Autism spectrum disorders

The priority of VIVERE CLINIC

is to solve the problem of childhood neuropsychiatric disorders. High achievements in immunology, genetics, biochemistry allow us to clearly understand the peculiarities of brain damage in children with ASD and develop effective methods to overcome the disease.

And first of all, we focus on identifying the factors that directly provoke the development of neuropsychiatric syndromes in children with multisystemic lesions - autoimmune, inflammatory, allergic, infectious.

Today, the VIVERE CLINIC uses a multidisciplinary team approach to managing children with ASD, including geneticists, nutritionists, gastroenterologists, immunologists, child psychiatrists, child neurologists, endocrinologists, and remedial educators. The available results of the team's practical work demonstrate that the method has the potential to make a full recovery in children even with an unfavorable prognosis, as well as to reduce the frequency of neuropsychiatric disorders among children.

Autism spectrum disorders: features and statistics

Autism spectrum disorders (ASD) are a group of neuropsychiatric disorders characterized by impaired social adaptation, interaction and communication with other people, and narrowing of interests. In recent years, the frequency of clinical cases has increased significantly: according to data for the U.S., from 1972 to 2014 the frequency of reported cases of ASD increased from 1 case per 10,000 people (0.01%) to 1 case per 44 children (2.0%), that is, 200-fold.

ASD not only predetermines the child's social disadaptation and creates communication problems, but is also accompanied by a variety of comorbid pathology (obsessive-compulsive syndrome, attention deficit, and hyperactivity disorder, cognitive impairment, and other forms of psychiatric syndromes). This significantly impairs the quality of life of the child and all family members. In addition, over time, signs of schizophrenia and suicidal tendencies can arise.

Therefore, the priority issue for doctors is the high-quality diagnosis and comprehensive treatment, and for parents of children with ASD - the timely application for medical care and complete therapy under the supervision of experienced specialists.

Recent advances in genetics, molecular biology, and immunology show biochemical and immune-dependent ways of formation of neuropsychiatric disorders and shed light on the mechanisms of brain damage in children with ASD. And this allows us to significantly improve the quality of treatment of the syndrome and talk about the possibility of complete recovery through the introduction of genetic, biochemical, and immunodiagnostic approaches, as well as metabolic and immunotherapeutic interventions with neuroprotective effects, used by doctors at our medical center.

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Genetic factors in the development of ASD

Recent studies confirm that it is genetic factors that are key in the development of ASD in children. However, the disease is caused by the lesion of a large number of genes that control different physiological processes in the body. Genetic pathology associated with autism disorder can be divided into 3 main groups - metabolic, immunological, and neurological disorders, which include disorders of metabolism, immune system functioning, neurogenesis, synaptic plasticity, and neurotransmitter exchange in the CNS.

When diagnosing, it is important to pinpoint the exact location of each of the many genetic disorders associated with ASD in order to choose an effective treatment. And that is exactly what the doctors at VIVERE CLINIC do.
In many clinical cases, there is a nucleotide substitution in the folate cycle genes, which can lead to severe consequences for the patient due to impaired absorption of folic acid, which functions in close relationship to other biochemical cycles in the body. Such a disruption leads to the development of RAS in at least three ways:
    • biochemical – by induction of hyperhomocysteinemia and other related manifestations of oxidative stress;
    • gene regulatory – because of the effect on the expression of many pathogenic and normal genes due to a violation of the universal mechanism of gene censorship by methylation of DNA;
    • epigenetic – due to methylation of proteins and lipids, which affects their functional activity.
 
Mutations in genes can also impair immune function and lead to immunodeficiency. Immune-dependent pathways of CNS damage in children with ASD and other neuropsychiatric syndromes can form on their background. Four such pathways are known - infectious, autoimmune, allergic, and inflammatory. The extent of brain damage depends on how many and in which genes mutations are observed.

Thus, we can speak of an individual pathological system of genes that form the pattern of ASD and other neuropsychiatric syndromes in each child, since the affected genes do not function independently, but interact with each other at different stages of disease development. When analyzing the individual pathological systems of the genes responsible for the polygenic nature of RAS inheritance, it should be taken into account that they lead to a qualitatively different clinical outcome than the simple sum of their components.

This substantiates the expediency of a comprehensive analysis of genetic patterns in patients with RAS.
In our clinical practice, specialized diagnostic genetic panels are created for children with suspected ASD, allowing the identification of individual pathological genetic systems in children with neuropsychiatric syndromes according to the evidence base.

Biochemical factors and autistic disorder

The presence of a pathological gene system contributes to the development of a whole complex of metabolic disorders, leading to CNS disorders and impaired functions of the child's body as a whole. The characteristic triad for RAS is primarily impairment of the brain, digestive system, and immune system functions.

Biochemical disorders can be described as oxidative stress. It is a process in which the oxidation and repair of cells is disrupted, causing them to become damaged or die. Above all, neurons are affected. If this mechanism is not affected, more severe symptoms and conditions can develop over time - asthma, concentration, and attention disorders, chronic fatigue syndrome, headaches, hypertension, etc.

Genetically determined metabolic disorders in children with ASD form individual patterns of biochemical disorders. Our physicians develop specialized laboratory diagnostic panels for their evaluation. Identification of the individual pattern is an important clinical task since it allows selecting an effective treatment program to attenuate CNS lesions and, as a result, eliminate the clinical manifestations of the disease.


Immunological factors in the development of RAS

Genetic and biochemical mechanisms lead to impaired maturation and functionality of the immune system of a child with ASD. Research suggests that the more pronounced the neuropsychiatric disorders in a patient, the more significant the damage to immune defenses.

In the immune status, there is an imbalance of factors providing protection of the body against infectious and allergic agents, tumor development, and autoimmune reactions. A specific form of primary immunodeficiency caused by folate cycle disorder has been isolated. Clinically, this condition in children with RAS is manifested by the following syndromes:
    • infectious;
    • autoimmune;
    • immunoinflammatory;
    • allergic;
    • Oncological.

Recent studies confirm that the presence of a primary immunodeficiency increases the risk of developing ASD in children by a factor of 3.2. Therefore, it is important in the presence of neuropsychiatric disorders to identify the immunological abnormalities that may have provoked them.

Our clinic uses research methods that allow us to accurately identify immunological disorders and eliminate them at the cellular level. In this way, we manage to remove the immunological factor and achieve high efficiency in the treatment of children with ASD.

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Infectious factors in the development of ASD

Due to immune damage, children with ASD are more susceptible to the development of infectious diseases, which spread primarily to the nervous system. We can distinguish direct CNS damage with the development of acute or chronic neuroinfections, as well as an indirect way of damage - immune-inflammatory and autoimmune reactions.

The infectious factor may contribute to CNS damage in children with ASD after viral encephalitis, cytomegalovirus neuroinfection. Children with ASD suffer more often from herpesvirus and streptococcal infections, toxoplasmosis, mycoplasmosis, and chlamydia, borreliosis.

When patients are examined in our clinic, a special diagnostic panel is administered to identify the specific microbial spectrum in children with RAS and other neuropsychiatric syndromes for accurate diagnosis. This allows the selection of effective antibiotic therapy, antiviral, antifungal, or antiprotozoal treatment aimed at eliminating the provoking factor.

Autoimmune factors in the development of ASD

Pathological immune response to brain autoantigens in children with ASD can be of two types:
    1. Alloimmune – develops as early as the antenatal period and gradually disappears on its own a few months after birth.
    2. Autoimmune is associated with immune dysfunction in the child's body, develops during the first years of life, and has a chronic course.

Microbial and non-microbial factors in children with RAS provoke anticerebral and extracerebral autoimmune reactions. The lesion does not spread to all nerve cells, but selectively to certain areas of the gray matter of the brain.

Recent studies confirm that there are associations between certain microorganisms and autoantibodies. And each patient has an individual microbial spectrum of lesions. By determining and evaluating a child's overall immune status, it will be possible to identify the most dangerous microorganisms for a particular patient that can provoke serious brain damage.

In the clinical practice of VIVERE CLINIC, physicians use specialized laboratory diagnostic panels to assess the specific profile of autoimmune reactions to cerebral and extracerebral autoantigens or autoimmune endophenotypes in children with PAS and other neuropsychiatric syndromes. This allows us to adequately select immunomodulatory therapy and evaluate its effectiveness.

Immunoinflammatory syndrome in ASD

Another characteristic manifestation of immune dysfunction in patients with autistic disorders is the immune-inflammatory syndrome, which causes immune-dependent brain damage. It can be:
    • primary – arises due to a disorder of the regulation of inflammation in conditions of immune dysfunction due to internal factors in the body;
    • secondary – is a part of infectious and autoimmune syndromes.
 
The systemic inflammatory response is accompanied by periodic exacerbations and leads to mental deterioration in the child with PAS caused by the neurotoxic effects of serum anti-inflammatory molecules.

Allergic syndrome in children with ASD

Compared with healthy children, patients with autistic disorders have respiratory, skin, and food allergic reactions 2-3 times more frequently. Allergic syndrome develops due to impaired immune function.

Two mechanisms of allergic syndrome formation in children with ASD can be distinguished:
    • central – caused by the synthesis of neurotensin in the hypothalamus of the brain under the influence of stress factors, provoking allergic inflammation in the brain parenchyma;
    • peripheral – occurs due to allergy to some food products (gluten, casein, etc.) and is accompanied by allergic inflammation in the intestinal wall with subsequent spread to the blood and brain.

Determination of the genesis of the allergic syndrome allows us to choose an effective treatment, in particular, to understand the appropriateness of dietary therapy to alleviate the manifestations of ASD and improve the social behavior of children with this diagnosis.

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The concept of the functional axis «microbiota – gut – brain»

It is this concept that explains the undulating course of the disease with periodic improvements and deteriorations in the psychological state of a patient with an autism spectrum disorder. Antigens to infectious agents, food allergens, and toxins that enter the body from the environment, reaching the immune cells and intestinal mucosa, provoke a local inflammatory reaction. As a result, children with ASD are often diagnosed with chronic enterocolitis.

In neuropsychiatric syndromes, inflammation in the intestinal walls is often caused by causes that are not harmful to a healthy person. Due to the chronic course, the permeability of the intestinal walls increases over time, and the inflammatory process can go from localized to generalized.

Encephalopathy in children with autism spectrum disorder

Children with autism spectrum disorders often have concomitant organic pathology that is not limited to psychiatric diagnoses, as previously thought. Moreover, this approach does not allow us to determine the cause of the disease and influence the mechanism of its development. After all, patients with autism spectrum disorders have brain damage (encephalopathy) with predominant damage to the cortex, neuronal connectivity phenomenon, disorder of synaptic plasticity.

The development of encephalopathy is caused by biochemical, immune-dependent, gene-regulatory, and epigenetic disorders discussed above. Clinically, the disease is accompanied by psychiatric and neurological syndromes occurring simultaneously or sequentially

Multisystem disease as a form of whole-body damage in ASD

An exclusively psychiatric approach to the treatment of children with ASD is inexpedient also because, in the disease, lesions occur not only in the nervous system but also in other internal organs. In particular, it is often possible to identify the following disorders:
    • diseases of the intestine and digestive system in general;
    • immune system dysfunction;
    • skin and upper respiratory tract pathologies;
    • blood disorder;
    • connective tissue dysplasia.

In other words, we are not just talking about neurological and psychiatric symptoms, but a special form of lesions of the whole organism - a polygenic multisystem disease. And autism in this case is one of the manifestations, not the cause of the development of other organs and systems.

They are of equal, rather than secondary, clinical importance. Sometimes the polygenic multisystem disease is manifested by severe lesions of internal organs and is not accompanied by mental disorders. In addition, it is the peculiarities of the disorders of internal systems, rather than the CNS, that can determine the prognosis of the disease. For example, a fatal case in a child with ASD may be provoked by sepsis, pneumonia resulting from immunodeficiency.

Consequently, both diagnostics and treatment should be based not on the flattening of neuropsychiatric disorders, but on a complex approach, identifying the cause of the illness and all of the existing disorders.

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Concepts of an individual multidisciplinary approach to the management of patients with ASD

The multidisciplinary approach involves comprehensive diagnosis and treatment of children with ASD, involving a geneticist, immunologist, neurologist, psychiatrist, and other subspecialists because the disease develops against a background of genetic, metabolic, immunological, neurological disorders, as well as lesions of many organs and systems. At the same time, it is impossible to develop a standard protocol for examination and therapy, because each patient has different lesions.

All these syndromes have a common origin and indicate lesions in certain parts of the CNS. Each syndrome may have a different intensity of manifestation in different children. Some patients have no signs of ASD at all, and the accident may not occur directly against the background of an autistic disorder, but due to attention deficit and hyperactivity disorder or an epileptic seizure.

The concept of induced encephalopathy provides a completely different perspective on the appropriateness of certain treatment approaches. The emphasis should not be on psychotropic therapy aimed at reducing symptoms, but rather on neuroprotective approaches aimed at protecting the brain from damage. It is important not just to alleviate clinical manifestations, but to direct efforts toward blocking infectious, autoimmune, and immune-inflammatory pathways of CNS damage.

Correct therapy allows to achieve improvement of communication and interaction of the child in society, speech, to increase attention and memory, eye contact, to overcome hyperactivity, hyperexcitability. And influence exactly on the mechanism of development of encephalopathy allows to eliminate displays of ASD completely

The development of encephalopathy is caused by biochemical, immune-dependent, gene-regulatory, and epigenetic disorders discussed above.

  1. autism spectrum disorders;
  2. Attention deficit and hyperactivity disorder;
  3. sleep disorders;
  4. Obsessive-compulsive syndrome;
  5. hyperkinetic syndrome;
  6. eating disorder;
  7. epileptic syndrome;
  8. motor disorders;
  9. cognitive decline.

However, to date, two types of multidisciplinary approaches to the clinical management of children with ASD have been substantiated:

  • The first involves an extensive group of laboratory biomarkers that allow the identification of abnormalities and the selection of targeted therapy. It is characterized by scientific validity, consistency, comprehensiveness, systematicity, step-by-step evaluation of the patient's condition, and prescription of corrective drugs.
  • The second approach involves a sequential detailed evaluation of the patient's condition and subsequent prescription of corrective therapy according to scientific evidence. First, the pathological gene system is examined; based on the results, biochemical tests are selected to identify specific metabolic, genetic abnormalities. The obtained genetic, biochemical, immunological, microbiological, and rheumatological results simplify the evaluation of the patient's condition and allow selecting a personalized etiological therapy. The last step is a comprehensive examination of the entire body to identify all the symptoms of the disease associated with the multisystem lesion of the child's body.
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VIVERE CLINIC specialists are guided by the latest scientific research and are the only ones in Ukraine to use a personalized multidisciplinary approach to the management of children with ASD and other neuropsychiatric disorders.

This allows us to identify the cause of the disease, determine all the lesions and choose an effective comprehensive treatment, which can significantly improve the patient's condition and even achieve complete recovery.

Treatment at our clinic is aimed at identifying and addressing the underlying mechanism that underlies autism spectrum disorder. Only this approach can guarantee a sustainable and pronounced result. You can familiarize yourself with the prices of individual services in the price list. At the same time, the final cost of RAS treatment is formed personally, as it depends on the methods used.

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Лікуємо нашого хлопчика і бачимо позитивні результати, хлопчик став краще розмовляти, з'явився апетит, з'явилось бажання пробувати нові продукти, легше реагує на все, легше домовлятися. Дякую лікарю Володимиру Михайловичу Стефанишину.

Юрій

В клинике уютно и светло. Приятно удивляет всегда быстрое реагирование на вопросы и просьбы девушек-регистраторов, их доброжелательное отношение. Ни один вопрос в вайбере не остался без ответа. Дважды были с сыном на консультации у Шейко Макара Васильевича. Неординарный, профессиональный и, в то же время, душевный, можно сказать дружеский подход, к решению проблем пациента, у Макара Васильевича. Также 2 года назад мы были на приеме у иммунолога Мельник Леси Игоревны. Остались тоже очень довольны. Впечатлило глубокое понимание проблемы, а также достаточно доступное объяснение и интересное изложение информации.

Елена Моцарь

Доброго дня! Нарешті я написала відгук, вже півроку з вами) Я мама дитини, яка до 18 років мала купу діагнозів, які і близько не мали відношення до нашої хвороби! Уявіть, скільки часу було витрачено... лікування ніяке (звісно) не допомагало, а ставало ще гірше. Доки нам не порекомендували Шейко Макар Васильовича! Сказати, що Він нам допоміг , це нічого не сказати! Макар Васильович врятував мою Софію! Завдяки правильній діагностиці, ми маємо НАШ діагноз (рідке орфанне захворювання) і правильне лікування. Я бачу поліпшення, моя дитина як заново народилася! Макар Васильович - це дбайлива і дуже чутна Людина, якій довіряєш! На прийомі немає оцього бар'єру лікар-пацієнт, ви як прийшли до друга, який вас підбадьорить, вислухає. Дуже рекомендую!

Анна

По аналізам у дитини герпес 6 типу, звернулись в клініку до імунолога Лесі Мельник на консультацію, лікар професійно все пояснила та назначила курс лікування.

Наталія

Дуже задоволений фаховим спеціалістом Монастирським В. О. Спеціаліст вищої категорії з величезним досвідом лікування. Уважний, компетентний, фаховий невропатолог, нейроімунолог. Моя подяка Володимиру Олеговичу.

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Lesya Melnyk
Do what you love, and you'll never have to work.

Treatment of children with ASD PANS/PANDAS/PITANS treatment Treatment of opportunistic infections Treatment of immune deficiencies Treatment of dermatoses of various etiologies (acne, rosacea, dermatitis) Treatment of fungal and viral diseases (herpes, warts, molluscum contagiosum), allergic dermatosis, streptoderma, eczema, atopic dermatitis Treatment and support of chronic dermatoses in order to prolong remission periods and reduce the number of relapses

Lesya Melnyk
Immunologist, pediatric immunologist, Dermatologist (adult and pediatric)

Stage: 4 years

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Daria Arsiriy
There are things that do not depend on us, but that does not mean that this is the end of life. We have to act, look for solutions, exhale, and look at the situation from a different angle.

I diagnose and treat patients with lesions of the central, peripheral, and autonomic nervous system. Possess the following manipulations: - paravertebral blockade; - kinesiotaping; - lumbar puncture.

Daria Arsiriy
Category II neurologist, a pediatric neurologist

Stage: 10 years

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Volodymyr Stefanyshyn
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PANS/PANDAS Mitochondrial disorders Chronic fatigue syndrome Autoimmune encephalitis

Volodymyr Stefanyshyn
Director of the Medical Center, President of the Association of Neuroimmunologists of Ukraine

Stage: 22 years

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Ihor Rybak
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Ihor Rybak
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Stage: 35 years

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Larysa Nifontova
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- consulting, diagnostic and therapeutic care for patients with endocrinological diseases - insulin pump therapy - use of author's methods with scientifically proven effectiveness for diagnostics and treatment of endocrinological diseases

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