My son (who also has high functioning autism) was dg with LC this summer. They started him on 9mg of Entocort, but he began having behavioral problems at school and severe insomnia (he had never had sleep issues before). Through some trial and error, both were found to be linked to the Entocort and we lowered his dose to 6mg. This eliminated the behaviors and sleep problems.
He was on the 6mg Entocort plus a tablespoon of polyethylene glycol for 3 months and his 2 year battle with abdominal pain slowly disappeared. His bowel movements became regular and "perfect" instead of swinging from end of the spectrum to the other. He has maintained this pain free "baseline" and regular bm's for the last month. We had the followup with his gi dr and she lowered his Entocort to 3mg per day for the next month and then to every other day for a month before stopping completely.
We are one week into 3mg per day and it has been h*** for his teacher at school. He had never 'escaped' from a classroom before, but in the past week he has done so 4 or 5 times. Today he was hiding under furniture. These are behaviors that we have not seen in him before. This is a child that, despite the autism, is very smart and work well enough independently that he does qualify for an aide.
He is on a GFCF diet for the past year and he has been tested for yeast in the past and all was negative. Other lab test supported the lack of a yeast issue. I know yeast overgrowth can cause behavior like this. Can withdrawal from Entocort create a favorable environment for yeast to grow? Or is it a direct withdrawal symptom? Anyone have experience on this or have suggestions?
Entocort withdrawal, yeast infection, or something else?
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I see no reason why it should, but the opposite is certainly a possibility. IOW, any corticosteroid can encourage a candida overgrowth, due to it's effects on the immune system. I wonder if the behavior that he is experiencing could possibly be due to his immune system beginning to attack the yeast, (after the dosage rate of Entocort was reduced). Candida is a very unique organism. It can alter chemical/neurological processes in the brain, and thereby induce the brain to alter behavior so as to benefit the yeast. IOW, if we try to starve candida, it makes us crave sugar. I can't quite visualize exactly what might be happening here, but I'm wondering if by allowing the immune system to attack the yeast, the yeast is fighting back by altering his brain chemistry. Normally, of course, Entocort is not used long enough to suppress the immune system significantly, but your son's original reaction shows that he is unusually sensitive to it.mom2boys wrote:Can withdrawal from Entocort create a favorable environment for yeast to grow?
A stool test sent to Enterolab, should pinpoint whether or not a yeast overgrowth is present, because we typically produce yeast antibodies, resulting in a positive test result, if we have a candida overgrowth.
I suppose it's at least theoretically possible that he might be experiencing withdrawal symptoms from Entocort, also. The fact that he experienced neurological symptoms from Entocort at the labled dosage rate, tells me that he is highly sensitive to it, and therefore he might possibly be a candidate for abnormal withdrawal symptoms. I'm sure your doctor will disagree with that opinion, but doctors can only relate to "normal" reactions to drugs, by "normal" test subjects. The original FDA test trials for Entocort almost surely excluded any test subjects who had any history of autism, (or any other issue, other than Crohn's disease).
Your doctor might be able to gain some insight into his status, by testing his HPA axis, (hypothalamic-pituitary-adrenal axis), to determine if any of those values are out of balance. Several studies have reported that the regulation of the HPA axis is dysfunctional in autistic children, which suggests that the use of a corticosteroid could really throw a monkey wrench into the works, (since corticosteroids tend to suppress the HPA axis). As his HPA axis becomes "unsuppressed", this could potentially cause unpredictable behavior.
I doubt that this type of situation has ever been reliably researched, so doctors probably have no information to go on, in such a situation. I'm not a doctor, so I can "speculate" on the possibilities that might be at play here, but remember that I'm simply "thinking out loud", with no research to back up what I'm suggesting.
I hope you can get to the bottom of this. Please keep us informed, and continue to ask questions, because sometimes the right questions at the right time, (and directed at the right person, such as your doctor), can inspire an "Aha!" response.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.