A Fireside Chat with Dr. Goh: Part 4 of 5

Next in our fireside chat series, Dr. Goh answers questions about inflammation and autoimmunity and how it relates to autism and other neurodevelopmental conditions.

Transcript from the Video:

Welcome to our fourth fireside chat. Thank you again for taking the time to send in your questions. When I think about how much has changed in the past month, I’m grateful that one thing which has grown tremendously is our medical and scientific knowledge about COVID-19. We know much more now than we did back in early March. We know the importance of physical distancing. The value of facial coverings, we know how long the virus can live on touched surfaces. We know that asymptomatic people can spread the virus. We know the importance of rapid diagnosis and contact tracing, and so much more. That knowledge empowers us to re-engage in ways that are good for us and our economy, but keep the risk of infection low. For me, one of the most important things that we know now is that this is the beginning of a different way of life for us. We’re going to be thinking about COVID-19 in our daily lives – both personal and professional – and constantly be thinking about how to keep our communities safe while also trying to re-engage and support our economy. I like to think of it as the beginning of a very gradual and staged return to re-engagement. So, I’m feeling hopeful, and I want to share that hope with you.

One more thing I want to say before I begin to answer some of the questions that you sent to me: this pandemic has affected each of us and each of our families and communities deeply and in different ways. If you are having a hard time, if you’re feeling a lot of stress, if you’ve had thoughts that you don’t know how you’ll manage – whatever the reason might be, maybe it’s because you have to work from home, and take care of your whole family – whatever the reason, please call us. I know that there is someone on our team – a physician, a therapist, a counselor, maybe even an administrator – someone who will be able to help you in a meaningful way. That’s our purpose. That's why we're here. And I believe that asking for help and letting others help is a brave thing to do, whether it’s for yourself, your child, or your whole family. There is someone at Cortica who can help – I feel confident in that – and we are grateful for the opportunity to do so. That’s why we’re here. At a time when we’re recognizing even more how much we value jobs and employment, our roles, it’s a kind and generous act to allow others to do their jobs, especially if it helps serve you in some way.

Questions about Inflammation and Autoimmunity

This is a very big topic and a very important one, so I’ll focus today on answering those questions and try to provide you with a foundation for understanding how the immune system can influence brain function and development and what that means for the steps we take in testing and treatment.

One parent asked me: "What is your opinion on autism and autoimmune disease? For example, with a high prevalence of folate receptor autoantibodies within the autism population, should we expect broader blood panels in the future to detect autoimmunity and metabolic abnormalities that will give us direction for treatment?"

This is such a good question. Research has come a long way in recent years on this really important topic. The first thing to recognize is that the immune system is a highly complex system with many different components – including different tissues in the body, different cell types, and different proteins. It’s also important to recognize that the immune system interacts closely with every other system of the body, especially the nervous system. We know without a doubt that the immune system has a very strong influence on brain development and brain function. There are many different ways that the function of the immune system can be disrupted. A well-balanced, well-functioning immune system is one that is effective in identifying and clearing infections, and at the same time is not overactive and is not generating excessive inflammation or autoimmune responses against the body itself.

There are several things that we know from research studies of autism and the immune system. We know that immune disturbances in the fetal period can increase the risk of developing autism, that some individuals with autism have immune deficiencies and can be more prone to infections, that some individuals with autism can be predisposed to heightened inflammatory, allergic, or autoimmune responses. We also know that autoimmune conditions tend to be more common in family members of those with autism.

For all these reasons, a medical evaluation for a child with autism should include a thorough evaluation of the immune system by taking a detailed history of symptoms and conducting appropriate laboratory tests. At the current time, we do have many tests available on a clinical basis, and that includes testing for folate receptor auto-antibodies as well as other types of auto-antibodies. Broader blood panels for both autoimmune and metabolic testing are available on a research basis, and increasingly available for routine clinical testing. I do think there is great promise in these tests and that they are already giving us important directions for treatment.

Another parent asked: "Are you familiar with and have you treated patients using the specific protocol developed by the organization called SCIA, which is meant to target microglial activation?"

Microglial activation is a term that refers to an inflammatory response that can occur in the brain when the microglial cells – which are immune cells in the brain – become activated. Microglial activation is seen in many different brain disorders and a lot of research is currently being conducted to better understand why and how it happens and whether treatments aimed at this specific process can help change the course of a wide variety of different brain conditions. I am familiar with the specific protocol this parent has asked about and many of the nutritional supplements and medications used in that protocol are ones that we use in Cortica’s neurological and functional medicine treatment program.

Along the topic of immune-modulating approaches for autism, another parent asked: "Do you offer low dose immunotherapy or have any thoughts about this for co-morbidities in autism? Any side effects?"

Over the years, I’ve seen many different treatment protocols used for autism. Low dose immunotherapy and the microglial activation protocol these parents asked about are two examples of such treatment protocols that have been developed by practitioners in the field. These two are intended specifically to try to modulate the immune system. I’m grateful to practitioners in the field who are using their expertise to try to advance therapies for brain development. I believe that when considering any protocol, it’s important to look at all the elements of the protocol and consider what potential benefits and potential risks there could be for a specific individual, given their unique biological make-up. The components of a specific protocol will impact different people in different ways. And sometimes protocols don’t allow the use of other treatments for a period of time – so we also have to think about what the risks might be of not offering those treatments.

It’s always been important to me to thoroughly understand every treatment protocol for brain development and to be open minded in considering all the potential risks and benefits it might provide for a particular individual under my care. If you’d like to discuss this treatment protocol or any others with me or any of the medical providers on our team, please reach out to schedule a visit with us. Our medical team also believes it is very important to refer to other qualified practitioners if we feel a specific treatment protocol could be beneficial, but it's not within our expertise necessarily to provide it. We do this frequently, and would be happy to talk more with you about it.

The main message I’d like to leave you with is that we’ve seen so many different protocols for autism treatment come and go over the years. The biggest goal of my professional work has been to bring what I’ve felt are the most important elements of treatment for neurodevelopment into the clinical program at Cortica. I’m always open to learning more and any time I receive a new question or a new treatment idea, I explore it fully and feel it’s my responsibility to learn as much as I can about it. What I value tremendously in my relationship with each of you and your child is the mutual learning that takes place and that attitude is one that I think and hope you’ll encounter with every clinician that you meet at Cortica.

Thanks again for listening in to this fireside chat. When we meet next, I’ll answer some of your questions about treatments for obsessive-compulsive symptoms, sound hypersensitivities, elopement, certain therapies like cranial electrotherapy stimulation, and specific medications. I’ll also answer the question one parent asked, which is: "what do you think is the most promising therapy for autism that all parents should know?" So I hope you’ll listen again. In the meantime, stay well and know that our team at Cortica is just a phone call away. Please let us know if there’s anything we can do to make this a better time for you and your family.