odd, but there is no data to suggest that getting the MMR more often will lead to autism or any other behavioral or developmental disorder.
I am not a paediatrician nor am I a neurologist, psychologist or child counselor. Her teachers’ description of her “glassing over” during class could be absence seizures or it could be boredom (I sometimes find myself “glassing over” during faculty meetings). If you are concerned, then your daughter’s behaviors need to be further evaluated by someone. This is not something that can be diagnosed over the Internet and it is definitely not something you should be seeking help for on-line.
You mention that your paediatrician suggested you take your daughter for “counseling” - was the recommendation simply “counseling” or was it more specific, such as “psychiatrist” or “psychologist”? There is a vast difference between going for “counseling” and being evaluated and treated by a psychiatrist or psychologist. In my state, there are “counselors” who have no more training in psychology than I do.
As for testing, what sort of testing did you have in mind? I ask this because it is unusual for parents to bring up the question of “testing” unless they have something in mind already.
I have to say that your complaint that “…my Dr. is not offering any advice..” is not strictly true. If you are not satisfied with your paediatrician’s advice, I would suggest that you start with either a paediatric psychiatrist, neurologist or developmental specialist. You also would not go wrong starting out with a child psychologist - they can help sort out what is going on and can do the specialised behavioral testing needed to help make a diagnosis.
Understand, too, that there may not be a diagnosis which fits your daughter and - even if there is - there may be no treatment (medical or behavioral) that will help (which is very different from saying that some people won’t claim to have a “cure”). You may end up after a lot of doctor visits with nothing more than a list of disorders she doesn’t have - which can be a relief in its own right.
I wish you luck.
Sincerely,
Prometheus