The Myth of Autism: How a Misunderstood Epidemic Is Destroying Our Children

225 Pages·2011·5.48 MB·English

by  Michael Goldberg

The Myth of Autism
How a Misunderstood Epidemic Is Destroying Our
Children
Dr. Michael J. Goldberg
Elyse Goldberg
Dr. Ismael Mena
Copyright © 2011 by Dr. Michael J. Goldberg
All Rights Reserved. No part of this book may be reproduced in any manner
without the express written consent of the publisher, except in the case of brief
excerpts in critical reviews or articles. All inquiries should be addressed to
Skyhorse Publishing, 307 West 36th Street, 11th Floor, New York, NY 10018.
Skyhorse Publishing books may be purchased in bulk at special discounts for
sales promotion, corporate gifts, fund-raising, or educational purposes. Special
editions can also be created to specifications. For details, contact the Special
Sales Department, Skyhorse Publishing, 307 West 36th Street, 11th Floor, New
York, NY 10018 or [email protected].
Skyhorse® and Skyhorse Publishing® are registered trademarks of Skyhorse
Publishing, Inc.®, a Delaware corporation.
www.skyhorsepublishing.com
10 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data available on file.
9781616081713
Printed in the United States of America
Table of Contents
Title Page
Copyright Page
FOREWORD
INTRODUCTION
1 - IN THE BEGINNING
2 - HOW CAN THIS BE ANYTHING BUT AN ILLNESS?
3 - CHANGING LETTERS: ADD? ADHD? MIXED ADHD? QUIET ADD?
4 - A HISTORY OF MEDICAL RESEARCH
5 - THE EVIDENCE
6 - NEUROSPECT: A NEW TOOL
7 - HOW EVALUATION AND TREATMENT BEGIN: THE GOLDBERG
APPROACH
8 - MISTAKES AND MISDIRECTIONS
9 - THE ROLE OF ALLERGENS AND DIET
10 - TIPS TO HELP GET THROUGH THE DAY (DEPENDING ON
BEHAVIORAL AGE)
11 - THE FUTURE
APPENDIX A - A CASE STUDY
APPENDIX B - PARENT STORIES
APPENDIX C - PATIENT SCREENING/DATA QUESTIONNAIRE FOR
AUTISM/PDD/ADHD USED AT DR. GOLDBERG’S PRACTICE
GLOSSARY
NOTES
Although the focus of this book is the autism myth, a lot of the
information, studies, and conclusions can be applied to how we
understand and approach ADHD variants, CFS, and CFIDS in
children and adults (and to many other nonspecific psychiatric and
learning labels applied to many “special needs” children today).
Initial 3-D NeuroSPECT imaging on patient with autism (see appendix A).
“Holes” are multiple areas of decreased perfusion and decreased function in the
brain. This brain scan graphically illustrates the difficulty of normal brain
function when “holes” are present.
NeuroSPECT scan 2.5 years later, after treatment with The Goldberg Approach
(see chapter 7). While brain function is not normal, it is significantly improved.
Conclusion: this disorder and its complications can be changed.
FOREWORD
SINCE 1994, DR. MICHAEL GOLDBERG AND I have collaborated during my
tenure as Director of the Department of Nuclear Medicine at Harbor-UCLA
Medical Center in Torrance, California. The development of quantitative
functional imaging techniques at our laboratory was instrumental for a long-
standing collaboration in the challenging field of autism that Dr. Goldberg
suspected from very early to be the consequence of an inflammatory process and
thus amenable for treatment. Over the years, the epidemic increase of the
prevalence of this dreadful condition has strengthened this hypothesis.
During the last fifteen years we have participated actively in the development
of quantitative software in order to assess brain perfusion by means of
NeuroSPECT. The development of this imaging software has achieved results by
comparing against a normal, age-matched database and expressed in standard
deviations above or below the normal mean. (The color gray is normal range,
whereas light blue, dark blue, and green denote hypoperfusion at 2, 3, and 4
standard deviations below the normal, age-matched mean, respectively. The
colors red, pink, and white are 2, 3, and 4 standard deviations above normal
mean, respectively). The process entails normalization of brain volume in order
to establish the comparisons mentioned above, and this is achieved by means of
the Talairach technique, which is currently performed by automatic
reconstruction, thus reaching the ultimate goal of 100 percent reproducibility of
results (Segami Corp. Neurogam Oasis). This highly accurate way of assessing
brain perfusion, and therefore of brain function, is performed with the
radiopharmaceutical Tc99m HMPAO, Ceretec, that provides stability of
distribution and concentration in the brain parenchyma after the first two
minutes of IV injection with a 1 percent / hour loss only.
THE MYTH OF AUTISM
The NeuroSPECT findings of cerebral cortical and subcortical perfusion in
chronic fatigue syndrome (CFS) and in pervasive developmental disorders,
namely, autism, have enabled us to define common features among these two
disorders. 1, 2, 3, 4 I’ve included these findings, in brief, to give the reader a sense
of the extensive research that informs The Myth of Autism.
Chronic Fatigue Syndrome
Patients with CFS present during the evolution of their chronic condition signs
of small vessel disease distributed in the lateral aspects of temporal lobes,
premotor areas, and parietal lobes reaching to the convexity of the brain and also
in the orbital-frontal areas of the frontal lobes. There is also frequent
involvement of temporal lobes in the mesial aspects, in the projection of the
hippocampus, and in the inferior gyrus at the level of the temporal poles also. In
the limbic system we observe diminished function in anterior and posterior
cingulate gyri and approximately in 50 percent of patients hypoperfusion in the
subgenual area thus implying the presence of a secondary depression. Finally
there is focal hypoperfusion also in both occipital lobes in the interhemispheric
fissure, highlighted in this patient in the posterior view and inferior aspects of
temporal and occipital lobes. In the subcortical structures there is very frequently
deep hypoperfusion of the head of the caudate nuclei, less frequently in the
dorso-ventral posterior aspects of both thalami and some times also
hypoperfusion in the lentiform nuclei. The findings of subgenual hypoperfusion,
anterior cingulate hypoperfusion, and increased thalamic perfusion are indicative
of the presence secondary depression. The caudate and posterior cingulate gyrus
hypoperfusion in the presence of hippocampus hypoperfusion are indicative in
other patients of cognitive dysfunction, which is a frequent symptom in CFS.
These findings suggest severe inflammatory changes involving, temporal,
frontal, parietal lobes, occipital lobes, and frequently caudate nuclei involvement
denoting cognitive impairment.
Autism
Quantitative rCBF absolute measurements with Xenon 133 were found to be
significantly higher than normal in autistic children, with maximal values in the
frontal lobes and visual cortex. Minimal perfusion was observed in the temporal
lobes. Decreased rCBF was also noted in the cerebellum and occipital lobe. Tc
99m HMPAO images demonstrate qualitatively increased frontal (subgenual)
perfusion, and also temporal, occipital hypoperfusion. In this patient increased
subgenual perfusion is indicative of a comorbidity of attention deficit disorder.
In other patients we have demonstrated with Tc 99m HMPAO imaging
increased frontal perfusion, and also temporal, occipital, and cerebellar
hypoperfusion. In the basal ganglia of these patients very frequently there is
normal perfusion and function of thalami, caudate nuclei, and lentiform nuclei.
They may also have many symptoms consistent with OCD characteristics,
associated with the following areas of dysfunction, namely, inferior frontal,
anterior poles of the temporal lobes (amygdala), and posterior cingulate gyri,
demonstrating increased perfusion of these areas.
In 1995, Mountz, Tolbert, Lill, Katholi, and Liu5 reported their HMPAO
findings in six children with severe autism and demonstrated with
semiquantitative techniques temporal and parietal hypoperfusion with
lateralization to the left hemisphere.
Georges, Costa, Coniz, Ring, and Ell reported in four autistic adults with Tc-
99 HMPAO diminished rCBF in temporal and frontal lobes. The temporal
abnormality appears to be confirmed mostly in adults, adolescents, and children
suffering of autism. Thus, damage to temporal lobe in an early developmental
stage may result in autistic manifestations.
The results are otherwise heterogeneous, denoting the presence of occipital
hypoperfusion and cerebellar hypoperfusion mostly in the mesial aspects
corresponding to the vermis area. This later observation correlates with reports
in the literature of atrophy of the cerebellar vermis demonstrated by MRI
technique. Further heterogeneity in our group of patients is demonstrated by
apparent comorbidity with OCD and ADHD in these children and their typical
presentation of increased perfusion in lateral frontal lobes.
In Asperger’s syndrome the hypoperfusion defects appear predominantly in
occipital lobes in the paramedial aspects and also in the cerebellar vermis.
In both chronic fatigue syndrome and autism the multifocal areas described—
strikingly in the occipital lobes and always more extensively in temporal lobes—
suggest strongly the inflammatory nature of both disorders, at vascular or
cellular level (vasculatis versus cellular damage), thus opening expectations for
early diagnosis and hopefully for treatment for these and other potentially related
crippling diseases.
Ismael Mena, MD
Emeritus Professor Radiological Sciences
UCLA School of Medicine
Doctor Honoris Causa
University d’Auvergne, France
Department of Nuclear Medicine
Clinica Las Condes
Santiago, Chile