Seizures and Head Protection: BUYING A SEIZURE HELMET

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I often get a question about helmets for children with seizures. The scariest seizures are drop seizures or  astatic seizures but generalized tonic clonic seizures can also cause injury. Its important to realize that with or without a helmet;  on or off medicines... accidental injury is more common in people with epilepsy.
 JR


Seizures and Head Protection: BUYING A SEIZURE HELMET

The doctor or another health care professional has just advised you to buy a protective helmet because you have been having seizures which have been causing sudden drops or falls that may lead to head injury. But what type of helmet is best? And where you should you go to get one?

To determine the best type of helmet, begin by thinking about your seizure behaviors. If you fall forward, a helmet with a face guard, face bar, or visor is needed. If you fall backward, the back of your head needs protection. A good helmet also needs a chinstrap that can be adjusted so that it is snug but not uncomfortable. No matter what direction you fall, the helmet should absorb the impact, so it will be useless if it does not remain securely on the head.

Not all types of helmets offer adequate protection. Bicycle helmets are comfortable and good-looking, but they do not offer the best protection for injuries from seizure activity. Coverage is insufficient in the back and on the sides of the head. When seizures cause forward falls, they do not protect the face, and if they are not adjusted properly, they move too much. Longevity of the helmet is another problem. With repeated hard falls, a bicycle helmet may crack.

Boxing helmets, made of soft leather, are comfortable but they offer no protection and do not allow adequate ventilation. Football helmets offer good protection but are large and uncomfortable to wear. Baseball batting helmets are loose-fitting and are made without a chinstrap, so they offer inadequate protection.

Suitable helmets are commercially available through sporting good stores, medical supply companies, and the rehabilitation departments of some hospitals. Hockey helmets (CCM and Bauer) are one of the best choices. They offer maximal protection, come in a variety of colors, fit all age groups (except infants) and can be purchased and fitted in any sporting goods store.

Other helmets are made especially to protect people with medical needs, including very small children. Some of them come in choices of style or color that may be more appealing to those who don't want to look like a hockey player.

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Comparing old-fashioned leather and modern football helmets

A study comparing old-fashioned leather helmets and modern helmets found that modern helmets provide much more protection than leather helmets.

Researchers at the Center for Injury Biomechanics at Virginia Tech in Blacksburg, Virginia compared the relative safety afforded by two 1930-vintage leather football helmets and 10 modern football helmets during impacts to players' heads. These researchers found that all 10 modern helmets provided significantly more protection than leather helmets used in the first half of the twentieth century, and demonstrated that differences also exist between modern helmets.

Details on their methods and findings are found in "Biomechanical performance of leather and modern football helmets. Technical note," by Steven Rowson, a research assistant professor. Ray W. Daniel, a biomedical engineering graduate student, and Stefan M. Duma, professor and head of the Virginia Tech -- Wake Forest School of Biomedical Engineering, published today online, ahead of print, in theJournal of Neurosurgery.

The authors evaluated leather and modern football helmets by performing a series of 20 drop tests that represent a variety of impacts that could occur during a football game. An anthropometric head form was placed on an adjustable mount suspended from an overhead carriage. Each helmet in turn was placed on the head form, which was dropped in a controlled fashion from heights of 12, 24, 36, 48, and 60 inches onto a standardized anvil to simulate impacts delivered from blows to the head during play. The head form was placed in four different positions before impact simulation -- front, side, rear, and top according to which surface of the head form faced downward -- so that linear acceleration of the helmeted head form in each position could be measured.

Drop tests were used to measure the performance of two Hutch H-18 leather football helmets and 10 modern football helmets that differed in model, manufacturer, and 2011 Virginia Tech Helmet Rating™. The measures were: 5 stars, best available; 4 stars, very good; 3 stars, good, 2 stars, adequate; 1 star, marginal; and no star, not recommended.

Each modern helmet was subjected to all 20 drop tests (four impact locations at five drop heights). Each vintage leather helmet was subjected to 12 drop tests; the 48- and 60-inch drop tests were not undertaken because it was feared that accelerations from those heights might damage the head form when covered by vintage helmets. Drop testing of modern helmets was conducted during an earlier study, at which time the modern helmets were assigned star ratings. Drop testing of vintage helmets was undertaken for the present investigation.

The ten modern helmets were split into two groups: six helmets with a four- or five-star rating in the first group and four helmets with a three-star or lower rating in the second group. The two vintage helmets constituted a third helmet group. Based on the results of the drop tests, the researchers calculated each helmet group's average peak accelerations for each head form position and each drop height.

Rowson and colleagues found that vintage leather helmets were associated with substantially greater peak accelerations for each drop height than all modern helmets. In addition, the researchers found modern helmets reduced the concussion risk by 45 percent for the 24-inch drop height and 96 percent for the 36-inch drop height. Modern helmets with lower star ratings had greater peak accelerations for each drop height than modern helmets with higher star ratings, and the differences in peak accelerations between the two modern helmet groups increased with each increase in drop height. All comparisons were statistically significant at a level of p < 0.001.

The authors state that the purpose of the technical note is to provide insight as to how a previous study (Bartsch A et al. Impact test comparisons of 20th and 21st century American football helmets. Laboratory investigation. J Neurosurg 116:222-233, 2012) could find little difference between older and modern helmets with respect to head impact doses and head injury risks at the severity level of subconcussive injury.

Rowson and his coauthors state that they offer "biomechanical analysis based on helmet testing methodologies that compare relative helmet performance." The source of their disagreement with the Bartsch study centers on the different methods used by the authors of the two studies. Much of the discussion explains how differences in impact testing methodologies can influence the resulting data.

In an editorial companying the paper by Rowson and his colleagues ("Editorial. Leather football helmets," by Adam Bartsch, Edward Benzel, M.D., Vincent Miele, M.D., and Vikas Prakash, also published today online, ahead of print in the Journal of Neurosurgery, Bartsch and his colleagues defend the study they published in the Journal of Neurosurgery in 2012 and state that differences in results between the two studies are based on the different testing methodologies used by the two groups of researchers and the resulting head motions that were induced.

They state that their study simulated both linear and rotational head motion, whereas the drop test used by Rowson and colleagues provided mainly linear head motion. Bartsch and colleagues reiterate that their data demonstrated test conditions akin to common on-field impact scenarios, which cause both linear and rotational head motion. These researchers call for continued examination of experimental protocols that may lead to better quantification of helmet performance during simulated on-field conditions.

In their response to the editorial, Rowson and colleagues discuss points of difference and agreement between the two sets of researchers and their methodologies.

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Sleep Tips for Children and Teens

This article discusses good sleep habits for children and teenagers.

When it comes to good sleep habits, the old saying "early to bed, early to rise, make a person healthy,wealthy and wise," has never been truer.

 

May is designated as Better Sleep Month, a good time to review some good sleep habits for kids and teens. Mohsin Maqbool, M.D., Director of the Pediatric Neurology Sleep Center and Laboratory on staff at the DMC Children’s Hospital of Michigan offers the following tips.

 

• The amount of sleep needed for optimal brain development in children varies with age. Newborns sleep up to 20 hours per day. The sleep requirement decreases in toddlers down to 12 to 14 hours of nightly sleep with naps during the day.
• A child’s bedroom should be cool, quiet and comfortable. Children who stare at clocks should have their clocks turned away from them. Bedtime should follow a predictable sequence of events, such as brushing teeth and reading a story.
• Avoid spending lots of non-sleep time in bed — spending hours lying on a bed doing other activities before bedtime keeps our brains from associating the bed with sleep time.
• Going to bed in a timely manner, assuring sufficient sleep duration, is the key to getting up on time in the morning, refreshed.
• Keep consistent bedtimes and wake times every day of the week. Late weekend nights or sleeping-in can throw off a sleep schedule for days.
• Adolescents can benefit from a daytime nap. A short nap (20 to 30 minutes) in the afternoon has shown to improve physical efficiency and cognitive performance. The key here is that the nap should not be longer than 45 minutes or else grogginess kicks in.
• Avoid high stimulation activities just before bed, such as watching television, playing videogames, communication with friends, or exercise. It is especially important to avoid these acitivites during a nighttime awakening. It is best not to have videogames, televisions, computers or phones in the child’s bedroom.
• Avoid caffeine (sodas, chocolate, tea, coffee) in the afternoons/evenings. Even if caffeine doesn’t prevent falling asleep it can still lead to shallow sleep or frequent awakenings. Caffeine should be avoided within 4 to 6 hours of bedtime.
• If a child is awake in bed tossing and turning, it is better for them to get out of bed to do a low stimulation activity, (i.e., reading) then return to bed later. This keeps the bed from becoming associated with sleeplessness. If the child is still awake after 20 to 30 minutes, spend another 20 minutes out of bed before lying down again.

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Treatment differences between boys and girls with autism

This article discusses how autism is different in boys and girls and what this means for their treatment options.

With four to five times more males affected by autism spectrum disorders than females, much less is known about girls with autism.

Fortunately, more research is beginning to focus on autism in girls, said Geraldine Dawson, chief science officer of Autism Speaks, with two such studies set to be presented Saturday at the International Meeting for Autism Research in San Sebastian, Spain.

"Autism affects boys much more frequently than girls. But, we may be missing some girls. The diagnostic criteria were developed using symptoms in boys, and symptoms in girls and boys may be different," Dawson explained.

"Because of this difference in incidence, researchers may end up with a small number of girls in studies," she said, adding that differences in symptoms or reactions to treatments may lead to the girls' data being excluded from studies. But, it's just those differences that may really need to be researched, to make sure girls are being diagnosed and treated correctly.

"Other neuropsychiatric disorders have already made the discovery that symptoms can be different in girls and may require different treatments for girls," said Dawson, who is also a research professor in the department of psychiatry at the University of North Carolina, Chapel Hill. One such example is attention-deficit/hyperactivity disorder. Girls tend to be less hyperactive than boys, and may instead appear as if they're daydreaming.

In the latest autism research, the first study compared visual scanning patterns in boys and girls with autism spectrum disorders. Scanning patterns were also collected for typically developing children.

"We used eye-tracking technology while the participants in these studies watched videotapes of social scenes that presented naturalistic stimuli," said study co-author Ami Klin, director of the Marcus Autism Center, in Atlanta.

The study, which was led by Klin's student, Jennifer Moriuchi, included 116 school-aged children with autism spectrum disorders. Eighty-one were boys and 35 were girls. The children with autism had varying degrees of social disability. The study also included 36 typically developing children.

"On a surface level, it appears that boys and girls with autism appear to spend equal time learning from the eyes. They did look less than other children," Klin said. But, when the researchers correlated the youngsters' eye tracking with their level of disability, a much different picture emerged.

"In boys, the more they looked at the eyes, the less socially disabled they are. In girls, the more they looked at the eyes, the more disabled they are," said Klin, chief of the division of autism and related disorders at Emory University School of Medicine and Children's Healthcare of Atlanta.

"What the study is suggesting is that we should not automatically assume that boys and girls learn about the world in the same way," Klin said, adding, "we have to take gender as a mediating factor."

Dawson said "the study found that there are differences in the way girls and boys look at the eyes, so there may be differences in the way autism is manifested in girls than in boys." She noted that an important criterion right now for diagnosing autism is a lack of eye contact and using the eyes for social cues.

The second study looked at the genetics involved in autism, and potential differences in boys and girls. Yale University researchers analyzed samples from 2,326 families. Included in those samples were those of 2,017 boys and 309 girls with an autism spectrum disorder.

The Yale team found differences between the boys' and girls' genetic samples.

"The fact that autism does affect boys so much more frequently has been staring us in the face for decades. There's been a hypothesis that there's something in the extra X chromosome that girls have that may be protective," Dawson explained. "The idea is that if you have this protective mechanism in place you may need more risk factors to overwhelm that protective effect and cause autism, and that's exactly what they found."

"To develop autism in a girl requires more genetic mutations," Dawson said. The type of mutations they found are called "de novo" mutations, she added. This means that the genetic change occurs in the sperm or the egg. It isn't a gene that's passed down from the parents. These mutations can occur randomly, or they can be caused by an environmental trigger.

Because these studies are being presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

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Genetic cause found for severe childhood epilepsies

The genetic cause of severe epilepsies in children was found. This could result in better treatment options for children with similar genetic causes of epilepsy.

Researchers at the University of Arizona have successfully determined the genetic mutations causing severe epilepsies in seven out of 10 children for whom the cause of the disorder could not be determined clinically or by conventional genetic testing.

Instead of sequencing each gene one at a time, the team used a technique called whole-exome sequencing: Rather than combing through all of the roughly 3 billion base pairs of an individual's entire genome, whole-exome-sequencing deciphers only actual genes, and nearly all of them simultaneously.

"My initial hope was that we would find something in one out of the 10 children in our study. But a 70 percent success rate is beyond anyone's imagination," said study leader Michael Hammer, who is a research scientist in the UA's Arizona Research Labs Division of Biotechnology and a member of the UA BIO5 Institute.

For Hammer, the research hit very close to home. Just last year, his lab tracked down the mutation that had caused the severe -- and ultimately fatal -- epilepsy in his teenage daughter.

"I figured, if we could do this for one child, we could do it for others." Hammer explained. "These are children who have had every test imaginable and tried every possible drug combination, and nobody has figured out where their seizures come from and how to stop them."

The children who participated in the study, published online in the journal Epilepsia, all suffered from severe seizure disorders, and most of them started having seizures within the first year or two after birth.

Unlike individuals afflicted with epilepsy later in life, many of whom can live normal lives with the right medical oversight and medications, early-onset epilepsy can be devastating. Children often develop other severe complications such as intellectual disability, autism and loss of muscle tone or coordination. Early death is not uncommon.

"Because their seizures are not well controlled, and that firestorm of electrical activity in the brain is bad for brain development, the damage can be extensive," added Linda Restifo, a professor in the UA department of neurology and a BIO5 member who co-authored the study. "The earlier the seizures start and the more severe and frequent they are, the more likely they are to leave the child with permanent developmental disability."

"The sooner we can catch problems in children and understand what is causing them, the better the chance we have to try and correct them," Hammer added.

To identify changes in the DNA that are the most likely cause of the disorders, the team focused on a class of mutations called de novo mutations: "typos" in the DNA sequence that are present only in the child. In order to find such mutations, the study included both parents and their child.

Overall, the team found 15 mutations in nine children, seven of which are known or likely to cause epilepsy. No mutations could be found in one of the children.

"In four of the patients. we found mutations that were already known to be associated with epilepsy," said Krishna Veeramah, a postdoctoral fellow in Hammer's group and the study's first author. "However, three patients had mutations in genes that were not previously associated with epilepsy in humans but presented plausible explanations for the disorder."

"The fact that we found three genes -- in a study involving only 10 subjects -- that had never been implicated in epilepsy before suggests that many more genetic defects related to developmental brain disorders remain to be discovered," Veeramah said.

One of the participants in the study was Ashley Wilhelm, a 14-year-old girl from Phoenix, Ariz., whose seizures started when she was only 5 months old. Her first seizures appeared to be triggered by fever, leading doctors to believe they were just that -- a side effect of the fever.

"But she soon began to have more and more seizures, and they would last half an hour or longer," said her mother, Ann. "We had all sorts of tests done, but the doctors kept saying her brain was normal, and that they didn't see any reason she'd have those seizures."

Ashley, whose development has severely suffered as a consequence of the repeated seizures, was enrolled in the study through her neurologist, Dinesh Talwar, who co-authored the paper.

Even though her treatment is unlikely to change with the new information, the family said the results brought "more relief than we can explain."

"Since insurance wouldn't pay for the testing, and we couldn't afford it on our own, we were very grateful we were able to participate in the study," said Jeff Wilhelm, Ashley's father. "If such a test could be done much earlier, it would ease the pain for everyone involved. What if our son had decided not to consider having children of his own out of concern they might have the disorder?"

"The results from this study have at last given us a breakthrough," said the mother of another participating teenager. "We had pursued every possible avenue to understand what might be responsible for his epilepsy -- magnetic resonance imaging, CT scans, searches for gross chromosome abnormalities or markers associated with epilepsy -- with no success."

"Although the discovery doesn't yet give us a treatment, it gives us hope for finding one," she said. "As more research is done on this mutation, drugs to control our son's seizures will be identified. If more children with epilepsy can be studied and families with children with similar mutations can organize and share resources, there will be more progress."

Hammer said the approach is applicable to other conditions in which conventional genetic testing has failed to reveal the cause.

"Our work bridges research and clinical practice," he added. "We can sequence all the genes in your genome in a matter of days and report it to the patient's family and the physician. That may make a difference in the treatment and management of the disorder in question."

Centers with the capabilities to do this kind of analysis are few and far between.

"Other centers that do this kind of work will sequence your genome and tell you where and what the mutation is in the DNA sequence, but it's not that simple," Hammer said. "In most cases, we find a mutation in a gene not previously known to cause disease, so we need to perform a follow-up study to find out what that mutation actually does."

To perform these follow-up studies, the UA team has established collaborations with leading scientists at the UA and at other institutions.

"Right now, the benefit to families is primarily to get answers," said Restifo. "The long-term goal is to collect this kind of information from more children, which will hopefully lead to new research into medications that improve brain development and function."

Hammer added: "In the meantime, a molecular diagnosis provides immediate relief to the unnecessary guilt parents might feel for their role in causing their child's suffering. They want answers, not endless doctors visits and tests with negative results, or to have their hopes raised and dashed over and over."

Encouraged by the success of their approach so far, Hammer and his colleagues already have bigger plans.

"We hope to involve other clinical areas such as cardiology, immunology, gastroenterology -- anything that we can apply molecular diagnostics or clinical genomics to at the UA, we want to explore. We want to make the University the core for clinical diagnostics using new sequencing technologies for at least the entire Southwest."

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Health link between the heart and the brain

This article discusses the link between risk factors of heart disease and declining brain function.

Heart disease risk factors can lead to a decline in brain function in both younger and older adults, Dutch researchers report.

The new study included nearly 3,800 people, aged 35 to 82, who were checked for heart disease risk factors such as smoking, diabetes and high levels of "bad" cholesterol, and given tests to assess their memory and mental skills such as the ability to plan and reason and to begin and switch tasks.

Those with the highest risk for heart disease did 50 percent worse on the mental tests than those with the lowest risk. Two heart disease risk factors -- smoking and diabetes -- were especially associated with poorer brain function, according to the study in the May 2 issue of the journal Stroke.

The link between heart disease risk factors and reduced brain function was seen in all age groups, the investigators noted.

"Young adults may think the consequences of smoking or being overweight are years down the road, but they aren't," study author Dr. Hanneke Joosten, a nephrology fellow at the University Medical Center in Groningen, the Netherlands, said in a journal news release.

"Most people know the negative effects of heart risk factors such as heart attack, stroke and [kidney] impairment, but they do not realize it affects cognitive [mental] health. What's bad for the heart is also bad for the brain," Joosten added.

She said doctors need to be aware of this link between heart disease risk factors and brain function decline, and more public action is needed to reduce heart disease risk factors.

"Smoking cessation programs might not only prevent cancer, stroke and cardiovascular events, but also cognitive [mental] damage," Joosten said.

The association between heart risk factors and poorer brain function seen in the study does not prove a cause-and-effect relationship.

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High school athletes claim they will continue to play with a concussion

A study of high school football players show that they would continue playing football after a concussion.

Many high school football players say it's OK to play with a concussion even though they know they are at risk of serious injury, according to a study to be presented Monday, May 6, at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC.

The study of 120 high school football players in the Cincinnati area also found that one-quarter had suffered a concussion, and more than half acknowledged they would continue to play with symptoms of a concussion.

"These attitudes could leave young athletes vulnerable to injury from sports-related concussions," said study co-author Brit Anderson, MD, pediatric emergency medicine fellow at Cincinnati Children's Hospital Medical Center.

Dr. Anderson and her colleagues administered two surveys to the athletes to measure their knowledge of concussions and symptoms as well as their attitudes about playing after a head injury.

Survey results showed that 70 percent of the players had been educated about concussions, and most could identify common signs and symptoms. Headache was identified as a symptom by 93 percent, dizziness by 89 percent, difficulty remembering and sensitivity to light/sound by 78 percent, difficulty concentrating by 76 percent and feeling in a fog by 53 percent.

While 91 percent recognized a risk of serious injury if they returned to play too quickly, only half would always or sometimes report their concussion symptoms to their coach.

"Despite their knowledge, many athletes in our sample reported that they would not tell their coach about symptoms and would continue to play," Dr. Anderson said. "A small percentage even responded that athletes have a responsibility to play in important games with a concussion."

The researchers found no association between a student's knowledge score and attitude score on the surveys. "In other words, athletes who had more knowledge about concussions were not more likely to report symptoms," Dr. Anderson said.

"Although further study needs to be done," she concluded, "it is possible that concussion education alone may not be enough to promote safe concussion behaviors in high school football players."

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