Friday, August 19, 2016

Can Parkinsonian Symptoms Be Brought On by Traumatic Brain Injury?

TBI linked to Parkinson’s and Parkinson-related brain defects

Researchers at the Group Health Research Institute relates research to Muhammad Ali—and how we can prevent late-life injuries and falls for our families and ourselves.-JR

by Eric B. Larson, MD, MPH, executive director of Group Health Research Institute and vice president for research at Group Health
Traumatic brain injury (TBI), including concussion, is a big problem in older adulthood, the stage of life when accidents—especially falls—happen most often. Yet we hear a lot about TBI from sports, particularly football head injuries in younger people.
Muhammad Ali, who recently died, had a symptom complex called Parkinsonism. It’s very likely that multiple blows to the head from boxing set the stage for this condition. A new study that I helped to lead confirms concern over effects of TBI that threaten the structure and function of brain cells.

Here’s what we found—and didn’t find

With colleagues from the University of Washington (UW), Mt. Sinai School of Medicine, Cleveland Clinic, Rush University Medical Center, and the University of Utah, Paul Crane, MD, MPH, and I recently published “Association between Traumatic Brain Injury and Late Life Neurodegenerative Conditions and Neuropathological Findings" iJAMA Neurology. Dr. Crane is a professor of general internal medicine at the UW School of Medicine, an adjunct professor of health services at the UW School of Public Health, and an affiliate investigator at Group Health Research Institute (GHRI).

How to prevent falls

On a practical level, though, this research should remind us of just how important it is to prevent falls and other accidents. Here’s how you can prevent falls:
  • Get regular exercise for general conditioning, strength, and balance training. 
  • Avoid drugs that impair balance and judgment, such as narcotics, anticholinergics, and tranquilizers, and avoid over-treating high blood pressure and diabetes.
  • Eliminate hazards in your environment—like inadequate lighting, rugs and cords that can cause tripping.
  • Wear shoes or slippers with good soles that are not too thick. The ACT study has shown that older people are much more likely to fall in the home if they walk barefoot or in stocking feet.  
  • At some point, consider using a cane or walker to avoid falls.

Wednesday, August 17, 2016

Helping Our School-Age Children Sleep Better when 23% have sleep problems!

Revisiting the importance of  healthy sleep habits in school-age children.
Common sleep problems and some strategies for resolving them... -JR

Helping Our School-Age Children Sleep Better
By Peri Klass, M.D.

"Everyone knows that getting a baby to sleep through the night can be a big challenge for parents. But sleep problems are common among preschool and school-age children, too. As we ask children to function in school, academically and socially, fatigue can affect their achievement and behavior.

Australian research on sleep problems in children has included work aimed at the “school transition” year in which children adjust to a school schedule. In a study of 4,460 children, 22.6 percent had sleep problems, according to their parents, at that transition age of 6 to 7 years. “We were surprised, we thought it was all baby sleep” that was the problem, said Dr. Harriet Hiscock, a pediatrician who is a senior research fellow at the Murdoch Childrens Research Institute at the Royal Children’s Hospital in Melbourne who was one of the authors of the study.

The most common sleep issues for children around the age of school entry, Dr. Hiscock said, definitely include limit-setting issues — that is, some of them need their parents to make the rules and routines clear. But there are also children with what sleep specialists call “sleep onset association disorder,” in which a child has become habituated to falling asleep only in a certain context, requiring the presence of a parent, or needing to have the TV on, to cite two common examples. Very anxious children are also often problem sleepers. And then there are children beset by nightmares, night terrors and early morning waking.

Many parts of the brain work less well when children are tired. “The prefrontal cortex is very sensitive to sleep deprivation, and it is key to the brain mechanisms which underlie executive function and some of the attention  processes,” she said. “The amygdala is affected by sleep deprivation and is essential for emotional processes.”"


Are Pregnant Women Suffering From a Form of Sleep Apnea?

Israeli-US research: Pregnant women may suffer from sleep apnea

New research suggests that pregnant women may commonly suffer from gestational sleep apnea.

Researchers say that further investigation will determine therapy and criteria for the condition. - JR

Overweight adults aren’t the only ones to suffer from potentially dangerous obstructive sleep apnea (OSA); about a quarter of pregnant women have the condition, according to sleep-medicine researchers in Jerusalem and St. Louis.

Just as pregnant women may be at risk for gestational diabetes and gestational hypertension that develop while carrying their fetuses, they may also develop gestational OSA, in which one stops breathing for several seconds during sleep, the researchers said. The obese most commonly suffer from OSA, putting them at higher risk for high blood pressure, heart disease and type 2 diabetes.

Now, in an editorial in the International Journal of Obstetric Anesthesia, sleep researchers from Israel and the US recommend a new diagnosis, “Gestational Sleep Apnea” (GSA). This would allow health professionals to properly describe, diagnose and treat OSA in pregnant women.


“Currently there is a lack of uniform criteria to diagnose, treat and classify OSA in the pregnant population, which in turn complicates efforts to determine the risk factors for, and complications of, gestational sleep apnea,” said Prof. Yehuda Ginosar, director of the mother and child anesthesia unit at Hadassah-University Medical Center in Jerusalem’s Ein Kerem who is on the faculty of the Hebrew University’s Faculty of Medicine.

Does early botox in the arm have LONG LASTING effects on the brain and motor learning? Maybe.

Was injecting botox today (under sedation) to kids so its on my mind.....

In the 13 years of practice, I have observed  motor learning and even language to rapidly  improve if I treat spasticity early. Other illnesses show that cortical reorganization changes with improved use of a limb.  I recognize that it takes a team, yet  I was not surprised to see kids "take off".  JR

 2015 Jun;18(3):145-8. doi: 10.3109/17518423.2013.796018. Epub 2013 Jul 19.

Quantification of long-term effects of botulinum injection in a case of cerebral palsy affecting the upper limb movement.



The aim of this work was to put into evidence the long-lasting modification induced by botulinum toxin injection and rehabilitative treatment on motor control.


In this contribution, we report the case of a female child showing hemiplegia, due to cerebral palsy. She underwent botulinum injection, followed by physical and occupational therapy. We quantified the biomechanical, cerebral and occupational aspects of her impaired upper limb, also dynamically, with respect to her pre- and post-treatment condition.


Small long-lasting improvements--induced on biomechanics by botulinum injection--triggered wide cerebral modification, well reflected in improved contextual movements and motor strategy.


These results provide evidences that small modifications in the end-effector performance often imply cerebral modifications and improvement in finalized motor strategy.


Botulinum injection; EEG analysis; cerebral palsy; movement analysis; upper limb

Doctor, can botox be used for excess sweating in teens.. Read on...

Sometimes I'm asked to help. Frankly, I am not sure why more do not ask me in Texas .... JR

80-93% have a 75% plus response that lasts 4-6 months.
5.6% with mild/moderate adverse response


A Prospective, Nonrandomized, Open-Label Study of the Efficacy and Safety of OnabotulinumtoxinA in Adolescents with Primary Axillary Hyperhidrosis.



To evaluate the efficacy and safety of onabotulinumtoxinA in adolescents with primary axillary hyperhidrosis.


This 52-week, multicenter, nonrandomized, open-label study was conducted in 141 adolescents ages 12 to 17 years with severe primary axillary hyperhidrosis. Patients could receive up to six treatments with onabotulinumtoxinA (50 U per axilla), with re-treatment occurring no sooner than 8 weeks after the prior treatment cycle and no later than 44 weeks after the initial treatment cycle. The primary efficacy measure was treatment response, based on self-assessed hyperhidrosis severity following the first two treatments using the 4-point Hyperhidrosis Disease Severity Scale (HDSS). Other efficacy measures included spontaneous resting sweat production and health outcomes.


Fifty-six (38.9%) participants underwent one treatment, 59 (41.0%) underwent two, 20 (13.9%) underwent three, 6 (4.2%) underwent four, and 3 (2.1%) underwent five. OnabotulinumtoxinA significantly improved HDSS scores and decreased sweat production compared with treatment cycle baselines. Seventy-nine patients (54.9%) responded to treatment based on HDSS criteria. From 56.6% to 72.3% of patients experienced a two-grade or more improvement at 4 and 8 weeks after each of the first two treatments. The majority (79.4%-93.2%) had a 75% or greater reduction in sweat production at week 4 (treatments 1-3). The median duration of effect for responders ranged from 134 to 152 days. Using quality of life measures, health outcomes improved markedly. Eight patients (5.6%) had mild or moderate treatment-related adverse events. No unexpected safety signals were observed in this study. Neutralizing antibodies to onabotulinumtoxinA did not develop.


OnabotulinumtoxinA injections provided beneficial effects in adolescents with primary axillary hyperhidrosis.

© 2015 The Authors. Pediatric Dermatology Published by Wiley Periodicals, Inc.

Botox for headaches in children, teen and adults? 82% returned in year-2!

Common questions for me include response rate to botox and how much might it help?

A very useful article about the use of botox for migraine. 

Response rate was 82% in year-one!

In responders, consumption of medication reduced by 53%, er visits reduced 61%.

Adverse events were uncommon (14%) and transient


 2015 Sep;35(10):864-8. doi: 10.1177/0333102414561873. Epub 2014 Nov 27.

Long-term experience with onabotulinumtoxinA in the treatment of chronic migraine: What happens after one year?



OnabotulinumtoxinA (onabotA) has shown its efficacy over placebo in chronic migraine (CM), but clinical trials lasted only up to one year.


The objective of this article is to analyse our experience with onabotA treatment of CM, paying special attention to what happens after one year.


We reviewed the charts of patients with CM on onabotA. Patients were injected quarterly during the first year but the fifth appointment was delayed to the fourth month to explore the need for further injections.


We treated 132 CM patients (mean age 47 years; 119 women). A total of 108 (81.8%) showed response during the first year. Adverse events, always transient and mild-moderate, were seen in 19 (14.4%) patients during the first year; two showed frontotemporal muscle atrophy after being treated for more than five years. The mean number of treatments was 7.7 (limits 2-29). Among those 108 patients with treatment longer than one year, 49 (45.4%) worsened prior to the next treatment, which obliged us to return to quarterly injections and injections were stopped in 14: in 10 (9.3%) due to a lack of response and in four due to the disappearance of attacks. In responders, after an average of two years of treatment, consumption of any acute medication was reduced by 53% (62.5% in triptan overusers) and emergency visits decreased 61%.


Our results confirm the long-term response to onabotA in three-quarters of CM patients. After one year, lack of response occurs in about one out of 10 patients and injections can be delayed, but not stopped, to four months in around 40% of patients. Except for local muscle atrophy in two cases treated more than five years, adverse events are comparable to those already described in short-term clinical trials.
© International Headache Society 2014.


Chronic migraine; onabotulinumtoxinA