Saturday, March 08, 2008

Vaccine payment for a mitochondrial disorder?

It's a weird story. The feds paid out a vaccine injury claim for a child with a mitochondrial disorder.
Deal in an Autism Case Fuels Debate on Vaccine - New York Times

...Hannah’s father, Dr. Jon Poling, was a neurology resident at Johns Hopkins Hospital at the time, and she underwent an intensive series of tests that found a disorder in her mitochondria, the energy factories of the cells...
Since the formal definition of autism doesn't exclude brain injury from other causes Hannah does technically have autism, but she'd be excluded from any research study of the disorder. She apparently has a well defined and extremely rare disorder of her mitochondria...
...symptoms of mitochondrial myopathies include muscle weakness or exercise intolerance, heart failure or rhythm disturbances, dementia, movement disorders, stroke-like episodes, deafness, blindness, droopy eyelids, limited mobility of the eyes, vomiting, and seizures. The prognosis for these disorders ranges in severity from progressive weakness to death. Most mitochondrial myopathies occur before the age of 20, and often begin with exercise intolerance or muscle weakness. During physical activity, muscles may become easily fatigued or weak. Muscle cramping is rare, but may occur. Nausea, headache, and breathlessness are also associated with these disorders....
I wonder what the legal basis of the claim was? Are vaccines known to precipitate a crisis in mitochondrial disorders? They are thought to be exceedingly rare, so I suppose that's possible.

I hope this gets covered in more detail in a major medical or science journal. Based on what I've read so far I think this has no relevance to 99.99% of the children and adults who have some form of idiopathic autism. I think this does emphasize that the definition of autism is impossibly broad.

Update 3/18/2008: Dr Rahul Parikh, writing for Salon, is the only writer on this topic I've read who bothered to include the Judge's statement:
the court "concluded that the facts of this case meet the statutory criteria for demonstrating that the vaccinations CHILD received on July 19, 2000, significantly aggravated an underlying mitochondrial disorder, which predisposed her to deficits in cellular energy metabolism, and manifested as a regressive encephalopathy with features of autism spectrum disorder. Therefore, respondent recommends that compensation be awarded to petitioners."
The vaccine court is predisposed to pay if there's any chance of injury. So they paid out, even though the expected course of some mitochondrial disorders includes, tragically, regressive encephalopathy.

The confusion in this case arises because the technical (DSM IV) definition of autism is exceedingly broad, and says nothing about the underlying cause. This story is yet another indicator that we need better ways to describe disorders of cognition.

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