Fever Plus Mitochondrial Disease Could Be Risk Factor for Autistic Regression

Fever Plus Mitochondrial Disease Could Be Risk Factor for Autistic Regression

Children diagnosed on the Autistic Spectrum present with a wide variety of genetic and environmental issues. Subgroups of these individuals have mitochondrial dysfunction. Very recent research was done to examine mitochondrial dysfunction and its association with autistic regression following  a fever. In this research the investigators identified 28 patients who met diagnostic criteria for autistic spectrum disorders and mitochondrial disease. Autistic regression occurred in 60.7% (17 of 28), a statistically significant increase over the general autistic spectrum disorder population. Of the 17 individuals with autistic regression, 70.6% (12 of 17) regressed with fever and 29.4% (5 of 17) regressed without identifiable linkage to fever or vaccinations.

These researchers also noted that none of the subjects showed regression with vaccination unless a febrile response was present. The researchers concluded that although the study is small, a subgroup of patients with mitochondrial disease may be at risk of autistic regression with fever. In addition, although recommended vaccinations schedules are appropriate in mitochondrial dysfunction, fever management appears important for decreasing regression risk.

This research is very interesting work and seems to have developed from the awareness surrounding the Hanna Poling case in 2008. Not surprisingly, the results of the research is  consistent with what parents have been telling us for years now, that their child was normal until they received their immunizations, developed a fever and regressed into autism. What it appears to say to me is that in this subgroup of children who received their immunizations and soon thereafter regressed, there may have been two factors at work. First, an underlying mitochondrial disorder and second an accompanying fever, which is not uncommon following viral infections and live virus vaccines such as the MMR.

There are many reasons why a child runs a fever. Normal body temperature is 98.6 F and may be slightly elevated after exercise, excessive clothing, a hot bath or hot weather. An infant’s temperature may rise after feeding for a half hour or more. Most childhood fevers in the range of 99F- 103F are not harmful and are often due to a virus.  In general, the increase in body temperature increases the body’s immune system function by increasing the release and activity of white blood cells, interferon and other substances. Therefore it is important NOT to prevent the body from this important infection fighting process.

However, in these children with mitochondrial dysfunction and ASD, fever may be just the thing that halts them into regression. What does this mean for the future? We know from earlier research that a common fever reducer that is often used in pediatric offices during vaccination administration, acetaminophen (Tylenol),  can decrease glutathione levels for nearly 1 month after single dose and is also associated with regressive autism. We also know how important glutathione is in the treatment of children with ASD who commonly measure low levels.

This research should bring about more interesting connections between fever, fever reducers, and autism in the near future. It should be noted that this is only in a subset of children with ASD and mitochondrial disease.

In our office, we currently use routine blood work to help identify those most at risk for mitochondrial dysfunction and associated regressive autism following fever. Certain markers within the blood help us identify if the mitochondria are functioning properly. Couple this with several therapies we know to be effective, and hopefully we can catch it early and prevent this tragedy in the future.

So what can you do to with this information, well first the obvious is caution when vaccinating. For example if your child has been sick 2 weeks prior to vaccinations it is a good idea to delay that vaccination as the body is already “primed” for a quick immune response. Also avoid getting multiple shots in one visit, which are also associated with an increase in fever. Most children in our office get one or maybe two vaccines, and we have yet to have a report of post vaccination fever.

Second, avoid the liberal use of acetaminophen. We prefer to use Children’s Motrin when medication is needed, but better is the use of elderberry leaf and berry extract. Elderberry stimulates the immune system to fight the infection which naturally brings down the fever as the body “conquers” the virus or bacteria. Give our office a call to learn more about elderberry extract.

References

Shoffner, J  et. Al J Child Neurol OnlineFirst, published on September 22, 2009 as doi:10.1177/0883073809342128