Frequently Asked Questions & Facts

FAQs

1.  Do you use the SPECT scan to make the diagnosis of Autism? 

No. The diagnosis of Autism is made by doctors and psychologists based upon the person’s behavior.

2.  Then what is the purpose of a SPECT scan?

Its purpose is to two-fold: 

1. It shows the location and the extent of brain area over function and under function.
2. It shows the presence of any co-morbidity factors that are present along with the person’s Autism.

3.  Is over function the same as hyperperfusion, and is under function the same as hypoperfusion?

Yes

4.  What is the meaning of hypoperfusion and hyperperfusion in Autism?

Hypoperfusion means that a brain area took up less than expected of the isotope when the person was injected.  This implies that that brain region is functioning at a lower than expected level and this may account for some of the atypical neurological symptoms and behaviors of that person.  It also helps us to know how many areas of that person’s brain are functioning at a too low level, in effect how extensive is that in that person at that time before any other therapy may be instituted.  In most autistic children the temporal lobes and cerebellum are under active to some degree, and this may be related to some of the person’s diminished emotional capacity or learning ability.

Similarly for hyperperfusion.  Areas of that persons brain are overactive and this
can be related to their symptoms and behavior.  An example: one focal area of over activity might be the indicator of an underlying seizure focus.

5.  What are the co-morbidities of Autism and how serious are they?

They are seizure disorder, anxiety, obsessive and compulsive tendencies, decreased mood, post traumatic stress disorder and hyperactivity.  My scan experience is that more than one of these occurs in an autistic child in at least one third of the time.  The more serious any one or two of these may be, the more difficulty the autistic child and their parent has in dealing with their underlying autistic disorder.

6.  Is there any risk associated with brain Spect scanning?

No.  There is no risk associated with the scan itself.  The scan test substance that is injected has been used for 20 years in children and adults and is extremely safe.  It is not a “dye” and thus does not have the reactions that are sometimes associated with intravenous dye or “contrast” materials.

The only risk is that which can be associated with the sedation medication.  For five years we have used only one sedation medication that is known and has proved to be very safe.

7. Do children have to be sedated for the scan?

Yes.  Most autistic children, and especially those under ten years of age, simply cannot hold their head still enough for the approximate 15-25 minute scan time.  Those over ten years may be able to hold still, and that is always discussed with the parent and Dr Uszler days before coming in for the scan.

8. How long does a scan take?

The scan itself usually takes 20 to 25 minutes.  Approximately 1.5 to 2 hours should be allotted for the scan appointment because time must be allotted for 10 minutes of quietness while the injection occurs and for the required 45 minute time between the injection and the scan itself.  If sedation has been used, another 20 minutes is generally needed before the child is released in the parent’s care from our waiting area.

9. Are there any preps for the scan?

As with adults the only preparation is that the person not take in any sources of caffeine at least 4 hours prior to the scan.  If the person is going to have sedation, then additional restrictions, such as withholding foods prior to the scan, will be discussed with the doctor the day before coming in for the scan.

10. Is there any radiation as part of the scan?

Yes, every brain Spect scan requires the use of a radioisotope labeled substance that goes to the brain and thereby indicates the level of function in each and all brain regions.   Radioisotopes give off small amounts of invisible radiation so the scan can work properly.  The radiation dose to the person is significantly less that that associated with x-ray scans such as CT.

11. Does my child have to an injection for the scan?

Yes, Spect scanning always requires an intravenous injection?
And if sedation is to be used, the scan injection should be done BEFORE the sedative is given.

12. How frequently should spect scanning be done and when?

Brain Spect scanning need not be done frequently.  Usually no person needs be scanned more frequently than 1 to 3 times a year.  Scanning is indicated as a “baseline” before beginning a course of any type of therapy, and is frequently used after a course of therapy to judge the effectiveness of the therapy.  This is more likely done when the therapy appears to not have achieved all of its expected effect.

13.  Can I get a Spect scan at any hospital or imaging center and do they know how to use it to help me with my child’s autism?
 Not all spect scanning locations are prepared or experienced in providing and interpreting brain spect scans regarding autism and learning disorders in general, especially in children. Before getting a scan on your child, be sure to ask them how many children’s scans have they done and do they do them routinely.

14.  Does Dr. Uszler and DRSPECTSCAN provide second opinions of brain Spect scans done at other imaging places?

Yes, a call to our office (310-264-0080) will explain how to send the scan to Dr. Uszler and what are the types of consultation, scan reviews and their costs.

15. If my doctor is not sure what the spect scan results mean in my child’s case, is Dr. Uszler available for consultations with me and my doctor?

Yes.  These are scheduled usually in half hour time intervals by calling our office at 310-264-0080.

16. What are the general ideas about how brain spect scan results can be used to guide choices about therapies?

The basic considerations relate to the degrees of hypoperfusion and hyperperfusion and in what brain areas this is occurring.  Typically hypoperfusion therapy leads to the usage of hyperbaric oxygen therapy (HBOT) and hyperperfusion to the use of medications. Because many cases have both hypoperfusion and hyperperfusion, medication and HBOT are frequently used in combination. Of course each case requires specific analysis to determine what seems most appropriate for therapy in that person at that time.

Facts

Autism

• There is an estimated 1 to 1.5 million Autistic individuals in the United States.  With an annual growth rate of 11-16%, and a 172% increase from the 1990’s, Autism is the fastest growing developmental disability in this country. The condition affects communication and social interactions and is the effect of neurological dysfunction.  Autism is a spectrum disorder, with varying degrees of impact and is the most common of the Pervasive Developmental Disorders (PDD).  Other disorders in this spectrum range include; Asperger's Syndrome, Rett's Disorder, Childhood Disintegrative Disorder and Not Otherwise Specified Pervasive Development Disorder. 
• Autism is the third most common developmental disability following mental retardation and cerebral palsy.
• Autism is more common than multiple sclerosis, cystic fibrosis or childhood cancer.
• 1 in 166 births
• 1 to 1.5 million Americans
• Fastest-growing developmental disability
• 10 - 17 % annual growth
• Growth comparison during the 1990s
• U.S. population increase: 13%
• Disabilities increase: 16%
• Autism increase: 172%
• $90 billion annual cost
• 90% of costs are in adult services
• Cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention
• In 10 years, the annual cost will be $200-400 billion

http://depts.washington.edu/uwautism/pdf/AutismOne-Pager.pdf

ASPERGER’S SYNDROME

Asperger’s Syndrome is the highest functioning form of autism. The criteria is the same except concerning language skills. They have no clinically significant delay in developing language, self-help skills, adaptive behavior or curiosity in their environment. People with Asperger’s generally have a normal to high IQ level. They also tend to focus interest in areas of intelligence such as memorizing facts about a particular interest, or focusing on maps, books, computers and computer games. People with Asperger’s can also range in ability with the highest functioning children getting along quite well, and others being far more restrictive and can closely resemble those with high functioning autism.

RETT’S DISORDER/ RETT SYNDROME

Children with Rett’s disorder are almost exclusively girls and must have all of the symptoms. They appear to be developing normally until they regress. There is a deceleration of head growth between the ages of 5 and 48 months, loss of previously acquired hand skills between 5 and 30 months with the subsequent development of stereotyped movements such as hand-wringing or hand washing. There is a loss of social engagement early on although it often develops later. They have the appearance of poorly coordinated gaits or trunk movements and severely impaired expressive and receptive language development with severe psychomotor retardation.

PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED (PDDNOS)

This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder, or avoidant personality disorder. It would encompass what is known as ‘atypical autism’ by not meeting criteria because of such things as late onset autism, atypical symptoms or subthreshold of symptoms.

CHILDHOOD DISINTEGRATIVE DISORDER

With this disorder, there is apparently normal development for at least 2 years after birth with age-appropriate verbal and nonverbal communication, social relationships, play and adaptive behavior.

A clinically significant loss of skills before the age of 10 in at least 2 areas:

1. Expressive or receptive language
2. Social skills or adaptive behavior
3. Bowel or bladder control
4. Play
5. Motor skills

There are abnormalities in functioning in at least two areas:

1. Qualitative impairment in social interaction such as in nonverbal behavior, failure to develop peer relationships, or a lack of social or emotional reciprocity.
2. Qualitative impairments in communication such as in a delay or lack of spoken language, inability to initiate or sustain conversation, stereotyped and repetitive use of language, or a lack of varied make-believe play.
3. Restrictive, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypes and mannerisms.

Within the categories of the spectrum, each has it’s own spectrum ranging from severe to mild. Autism occurs in more boys than girls, with a 4 to 1 ratio. In the milder form of Asperger’s syndrome, boys outnumber girls at approximately 6 to 1.

Cases of autism and autistic spectrum disorders have risen dramatically over the last 15 to 20 years. Today, autism is the fastest growing developmental disability. It is more common than Cerebral Palsy, Down Syndrome and Childhood Cancers combined. Today, 1 in every 166 children in the United States is diagnosed with an autistic disorder. Some studies show an even higher rate of autism among children today. Most of these cases are autism, Asperger's syndrome, and PDDNOS.