A segment on ABC’s Good Morning America May 19 caught my attention, so much so that I spent a good chunk of time attempting to find research to back up the claims. The idea itself seems to be obvious – if you have a neurological disorder affecting your brain, you should examine the brain in order to figure out exactly what’s going on to figure out how to best treat the problem, right? I am not a neurologist, so my thinking could be flawed. A comment by the doctor featured in the segment made sense to me, though: diagnosing children with behavioral disorders like ADHD and autism without looking at their brains is like trying to diagnose heart problems without actually looking at the heart. GMA kicked off a new series on unlocking the puzzles inside the brain with Dr. Fernando Miranda, a neurologist from the Bright Minds Institute, who said neurologists should be more involved in autism. The typical method of diagnosing autism is through behavioral tests, with advanced tests like MRIs and EEGs (which Miranda touted) used selectively, according to GMA. Two children were featured in the segment. Both had been diagnosed with autism – which was wrong, Miranda said. The two boys were having seizures, according to EEG readouts, and were put on anti-seizure medication. The results for both children, in the words of the parents and Miranda, were “astounding.” ABC made the point that “there is great debate within the autism medical community about when anti-seizure drugs should be used and about how severe the seizures have to be before they are treated.” Further complicating things, these seizures can often be completely invisible to the naked eye, or mistaken for staring or daydreaming – symptoms typical of autism. Some research shows that children with autism are prone to seizures and that 50 percent of children diagnosed as autistic would have abnormal EEGs if tested. Many top neurologists caution that these tests would by no means make sense for every child with autistic symptoms. Many experts say there may not be the equipment or expertise to do it. And top neurologists say there is no clear research on how many children this would really help. "Doing an EEG and MRI in every child with autism is absolutely not recommended," said Dr. Robert Tuchman, director of the Autism Program at Miami Children's Hospital. Tuchman and others said there would have to be a sign of something else, maybe the staring or some other symptom that might lead a doctor to believe there is more going on. And it is possible that specialists have more experience in judging who might be best helped by these tests that "look at the brain." Although not addressed on the show, the online story notes that if everyone had an EEG, too many kids would be put on anti-seizure medication for no reason because so many tests would yield “abnormal” EEGs. And at the heart of the matter, ABC concluded, “There is simply no research yet to show exactly which kids with seizure-like activity might really be helped. What the level of this seizure-like activity needs to be for drugs to make a difference, nobody knows.” A quick scan of articles on PubMed revealed that indeed, results are ambiguous. An electroencephalographic study on autistic children by Hughes and Melyn in January 2005) found 46 percent had seizures, and also a relatively high prevalence of 20 percent with epileptiform discharges but without any clinical seizures. (Citation, if you’re interested: Clin EEG Neurosci 2005;36:15-20). Another study published this month by Coben et al. noted that EEG, MRI and fMRI research suggests neural connectivity anomalies are a major deficit leading to autistic symptomatology. Their review on EEG screening for autism found that 20 to 30 percent of autistics had seizures, anywhere from 10.3 to 72.4 percent of patients had epileptiform abnormalities, and 6.1 to 31 percent had subclinical anomalies. They wrote: “While such problems are important in the diagnostic and screening process, Deonna and Roulet (2006) concluded that there is no evidence that autism can be attributed to an epileptic disorder.” (Citation: Clin Neurophysiol. 2008 May;119(5):1002-9.) What about the doctor, who was hailed as an expert and prominent neurologist? He has a private practice, founded the Bright Minds Institute, and is a co-founder and chief science officer at Lucid Systems. Fernando and Lucid Systems were featured in a number of news stories recently on “neuropunditry.” Lucid, a neuromarketing firm, according to Slate:
…sells its services on the grounds that we all lie about our preferences—to pollsters, to friends, even to ourselves. They claim to suss out the "unspoken truth" in our minds, using a variety of not-quite-cutting-edge technologies. (CNN.com is pushing the story on its homepage under the tabloid headline"Machine reads voters' lying minds.")I’m curious to see how the story plays out, especially in light of the recent brouhaha on Capitol Hill over vaccines and autism. I also wonder how neurologists feel – is this guy a snake oil salesman or legitimate pioneer? A quick skim of the comments posted on the story site shows a lot of confusion and even more questions: parents hopeful that this can help their child and asking for help interpreting confusing symptoms, a few vehement "autism is caused by vaccines" arguments, calls for more research, and even a posting by the correspondent who reported the story (at least, that's what the post says). Whether this was free advertising for Miranda or a legitimate service to parents with autistic children, it seems that a lot more research needs to be done for a disease that is affecting so many.