Autism and Asperger’s disorder (a better prognostic variety) that used to be classified under pervasive developmental disorders (PDD) in DSM-IV (1) are currently grouped under autistic spectrum disorders (ASD) in DSM-5 (2). These disorders were not recognized in the first and second editions of DSM in 1952 (3) and 1968 (4) and the closest term to them was “schizophrenic reaction of childhood type”! DSM-III in 1980 (5) introduced the PDD and classified them to childhood onset PDD, infantile autism, and atypical autism. In 1987, DSM-III-R (6) classified these disorders into PDD-NOS (not otherwise specified) and autistic disorder. In 1994, DSM-IV (7) classified these disorders into PDD-NOS, autistic disorder, Asperger disorder, childhood disintegrative disorder and Rett syndrome, that did not change in DSM-IV-TR in 2000. (8) The new DSM 5 published in may of 2014, with the explanation that all these disorders are along a spectrum and labeled them under the new term “Autistic Spectrum Disorders”.
Regardless of the terminology, ASD like schizophrenia are neurodevelopmental disorders and that is why in the past was classified under childhood psychoses or schizophrenic reaction of childhood. (9-13) These neurodevelopmental disorders, while share some common features in underlying pathogenesis and clinical manifestations, they have their own specific differences at both pathophysiologic and phenomenological levels. These disorders etiopathologically share an early insult to the developing brain, e.g. the prenatal maternal infections that trigger maternal and fetal immune reactions, damaging the fetal neurodevelopment. Although the insult such as infection could be non-specific, the severity, acuteness, latency of the invasion and the time window of neurodevelopment, determines which disorder to be manifested. (14) Moreover the pathophysiology of these neurodevelopmental disorders seems to be a multi-steps process. In the first step there is the microbial attack at a specific time of neurodevelopment that triggers the second step of maternal and fetal immune reaction response that would be damaging the fetal brain development. In the third step, the microbial invasion causes genetic mutations to pass on its impact to the next generation through genetic inheritance. In this paper, I will strive to present research evidence of the link between infective insults and the causation of ASD, e.g. autism, so hopefully to get us closer to the prevention of such disorders, by intervening in any of the above-mentioned steps, as the current treatments are nothing but symptomatic reliefs at the best!
As many already know and have watched the movie “Still Alice”, based on the same name bestselling novel by Lisa Genova in 2007, is the story of a university professor in linguistics with an early onset Alzheimer’s disease. The movie brought more recognitions and many awards across the globe and finally the most prestigious of all, Golden Globe and Academy awards, for Julianne Moore who played the role of Alice Howland, the Columbian University professor.
While it is commendable that Hollywood addresses medical and mental suffering of people at large, but it also needs to consult with the medical profession for the validity of its portrays on the screen. Although anybody can catch any disease including Alzheimer’s but there are certain protective factors against almost any disease, as high education and intelligence is against development or clinical presentations of Alzheimer’s disease, so there would be a lower risk or late and slow clinical presentations of the disease in a highly educated university professor. This fact proven by many research over the past couple of decades has created the “cognitive reserve” theory and the possibility of non-pharmaceutical prevention and intervention of this devastating disease by maintaining our brains active as a safeguard to certain degree! Therefore it had been more prudent if Julianne Moore, whom I have a great adoration, would have said more about Alzheimer’s disease in her Oscar acceptance speech, instead of saying “ I have read an article that winning Oscar, leading to living 5 years longer!” that was totally inappropriate and unexpected. To finish off this introduction and leave Hollywood with their more informed film making and interpretations of real life problems and diseases, I need to emphasize the importance of high education and intelligence and keeping our brains active as the only probable preventive measures against this man knocking down disease at the present time.
I thought that I already know a lot about the impact of microbial invasion into our beings as I documented throughout the articles on this site, that she came in recently with her father to see me and find out the reason for her mental slowness and learning disability. She is 24 years old, immigrated from Haiti 8 years ago with her family. Her birth and early couple of years of life were normal like other children in their poor rural Haiti, until when 3 years old, worms were coming out of her nose and she started to have seizure. She was taken to hospital each time after the seizures but no diagnosis or final treatment were provided. Later on the worms and seizures both stopped, but she was left with delays in her full speech function and then in school learning disability. She was slow in comprehension and after all special education classes in her new country, since formal graduation from high school, she has not been able to be hired for any job due to her neuro-developmental delay.
To many including physicians, the cause or major risk factor to lung cancer is smoking! But global statistics estimate that 15% of all cases of lung cancer in men and 53% in women are not attributable to smoking, and these data indicate that worldwide, approximately 25% of patients with lung cancer are never smokers. Moreover simply quitting smoking has not been sufficient as the primary means
of preventing lung cancer. Although indirect exposure to environmental tobacco smoke or second hand smoking and exposure to workplace carcinogens or industrial air pollutions have been considered, the two most important alternative risk factors, such history is absent in more than a third of such non-smokers population with lung cancers. This has made some researchers in the field to suspect two different pathophysiologic pathways to the causation of lung cancers in smokers than non-smokers with different genetic susceptibilities. Surprisingly the type of lung cancer in never-smokers is adenocarcinoma or small cell carcinoma that is the major type of lung cancer in both smokers and non-smokers!