Computerized Tests For Concussions May Be Unreliable

Concussion testing is a neuropsychological test. Schools are collecting this data on children at baseline often using non-standard methods.  I have been advocating using post-concussive testing as one component of an expert medical examination. The results must be interpreted in light of the individuals neurologic examination.  Are you going to trust your child's brain to a computer program alone?  JR

Schools worried about concussions increasingly use computerized tests to tell if a student athlete has a brain injury. But new research says those tests aren't reliable enough to diagnose concussion, or to tell if it's safe to return to play.

The researchers looked at research on one computerized neuropsychologist test, called ImPACT, that is widely used by colleges and high schools. (Here's one NPR story on how high schools use ImPACT to assess concussions.)

It's also used by the National Football League and National Hockey League.

But very few studies have been done on the reliability of these tests in real-world situations.

So Lester Mayers, a sports medicine doctor at Pace University in Pleasantville, N.Y., and Tom Redick, an assistant professor of psychology at Indiana University-Purdue University in Columbus, Ind., surveyed the data. They weren't happy with what they found. They say computerized tests aren't reliable enough to serve as the sole measure of brain health.

"I'm not suggesting abandoning the whole practice," Redick told Shots. "But I do think that we want to be sure we're not using something just because it's popular." Theirwork is published in the current Journal of Clinical and Experimental Neuropsychology.

One issue with the computerized testing is the length of time that passes from when a healthy athlete takes a baseline test, and when they're tested after a suspected concussion.

After a few weeks, the test becomes increasingly unreliable, the review found. That's an issue because the manufacturers recommend testing athletes twice in high school, and once in college. "This increases the likelihood that a true cognitive impairment will be missed," the authors write.

Another issue is how reliable the tests are in determining when it's safe for an athlete to return to play without risking further brain damage. Just three studies looked at that. Those studies were very small, and the results inconsistent, the authors report. They write:

"We therefore question the rationale of using ImPACT for clinical management of sport-related concussion and specifically for determining the time of return to play."

There is no gold standard for figuring out when an athlete is safe to return to play, Redick says, which makes it hard for coaches, parents, and athletes to know what to do. But computerized testing is not the solution to that problem.

The U.S. military has invested millions into computerized testing service members for traumatic brain injury, but that program has been a debacle, according to aninvestigative report last November by NPR and ProPublica. Researchers say the computerized test used, called ANAM, isn't robust enough to screen for problems that could continue weeks or months after a brain injury.

Last August, the American Academy of Pediatrics said that parents shouldn't let children box, urging parents to recommend sports "that do not encourage intentional head injuries."

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Irregular Sleep Could Weaken Your Immune System

I frequently see one symptom of disrupted sleep as frequent colds...JR


We have all heard about just how important sleep is for our bodies. Not only is it necessary for us to function, but it also plays an important role on our weight and metabolism, our mood, our cardiovascular health, and disease . The frightening side effects of sleep deprivation are only compounded by the fact that a many Americans are sleep deprived. According to the National Sleep Foundation (NSF), 40 million Americans suffer from some type of sleeping disorder, with 60% of adults saying that they do have sleep problems a few nights a week, if not more.

But do we do anything to help cure our insomnia or our sleep problems? Not really.

Perhaps the newest study to come out of the journalImmunity this week will have people taking their sleep a whole lot more seriously than they have before. Now we’ve all heard about our circadian rhythm and we’re aware that our body functions on a 24 hour cycle. While it’s been proven that this rhythm and how we follow it does affect things like our metabolism and memory, researchers at the Yale School of Medicine in the United States have now been able to prove that sleep – or lack thereof – can influence our vulnerability to disease.

Lab mice were used to conduct the study. Dr Erol Fikrig, a professor of epidemiology and microbial pathogenesis at Yale, along with his colleagues, found that the circadian clock in mice was controlled by the “Toll-like receptor 9” (or TLR-9). This gene is incredibly important for our immune system as it reacts any presence of DNA from harmful bacteria and viruses.

What was discovered was that the mice had the strongest response to vaccinations, and the highest ability to resist any infection, when their expression levels of TLR-9 were also at their highest point. And in order for the TLR-9 to be at its highest point, the mice needed to have a decent amount of sleep.

This has raised a lot of questions about how sleep deprivation and sleep problems may affect human health. One observation that researchers find to be significant is the fact that septic human patients are most likely to die between 2 and 6am, possibly when their sleep is disturbed. Fikrig made the comment that the “… sleeping patterns of patients in intensive care are often disrupted because of the noise and prolonged exposure to artificial light… it will be important to investigate how these actors influence immune system response.”

The study could have very important implications on how we both prevent and treat diseases. Rather than reach for a pill, perhaps a darkened, quiet room that allows one to ease into sleep would be better treatment. Maybe sleep plays a far larger role on our immunity than we even realize. The study has unveiled a new, direct molecular link between the body clock and our immunity, thus opening up a pathway to explore all new therapies that could help treat and even cure disease.

Read more: http://www.healthenclave.com/news/irregular-sleep-could-weaken-your-immune-system-1480.html

Epi-Pen to Stop Epileptic Seizures?

I used these devices in the military. Its about time that EMS had a better approach. JR


The longer an epileptic seizure lasts, the more likely it is to turn deadly.

Besides administering an oral or anal gel suppository – which can be difficult to give successfully in the midst of a seizure – caregivers are at a race against time, with little to do but wait for paramedics to arrive.

But researchers through the National Institute of Neurological Disorders and Stroke, a branch of the National Institutes of Health, say creating an injectible pen to stop seizures -- much like the popular EpiPen used widely for treating acute allergic reactions - may prove to be a lifesaver.

In a new study, published Wednesday in the New England Journal of Medicine, researchers found that injecting emergency anti-seizure medication into the muscle can stop prolonged seizures -- those seizures that last for five minutes or longer -- faster than if it were administered through an IV line administered by a paramedic.

Nearly 900 patients with epilepsy who experienced seizures lasting longer than five minutes, either were given a shot in the muscle with the anticonvulsant midazolam by paramedics, or the standard IV line of the anticonvulsant drug lorazepam.

On average, the seizures were shorter for those patients who were administered a shot of midazolam directly into the muscle, lasting just 1 1/2 minutes after the medication was injected. Patients who received anticonvulsant drugs by IV drip, by contrast, suffered longer seizures, which continued on average for as long as five minutes before the treatment took effect.

Nearly 55,000 people die each year from prolonged seizures, according to Dr. Robert Silbergleit, emergency physician at the University of Michigan Health System, and lead author of the study.

"It's difficult to start an IV in somebody who's having convulsions, who's shaking, and that difficulty can cause a delay in getting the IV started, which can cause a delay in stopping the seizure," said Silbergleit. "And it can also be a safety hazard for the paramedic who's got a sharp object and a shaking patient," he said.

Although paramedics administered the shot to patients in the study, the findings could pave the way for a shot that can be administered by caregivers before paramedics even arrive, according to Dr. Jason McMullan, assistant professor of clinical emergency medicine at the University of Cincinnati and co-investigator of the study.

"The earlier they are treated, the sooner the seizure will stop, the easier it will be to control and the better the outcome," said McMullan.

The study enrolled adults and children as young as 2 years old.

"Most seizures stop on their own without any type of medication," said McMullan, adding that the findings only apply to those who have prolonged seizures, known as status epilepticus.

Read more: http://abcnews.go.com/Health/Wellness/epi-pen-epileptic-seizures-researchers-step-closer/story?id=15646106#.Tz6KR3K3DlM