Study: No proof that medications ease migraines in children

A recent study showed that many medications that adults use to ease migraines may not have any effect on children with migraines. In fact, the placebos seemed just as effective as the medications in children.

Medicines to prevent or treat migraines in adults aren’t effective in stopping the headaches in children, according to two studies that suggest doctors may want to re-evaluate the use of the drugs in pediatric patients.

An analysis of 21 trials published in JAMA Pediatrics showed that Johnson and Johnson’s seizure medicine Topamax and the antidepressant trazodone “have limited evidence” to support use in children’s migraines occurring fewer than 15 times a month. Other drugs, including some medicines for hypertension are no better than a placebo, the research found.

About 8 million kids, or 1 of 20 in the U.S., get migraines, according to Jacksonville, Florida-based Nemours, a nonprofit children’s health organization. The results show that more studies are needed to look at the use of adult migraine medicines in kids and what role placebos have in helping children and adolescents, researchers said

“Pediatric clinical trials are different than trials conducted in adults for many reasons,” William Rodriguez, Pediatric Science Director of the Food and Drug Administration Office of Pediatric Therapeutics, said in an e-mail. “One of the issues is that a failed pediatric trial seldom motivates a sponsor to conduct additional pediatric trials. This is in contrast to what happens with failed adult trials. It has to do with the fact the sponsor is usually much more interested in the adult market as the pediatric populations with diseases are small.”

FDA Analysis

Rodriguez was an author on a second analysis by the FDA of trials of children given a commonly used class of migraine drugs called triptans. It found that many children got better without the medication.

In the first study from the Medical College of Wisconsin in Milwaukee, the researchers analyzed 21 trials of migraine medicines that included children and adolescents. Of those, 13 included a group that received a placebo rather than study drug.

They found that Topamax and trazodone reduced episodic migraines more than placebo, less than one headache a month when compared to placebo, while clonidine, for high blood pressure; flunarizine, a calcium channel blocker; pizotifen, a migraine drug; propranolol, for high blood pressure; and valproate, an anticonvulsant, were no more effective than placebo.

The analysis also showed that children taking a placebo, rather than the study drugs, reduced their migraines by an average of about three headaches a month. The high placebo response suggests more studies of pediatric headaches should include a placebo group, the authors said.

Few Studies

“There were surprisingly few studies on treating headaches in children, particularly compared to the hundreds that have been done in adults,” said Jeffrey Jackson, a study author and professor of medicine at the Medical College of Wisconsin, in a Jan. 28 e-mail. “Most of the drugs that are effective in adults do not have evidence of effectiveness in children.”

The FDA analysis found that high placebo response rates were consistent across the migraine trials studied and pose a challenge to those who design the research. When putting together clinical trials, researchers need to take into account those children who feel better after taking a placebo.

“These studies clearly demonstrate why we cannot assume what works in adults will work in kids and why children need their own studies,” Rodriguez said. “There are many -- over 50 percent in most studies -- of children who do not need a drug for the migraine to resolve in a couple of hours. Drug therapy appears to be effective in a certain subset of children with migraine.”

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Yoga may help with depression and sleep problems

A review of studies on yoga shows that yoga may benefit those with depression and sleep problems. People with ADHD or schizophrenia may also benefit.

Some people with certain psychiatric conditions may benefit from yoga, according to a new review.

The review, which examined results from 16 well-designed studies of yoga's effect on mental illness, concluded that yoga may have positive effects for people with depression and sleep complaints even if they don't take medication, as well as for people suffering from schizophrenia and ADHD who are taking medication.

However, the review did not find a benefit for people with eating or cognitive disorders.

Studies that have looked at yoga suggest the practice influences chemical messengers in the brain, inflammation in the body, and other biological factors in much the same way antidepressants and psychotherapy do, said study researcher Dr. P. Murali Doraiswamy, a professor of psychiatry and medicine at Duke University Medical Center in. [See The Science of Yoga and Why It Works.]

However, the studies in the review had limitations. Most of the studies on depression included patients with mild depression, so it's not clear if the results will apply to those with more severe forms of the disorder. Also, in many of the studies, people performed yoga in groups, and it's difficult to separate the effect of yoga from that of social interaction, Doraiswamy said.

In one study of 69 older adults with mild depression, weekly yoga sessions reduced depression scores by 40 percent at six months. A comparison group of adults who didn't take yoga, and a group that practiced a form of complementary medicine called Ayurveda, did not show changes in depression scores.

In another study of 39 adults who were sleeping poorly (they were receiving chemotherapy), seven weeks of yoga improved sleep quality and reduced the need for sleep aids. People who did not take the yoga sessions (control group) did not have an improvement in sleep.

The National Center for Complementary and Alternative Medicine (NCCAM) says people should not  replace conventional medical care with yoga. Nor should people who practice yoga postpone seeing a health care provider. Patients should tell their doctor about any complementary health practices they use. Anyone with a medical condition should check with a health care provider before starting yoga, NCCAM says.

Pass it on: Yoga may have positive effects for people with depression, complaints, schizophrenia or ADHD.

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Prenatal Inflammation Related to Autism Development

A new study claims that prenatal inflammation may be related to the development of autism.

Maternal inflammation during early pregnancy may be related to an increased risk of autism in children, according to new findings supported by the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health. Researchers found this in children of mothers with elevated C-reactive protein (CRP), a well-established marker of systemic inflammation.

The risk of autism among children in the study was increased by 43 percent among mothers with CRP levels in the top 20th percentile, and by 80 percent for maternal CRP in the top 10th percentile. The findings appear in the journal Molecular Psychiatry and add to mounting evidence that an overactive immune response can alter the development of the central nervous system in the fetus.

"Elevated CRP is a signal that the body is undergoing a response to inflammation from, for example, a viral or bacterial infection," said lead scientist on the study, Alan Brown, M.D., professor of clinical psychiatry and epidemiology at Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, and Mailman School of Public Health. "The higher the level of CRP in the mother, the greater the risk of autism in the child."

Brown cautioned that the results should be viewed in perspective since the prevalence of inflammation during pregnancy is substantially higher than the prevalence of autism.

"The vast majority of mothers with increased CRP levels will not give birth to children with autism," Brown said. "We don't know enough yet to suggest routine testing of pregnant mothers for CRP for this reason alone; however, exercising precautionary measures to prevent infections during pregnancy may be of considerable value."

"The brain develops rapidly throughout pregnancy," said Linda Birnbaum, Ph.D., director of NIEHS, which funds a broad portfolio of autism and neurodevelopmental-related research. "This has important implications for understanding how the environment and our genes interact to cause autism and other neurodevelopmental disorders."

The study capitalized on a unique national birth cohort known as the Finnish Maternity Cohort (FMC), which contains an archive of samples collected from pregnant women in Finland, where a component of whole blood, referred to as serum, is systematically collected during the early part of pregnancy. The FMC consists of 1.6 million specimens from about 810,000 women, archived in a single, centralized biorepository. Finland also maintains diagnoses of virtually all childhood autism cases from national registries of both hospital admissions and outpatient treatment.

From this large national sample, the researchers analyzed CRP in archived maternal serum corresponding to 677 childhood autism cases and an equal number of matched controls. The findings were not explained by maternal age, paternal age, gender, previous births, socioeconomic status, preterm birth, or birth weight. The work was conducted in collaboration with investigators in Finland, including the University of Turku and the National Institute for Health and Welfare in Oulu and Helsinki.

"Studying autism can be challenging, because symptoms may not be apparent in children until certain brain functions, such as language, come on line," said Cindy Lawler, Ph.D., head of the NIEHS Cellular, Organ, and Systems Pathobiology Branch and program lead for the Institute's extramural portfolio of autism research. "This study is remarkable, because it uses biomarker data to give us a glimpse back to a critical time in early pregnancy."

This work is expected to stimulate further research on autism, which is complex and challenging to identify causes. Future studies may help define how infections, other inflammatory insults, and the body's immune response interact with genes to elevate the risk for autism and other neurodevelopmental disorders. Preventative approaches addressing environmental causes of autism may also benefit from additional research.

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Mouth Guard to help with Sleep Apnea

A new mouth guard could replace CPAP for people who have mild to moderate sleep apnea.

Debbie Blenis doesn’t know yet if she has obstructive sleep apnea, but the Palm Bay woman knows all about the subject.

“My father has sleep apnea, and I understand what that can be like,” she said. “When he finally saw the doctor about it ... he was told he was a stroke waiting to happen.”

So, knowing sleep apnea runs in her family, aware of the dangers and already possessed of two of its classic symptoms, bruxism (grinding of the teeth) and snoring, she has agreed to be tested for the condition by her dentist, Dr. Lori Nelson of Ultimate Smile Design in Palm Bay.

Nelson and other dentists screen, and now, collaborating with sleep medicine specialists, treat patients for the potentially life-threatening disorder that causes breathing to stop during sleep.

So important is the subject to dentistry that the American Academy of Dental Sleep Medicine, a nonprofit professional society founded in 1991, has more than 2,800 members nationwide and is growing. It and other professional organizations, including the American Dental Association, now offer courses to better acquaint dentists with sleep medicine.

Last year, Dr. Gail Demko, president of AADSM and expert adviser to the Food & Drug Administration in oral appliance therapy, told the publication Dentistry IQ(dentistryiq.com) that dentists are particularly well-equipped to handle “sleep-disordered breathing.”

Once, sleep medicine was strictly the province of specialist physicians who tested and treated apnea and related conditions, often prescribing use of sometimes-cumbersome continuous positive airway pressure devices, which use mild air pressure to keep airways open while patients are sleeping. It involves wearing a mask or other device that fits over the nose and mouth, which is connected by tube to a machine that blows air into the airways.

Patients determined by their physicians to have severe cases of apnea still are prescribed CPAP treatment, but a patient with mild to moderate sleep apnea now may be fitted by his or her dentist with a small, custom-fitted, mouth guardlike appliance that maintains an open, unobstructed airway during sleep.

“The device, which is worn while sleeping, repositions the mandible (lower jaw), so that the airway remains open,” said Nelson, who has practiced dental sleep medicine since 2006.

But it is not simply a matter of fitting a mouthpiece. Potential wearers must first undergo testing and studies, and the dentist’s work is done in conjunction with the doctor’s.

“The important thing to convey is that a dentist cannot treat these conditions alone,” said Dr. Duongvannak Keo, who practices dentistry on Merritt Island. “We’re not allowed to diagnose sleep apnea, we only screen our patients for it. Then, we can treat them based on a physician’s referral and recommendation.”

But dentists, because of their training and the very nature of their profession, do notice the signs.

“The clinical aspect of treating sleep-disordered breathing, be it snoring or sleep apnea, requires basic skills that have been taught to dentists in their restorative dental training. The most important aspect is the academic knowledge required to become part of a team that is treating a medical disease,” Demko said.

It is less a procedure than a process, dentists add.

“We are looking for signs of dental disease, no doubt, but we’re also looking at a patient’s bite and its possible effect on his or her overall health,” Nelson said.

That means questions about sleeping habits as well as teeth.

Nelson said that when a patient reports he or she is not sleeping well, the Epworth Sleepiness Scale, which measures daytime sleepiness by asking a patient to rate his or her likelihood of falling asleep, is used at Ultimate Smile Design, followed by checks of oral and nasal airways.

“If we see something that possibly indicates sleep apnea, we will order a sleep study, coordinated with the patient and his or her physician,” she said.

Keo agreed: “We guide them through the process and refer them to a sleep physician.”

Only after mild to moderate sleep apnea is diagnosed will the dentist recommend the new device.

“A pharyngometer is used to measure the pharyngeal airway size to assess the patient for obstruction, so when the patient is fitted, (the jaw) is in a scientifically specified position,” Nelson said. “And we do confirm things with another sleep study, which we have read by a certified sleep medicine physician.”

Thus, physicians and others who work with sleep apnea patients in the traditional, medical setting say they welcome the involvement of dentists, who may be the first practitioners to notice potential problems

“We work primarily with Dr. Keo, who is certified (in dental sleep medicine and oral appliance therapy),” said Kristina Weaver, sleep center supervisor for Parrish Medical Center in Port St. John. “We will do a sleep consultation and a sleep study, and if the patient has mild sleep apnea, he does the consultation. He makes the mold, and he fits the patient with the device.”

Patients should not expect, however, that the dental device will work on all sleep apnea patients.

“These devices are intended primarily for people with mild sleep apnea,” Weaver said. “The CPAP still is always the first alternative, because we know without a doubt that it will correct the problem. (The mouthpiece) is not as good as the CPAP, but if the apnea is mild, it may help.”

Keo, who estimates he has made about 100 oral appliances for sleep apnea patients, called them “devices for people who cannot tolerate CPAPs; people who are looking for alternatives,” and referred to the CPAP as “the gold standard.”

Furthermore, dentists who screen patients for possible sleep apnea are by no means attempting to usurp anything from physicians.

“We tell every physician, ‘Look, I’m not taking your patient, I’m just screening for problems that you can help with. I’m not taking your patients, I’m giving you patients.’ ”

Most physicians don’t realize that such appliances even exist, he added, and so the dentist becomes a source of information as well.

“I think this is the way of the future,” Nelson said. “This is where medicine and dentistry are headed: working together for the good of our patients.

Blenis couldn’t agree more.

“I absolutely think sleep apnea is life-threatening,” she said. “It’s easy to ignore, especially if you don’t sleep with a partner who would notice that you are snoring loudly, or that your breathing has stopped. ... I feel a lot of comfort in that my dentist is watching out for my overall health and not just my teeth.”

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Study: Alcohol is bad for your sleep

A new study shows that drinking alcohol before bed is bad for your quality of sleep by reducing the amount of REM sleep.

Think a nightcap may help you get a better night’ssleep?

Think again.  

A new review of 27 studies shows that alcohol does not improve sleep quality. According to the findings, alcohol does allow healthy people to fall asleep quicker and sleep more deeply for a while, but it reduces rapid eye movement (REM) sleep.

And the more you drink before bed, the more pronounced these effects. REM sleep happens about 90 minutes after we fall asleep. It's the stage of sleep when peopledream, and it's thought to be restorative. Disruptions in REM sleep may cause daytime drowsiness, poor concentration, and rob you of needed ZZZs.

“Alcohol may seem to be helping you to sleep, as it helps induce sleep, but overall it is more disruptive to sleep, particularly in the second half of the night,” says researcher Irshaad Ebrahim. He is the medical director at The London Sleep Centre in the U.K. “Alcohol also suppresses breathing and can precipitate sleep apnea,” or pauses in breathing that happen throughout the night.

The more a person drinks before bed, the stronger the disruption. One to two standard drinks seem to have minimal effects on sleep, Ebrahim says.

Alcohol Is Not a Sleep Aid

“The immediate and short-term impact of alcohol is to reduce the time it takes to fall asleep, and this effect on the first half of sleep may be partly the reason some people with insomnia use alcohol as a sleep aid,” Ebrahim says. “However, this is offset by having more disrupted sleep in the second half of the night.”

“Alcohol should not be used as a sleep aid, and regular use of alcohol as a sleep aid may result in alcohol dependence,” he says.

The findings will appear in the April 2013 issue of Alcoholism: Clinical & Experimental Research.

Alcohol tricks people into thinking they are getting better sleep, says Scott Krakower, DO. He is an addiction specialist at North Shore-LIJ in Mineola, N.Y. “People who drink alcohol often think their sleep is improved, but it is not.”

REM is the more mentally restorative type of sleep, says Michael Breus, PhD, a sleep specialist in Scottsdale, Ariz. “Alcohol is not an appropriate sleep aid. If you rely on alcohol to fall asleep, recognize that you have a greater likelihood to sleepwalk, sleep talk, and have problems with your memory.”

If you are having trouble sleeping, talk to your doctor about how to improve your sleep quality. He or she may be able to rule out underlying sleep disorders like sleep apnea and suggest appropriate sleep aids.

Better sleep habits can also help. Some tips to improve sleep habits include:

• Get regular exercise, but no later than a few hours before bed.
• Avoid caffeine, alcohol, or nicotine in the evening.
• Reserve the bed for sleeping and sex only.
• Keep your bedroom at a cool temperature.
• Set regular wake and bed times.

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Migraine Triggers may not directly cause Migraines

Research has shown that migraine triggers may not be to blame for causing migraine headaches.

People who suffer from migraines often try to avoid potential triggers like bright or flickering lights or vigorous exercise. But, new research suggests that these events may not cause the painful and debilitating headaches.

"People with migraine with aura are told to avoid possible triggers, which may lead them to avoid a wide range of suspected factors," said study author Dr. Jes Olesen, with the University of Copenhagen in Denmark and a Fellow of the American Academy of Neurology, in a press release. "Yet the most commonly reported triggers are stress, bright light, emotional influences and physical effort, which can be difficult to avoid and potentially detrimental, if people avoid all physical activity."

Migraine with aura is a migraine which normally occurs with sensory warning signs like flashes of light, blind spots or tingling in your hands and face, according to the Mayo Clinic. "Aura" refers to a group of symptoms, including vision disturbances, that are a warning sign that the bad headache is coming.

A recent study showed that women who suffer from migraines with aura are at a greater risk for heart problems and blood clots.

For the study, researchers looked at 27 people who had migraines with aura who believed that bright or flickering lights, vigorous exercise or both had caused a prior episode.

They then subjected the participants to the trigger either by going on an intense run or using an exercise bike for an hour so they could reach 80 percent of their maximum heart rate. They were also exposed to bright, flashing or flickering light for 30 to 40 minutes. After each period, the subjects were monitored for three hours and asked if they had a migraine or migraine with aura.

Only 11 percent of participants said they had a migraine with aura after the light or exercise episode. Another 11 percent of people had a regular migraine.

"Our study suggests that if a person is exposed to a suspected trigger for three months and does not have a migraine attack, they no longer have to worry about avoiding that trigger," said Olesen.

Dr. Randall Berliner, a neurologist specializing in headaches at Lenox Hill Hospital in New York City, told HealthDay that the triggers may only work in specific situations. He was not involved in the study.

"Perhaps the triggers only exert their effect when the brain is already susceptible to a migraine," he said. He added that the study helps people understand the complex relationship between migraine triggers and migraines.

However, Dr. Stephen D. Silberstein, a professor of neurology at Thomas Jefferson University and the director of the Jefferson Headache Center who wrote an accompanying editorial, said to TIME that supposed triggers may in fact be symptoms of the migraine itself.

"You eat chocolate and you get a headache. Does that mean chocolate triggers the headache?" Silberstein explained. "What probably happens is the first symptom of your migraine attack is the desire to eat chocolate. Just like when you're pregnant, you might want pickles or ice cream. That's one end of the spectrum, where the desire to do something is part of the migraine attack, not the trigger."

The study was published online on Jan. 23 in Neurology.

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What Immediate Health Problems are Linked to Childhood Obesity

Researchers at UCLA shows that childhood obesity has negative immediate health effects in addition to the well-studied long-term health issues.

While a great deal of research on childhood obesity has spotlighted the long-term health problems that emerge in adulthood, a new UCLA study focuses on the condition's immediate consequences and shows that obese youngsters are at far greater risk than had been supposed.

Compared to kids who are not overweight, obese children are at nearly twice the risk of having three or more reported medical, mental or developmental conditions, the UCLA researchers found. Overweight children had a 1.3 times higher risk.

"This study paints a comprehensive picture of childhood obesity, and we were surprised to see just how many conditions were associated with childhood obesity," said lead author Dr. Neal Halfon, a professor of pediatrics, public health and public policy at UCLA, where he directs the Center for Healthier Children, Families and Communities. "The findings should serve as a wake-up call to physicians, parents and teachers, who should be better informed of the risk for other health conditions associated with childhood obesity so that they can target interventions that can result in better health outcomes."

With the dramatic rise in childhood obesity over the past two decades, there has been a parallel rise in the prevalence of other childhood-onset health conditions, such as attention deficit-hyperactivity disorder, asthma and learning disabilities. But previous studies on the topic have been limited due to a narrow focus on a specific region of the county, a small sample size or a single condition.

The new UCLA research, a large population-based study of children in the United States, provides the first comprehensive national profile of associations between weight status and a broad set of associated health conditions, or co-morbidities, that kids suffer from during childhood.

Overall, the researchers found, obese children were more likely than those who were classified as not overweight to have reported poorer health; more disability; a greater tendency toward emotional and behavioral problems; higher rates of grade repetition, missed school days and other school problems; ADHD; conduct disorder; depression; learning disabilities; developmental delays; bone, joint and muscle problems; asthma; allergies; headaches; and ear infections.

For the study, the researchers used the 2007 National Survey of Children's Health, analyzing data on nearly 43,300 children between the ages 10 and 17. They assessed associations between weight status and 21 indicators of general health, psychosocial functioning and specific health disorders, adjusting for sociodemographic factors.

Of the children in the study, 15 percent were considered overweight (a body mass index between the 85th and 95th percentiles), and 16 percent were obese (a BMI in the 95th percentile or higher).

The study, which is currently available online, will be published in the January-February print issue of the journal Academic Pediatrics.

The UCLA researchers speculate that the ongoing shift in chronic childhood conditions is likely related to decades of underappreciated changes in the social and physical environments in which children live, learn and play. They propose that obesity-prevention efforts should target these social and environmental influences and that kids should be screened and managed for the co-morbid conditions.

The researchers add that while the strength of the current study lies in its large population base, future studies need to examine better longitudinal data to tease out causal relationships that cannot be inferred from a cross-sectional study.

"Obesity might be causing the co-morbidity, or perhaps the co-morbidity is causing obesity -- or both might be caused by some other unmeasured third factor," Halfon said. "For example, exposure to toxic stress might change the neuroregulatory processes that affect impulse control seen in ADHD, as well as leptin sensitivity, which can contribute to weight gain. An understanding of the association of obesity with other co-morbidities may provide important information about causal pathways to obesity and more effective ways to prevent it."

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Webinar - Sleep & Down Syndrome from Down Syndrome Research Center at Stanford Univeristy

JOIN US FOR OUR JANUARY WEBINAR

Dr. H. Craig Heller, Stanford University Tuesday, January 29, 10 AM PT / 1 PM ET What can we learn about Down syndrome by studying the neural mechanisms of sleep? Plenty, according to H. Craig Heller, Ph.D., co-director of Stanford's Down Syndrome Research Center.  Dr. Heller, an expert in the area of sleep and a DSRTF grant recipient, joins us for our January webinar to discuss the roles that sleep and circadian rhythm may play in the cognitive impairment that occurs in people with DS. Register now for this free one-hour presentation, then join us on Tuesday, January 29 at 10 AM PT / 1 PM ET to learn what research tells us about the influence of sleep and circadian rhythm on learning, memory, and attention — and what that may suggest for the future of improved cognition. We look forward to seeing you there. The DSRTF Team

Sleep Apnea May Damage Brain Cells Associated With Memory

"How do I motivate my spouse to see a doctor?" I was asked this question yesterday and I could offer some facts. But, a picture really goes a long way. JR

Sleep Apnea May Damage Brain Cells Associated With Memory

June 11, 2008

June 11, 2008 — People with obstructive sleep apnea (OSA), a common sleep disorder linked to heavy snoring, may lose tissue in brain regions that store short-term memories—the type used to recall a recent joke or recognize a person you met at a party—say researchers at the University of California at Los Angeles.

Daytime confusion and memory loss are known symptoms of sleep apnea; people with the condition often rouse hundreds of times a night (without fully waking) and are tired and forgetful the next day. But a study in the June 27, 2008, edition of the journalNeuroscience Letters suggests that there may be more to it than just that.

Why sleep apnea may affect memory
Memories are formed in the mammillary bodies, structures on the underside of the brain that resemble small breasts. When UCLA neuroscientists scanned the brains of 43 sleep apnea patients and 66 healthy volunteers using magnetic resonance imaging (MRI), they discovered that the sleep apnea patients’ mammillary bodies were nearly 20% smaller than those of the untroubled sleepers.

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Study: Vitamin B and folic acid may help Migraine

An Australian study showed that vitamin B and folic acid supplements can reduce the severity and frequency of migraine headaches.

I welcome news of added treatments but I worry about announcing findings BEFORE research is completed. odd. JR

In a relief to migraine sufferers, Australian scientists have claimed that Vitamin B and folic acid supplements can treat severe headaches.

Researchers from Griffith University are on the final phase of this study to determine the most effective vitamin B and folic acid dosage required to treat this debilitating condition.

They have recruited women aged between 18 and 65 who suffer at least four migraine episodes a year, as they are three times more likely than men to experience migraines.

Queensland researcher Bridget Maher said the remedy would help the 20 per cent of migraine sufferers whose condition is genetic.

"It basically reduces the frequency and severity of the migraines," she was quoted as saying by AAP.

One in five people prone to migraines have an enzyme that doesn't work as well as other people, she said adding "By supplementing them with vitamin B and folate you can get around that enzyme's defect."

Migraines linked to genetics are associated with auras, which refers to the experiencing temporary neurological disturbances such as seeing stars, getting pins and needles and numbness.

The team at Griffith is working on the correct dose of the supplements and Maher said the treatment could be available in the market by next few years.

Some people don't respond to current migraine remedies so the new research could significantly help those with a genetic predisposition to the condition.

About 12 per cent of the population suffers from severe headaches, which can last up to three days and make people painfully sensitive to light and sound

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Sleep Disorders May Lead to Marriage Problems, Study Claims

This article discusses a study that claims that sleep issues may lead to marriage problems due to under-appreciation. In teens, sleep loss reduces motivation to learn, emotional instability and inattentiveness. I wonder if this article may apply this knowledge to behavior in adults. 

Should we count sheep in order to count blessings? Ok, that's a bit hokey....but anyway...JR

If you feel underappreciated by your spouse, it may be because he or she isn't getting enough sleep, a new study suggests.

Sleep deprivation can leave couples "too tired to say thanks" and may leave a partner feeling as if they are being taken for granted, according to the findings by University of California, Berkeley researchers.

More than 60 couples took part in each of two experiments. The participants ranged in age from 18 to 56. In one experiment, couples kept a diary of their sleep patterns and how the quality of their sleep affected their appreciation of their partner.

In the other experiment, couples were videotaped as they did problem-solving tasks. People who had slept poorly the previous night showed less appreciation for their partner, the investigators found.

Overall, the findings suggest that poor sleep might make it harder for people to count their blessings and value their partners, said study investigator and UC Berkeley psychologist Amie Gordon.

"Poor sleep may make us more selfish as we prioritize our own needs over our partner's," she said in a university news release.

What can you do?

"Make sure to say 'thanks' when your partner does something nice," Gordon suggested. "Let them know you appreciate them."

Although the study found an association between poor sleep and less gratitude among partners, it didn't prove that sleep deprivation was the cause of the behavior in these spouses.

The study was scheduled for presentation Saturday at the annual meeting of the Society for Personality and Social Psychology in New Orleans. The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

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Women With Migraine With Aura May Have Higher Risk of Heart Attack and Blood Clots

This article discusses health concerns for women who have migraines with aura. Such health concerns include cardiovascular problems such as heart attach and stroke.

Women who have migraines with aura, which are often visual disturbances such as flashing lights, may be more likely to have problems with their heart and blood vessels, and those on newer contraceptives may be at higher risk for blood clots, according to two studies released today that will be presented at the American Academy of Neurology's 65th Annual Meeting in San Diego, March 16 to 23, 2013.

The first study showed that migraine with aura is a strong contributor to the development of major cardiovascular events such as heart attack and stroke. The Women's Health Study involved 27,860 women, 1,435 of whom had migraine with aura. During the 15-year study, there were 1,030 cases of heart attack, stroke or death from a cardiovascular cause. The study examined the relative contribution of various vascular risk factors to these major cardiovascular events.

"After high blood pressure, migraine with aura was the second strongest single contributor to risk of heart attacks and strokes," said study author Tobias Kurth, MD, ScD, of INSERM, the French National Institute of Health and Medical Research in Bordeaux and Brigham and Women's Hospital in Boston. Kurth is also a Fellow of the American Academy of Neurology. "It came ahead of diabetes, current smoking, obesity, and family history of early heart disease."

Kurth cautioned that while people with migraine with aura have an increased risk, it does not mean that everyone with migraine with aura will have a heart attack or stroke. He said people with migraine with aura can reduce their risk in the same ways others can, such as not smoking, keeping blood pressure low and weight down and exercising.

The second study looked at women with migraine who take hormonal contraceptives and the occurrence of blood clots. The study involved women with migraine with and without aura who were taking both newer contraceptives such as the contraceptive patch and ring and older contraceptives. Of the 145,304 women who used the contraceptives, 2,691 had migraine with aura and 3,437 had migraine without aura.

Women with migraine with aura were more likely to have experienced blood clot complications such as deep vein thrombosis with all types of contraceptives than women with migraine without aura. For example, 7.6 percent of women with migraine with aura who used a newer generation combined hormonal contraceptive had deep vein thrombosis compared to 6.3 percent of women with migraine without aura, but the timing of the two events is not clear. The occurrence of blood clot complications was also higher in women with migraine who took contraceptives than women taking the contraceptives who did not have migraine.

"Women who have migraine with aura should be sure to include this information in their medical history and talk to their doctors about the possible higher risks of newer contraceptives, given their condition," said study author Shivang Joshi, MD, MPH, RPh, of Brigham and Women's Falkner Hospital in Boston and a member of the American Academy of Neurology.

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Tipping Point in Autism: What is Whole-Exome Sequencing? How it Identifies Inherited Mutations in Autism

If your child has undergone testing before without diagnosis, consider re-visiting testing. JR

Whole-Exome Sequencing Identifies Inherited Mutations in Autism

Jan. 23, 2013 — While autism clearly runs in some families, few inherited genetic causes have been found. A major reason is that these causes are so varied that it's hard to find enough people with a given mutation to establish a clear pattern. Researchers at Boston Children's Hospital have pinpointed several inherited mutations -- among the first to be identified -- through an unusual approach: using whole-exome sequencing to study large Middle Eastern families with autism.

The study, published in the January 23 issue of the journal Neuron, also found evidence for some of the same mutations in U.S. families. It shows that a number of genes implicated in severe genetic syndromes can have milder mutations that primarily cause autism, and could broaden the number of genetic tests available to families.

Researchers Tim Yu, MD, PhD, Maria Chahrour, PhD, and senior investigator Christopher Walsh, MD, PhD, of Boston Children's Hospital, began with three large Middle Eastern families that had two or more children with autism spectrum disorders (ASDs), looking for recessive mutations -- those requiring a "double hit" for the child to have an ASD.

"Families from the U.S. are not ideal for finding inherited genetic mutations, since family sizes are often small," says Walsh, chief of Genetics at Boston Children's and an investigator of the Howard Hughes Medical Institute.
In all three families, the parents were first cousins, a common tradition in the Middle East and one that greatly facilitates the identification of inherited mutations. The researchers first used genetic mapping techniques to narrow their search to specific chromosomal locations, then sequenced the protein-coding genes in those areas (known as whole-exome sequencing).

That turned up recessive mutations in three genes not previously known to be involved in autism, but rather in severe genetic syndromes:

• Mutations in AMT, a gene classically associated with a severe metabolic syndrome known as nonketotic hyperglycinemia, marked by severe seizures and death during infancy.
• Mutations in PEX7. Typical PEX7 mutations cause rhizomelic chondrodysplasia punctata, a severe syndrome causing metabolic and bone abnormalities, cataracts, severe epilepsy and early death.
• Mutations in SYNE1, a gene associated with brain malformation, severe motor and muscle problems, and possibly bipolar psychiatric disease.

The severe syndromes linked to these genes often include autistic behavior or intellectual disability, but not as the primary symptom. Interestingly, the milder mutations discovered in these families seemed to cause disease that is more brain-specific.
"This is the first time these genes have been associated with autism," says Chahrour, who shares first authorship of the study with Yu. "The AMT and PEX7 mutations weren't picked up by standard tests for metabolic disorders, but when you're able to sequence the entire exome, you can find them."
These findings inspired the team to look for other metabolic and other genetic syndromes affecting cognition and behavior with milder forms showing up simply as autism. They screened 163 Middle Eastern families with autism for mutations in 70 genes associated with these syndromes, using a whole-exome approach but analyzing only the 70 genes of interest.
This approach turned up several additional families with ASD mutations, including:

• An additional family with a recessive mutation in AMT
• Two families with recessive mutations in VPS13B (known to cause Cohen syndrome, which includes intellectual disability, obesity, vision and joint problems, and small head size)
• A family with a recessive mutation in POMGNT1 (known to cause muscle-eye-brain disease, marked by brain malformation, intellectual disability, muscle and vision problems)
• A family with an X-linked mutation in MECP2 in two boys (MECP2 mutations are known to cause Rett syndrome in girls, but are typically lethal in boys)

"We have textbook descriptions of all these diseases, but in real life, there can be atypical, milder presentations of the same disease," says Yu. "The kids we were studying with autism were alive at age 13. They had double hits for these mutations, but they were much milder mutations. The proteins retained a bit of their function."

The team also examined a cohort of U.S. patients, looking for recessive mutations in six of the genes they identified. They analyzed whole-exome sequence data from 612 families with ASDs, part of a registry known as the Simons Simplex Collection. The analysis suggested that some of the affected children had causative recessive mutations in at least two of the genes identified in the Middle Eastern families, and that larger-scale efforts to examine all 70 genes more fully for recessive mutations may prove fruitful.

"It's not clear yet how many U.S. families have these recessive mutations," says Yu. "Further studies could begin to estimate what fraction of autism cases might fall under this model."

"Together, these two studies firmly establish that recessive mutations contribute importantly to autism, not just in specialized populations but in the population at large," says Yu. "Genome sequencing is going to be a huge advance in identifying more of these mutations, since there are a lot of rare syndromes that are otherwise very difficult to detect."

Researchers Link 25 New Gene Variants to Autism

By Robert Preidt

Monday, January 14, 2013

MONDAY, Jan. 14 (HealthDay News) -- Twenty-five newly identified gene variants have been linked to an increased risk for autism, according to a new study.

He and his colleagues discovered the new gene variants after analyzing DNA from thousands of people with and without autism, according to the study published Jan. 14 in the journal PLoS One.

The variations occur in genes involved in the development of neurons and signaling pathways in the brain, the study authors noted in a hospital news release.

"These high-impact variants could be most useful in advising parents who already have one child with an autism spectrum disorder," Hakonarson said in the release. "If a second child has delays in reaching developmental milestones, testing for these [gene variants] could help predict whether that child is also likely to develop an autism spectrum disorder," he explained.

Although the study found an association between these genetic variants and a raised risk of autism spectrum disorder, it did not prove cause-and-effect.

...

SOURCE: Children's Hospital of Philadelphia, news release, Jan. 14, 2013

http://www.nlm.nih.gov/medlineplus/news/fullstory_133065.html

What pediatric illnesses provoke readmission? Pediatric Readmission Prevalence & Variability Across Hospitals

What diseases provoked the highest Number

 of  Hospital Re - admissions?

• Seizure

• Bronchiolitis

• Pneumonia

My advice to parents -  Be vigorous in your request for rapid follow-up with specialty care after discharge from the hospital or emergency room.

January 23/30, 2013, Vol 309, No. 4 >

Original Contribution | January 23/30, 2013

Pediatric Readmission Prevalence 

and Variability Across Hospitals

Jay G. Berry, MD, MPH; Sara L. Toomey, MD, MPhil, MPH; Alan M. Zaslavsky, PhD; Ashish K. Jha, MD, MPH; Mari M. Nakamura, MD, MPH; David J. Klein, MS; Jeremy Y. Feng, BA; Shanna Shulman, PhD; Vincent K. Chiang, MD; William Kaplan, BS; Matt Hall, PhD; Mark A. Schuster, MD, PhD

JAMA. 2013;309(4):372-380. doi:10.1001/jama.2012.188351.

Text Size: A A A

ABSTRACT

ABSTRACT | METHODS | RESULTS | COMMENT | CONCLUSIONS | AUTHOR INFORMATION| REFERENCES

Importance  Readmission rates are used as an indicator of the quality of care that patients receive during a hospital admission and after discharge.

Objective  To determine the prevalence of pediatric readmissions and the magnitude of variation in pediatric readmission rates across hospitals.

Design, Setting, and Patients  We analyzed 568 845 admissions at 72 children's hospitals between July 1, 2009, and June 30, 2010, in the National Association of Children's Hospitals and Related Institutions Case Mix Comparative data set. We estimated hierarchical regression models for 30-day readmission rates by hospital, accounting for age and Chronic Condition Indicators. Hospitals with adjusted readmission rates that were 1 SD above and below the mean were defined as having “high” and “low” rates, respectively.

Main Outcome Measures  Thirty-day unplanned readmissions following admission for any diagnosis and for the 10 admission diagnoses with the highest readmission prevalence. Planned readmissions were identified with procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification.

Results  The 30-day unadjusted readmission rate for all hospitalized children was 6.5% (n = 36 734). Adjusted rates were 28.6% greater in hospitals with high vs low readmission rates (7.2% [95% CI, 7.1%-7.2%] vs 5.6% [95% CI, 5.6%-5.6%]). For the 10 admission diagnoses with the highest readmission prevalence, the adjusted rates were 17.0% to 66.0% greater in hospitals with high vs low readmission rates. For example, sickle cell rates were 20.1% (95% CI, 20.0%-20.3%) vs 12.7% (95% CI, 12.6%-12.8%) in high vs low hospitals, respectively.

Conclusions and Relevance  Among patients admitted to acute care pediatric hospitals, the rate of unplanned readmissions at 30 days was 6.5%. There was significant variability in readmission rates across conditions and hospitals. These data may be useful for hospitals' quality improvement efforts.

Be vigorous in your request for rapid follow-up with specialty care after discharge from the hospital or emergency room.