HOLLI W. HAYNIE

Pediatric neurologists at Le Bonheur Children’s Medical Center follow about 200 children in a tri-state area evaluated for epilepsy and autism. Pediatric neurologist and epileptologist, Fred Perkins, MD, looks for the physiological differences between children with autism and those who are normally developed, as well as the variable differences across the spectrum.

“I always universally recommend an imaging study,” Perkins said. “(Children) all need to get an MRI scan at least once in their life if they haven’t.”

Perkins’ approach may be a bit different than colleagues in developmental pediatrics, he said, in that while he agrees autism is a developmental problem, he believes at its root it is fundamentally a neurological disorder. He contends that understanding how an autistic brain works could help better define treatments.

“If you take your car to a mechanic and he drives your car around the block and tells you, ‘I agree your car is hesitating in some way, here, put this additive in the tank,’ and never cracks open the hood, would you feel your mechanic is doing a (thorough) job?” he posited.

While most imaging appears to be grossly normal, Perkins said, occasionally he finds a child who has cortical dysplaysia or some other type of developmental anomaly.

“It’s important to characterize those kids out because we’re using really broad paint strokes to characterize what autism is,” he said. “Autism is no more an enigma than leukemia was 45 years ago.”

In fact, he suggested that autism may have multiple disorder syndromes in the way that epilepsy has dozens of various syndromes.

“I have lots of kids with physiological studies that show marked differences in them compared with the general population and that tells me this is a brain disorder,” maintained Perkins. “The brain isn’t wired “normally.”

While you can’t necessarily rewire the brain in a normal way, he said, you can teach kids to work with and strengthen the wiring they have.

“I can’t cure autism any more than I can cure left handedness,” Perkins added. “It’s a matter of getting these kids to function at a level that is age and developmentally appropriate.”

Perkins has the ability to offer families medications as well, but doesn’t universally recommend them for autism patients. The only FDA approved drug for the symptoms of autism is Risperdal, an atypical anti-psychotic. Perkins said he only uses it in very special circumstances because it tends to zone kids out and make them gain weight. In some cases he uses antidepressants.

Perkins also recommends genetic, chromosomal and neuropsychological testing for a finer level of detail.

“I think all those things become important to paint a physical as well as a functional and physiological picture of this person and then make a determination about what is the best way to treat them,” he said. “If I were a pediatrician, I’d be pulling all the levers.”

Le Bonheur has a unique capability to contribute research on autism thanks to the installation of the MEG (magnetoencephalography) lab last fall, which Memphis Medical News featured in our April issue. Le Bonheur is one of only three sites in the U.S. with a MEG lab, which attracted Perkins to Memphis. The MEG is a non-invasive imaging technique that measures the magnetic fields produced by intracranial electrical currents, allowing scientists to essentially “map” the various functions in the brain. It’s primarily used in children with neurological conditions like epilepsy and brain tumors. There is growing usage of the MEG with developmental disorders such as autism, ADHD and dyslexia, because it can detail changes in the brain that happen when performing cognitive tasks, a function that is still not well understood.

Children and young adults with autism have abnormal brain activation patterns when they read, explained Perkins, which were bilaterally distributed rather than unilaterally. Bilateral distribution is much less efficient and represents poor organization. Using the MEG, clinicians can do language mapping, epileptic form activity mapping, motor mapping and more; then compare the information to that of normal children.

“Then we’ll have the ability to see if the therapies we use (create a) physiological change,” maintained Perkins.

Many barriers exist in dealing with autism, from having too few behavioral therapists to meet the need, to children going undiagnosed because signs weren’t recognized by parents or brought up to medical professionals. In order to create the unified continuum of care needed for autistic children to thrive, Perkins said, “it has to be a multidisciplinary approach. You need a neurologist in the equation, a psychologist, therapists are critical, and at the end of the day, you need a really good pediatrician who acts as captain of the boat and helps to oversee.”



August 2008