Sunday, 4 March 2012

Antibiotics and autism: friend or foe?

Ear @ Paul Whiteley
An interesting headline caught my eye recently: 'Scientists shocked to find antibiotics alleviate symptoms of schizophrenia'. I'm cautiously intrigued. Intrigued enough to post this entry on antibiotics in relation to autism spectrum conditions with some potential overlap with the 'shocking' headline.

Bacteria is something which has cropped up quite a bit on this blog and its derivative. Most of the more intriguing posts have concerned the trillion or so bacteria residing in our deepest, darkest bowels alongside various suggestions on how such bacteria might (a) have quite a close connection to our health and wellbeing or (b) how different types of bacteria might be more prevalent in certain groups.

In amongst some of the discussions, some mention of the use of antibiotics (antimicrobials if you wish) has also been made. With autism spectrum conditions particularly in mind, the surprising effects from certain types of antibiotic use has been noted. I refer for example, to this study by Sandler and colleagues* which suggested that administration of quite a powerful antibiotic, the glycopeptide antibiotic vancomycin, seemed to tie in with some short-term improvements in various facets of behaviour seen in autism. The authors speculated on a gut flora-brain connection which, in light of subsequent findings, might eventually turn out to have been quite a good forecast.

Backing up slightly I perhaps should mention a few things. As any good Doctor / Pharmacist will tell you, the term 'antibiotics' is a bit of a catch-all for a large group of medications targeting various, different kinds of bacteria. So as one might imagine, treating cellulitis thought to be due to staphylococcal infection will involve a different antibiotic compared with cellulitis caused by streptococcal infection. Not all bacteria are created equal; the trick is to link bacteria to antibiotic. I should also point out that generally speaking, antibiotics tend not to be very selective in the bacteria they target; thinking shock-and-awe rather than precision bombing when it comes to bacterial destruction of like-minded species. That and the fact like many of our medications, there may be more effects than those merely detailed on the patient information leaflet.

An interesting study has surfaced suggesting that antibiotic administration, a certain type of antibiotic called D-cycloserine (not chirality again), might have some interesting effects on some behaviours linked to autism. The study by Deutsch and colleagues** carried out on BALB/c mice who might share some characteristics relevant to autism, suggested that the social behaviours of young mice were "attenuated" following D-cycloserine administration. In effect, mice were observed to become more social. The authors suggested that the effects were more central, in that cycloserine is known to act on the NMDA receptor.

Not for the first time has D-cycloserine turned up in autism research circles. On that occasion suggesting that administration to people with autism, not mice, again targeted one of the core symptoms of autism, the sociability side of things. Indeed looking around the research landscape, D-cycloserine seems to have developed a bit of a following for quite a few, behaviourally-related conditions including OCD and schizophrenia albeit not universally so and not necessarily with sociability in mind. Not bad for a drug more commonly used to treat TB.

A possible role for other antibiotics in cases of autism litter the research landscape. Paribello and colleagues*** discussed the possible usefulness of minocycline - the same antibiotic listed in the headline at the start of this post - and Fragile X syndrome; something which has cropped up again fairly recently. I note that minocycline is one of the drugs of choice for spirochaete infections potentially taking us back to some 'speculations' on Lyme disease (if we were to stick to its normal action). Indeed there is further speculation about this Lyme connection in this article by Kuhn and colleagues**** recently published.

Several interesting studies indeed, but antibiotics are potentially a bit of a double-edged sword with regards to autism. I say this because of the various suggestions linking a medical history of antibiotic use to autism particularly where ear infections (otitis media) seem to be frequent. I know, I know, correlation/association does not imply causation and all that; nevertheless, I tread very carefully with the reports detailing a possible connection (and their retort).

We are all told that we should be cutting back on our antibiotic use as bacteria become more and more resistant to them. The scariest scenario is that of conditions such as tuberculosis (TB) becoming totally resistant to our antibacterial defences leaving us with lots of potential problems. With this in mind, the long-term use of specific antibiotics for some cases of autism is probably not going to be a strategy that most people would desire or want. That, and the potential longer term side-effects of antibiotic administration which might compound existing peripheral issues noted in cases of autism, means that other intervention strategies need to be identified.

Not being a bacteriologist or anything related I can't speculate much further aside from asking about two related issues: (1) how about competition rather than eradication? and (2) set yuck factor to 10 but what about the growing interest in bacterial transplantation as a potential area of investigation?

To finish, paying homage to the spooky appearance of fireballs in the sky over England and Mars being so close, Jeff Wayne and Eve of the War. You might not be alone... (although Martian invaders are probably not about to take over Earth just yet).

* Sandler R. et al. Short-term benefit from oral vancomycin treatment of regressive-onset autism. Journal of Child Neurology. 2000; 15: 429-435.

** Deutsch SI. et al. d-cycloserine improves sociability and spontaneous stereotypic behaviors in 4-week old mice. Brain Research. 2011

*** Paribello C. et al. Open-label add-on treatment trial of minocycline in fragile X syndrome. BMC Neurology. 2010; 10: 91.

**** Kuhn M. et al. Long term antibiotic therapy may be an effective treatment for children co-morbid with Lyme disease and Autism Spectrum Disorder. Medical Hypotheses. February 2012.

8 comments:

  1. Interesting article, I'm one of the peeps with ASD who had a lot of ear infections treated with antibiotics. However I have bad reactions to a couple of them so would not want to be recommended antibiotics as a 'treatment'!

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  2. Many thanks for the comment catastrapie.

    Antibiotics are very potent medications not to be administered lightly. These studies looking at antibiotics as an intervention perhaps more importantly highlight potential 'mechanisms' pertinent to symptoms associated with autism above any 'treatment' significance.

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  3. Have you ever heard of PANDAS or PITANDS? They are autoimmune disease triggered by strep or infections that affect the brain and cause psychiatric symptoms, OCD, repetitive behaviors, sensory issues, violent behavior, and some kids also get hallucinations. My son with autism has this, as does my other boy without autism. As more and more of the brain is infected, you will start to see more symptoms mimicking other psychiatric diagnosis. The oldest has had PANDAS since age 1 and is now 8, which is probably why he has such a broader range of symptoms, compared to his younger brother of 4, who has only had it maybe a year or two.
    Antibiotics reduce the inflammation in the area of the brain being attacked, and stop the symptoms, if done at the right dosage. Doctors who treat PANDAS and autism are finding out more and more that many individuals who are ASD or PANDAS often have lots of underlying inflammation and also latent infections (Lyme is very common with ASD, mycoplasma and many of the 10 herpes viruses also are, and my son's immunologist also mentioned he's had kiddos suffering from parvovirus as well. My autistic boy also had Epstein Barr Virus, but now those titers are back to normal.). The brain has it's own immune system, and when that is crossed by lymphocytes, bacteria or other things, behaviors and functioning can go completely haywire.
    This is why antibiotics can work for autism and other mental illnesses. They lower the inflammation. The problem is that they often have to be used long term, and relapse can happen.
    On regular cephalexin, my son's PANDAS and ASD went into remission. He was like a normal boy. What sucked was that he started getting swollen joints so we had to take him off of it and put him on Zithromax, which isn't working as well.
    Also, researchers at John Hopkins University linked ASD to microglial activation in the brain, and found the immune system is playing a major role.
    I am also a firm believer in lowering inflammation through diet and lots of probiotics to offset the bad effects of antibiotics.

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  4. Many thanks for the comment rmagliozzi.

    PANDAS has been a topic of conversation on this blog previously and I would agree with many of your sentiments about it with regards to overlap with autistic symptoms.

    Inflammation... well, evidence is accumulating on a role for inflammation with regards to lots of things around autism.

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  5. I am very, very intrigued; both in this article, and the response by rmagliozzi. How did you discover your son's "titers?" What doctor was willing to test for this? Many doctors discount these ideas of autism as a "treatable" entity altogether, choosing rather to see it as an incurable birth defect.
    Have either of you heard of the book "Saving Sammy" by Beth Maloney? Her son had PANDAS and was cured by an antibiotic called "Augmentin." I have not since heard any mention of this particular antibiotic.

    I'm a few months late to the discussion, but hope it's still relevant as I have a son with high-functioning ASD and have a lot of questions about antibiotics, and exactly how much probiotic is used when someone says their child takes "a lot."

    thanks!

    -karen

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  6. I am a father of a young son who has been diagnosed with autism. The medical community in Canada does not recognize autism along with any of its potential subsets as being caused by a biologically environmental condition. It only recognizes it as a behavioural condition and treats it as such. I am open minded to the possibility that my son falls into a subset whereby his autistic tendencies are related to some kind of infection that came about either In utero or otherwise. Early on as a baby my son had skin rashes that his mother was treating with a light topical steroid. I often wondered if the rashes were caused by some infection. At five years of age, most of the rashes are gone but he still has it around his mouth. I have since read about cycloserine and am just starting to give him 10mg daily doses. I am not sure how he will react to it but if he does improve i.e. he is less OCD and hyperactive I could be convinced that this anti-biotic is targeting something that his normal immune system is not. I know the medical community has a reputation for being closed minded. Take for instance Helicobacter pylor bacteria, it took a maverick doctor in 1982 to prove to the medical community that bacteria can cause ulcers. He faced a lot of resistance to this theory but in the end he proved right. I wonder if one day a subset of autism will be identified as being caused by a certain pathogen. It would open the doors to the medical community in screening for such things and maybe prevent a few children from living a debilitating life. I should also mention that genetic related mental conditions more often than not show for dysmorphic feature traits. Children like my son who appear perfectly normal will be grouped together with children that might have a genetic condition and who are also categorized as being autistic. It is important for the medical community to categorize Autism into its subsets otherwise it is prone to being abused. A one size fits all approach helps no one.

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  7. Many thanks for the comment Skepticon.

    The idea that autism is more likely autisms (plural) is gaining some support:

    http://questioning-answers.blogspot.co.uk/2012/10/more-autism-developmental-trajectory.html

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  8. i am a mom of 2 year son who has been diagnosed with autism very recently..by looking at this page..i felt a ray of hope..cuz here in republic of maldives we dont have such technology apart from that we have so many autism children who's parents praying for atreatment..i fond about b12 vitamins are also given to these children. i wish i could treat my son..it's heartbreaking to see him when going to school with other normal kids and my boy remains silently at a corner..here they believe there are no medical treatments for autism only that therapy thing and speech therapy...but i had this belief that someday soon we will cure our little kids with autism...this is all i have to say and i hope i will be answered with very positively..thank you..rumsha

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