Louisville Magazine

AUG 2013

Louisville Magazine is Louisville's city magazine, covering Louisville people, lifestyles, politics, sports, restaurants, entertainment and homes. Includes a monthly calendar of events.

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TROUBLE IN MIND Continued fom page 62 "Most people actually put some of their money into research. I put maybe a little bit more than I was supposed to. And it came at a personal expense," he says. "I divorced in part due to this." But based on this selffunded work, in 2009 he and Sokhadze received a National Institutes of Health Eureka Award for innovation, a grant for $900,000 over four years. It makes a nice story, how it's all working. But there's a hitch. Hardly anyone in autism research agrees about what's going on in the brain and how it might be fxed. Casanova's hypothesis about minicolumns and autism is just one in a logjam of ideas about what goes wrong in the autistic brain. Not only do few of the researchers who study brain tissue agree that the minicolumns of the cortex are the missing link to autism, but few of them even agree that the cortex is the crux of the problem. Some research groups say autism stems from a part of the brain below the cortex called the limbic system, in structures that play a role in learning, memory formation and emotion, among other things. Other researchers found changes in the cerebellum, a densely folded matzo ball at the back of your brain responsible for motor control, balance, equilibrium and muscle tone. Still others found diferences in the brain stem, where brain meets spinal column. Te brain stem governs our automatic functions such as heart rate, blood pressure and breathing, as well as alertness and arousal. And even though some groups found diferences in the cortex, they identify diferent diferences than those found by Casanova. "We don't have a dearth of fndings in autism," Casanova says. "We have too many fndings. Te important thing is pruning them for the important facts." David Amaral of the University of California MIND Institute says the reason for this gray area about gray matter is not the researchers nor their technology. It's the brains. Tere simply aren't enough of them. "If you compare autism to something like Alzheimer's disease, the reason we know so much more about Alzheimer's is that we can look at literally tens of thousands of Alzheimer's brains," Amaral says. "Tat's why we've made progress in Alzheimer's and progress in Parkinson's. Even schizophrenia is way in advance of autism." Te efort to collect more brains from people with schizophrenia began 15 years ago. Today, there are just 800 ready for researchers to explore. Why so few? Tey simply haven't been donated. 15 0 LOUISVILLE MAGAZINE 8.13 Tis spring, in response to the brain drain, Autism Speaks — a leading science and advocacy organization — and the Houston-based Simmons Foundation established the Autism BrainNet, an efort to increase the number of brains available for research. Amaral is the director of the effort. He expects that as more brains become available, and more data rolls in, what we will see is not one model of autism in the brain, but several. "Tink of autism almost like you think of cancer," Amaral says. "Te word cancer has almost no meaning, beyond, generally speaking, the abnormal proliferation of cells. Cancer doesn't have one cause; lots of things cause it. Tat's exactly the way we think of autism now." His own research using MRI to look at the brains of living people with autism is uncovering this diversity. For instance, one theory holds that the brains of children with autism are larger than those of other children, starting sometime during the child's frst year or two of life. Yet Amaral found, after conducting 300 MRIs in children with autism, that large brains aren't universal. "Our best estimate is it happens in about 16 percent of children," Amaral says. Te amygdala, part of the limbic system that is important in emotions and the storage of memory, is another autism suspect. Amaral's studies show that 40 percent of kids with autism have an amygdala that grows too rapidly — twice as fast as in typically developing kids. Another 20 percent of children with autism have an amygdala that grows too slowly. Forty percent have an amygdala just like every other child's. "What MRI studies would predict is that you're not going to see a consistent pathology of the brain," Amaral says. All this may tempt you to put your faith in MRIs to solve the autism puzzle, but it shouldn't. Notice these studies don't go beyond questions of size and growth rates. "MRI can only tell you, for example, is the brain larger," Amaral says. "It won't tell you why." Imaging technology isn't capable of the fne-grained view that only brain tissue makes possible. Ione Opris at Wake Forest University looks at the fne grain. Using special probes developed at the University of Kentucky Center for Microelectrode Technology, he was able to record in 2006 the simultaneous fring of cells in a single minicolumn in response to stimuli. He was building on the work of Shelbyville native Vernon Mountcastle, who, as a neuroscientist at Johns Hopkins University, painstakingly identifed the close relationship of neurons within the minicolumn, uncovering how all neurons in the column were dedicated to the same purpose. Opris is convinced that what Casanova has concluded about minicolumns in autism is an important step for the feld. "Nobody has shown more eloquently than Manuel Casanova (one) very important fact," he wrote in an email. "Te disruption of cortical minicolumns is the common denominator of most psychiatric disorders." I t is too soon to tell if Augusta Womack's minicolumns are having much beneft from her weekly magnet sessions. After each session, she performs a second test, in which she watches clips of a nature flm, controlling the video image with her concentration. When her concentration lags, the image shrinks and fades. When her attention is sharp, the swimming dolphins fll the whole screen. Te exercise is called neurofeedback, and her performance will tell if rTMS enhances concentration in children with autism. But Augusta already has a genius for focusing on something, and that's her artwork. Her parents' basement is flling up with her creations, each one dancing with surprising and inventive ideas. One Sunday afternoon she produces a nonstop series of pictures, labeling each one. Tere is Wabba Woo, the Japanese mermaid, and her 260 sons; Zorb, the dragon king; and Melkaw, the merman. Tere's also Dumb Dragon. Along the side of the goofy-looking dragon she writes, "0% smart, 100% stupid." A thought balloon from the dragon's head says "beer." A few days later, after receiving a book about Japanese anime, she draws in that style all afternoon. She's a smart kid. When she was fve, her family realized that she knew how to read. Her brother, Ford, 14, who made huge strides using Sokhadze's neurofeedback for his own attention-defcit disorder, is devoted to her. He makes no big deal about Augusta's autism, considering it just her burden to bear. "She's got her problems," he says, "I got mine." "Tat's the struggle — not to let her diagnosis defne the person," her dad says. Yes, there are times she shows classic autistic behavior, he says, including no-holds-barred meltdowns, but there are hours and hours where she seems just like any kid. "A lot of people who meet her, especially now," Rob Womack says, "they don't realize she's autistic."

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