senco-forum Prednisone in experimental treatment of Autism...? (long)

Here's a interesting cross-post from another highly regarded support list I
subscribe to.  What I find interesting is not just the experimental use of
this particular medication, but in particular the insights it gives into
what mechanism might cause autism and other disorders (in the last few
paragraphs of this post).  I hope others on this list find it as interesting
as I did - sorry it's so long.

DAVID BOWLES
Education Support

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June 1, 2000

A Look at Prednisone in Treating Autism

      [This information comes directly from the Ahead With Autism website.
It is not intended as medical advice, rather it is for the reader's
information.  This reproduction does not mean that this therapy is endorsed
nor has been evaluated by FEAT.]
http://aheadwithautism.com/pred01.html

      To date, prednisone appears to be one of the only medications that has
a high rate of success in treating the underlying cause of speech loss or
lack of speech in autism.
      IMPORTANT: Prednisone is a very strong medication, and MUST be
administered under a physician's prescription and close surveillance.
Treatment should start with several tests to provide a baseline from which
to measure the results. Treatment with prednisone is not a stand-alone
intervention for autism. Parents MUST also pursue appropriate interventions
such as behavioral therapy, speech and occupational therapy where needed,
and should not rule out dietary interventions. Other medications may be
called for as well (e.g., Prozac, Clonidine), though the neurologist may
wait to use other medications until treatment with prednisone is finished,
or may recommend continuing with medications already in use.
      Prednisone is not a new drug; has been used for almost 50 years for a
variety of diseases. Its side effects are very well understood. However, its
use for treating autism is still in the early stages.
      Note: the use of prednisone in autism is still experimental, and has
not      been clinically studied in a scientific manner. No "random
placebo-controlled crossover" studies have been carried out, nor have there
been any long term follow-up studies of children who have received
prednisone for autism. To date, its effectiveness and safety are known only
through only anecdotal evidence from parents and doctors, based  on
individual accounts or small sample sizes. There is no way at this time to
predict whether prednisone could be helpful or harmful for any given child.
What does prednisone do for autism?
      The primary effect is to "unlock" the speech and language capacity in
autistic children, both regressive (those who previously had some speech and
then lost it), as well as those who never developed speech.
      So far, it has been hard to quantify whether prednisone (by itself)
materially improves behavior or social skills; however:
      Speech & language development is THE MOST IMPORTANT KEY to improving
behavior and socialization and helping the child "get to normal". For this
reason, it is important that you consider prednisone treatment as part of an
overall treatment program.
      In children with Landau-Kleffner Syndrome (LKS) or variants, which are
marked by an abnormal EEG and sometimes by seizures, prednisone helps
normalize the EEGs and reduce seizures, as well as improving speech /
language functioning. However, it is not known how these effects are
related.
      What exactly is prednisone? What else is it used for? A brief history
of prednisone and how it came to be used for autism
      Prednisone is a steroid; NOT the anabolic steroid that bodybuilders
use, but rather a "corticosteroid", like the hydrocortisone used to treat
inflammation, or to treat autoimmune disorders such as rheumatoid arthritis
and asthma. Prednisone is the generic name; some common brand names are
Prelone, Deltasone, Meticorten, Orasone, Prednisolone and SK-Prednisone.
      Prednisone was developed in 1955 as a man-made replica of cortisone, a
hormone produced by the outer portion (or cortex) of the adrenal glands,
located on top of the kidneys. Cortisone and related hormones help regulate
the blood pressure, salt and water balance, and controls inflammation. It
may also be important for normal brain development. The adrenal glands
normally produce about 25mg of cortisone a day, which is equivalent to about
5mg of prednisone a day.
      When prescribed in higher doses, prednisone suppresses inflammation as
well as the body's immune system, and can help treat a variety of diseases
such as severe allergies or skin problems, asthma, arthritis, ulcerative
colitis, and multiple sclerosis. Prednisone is also used to help prevent
rejection of organ transplants.
      The original uses of steroids (dating back to 1948) were to treat
immune-system diseases such as rheumatoid arthritis and polio. Over time, it
became clear that it could treat many other conditions as well, and could
suppress the immune system in the case of organ transplants.
      Prednisone was used to treat certain childhood epilepsies in the
1970s, as it helped to reduce seizure frequency and normalize epileptic
EEGs. In the 1980s, it began to be used for treatment of seizures and
abnormal EEGs in LKS, infantile spasms, Lenex-Gastault syndrome (multiple
seizures coupled with global delays) and related conditions, where its
effects on speech recovery were noted. In the 1990s, some neurologists began
using it to treat autism & Autistic Spectrum Disorders even when no seizures
or EEG abnormalities were noted, first only the regressive form and later
the "delayed from birth" form.
      The moral here is, although its use in autism is new, prednisone has a
long history behind it.
How does it work for autism?
      No-one knows the exact mechanisms of action for prednisone or other
steroids in autism, LKS or epilepsy, or even in diseases such as multiple
sclerosis. As stated, it helps reduce seizures and normalize EEGs in LKS,
but it is not clear how that is related to its effect on speech and language
functioning.
      In fact, no-one knows what causes autism, so it is far from clear how
any medication treats it.
      A leading theory is that autism is the result of an autoimmune
reaction (i.e., the body's own immune system attacking itself), similar to
disorders such as diabetes and multiple sclerosis. More information can be
found on the Autism Autoimmunity Project website. The theory goes something
like this: the body's immune system reacts to an outside "insult", such as a
disease, a vaccine or a toxin, but it is triggered into an abnormal response
and starts to attack parts of the brain as well. Studies on diseases such as
multiple sclerosis and dyslexia are beginning to suggest that the autoimmune
attacks on myelin (the sheath surrounding nerve fibers) may be a key to the
disorder.
         Some possible mechanisms are:
         Reduction of myelin inflammation
         Restoration and stabilization of cell membranes, including myelin
         Improvement of neuro-hormonal pathways
         Creation of new synapses
         Multiple effects at the cellular level

      [For more information, visit the website:
http://aheadwithautism.com/pred04.html ]
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