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  Antibiotic Therapy to Improve Autism

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Antibiotic Therapy to Improve Autism

On the Autism-Research discussion list, Teresa Binstock describes Ellen Bolte's Clostridium tetani hypothesis, which has prompted a one-child trial with vancomycin:

Index Case

"The index case was a 4 1/2-year-old Caucasian boy with chronic diarrhea and autism whose motor, cognitive, and social development was normal until 18 months of age. Diarrhea began at approximately 17 months of age after three 10-day courses of broad-spectrum antimicrobials prescribed over a 6-week period for chronic otitis media. There was no blood or pus in the stool nor associated constitutional symptoms. At 19 months of age there was profound behavioral and developmental deterioration, along with emergence of severe autistic features.

Extensive genetic, neurologic, gastrointestinal, and immunologic evaluations were all unrevealing. Neither conventional (e.g., full-day special education program, speech, and play therapy) nor unconventional interventions (e.g., special diets, megavitamin loading) had a significant effect on his autistic symptoms.

A 12-week therapeutic trial of oral vancomycin (125 mg four times per day) was begun with expanded observations by a pediatric neuropsychologist pre-and post-treatment. At baseline, the child was not on a special diet nor was he taking any vitamin supplements. Three days after initiation of the vancomycin therapy, a hyperactivity pattern emerged that lasted 4 days. This was followed by 2 days of lethargy and subsequently by a rapid and dramatic clinical improvement. He became affectionate and relatively calm. He promptly achieved toilet training and increased vocabulary.

Follow-up behavioral observation after 8 weeks of therapy noted an increase in on-task performance, compliance with parental requests, awareness of environmental surroundings, and persistence when engaging in positive activities. A significant reduction in repetitive and self-stimulatory behaviors was also noted. The child's educational therapies remained unchanged for both 6 months before and during the vancomycin trial.

Shortly after vancomycin discontinuation, behavioral deterioration was observed. Though still improved over baseline, he eventually lost most of the initial gains."

[excerpted with kind permission of Ellen R. Bolte from: Short-term benefit from oral vancomycin treatment of regressive onset autism, Journal of Child Neurology 2000;15:pg. 430]

During a subsequent clinical trial, a subgroup of the children improved as did the first child, but nearly all who experienced the improvement had varying degrees of back-sliding towards baseline. Vancomycin has the advantage that it is not absorbed into the blood stream from the gut.

Binstock has proposed neuroanatomical linkage in an essay on the insular cortex to explain the children's improvement in language and other frontal and temporal lobe functions after treatment with a gastrointestinal antibiotic. See Binstock's draft, "Anterior Insular Cortex: the Gut-Brain Connection in Aphasic Autism-Spectrum Children".

Antibiotics effectively killing pathogens would induce dead cells and processes that act against dead cells and fragments thereof. Such "bits and pieces" of cellular debris, especially if from a pathogen stimulate cytokines production. Her proposal is that these responsive children have an immune-tolerance towards and chronic-infection by a specific pathogen (Clostridium or Pertussis, for example). They do not have such tolerance towards most pathogens. When the antibiotic-induced pulse of cytokines occurs, the child's immune system is sufficiently activated so as to override, at least for a few days or slightly longer, the child's more deeply embedded infection towards which he or she has a mild genetic and/or acquired immune impairment and at least some degree of immune tolerance.

This is to explain parents' observations of a noticeable burst of words for about 10 days after a course of antibiotics. In these children, stool tests have shown
elevated Candida, Klebsiella, and Blastocystis hominis, along with several other pathogens.

Other parents have reported improvement after antibiotic use of drugs such as metronidazole, which does cross the intestines into the blood stream. Some of these parents have reported changes in live cell blood analyses from before to after antibiotic. For those of us with conventional medical training, it is hard to imagine parasites swimming in the bloodstream that can be eradicated with one course of oral Flagyl.

I still remain suspect of these so-called parasites, suspecting that they represent another phenomenon, which, of course, may be equally important. It's hard for me to know how to respond to the antibiotic therapies, though I think it is a reasonable request for a parent to make, and I am willing to help with a trial of antibiotics to see what will happen. Whether or not it is placebo or a genuine biological effect remains to be determined. My other concern, of course, is that it can induce severe Candida and can encourage the growth of more dangerous, resistant bacteria, such as Clostridium difficils.


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