This segment features the use of MRI and EEG tests in the diagnosis and treatment of children who may have autism. It focus on the work of Dr. Fernando Miranda and two of his patients.
The broadcast devotes an admirable amount of time to an important subject–the use of imaging technologies to understand autism and many other neurological disorders. Unfortunately, it focuses on anecdotal successes and doesn’t describe the considerable amount of high-quality research in the field. That research is promising but inconclusive. But most researchers in the field consider brain imaging very promising and likely to play a large role in the diagnosis and treatment of many disorders over the coming years.
As a result of this out-of-context presentation, viewers come away with the sense that Miranda is a maverick chasing a unique vision. The truth, a bit less exciting, is that he is a clinician operating in some ways ahead of the research in the field and in other ways very consistently with it.
For instance, one of the key examples in the piece is the child who is found via EEG to have seizures that may have been causing his autism-like symtoms. But EEGs are often used to rule out seizures or other brain abnormalities when autism is being diagnosed. It’s no so much that Miranda is a maverick here–he’s following developing best practices. The doctors the parents first consulted did not.
The network published a more detailed report on its web site. This is an excellent practice for TV health news.
The segment reports approximate costs of the diagnostic scans and the fact that they often are not covered by insurance for this use.
The segment does not provide any information to quantify the benefits–how often the imaging turns up alternative diagnoses, how often children treated on this basis of this alternative diagnosis improve, how much and for how long they improve, etc.
The potential harms of treating an autistic child with anti-seizure or other medications based on brain imaging diagnosis are not mentioned.
The harm of money that may be wasted on non-productive tests is not mentioned.
Contrast enhanced MRI’s are now known to be associated with renal dysfunction. If the scans are contrast enhanced, this could cause direct harm to children with pre-existing renal problems.
The story is based on anecdotal clinical observations by the proponent and parents who have seen their children improve.
There is no source given for this provocative claim: "Research does show that as many as 50 percent of children diagnosed with autism may be prone to hidden, seizure-like activity in their brain."
Autism is a serious and disabling condition. The segment does nothing to exaggerate its severity.
However, the story addresses autism as a misdiagnosis, indicating how antiseizure medication "transformed" a child. The story states that 50 percent of children with autism have "seizure-like" activity … What we don’t know is how often autism is a misdiagnosis for a seizure disorder that can be helped by antiseizure meds. There are no data presented and the overall context could be seriously misleading – despite the multiple admonitions that we don’t have the data and these diagnostic tests are not recommended routinely.
The segment interviews two parents who have seen their children improve after diagnosis and treatment, a physician who provides the treatment, and one physician who is skeptical about whether brain imaging can produce useful diagnostic information. The one skeptic is quoted too briefly to provide balance to the segment.
The physician who is at the center of the piece, while well qualified and trained, operates a for-profit medical clinic that sells the diagnostic and treatment services described. This disqualifies him as an objective evaluator of the benefits or risks of the services.
The segment did not describe the usual approaches to diagnosing autism. It is stated that the main diagnostic method is observation of behavior, yet we are given no information about the standard evaluation. Is there a physical examination? Laboratory testing? Other types of imaging? What is involved for the behavioral observations?
The segment also fails to describe standard methods of treating children with autism, which have changed significantly in the past several years and are showing marginally better results.
The story says that MRIs and EEGs used in this diagnostic work are available. But it doesn’t say how many specialists other than Dr. Miranda know how to interpret the images to make diagnoses.
The segment properly describes the clinical application of this imaging-plus-diagnosis approach to children with autism as novel and controversial within the field.
There does not appear to be a press release associated with this report.