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Title: A Review of Chelation Therapy in the Treatment of Autism


1
A Review of Chelation Therapy in the Treatment
of Autism
  • Kelly Ann LaPietra
  • Caldwell College

2
Source Identification
  • Keywords chelation, chelation and autism
  • Assigned Textbooks
  • Barnes and Noble bookstore Special Needs
    Children section
  • Pubmed Database
  • Academic Search Premier Database
  • Psychinfo Database
  • Google Scholar
  • Google Search Engine
  • Autism Resource Websites
  • References cited in articles and in books

3
OUTLINE
  • TOPIC Chelation Therapy
  • I. Introduction
  • A. Origin of the word
  • B. Description
  • II. History
  • III. Common Uses
  • A. Unapproved
  • B. Approved
  • IV. Chelation autism
  • A. Theory
  • B. Basis
  • C. Contradictory evidence
  • V. Video
  • VI. Commonly Used Chelators
  • A. Drug names
  • B. Administration
  • VII. Chelation Therapy
  • A. Preparation
  • B. Sample Treatment Regimen

4
OUTLINE
  • IIX. Testing
  • A. Methods
  • B. Provoked urine excretion test
  • 1. Information gleaned
  • 2. Limitations
  • IX. Effects of Chelation Therapy
  • A. Claimed benefit
  • B. Side effects
  • X. Treatment
  • XI. A. Guidelines
  • B. Qualifications
  • C. End of treatment indicators
  • D. Problems
  • XII. Participating Doctors
  • XIII. Research
  • XIV. Any Evidence?
  • XV. Points of View
  • X. Pseudoscience

5
Chelation Therapy
  • Derived from the Greek word chele, which means
    claw
  • Named for the grabbing effect chelating agents
    have on metal molecules
  • Refers to the way certain synthetic chemical and
    body proteins can bind metal molecules
  • Walker, Morton. (1990). The Chelation Way.
    NY Avery Publishing Group.

6
What is Chelation?
  • Detoxification process by which heavy metals are
    pulled from tissues and made water-soluble so
    they can be excreted through urine or stool.
  • Heavy metals have an affinity for the binding
    sites of chelators.
  • There are many different chelating agents and are
    selected for use based on the metal targeted for
    removal.
  • Jepson, B. (2007). Changing the course of
    autism A scientific approach for
    parents and physicians. Boulder, CO
    Sentient Publications.

7
HISTORY
  • First introduced into medicine to cure
    aresenic-based poison gas that was used in WWI
  • First chelating agent used was the organic
    dithiol compound dimercaprol AKA British
    Anti-Lewisite (BAL)
  • Large scale lead poisoning of Navy personnel in
    the wake of WWII, led to the use of EDTA
  • 1960s DMSA began use (a modified form of BAL
    with less side effects)
  • EDTA and BAL were used less after introduction of
    DMSA
  • DMSA- became the mainstay for lead, arsenic, and
    mercury poisoning in the US
  • Retrieved from http//research-chelation
    -therapy.com

8
HISTORY
  • Former Soviet Union gave us DMPS, a
    mercury-chelating agent and ALA, a mercury and
    arsenic chelator
  • Today DMPS remains an experimental chelator ALA
    is used as a nutritional supplement
  • EDTA approved by FDA for treating lead and heavy
    metal toxicity
  • American College for the Advancement of Medicine
    (ACAM) began claiming the restorative effects of
    EDTA in the treatment of atherosclerosis
  • 1998, Federal Trade Commission (FTC) argued
    against this misrepresentation, citing a lack of
    evidence
  • 1999, ACAM no longer advertised this claim


  • Retrieved from http//research-chelation-therapy.c
    om

9
A Note of Caution
  • NOTE Due to pharmacological property
    differences and mechanisms of action, each drug
    agent should be used as indicated by the FDA or
    off label usage noted. CIGNA HealthCare does not
    cover Chelation Therapy for the following
    indications because they are considered
    experimental, investigational or unproven!




  • Retrieved from
    www.cigna.com

10
What is chelation being used for?
  • atherosclerotic vascular diseases
  • coronary artery disease
  • reperfusion injury during coronary angioplasty
    or cardiopulmonary
  • bypass surgery
  • progressive renal insufficiency in Type II
    diabetic nephropathy
  • Alzheimers disease
  • Parkinsons disease
  • primary biliary cirrhosis
  • ankylosing spondylitis
  • autism
  • glioblastoma
  • scleroderma
  • porphyria
  • hypercholesterolemia
  • Retrieved from www.cigna.com

11
Chelating Agents the Condition they Treat
  • Coverage Policy
  • CIGNA HealthCare covers each respective Chelation
    Therapy agent as Medically necessary when it is
    used for its usage/FDA approved indication and
    associated condition as listed in the table
    below
  • DRUGS Edetate Calcium Disodium (Calcium EDTA)
    (Calcium Disodium Versenate)
  • Succimer (DMSA) (Chemet)
  • CONDITION heavy metal overload or toxicity
    (e.g., lead, arsenic, mercury, iron,
  • copper, or gold)
    confirmed by appropriate laboratory results
    (e.g.,
  • blood, plasma, and/or
    urine) or clinical findings consistent with metal
  • toxicity


  • Retrieved from www.cigna.com

12
CHELATION AND AUTISM
  • THEORY Children with autism carry a toxic heavy
    metal body burden (Bernard,
    S., Enayati, A., Redwood, L., Roger,
    H., Binstock, T., 2001).
  • RATIONALE FOR TX Chelating agents will remove
    the offending toxins from the body and
    the symptoms of autism will
    decrease.

13
What evidence are they basing this theory on?
  • Low levels of mercury found in baby hair of
    children with autism compared to controls
    (Holmes, A. S., Blaxill, M. F., Haley, B. E.,
    2003).
  • High levels of mercury in baby teeth of children
    with autism compared to controls (Adams, J. B.,
    Romdalvik, J., Sadagopa, V. M., Legator, M. S.,
    2007).
  • Higher mercury excretion after a 3-day treatment
    with DMSA in children with ASDs compared to
    controls (Bradstreet, J., Geier, D. A.,
    Kartzinel, J. J., Adams, J. B., Geier, M. R.,
    2003)

14
CONTRADICTORY EVIDENCE
  • Williams, Hersh, and Sears (2008) found that
    there were no significant differences between
    mercury levels in hair of children with autism
    and their typically developing siblings.
  • In 2007, Soden, Lowry, Garrison, and Wasserman
    found that when a 24-hr DMSA provoked excretion
    test was administered to children with autism
    there was no measurable increase in excretion of
    toxic metals.

15
VIDEO
  • Dateline MSNBC (2006) Interview with Dr. Jim
    Adams
  • http//www.youtube.com/watch?vFHkr4l12veI
  • http//www.youtube.com/watch?v4eyJb-izu6MNR1

16
4 Most Commonly Used Chelators in the Treatment
of Autism
  • DMSA (dimercaptosuccinic acid)
  • EDTA (Calcium EDTA)
  • DMPS (2, 3-dimercapto-1-propanesulfonic acid)
  • Jepson, B. (2007). Changing the course of
    autism A scientific approach for parents
    and physicians. Boulder, CO Sentient
    Publications.
  • TTFD (thiamine tetrahydrofurfuryl disulfide)
  • Lonsdale, D., Shamberger, R. J., Aduhya,
    T. (2002). Treatment of autism spectrum
    children with thiamine tetrahydrofurfuryl
    disulfide A pilot study.
    Neuroendocrinological Letters, 23, 303- 308.

17
How are they administered?
  • Orally
  • Transdermally
  • Intravenously
  • Rectally (suppositories)

Jepson, B. (2007). Changing the
course of autism A scientific approach for
parents and physicians. Boulder, CO
Sentient Publications.
18
PREPARATION FOR CHELATION THERAPY FOR AUTISM
  • Reduce exposure to toxins
  • Ex. Consuming organic foods and drinking reverse
    osmosis water, remove mercury dental fillings,
    avoid pesticide use
  • Improve levels of essential vitamins and minerals
  • Improve glutathione levels
  • Treat gut dysbiosis
  • Retrieved from www.autism.com

19
RECOMMENDED TREATMENT REGIMEN
  • According to the Treatment Options for
    Mercury/Metal Toxicity in Autism and Related
    Developmental Disabilities Consensus Paper
    (2005), chelation treatment should be
    administered as follows
  • Oral/Rectal Suppository - 3 days of Tx, followed
    by 11 days off
  • Transdermal- Tx on alternating day schedule
  • TTFD Oral, Transdermally, Rectal Suppository- no
    Tx recommendations

20
How are metals being tested?
  • Hair
  • Stools
  • Urine
  • Blood
  • Baby teeth
  • Jepson, B. (2007). Changing the course of
    autism A scientific approach for parents
    and physicians. Boulder, CO Sentient
    Publications.

21
PROVOKED URINE EXCRETION TEST
  • AKA Diagnostic Chelation Challenge
  • PROCEDURE
  • Levels of toxic metals are measured in the urine
    before the
  • dose of chelator is administered and then urine
    is collected for
  • 6-8 hours after and a sample of the accumulation
    of urine is
  • tested.
  • RISK short-term, if any.
  • RATIONALE Metals tend to hide in the body and
    these
  • hidden metals are not reflected by
    evidence- based testing methods
  • Zhiping, Y., Wu, Q., Fan, D. (2009).
    Inappropriate diagnosis and chelation
    treatment of alleged heavy-metal toxicity.
    Annals of Internal Medicine. 151, 8.

22
What an Increase in Toxic Metals in Urine tells
us after Administration of a Challenge Dose of
Chelator
  • 1. Metal was present in the body
  • 2. Chelator was able to assist in excretion of
    metals
  • Zhiping, Y., Wu, Q., Fan, D. (2009).
    Inappropriate diagnosis and chelation
    treatment of alleged heavy-metal toxicity.
    Annals of Internal Medicine. 151, 8.

23
LIMITATIONS OF PROVOKED TESTING
  • 1. No provoked excretion reference range for
    comparison.
  • 2. Collecting urine for less than 24-hrs. is
    not representative of excretion levels.
  • 3. Provocation has been shown to artificially
    increase the 24-hour average urine mercury level.
  • Zhiping, Y., Wu, Q., Fan, D. (2009).
    Inappropriate diagnosis and chelation
    treatment of alleged heavy-metal toxicity.
    Annals of Internal Medicine. 151, 8.


24
CLAIMED BENEFITS OF CHELATION TREATMENT FOR
AUTISM
  • Highly effective in
  • removing toxic metals
  • improving glutathione
  • normalizing platelets (a marker of inflammation)
  • Adams, J. B., Baral, M., Geis, E., Mitchell,
    J., Ingram, J., Hensley, A., Zappia, I.,
    Newmark, S., Gehn, E., Rubin, R. A., Mitchell,
    K., Bradstreet, J., and El-Dahr, J. (2009).
    Safety and efficacy of oral DMSA therapy for
    children with autism spectrum disorders Part
    A-Medical results. BMC Clinical Pharmacology,
    9, doi10.1186/1472-6904-9-16.
  • Possibly beneficial in
  • reducing the symptoms of autism
  • Rapid progression of language ability
  • Improved social interaction
  • Improved eye contact
  • Decreased Self-stimulatory behaviors
  • Improvement in both strength and
    coordinator
    Retrieved from
    www.autism.com

25
POTENTIAL SIDE EFFECTS OF CHELATION I
  • toxic epidermal necrolysis (TEN)
  • thrombocytopenia
  • erythema multiforme (Stevens-Johnson syndrome)
  • cardiac arythmias
  • hepatic enzyme elevation
  • hemolytic anemia
  • neutropenia
  • neuropathies
  • renal dysfunction
  • essential mineral depletion
  • potential for medical errors
  • death
  • Zhiping, Y., Wu, Q., Fan, D. (2009).
    Inappropriate diagnosis and chelation
    treatment of alleged heavy-metal toxicity.
    Annals of Internal Medicine. 151, 8.
  • Retrieved from
    www.autism.com


26
POTENTIAL SIDE EFFECTS OF CHELATION II
  • abdominal cramps
  • various dermatological symptoms
  • diarrhea
  • vomiting
  • convulsions
  • severe constipation
  • bowel paralysis
  • acute toxicity
  • allergic reactions (Freeman, 2007)
  • brain damage (Strangle, D. E., Smith, D. R.,
    Beaudin, S. A., Strawderman, M. S.,
    Levitsky, D. A., Strupp, B. J., 2007)
  • regression in language and behavior
  • clinical symptoms of mercury poisoning
  • Retrieved from www.autism.com

27
GUIDELINES FOR CHELATION THERAPY
  • For lead poisoning, candidates are individuals
    with lead levels of gt45mcg/100mL in their
    blood-only approved standard
  • Mineral and vitamin supplements should be given
    before, during, and after chelation therapy
  • Should be done under supervision of a physician
  • Kidney and liver function must be evaluated
    regularly
  • White blood cell count must be monitored
  • Adams, J. (2010). Chelation Removal of
    toxic metals. In K. Siri T. Lyons
    (Eds.), Cutting Edge Therapies for Autism
    (pp 74- 78). NY Skyhorse Publishing.





28
QUALIFICATIONS FOR CHELATION THERAPY
  • No standard excretion level
  • Dr. Neubranders office childrens urine
    excretion is categorized as in the normal,
    elevated, or highly elevated range, with those in
    the highly elevated range qualifying for
    chelation based on a provoked urine test (6-8
    hr. sample).
  • R. Neubrander, personal communication, June
    1, 2010

29
END OF TREATMENT INDICATORS
  • At least until urinary collections reveal only
    modest amounts of toxic metals
  • When improvement ceases
  • If the child shows no significant progress during
    therapy or if they experience regression
  • Retrieved from www.autism.com
  • Begin chelating with an agent that preferentially
    binds to a different metal than the one already
    chelated with
  • Adams, J. (2010). Chelation Removal of
    toxic metals. In K. Siri T. Lyons
    (Eds.), Cutting Edge Therapies for Autism
    (pp 74- 78). NY Skyhorse Publishing.

30
PROBLEMS WITH CHELATION IN CHILDREN WITH AUTISM
  • Measures of unprovoked blood and urine reflect
    only acute, ongoing exposure, and are not a
    reflection of tissue levels or total body burden
    make it difficult to assess metal toxicity in the
    body.
  • There are no set standards for determining what
    qualifies as an abnormal or dangerous level in
    the general population on provocation challenges.
  • Single provocation challenge tests can be
    misleading in determining total body burden
    because of metals tendency to compartmentalize
    in the body.
  • There are no universal standards of
    qualifications for chelation therapy or for
    treatment protocol.
  • Jepson, B. (2007). Changing the course
    of autism A scientific approach for
    parents and physicians. Boulder, CO
    Sentient Publications.

31
Where can your child get chelated locally?
  • DAN! Physicians affiliated with Autism Research
    Institute Directory
  • www.autism.com
  • New Generation Medical Doctors affiliated with
    Generation Rescue Directory
  • www.generationrescue.org

32
HOW DO YOU BECOME
  • a DAN! physician?
  • 1. Be a medical doctor
  • 2. Sign the ARI/DAN! philosophy statement
  • 3. Pay 250
  • 4. Attend a professional seminar 1x/2 years
  • Retrieved from www.autism.com
  • A New Generation Medical Doctor?
  • 1. Be an M.D. or D.O.
  • 2. Share the philosophy or Autism Research
    Institute
  • Retrieved from www.generationrescue.or
    g

33
RESEARCH
  • In a pilot study, Lonsdale et al. (2002) explored
    the
  • effects TTFD have on children with autism.
  • PARTICIPANTS 10 children diagnosed with autism
  • TREATMENT 2x/day rectal suppository containing
  • TTFD for 60 days
  • MEASURE Clinical effects-ATEC
  • FINDINGS Autistic spectrum symptoms improved in
    8/10 children
  • CONCLUSION TTFD might be valuable in the
    treatment of this devastating and
    increasingly common disease in
    children.

34
LIMITATIONS
  • Other therapies were allowed to continue
  • Group design masks individual results
  • No control group
  • Employed use of hair analysis as one of its
    measures

35
RESEARCH
  • In 2004, Dietrich et al. explored the effect DMSA
    would have on standardized tests of
    neurodevelopment at age 7 versus controls for
    children who presented with blood lead levels
    slightly below lead poisoning level.
  • DESIGN Randomized, double-blind
    placebo-controlled trial
  • PARTICIPANTS 780 647 _at_ completion
  • TREATMENT 6-13 month administration of DMSA
    daily vitamin or placebo
  • FINDINGS Blood level levels were lowered by
    DMSA Tx, but no benefit in cognitive, behavioral,
    and neuromotor endpoints

36
RESEARCH
  • A controlled study by Strangle et al. (2007 )
    looked at risks/benefits of succimer in the
  • tx of lead poisoning in rats.
  • Tx group rats exposed to neurotoxic levels of
    lead poisoning and then injected with succimer
    chelator
  • Control group rats with no lead poisoning were
    injected with succimer chelator
  • FINDINGS 1. Learning ability returned to normal
    in the Tx group
  • Matches hypothesis
    that lead in the brain impairs brain function
  • 2. Test scores went down
    in the control group- actually doing as poorly as
    the lead-poisoned rats
  • CONCLUSIONS Chelation is an effective treatment
    for lead poisoning, but with no lead to pull from
    the control rats brains, the succimer started
    attacking the brain cells themselves.
  • REPERCUSSIONS In 2008, the National Institutes
    of Health canceled a controlled trial of succimer
    treatment in children with ASD because of the
    risk of brain damage from succimer.

37
RESEARCH
  • In 2009, Dr. James Adams et al. published a
    randomized,
  • double-blind investigation of the effect oral
    DMSA therapy
  • has on children with autism.
  • 2-part study (Part A Medical Results, Part B
    Behavioral Results)
  • Phase 1 All 65 participants (3-8yrs old)
    received a round of DMSA to screen for
    excretion level.
  • Those with high urinary excretion of toxic metals
    (49/65) were randomly assigned to either a Tx or
    control group.
  • Phase 2 Tx group- 6 more rounds of DMSA therapy
  • Control group- 6 rounds of placebo

38
RESEARCH
  • Children with ASD
  • Randomized in double-blind manner
  • Topical Glutathione 7
    days Placebo Cream
  • Phase 1
  • 1 round of oral DMSA 3
    doses/day 1 round of oral DMSA
  • x 3 days
    Metal excretors
    Metal excretors
  • Phase 2
  • 6 rounds DMSA
    6 rounds of placebo
  • NOTE 4 discontinued study due to adverse side
    effects.

39
RESEARCH
  • How were they measuring effects?
  • Parental Assessments
  • Pervasive Developmental Disorder Behavior
    Inventory (PDD-BI)
  • Autism Treatment Evaluation Checklist (ATEC)
  • Severity of Autism Scale (SAS)
  • Parent Global Impressions (PGI)
  • Trained Evaluator
  • Autism Diagnostic Observation Schedule (ADOS)

40
RESEARCH
  • FINDINGS In a single round for all groups,
  • glutathione and platelet counts were
    normalized-making study more a comparison
    of 1 vs. 7 rounds of DMSA. Those in the
    7-round group continued to excrete metals
    (PART A).
  • FINDINGS The severity of autism significantly
    decreased during the study for
    both the
  • Tx and control groups
    (PART B).

41
LIMITATIONS
  • Urine collection for only 8 hours
  • Parents rated behavior change
  • Lost placebo comparison
  • Arbitrarily chosen level for qualification into
    Phase 2 above Doctors Data reference range- top
    95 for typical children not undergoing chelation
    therapy
  • Nature of group design average may not reflect
    the effect for any one participant
  • Treatment and placebo group did not differ in
    treatment effects

42
SOME POINTS OF VIEW
  • www.asatonline.org- does not endorse it, citing
    that it is not an evidence-based treatment for
    autism
  • www.autismspeaks.org- cautions parents to
    research available treatments
  • www.autismnj.org- endorses those treatments that
    are science-based and have proven effectiveness

43
American Academy of Pediatrics
  • Preliminary data from the Centers for Disease
    Control does not suggest a relationship between
    thimerosal-containing vaccines and ASD.180 Hair
    analysis is not recommended for biomonitoring,
    because false elevations may occur if the
    specimen is not carefully collected. Provocative
    chelation tests for mercury have not been
    scientifically validated and are also not
    recommended. Several chelating agents, including
    succimer, dimercaprol, d-penicillamine, and
    N-acetylcysteine, have been shown to accelerate
    mercury elimination from the body.181 However,
    there is no evidence that chelation therapy will
    improve developmental function when given to
    treat mercury toxicosis. Moreover, chelating
    agents can have significant toxicity (eg,
    hepatotoxicity) and precipitate allergic
    reaction.182 Chelation therapy is therefore not
    recommended for the purpose of improving
    neurodevelopmental function in children with
    ASD.
  • Committee on Children with Disabilities,
    2001. Technical Report The Pediatricians Role
    in the Diagnosis and Management of Autistic
    Spectrum Disorder in Children. Pediatrics, 107,
    e85.

44
Any Evidence?
  • Based on the theory that autism is a result of
    heavy metal poisoning, but there is no clear
    evidence to support this assertion
  • Diagnosis of autism is based on behavioral
    characteristics- Today still no commonly
    accepted, biological marker associated with
    autism
  • No medical test to diagnose autism
  • After chelation therapy still no biological
    marker we can use to see if there has been
    significant improvement in the childs degree of
    autism
  • Use hair analysis which is not yet accepted by
    the mainstream community for this application
  • Freeman, S. K. (2007). The complete guide
    to autism treatments A parents handbook.
    Lynden, WA SKF Books.

45
Any Evidence?
  • Is there scientific data published in
    peer-reviewed journals to suggest that chelation
    therapy is an effective treatment for autism?
  • No controlled studies with outcome data regarding
    the effectiveness of chelation in improving
    symptoms of autism
  • Claim that chelation can extract metals and
    repair possible damage to the brain has no
    supporting evidence in children with autism
  • There is much anecdotal support in the form of
    parental report.
  • Freeman, S. K. (2007). The complete guide
    to autism treatments A parents handbook.
    Lynden,WA SKF Books.

46
Future Research?
  • Strangle et al. (2007) demonstrated that it would
    be unethical to test effects of chelation on
    children in clinical studies due to the potential
    health risks associated with the drugs.

47
CONTROVERSIAL CONTROVERSIAL CONTROVERSIAL
  • What part of using chelation in the treatment for
    autism
  • is NOT experimental?
  • From the experimental testing to the
  • unproven high body burden of chelable metals to
    the unapproved treatment to the lack of clinical
    trials.
  • THERE IS NOT ONE EVIDENCE-BASED LEG TO STAND ON!
  • DO NO HARM!
  • NOT ONLY DOES IT LACK SCIENTIFICALLY SOUND
    EVIDENCE, BUT IT IS A HARMFUL AND POTENTIALLY
    FATAL EXPERIMENT TO DO ON A CHILD!

48
PSEUDOSCIENCE?
  • Promoters benefit financially or otherwise from
    adoption of the therapy.
  • Authors of the studies and those with websites
    touting parent testimonials are the same
    professionals who are directly benefitting from
    the use of chelation therapy to treat autism.
  • Catchy, emotionally appealing slogans are used in
    marketing the therapy.
  • The two largest organizations that are promoting
    biomedical interventions, including metal
    detoxification/chelation therapy have as part of
    their slogans, Autism is Reversible (Generation
    Rescue) and Autism is Treatable (Autism
    Research Institute). The word, recovery is
    often used on both website.
  • Promoters resist objective evaluation and
    scrutiny of the therapy by others.
  • Maintain that their findings are accurate
    despite other studies showing contradictory
    evidence.
  • Testimonials, anecdotes, or personal accounts are
    offered in support of claims about the therapy's
    effectiveness, but little or no objective
    evidence is provided.
  • These websites are chockful of parent
    testimonials. Much credence is put on the Autism
    Research Institutes Parent Ratings of Behavior
    Effects of Biomedical Interventions that report
    chelation therapy scores the highest (74) for
    reports of children who got better and a low 3
    of parents reporting that children got worse.
  • Retrieved from www.autism.com
  • Negative findings from scientific studies are
    ignored or dismissed.
  • Despite evidence that contradicts theory,
    continue to argue that the theory is supported by
    scientific evidence.

49
PSEUDOSCIENCE?
  • Critics and scientific investigators are often
    met with hostility, and are accused of
    persecuting the promoters, being "close-minded,"
    or having some ulterior motive for "debunking"
    the therapy.
  • Argue there is a cover-up by the CDC and Big
    Pharm to prove their theory as unsubstantiated.
  • Rapid effects are promised.
  • Claim in the studies is that children improve
    with only a few rounds- in 1 study 1 round was
    sufficient! That is a total of 3 days! Wow, that
    WAS easy!
  • The "theory" behind the therapy contradicts
    objective knowledge (and sometimes, common
    sense).
  • Autism has not been shown to be a disease that
    can be tested medically. Yes, it may comorbidly
    exist with many other medical ailments, but it
    itself is not diagnosed medically. Treating the
    disorder by medical means contradicts all that we
    know about autism and its diagnosis.
  • The therapy is said to be easy to administer,
    requiring little training or expertise.
  • There are many parents at home chelating their
    child with autism.
  • High "success" rates are claimed.
  • Many children are being cured of autism by
    chelation therapy. Almost all in the study by
    Adams et al. (2009) showed improvement after just
    1 round of DMSA according to the authors.
  • Use uncoventional ways to measure.
  • Blood test wont show these metals- do a hair
    test or provoke the toxins out

50
PSEUDOSCIENCE?
  • Professionals or other people recommend them.
  • Majority, if not all, of the people claiming
    that children with autism have a toxic metal body
    burden are the same people who are extolling the
    benefits of chelation. Who are these people?
    DOCTORS, one of the most historically trusted
    professions! If they are saying it, it has to be
    true!

51
Questions
  • ?

52
  • THANK YOU

53
REFERENCES
  • Adams, J. B., Romdalvik, J., Sadagopa, V. M., and
    Legator, M. S. (2007). Mercury, lead, and zinc
    in baby teeth of children with autism versus
    controls. Journal of Toxicology and
    Environmental Health, 70, 1046- 1051.
  • Adams, J. B., Baral, M., Geis, E., Mitchell, J.,
    Ingram, J., Hensley, A., Zappia, I., Newmark,
    S., Gehn, E., Rubin, R. A., Mitchell, K.,
    Bradstreet, J., and El- Dahr, J. (2009). Safety
    and efficacy of oral DMSA therapy for children
    with autism spectrum disorders Part A-Medical
    results. BMC Clinical Pharmacology, 9,
    doi10.1186/1472-6904-9-16.
  • Adams, J. B., Baral, M., Geis, E., Mitchell, J.,
    Ingram, J., Hensley, A., Zappia, I., Newmark,
    S., Gehn, E., Rubin, R. A., Mitchell, K.,
    Bradstreet, J., and El- Dahr, J. (2009). Safety
    and efficacy of oral DMSA therapy for children
    with autism spectrum disorders Part
    B-Behavioral results. BMC Clinical
    Pharmacology, 9, doi10.1186/1472-6904-9-17.

54
REFERENCES
  • Adams, J. (2010). Chelation Removal of toxic
    metals. In K. Siri T. Lyons (Eds.), Cutting
    edge therapies for autism (pp 74-78). NY
    Skyhorse Publishing.
  • Bernard, S., Enayati, A, Redwood, L., Roger, H.,
    Binstock, T. (2001). Autism A novel form of
    mercury poisoning. Medical Hypotheses, 56,
    462-471.
  • Bradstreet, J., Geier, D. A., Kartzinel, J. J.,
    Adams, J. B., and Geier, M. R. (2003). A
    case-control study of mercury burden in children
    with autistic spectrum disorders. Journal of
    American Physicians and Surgeons, 8, 76-79.
  • Committee on Children with Disabilities, 2001.
    Technical Report The Pediatricians Role in
    the Diagnosis and Management of Autistic Spectrum
    Disorder in Children. Pediatrics, 107, e85.
  • Coplan, J. (2010). Making sense of autistic
    spectrum disorders Creating the brightest
    future for your child with the best treatment
    options. NY Bantam Books.

55
REFERENCES
  • Dietrich, K. N., Ware, J. H., Salganik, M,
    Radcliffe, J., Rogan, W. J., Rhoads, G.
  • G., Fay, M. E., Davoli, C. T., Denckla, M. B.,
    Bornschein, R. L., Schwarz,
  • D., Dockery, D. W., Adubato, S., Jones, R. L.
    (2004). Effect of chelation therapy on the
    neuropsychological and behavioral development of
    lead- exposed children after school entry.
    Pediatrics, 114, 19-26.
  • Freeman, S. K. (2007). The complete guide to
    autism treatments A parents handbook.
    Lynden, WA SKF Books.
  • Holmes, A. S., Blaxill, M. F., and Haley, B. E.
    (2003). Reduced levels of mercury in first baby
    haircuts of autistic children. Internal Journal
    of Toxicology, 22, 277-285.
  • Jepson, B. (2007). Changing the course of
    autism A scientific approach for parents and
    physicians. Boulder, CO Sentient Publications.
  • Lonsdale, D., Shamberger, R. J., Audhya, T.
    (2002). Neuroloendocrinology Letters, 23,
    303-308.

56
REFERENCES
  • R. Neubrander, personal communication, June 1,
    2010
  • Soden, S., Lowry, J. A., Garrison, C. B.,
    Wasserman, G. S. (2007). 24- Hour provoked
    urine excretion test for heavy metals in children
    with autism and typically developing controls, a
    pilot study. Clinical Toxicology. 45, 476-483.
    doi 10.1080/15563650701338195.
  • Strangle, D. E., Smith, D. R., Beaudin, S. A.,
    Strawderman, M. S., Levitsky, D. A., Strupp,
    B. J. (2007). Succimer chelation improves
    learning, attention, and arousal regulation in
    lead-exposed rats but produces lasting cognitive
    impairment in the absence of lead exposure.
    Environmental Health Perspectives, 115, 2,
    201-209.
  • Walker, Morton. (1990). The Chelation Way. NY
    Avery Publishing Group.
  • Williams, P. G., Hersh, J. H., Allard, A.,
    Sears, L. L. (2008). A controlled study of
    mercury levels in hair samples of children with
    autism as compared to their typically developing
    siblings. Research in Autism Spectrum
    Disorders, 2, 1 170-175. doi 10.1016/j. rasd.
    2007.05.001

57
REFERENCES
  • Zhiping, Y., Wu, Q., Fan, D. (2009).
    Inappropriate diagnosis and chelation treatment
    of alleged heavy-metal toxicity. Annals of
    Internal Medicine, 151, 8.
  • http//research-chelation-therapy.com
  • www.cigna.com
  • www.autism.com
  • www.generationrescue.org
  • www.youtube.com
  • www.autismnj.org
  • www.autismspeaks.org
  • www.asatonline.org

58
RESEARCH
  • Autism A Novel Form of Mercury Poisoning
  • Bernard, et al.
  • Hypothesized that the regressive form of autism
    represents another form of mercury poisoning
    based on similarity between traits of mercury
    poisoning and autism and physiological
    abnormalities the known exposure to mercury in
    vaccines

59
RESEARCH
  • In 2007, a pilot study was conducted by that
    in
  • 24-Hour provoked urine excretion test for heavy
    metals in children with autism and typically
    developing controls, a pilot study (2007)
  • QUESTION POSED Does a proportion of children
    with autism have an excess chelatable body burden
    of arsenic, cadmium, lead, or mercury?
  • FINDINGS DMSA provoked excretion testing did
    not produce evidence of an excess chelatable body
    burden among the autistic participants in this
    study. The data presents no justification for
    chelation therapy for the participants.
  • CONCLUSIONSNO DEFINITIVE EVIDENCE TO SUPPORT
    LIKELIHOOD THAT CHILDREN WITH A. ARE AT INCREASED
    RISK OF A CHELATABLE HEAVY METAL BODY BURDEN WITH
    THE POSSIBLE EXCEPTION OF CHILDREN WITH PICA OR
    MOUTHING BEHAVIORS SECONDARY TO AUTISM

60
RESEARCH
  • Reduced Levels of Mercury in First Baby Haircuts
    of Autistic Children
  • Holmes, et al.
  • FINDINGS found children with autism had less
    mercury in their hair than age and gender-matched
    controls
  • IMPLICATIONS children with autism may have
    impaired detoxification capacity and if reduced
    overall mercury elimination is related to hair
    elimination, then autistic infants will retain
    significantly higher levels of mercury in tissue,
    including the brain, than normal infants

61
RESEARCH
  • Williams, et al.
  • -blind study
  • Found no significant differences between mercury
    levels in hair of 15 children with autism and
    those of the hair of their typically developing
    siblings
  • Question the theory that mercury toxicity causes
    autism and points to difficulty in quantifying
    chronic mercury exposure through currently
    available laboratory measures

62
  • Even if the claims that mercury causes ASD and
    that chelation helps are both true (and at
    present there is very contradictory support for
    and against these hypotheses), somewhere there
    has to be a tipping point between the risks of
    mercury exposure and the risk of brain damage
    from succimer, itself. If the childs mercury is
    not high enough, the succimer will go after the
    childs brain instead
  • Coplan

63
Disclaimer
  • I could talk for a whole semester on the theory
    behind these interventions and whether they have
    a leg to stand on and THEN whether the
    intervention proposed is effective at treating
    autism, but for the purpose of this class I will
    just inform you of the theory behind the
    rationale and then speak to the txs
    effectiveness in treating the symptoms of autism
  • Neither of these two txs are to be used in a
    vacuum- proponents of both call for multiple txs-
    making anecdotal report for these treatments in
    the autism community even less credible

64
  • A Review of
  • Hyperbaric Oxygen Therapy
  • in the Treatment of Autism

Kelly Ann LaPietra Caldwell College
65
Source Identification
  • Keywords chelation, chelation and autism,
    hyperbaric oxygen therapy, hyperbaric oxygen
    therapy and autism
  • Assigned Textbooks
  • Barnes and Noble bookstore Special Needs
    Children section
  • Pubmed Database
  • Academic Search Premier Database
  • Psychinfo Database
  • Google Scholar
  • Google Search Engine
  • Autism Resource Websites
  • References cited in articles and in books

66
OUTLINE
67
What is Hyperbaric Oxygen Therapy?
  • Hyperbaric oxygen therapy involves breathing up
    to 100 oxygen at greater than 1 atmosphere (ATA)
    in a pressurized chamber.
  • Hyperoxia- an increased level of oxygen in the
    tissues of the body (Coplan)

68
3 factors that are varied to achieve tx protocols
and clinical results for children with autism
  • 1. how much pressure is applied (1.3-1.75)
  • 2. how strong oxygen concentration is (24-100)
  • 3. how long tx session lasts (1-1.5 hrs. per
    dive)
  • Neubrander

69
History of Hyperbaric Oxygen Therapy
  • 1783 French physician Caillens- first to use
    oxygen as remedy
  • 1930-40s oxygen tolerance limits were
    established for divers- basis for oxygen
    recompression tables used today
  • Borema, Father of Modern Hyperbaric Medicine-
    late 50s removed all red cells from pigs, with
    only plasma remaining, living under hyperbaric
    conditions
  • First Hyperbaric Oxygen Therapy textbook
    published by Davis and Hunt (1977)

70
Uses for Hyperbaric Oxygen Therapy
  • Wound healing (Coplan)
  • Carbon monoxide poisoning
  • Decompression sickness (Jepson)
  • Burns
  • Gas gangrene
  • Exceptional blood loss (Lerman)

71
HBOT AND AUTISM
  • THEORY some children with autism have hypoxia,
    gut inflammation, compromised
    immune function
  • RATIONALE FOR TX providing an elevated level of
    oxygen to the tissues in a pressurized chamber
    will decrease core symptoms of autism.
  • (2002) Heuser published SPECT scan results from a
    4-yr. old with autism post-HBOT
  • Include what he found

72
What evidence are they basing this theory on?
73
  • Lerman reports such nerurological abnormalities
    have been verified and no controlled studies have
    been conducted on the behavioral outcomes of HBOT
    with this population

74
CLAIMED BENEFITS OF HBOT FOR AUTISM
  • Relieves hypoxia
  • Lowers the presence of anaerobic gut bacteria
  • Decreases inflammation
  • Improves immune function
  • Lowers oxidative stress
  • Increases glutathione levels
  • (Jepson)
  • Improves symptoms of autism (Rossignol 2006)

75
Dr. Neubranders PREDICTED OUTCOMES
  • Only mild or mild to moderate responses within
    first 40 hr set
  • Recommended to continue for several cycles- most
    powerful tx to induce language, increase
    awareness and cognition, and allow more normal
    socialization and emotional responses
  • Better with pre-tx adjunct therapies including,
    methyl-B12 shots and supplements

76
POTENTIAL SIDE EFFECTS OF HBOT
  • Increases oxidative stress which potentially can
    cause brain damage
  • Triggers cell death by a process known as
    apotosis
  • Leads to Alzheimers disease-related changes in
    the brain
  • Death
  • (Coplan)
  • Death (cite)
  • Increased oxidative stress
  • Barotruma
  • Sinus squeeze
  • Serous otitis
  • Claustrophobia
  • Reversible myopia
  • Seizures
  • Oxygen toxicity (Lerman)
  • Aspiration (Lerman)

77
Variations in Protocol
  • Pressure used (1.1-2.8 ATA)
  • 100 oxygen vs. oxygen concentrator
  • Length of session (between 60-90min.)
  • Number of sessions per day (1-2)
  • Time elapsed between sessions (2-12hrs.)
  • Number of treatment hours per treatment set
    (40-90hrs.)
  • Q. What is the right
    recipe?
  • A. No one knows right now.

78
GUIDELINES FOR HBOT
  • Requires a medical doctors prescription
  • Remember it is a drug therapy- too little may not
    be effective, but too much is toxic

79
Where can you go for a dive?
  • Many clinics
  • No hospitals- not an approved indication for HBOT
  • Dr. Neubrander, Edison, NJ- home rental
  • Can purchase via (put price)

80
RESEARCH
  • Rossignol (2007) first prospective study of HBOT
    with autism
  • The effects of hyperbaric oxygen therapy on
    oxidative stress, inflammation, and symptoms in
    children with autism An open label pilot study
  • PURPOSE
  • 1. Measure the effects of HBOT on oxidative
    stress markers
  • 2. Measure the impact of HBOT on an inflammatory
    marker
  • 3. Examine the changes in clinical symptoms, as
    rated by parents or caregivers, after tx with
    HBOT
  • 4. Evaluate the safety of HBOT, used at 1.3 and
    24 oxygen and 1.5 ATA and 100 oxygen

81
  • Rossignol (2007)
  • FINDINGS
  • Not significantly associated with increased
    intracellular oxidative stress
  • Improved inflammation
  • HBOT was safely administered to all participants
    and all finished 40 dives without any major
    adverse events

82
RESEARCH
  • Rossignol (2007)
  • LIMITATIONS
  • Clinical outcomes were based on parent-ratings
  • Parents were not blind
  • No placebo-control group
  • Small sample size

83
RESEARCH
  • Rossignol et al. 2006 67 medical hypotheses
  • PURPOSE on 6 children with autism
  • Study Design Retrospective pilot study
  • FINDINGS showed modest behavioral improvements,
    especially in the younger patients, according to
    parent assessment using various behavior scales
  • 40 1 hr. sessions _at_ 1.3 ATA and 28-30 oxygen
    over 3 mos.

84
RESEARCH
  • Rossignol et al. 2006 67 medical hypotheses
  • LIMITATIONS
  • based on parent report
  • not blind
  • no placebo group
  • allowed participants to continue with other
    treatments
  • and add new ones during the time of the study

85
RESEARCH
  • Granpeesheh, D. et al.
  • Randomized trial of hyperbaric oxygen therapy for
  • children with autism.
  • PURPOSE to test the hypothesis that HBOT would
    have a beneficial effect on ASD symptoms in the
    context of a double-blind placebo-controlled
    trial
  • INDEPENDENT VARIABLE 24 oxygen at 1.3 ATA
  • DEPENDENT VARIABLE direct observational
    measures of behaviors symptomatic of autism and
    standardized psychological assessments
  • FINDINGS there were no differences detected
    between HBOT and placebo groups across any of the
    outcomes

86
RESEARCH
  • Granpeesheh, D.
  • LIMITATIONS

87
RESEARCH
  • Lerman et al.
  • Using behavior analysis to examine the outcomes
    of unproven therapies An evaluation of
    hyperbaric oxygen therapy for children with
    autism
  • Purpose to conduct a systematic evaluation of
    HBOT with children who were attending a day
    program for children with autism
  • Design multiple-baseline across participants
  • Findings HBOT did not improve task engagement
    or decrease problem behavior beyond that provided
    by ongoing behavior analytic services. Also not
    associated with changes in spontaneous
    communication for 2/3 participants.
  • Conclusion The effects of HBOT were not worth
    the price.

88
RESEARCH
  • Lerman et al. (continued)
  • LIMITATIONS
  • Small sample size, 1 participant dropped out
    after 27 due to a non-related ear infection
  • Only tested at 88 oxygen at 1.3 ATA, 40 dives at
    60 minutes each
  • Along with HBOT, 60-minutes of access to
    preferred items was added to their day

89
RESEARCH
  • Rossignol et al.
  • First randomized controlled trial of HBOT
  • 62 children either received HBOT or placebo
    treatment
  • Authors used 3 scales- the Aberrant Behavior
    Checklist (ABC), the Autism Treatment Evaluation
    Checklist (ATEC), and the Clinical Global
    Impression (CGI) as outcome measures.
  • Found differences in favor of the HBOT group for
    one of six subscales on the ABC, 1/5 on the ATEC,
    and 3/18 on the CGI, but even those few
    beneficial results were inconsistent- while eye
    contact and receptive language were improved on
    the CGI post-tx, social awareness, social
    interaction, and speech/language were not
  • Authors completely disregard the research showing
    oxygen toxicity to the developing brain,
    asserting that it is generally regarded as safe
    on the basis of a single paper
  • TAKEN FROM COPLAN BUT WILL CITE ROSSIGNOL

90
FUTURE RESEARCH
  • More controlled research with randomized
    participants with autism
  • More controlled experimentation with magnitude
    and duration of independent variables
  • Replication, replication, replication

91
  • Even if you are convinced that the exposure to
    increased oxygen levels is effective in the
    treatment of ASD, and the risks of brain damage
    from oxygen are exaggerated, you may be surprised
    to learn that breathing oxygen from a mask can
    achieve the same increase in brain oxygen levels
    as going into a tank at a fraction of the cost-
    smells like quackery
  • Coplan

92
Questions
  • ?

93
  • THANK YOU

94
REFERENCES
  • Jepson, B. (2007). Changing the course of
    autism A scientific approach for parents and
    physicians. Boulder, CO Sentient
    Publications.
  • Coplan, J. (2010). Making sense of autistic
    spectrum disorders Creating the brightest
    future for your child with the best treatment
    options. NY Bantam Books.
  • Freeman, S. K. (2007). The complete guide to
    autism treatments A parents handbook.
    Lynden, WA SKF Books.

95
REFERENCES
  • Siri, K., and Lyons, T. (2010). Cutting-edge
    therapies for autism 2010-2011. NY Skyhorse
    Publishing.
  • Rossignol, D. A., Rossignol, L. W., Smith, S.,
    Schneider, C., Logerquist, S., Usman, A.,
    Neubrander, J. Madren, E. M., Hintz, G.,
    Grushkin, B., Mumper, E. A. (2009).
    Hyperbaric treatment for children with autism A
    multicenter, randomized, double- blind,
    controlled trial. BMC Pediatrics. 921 doi
    10.1186/1471-2431-9-21

96
REFERENCES
97
REFERENCES
  • Strangle, D. E., Smith, D. R., Beaudin, S. A.,
    Strawderman, M. S., Levitsky, D. A., Strupp,
    B. J. (2007). Succimer chelation improves
    learning, attention, and arousal regulation in
    lead- exposed rats but produces lasting
    cognitive impairment in the absence of lead
    exposure. Environmental Health Perspectives,
    115, 2, 201- 209.
  • Williams, P. G., Hersh, J. H., Allard, A.,
    Sears, L. L. (2008). A controlled study of
    mercury levels in hair samples of children with
    autism as compared to their typically developing
    siblings. Research in Autism Spectrum
    Disorders, 2, 1 170-175. doi 10.1016/j. rasd.
    2007.05.001

98
REFERENCES
99
  • Even if your child has proven metal toxicity,
    chelation is just one of the ones to address the
    problem (list ways- change diet, environment, add
    supplements, etc.)- many things you can do before
    you do that

100
Approved Indications
  • DRUG Edetate Calcium Disodium (Calcium EDTA)
    (Calcium Disodium Versenate)
  • USAGE/APPROVED FDA INDICATION
  • Edetate calcium disodium is indicated for the
    reduction of
  • blood levels and depot stores of lead in lead
    poisoning (acute
  • and chronic) and lead encephalopathy, in both
    pediatric
  • populations and adults. Chelation therapy should
    not replace
  • effective measures to eliminate or reduce further
    exposure to
  • lead.

  • www.cigna.com

101
Approved Indications
  • DRUG Succimer (DMSA) (Chemet)
  • USAGE/APPROVED FDA INDICATION
  • Lead poisoning in pediatric patients with blood
  • lead levels above 45 mcg/dL

  • www.cigna.com
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