Tuesday, September 30, 2014
This article discusses a new product called Easy Peezy, a urine tests to diagnose obstructive sleep apnea in children.
A survey showed that informing parents does not make them confident enough to treat a concussion.
Many parents whose kids participate in athletics will be asked to sign a waiver about concussion education, but that's not enough to ensure parents are confident about handling the injury, according to a new University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health.
In the poll, about half of the 912 parents of middle and high school children surveyed reported participation in some type of concussion education:
• 23% have read a brochure or online information
• 17% have watched a video or attended a presentation
• 11% have signed a waiver form, with no other educational component
• 49% report no concussion education at all
Concussion education is more common among parents of children who play sports compared to non-sports parents (58% vs 31%).
"It is good news that many parents report they have received concussion education. We found, however, that the format of that concussion education really matters. The way the concussion information is delivered is linked to the parents' confidence about managing their child's injury," says Sarah J. Clark, M.P.H., associate director of the National Poll on Children's Health and associate research scientist in the University of Michigan Department of Pediatrics and U-M Medical School.
"Many schools mandate that a waiver form to be signed, but the danger is that parents will skip over information to get to that required signature line."
The poll showed that 63 percent of parents who watched a video or a presentation rated it as very useful. Forty-one percent of parents who read a brochure or online information rated that as very useful.
However, only 11 percent of parents whose only concussion education was signing a waiver form reported that was very useful.
"If the waiver is done online or on a form returned to school, parents may be left without information at home to guide them if or when their child is injured," says Clark, who is also a member of the U-M Institute for Healthcare Policy and Innovation.
The U.S. Centers for Disease Control estimates that each year, nearly 175,000 children are treated in US emergency rooms for concussions related to sports or recreational activities, including bicycling, football, playground activities, basketball and soccer.
Research has shown that the healing process for a concussion is different for kids than adults and that repeated concussions in a short time period are particularly dangerous.
Parents should get information about when to seek medical attention, monitoring the child's symptoms, and limiting physical activity until symptoms have subsided, says Clark. Health care providers also may recommend limiting homework and other mental activities to allow the brain to heal.
"Parents play a key role in deciding when a child returns to school and extracurricular activities, and concussion education can assist them in making good decisions," Clark says. "So one solution could be to offer multiple education formats to ensure that parents truly hear the concussion information rather than focusing on just signing a form."
Clinical pharmacists can reduce anti-epileptic drug (AED) prescription errors that commonly result from incomplete or poor documentation, according to a literature review published in Seizure, The European Journal of Epilepsy.
Researchers from the Alder Hey Children’s NHS Foundation Trust in the United Kingdom conducted a 12-month retrospective review of all pediatric outpatient prescriptions of anti-epileptic drugs (AEDs) at a large children’s hospital. In the study, the authors acknowledged that pediatric AEDs are particularly difficult to prescribe, given the wide variety of available choices and potential interactions among AEDs and other medications.
The investigators monitored all new prescriptions for AEDs issued from the hospital’s general pediatric and pediatric neurology departments in 2012. Data was collected regarding patient demographics, diagnosis/indication for the AED, clarity of dosage instructions, prescriber details, and whether a pharmacist intervention was required prior to dispensing the medication.
Over the course of the year, a total of 262 new AED prescriptions were written, with 19 patients receiving more than 1 AED prescription. Of those prescriptions, an astounding 72.1% were deemed incomplete with at least 1 piece of missing information, the study authors noted.
Furthermore, 164 (62.6%) of the prescriptions did not document any diagnosis or reason for prescribing the AED. Of the remaining 98 prescriptions, 50 documented only the word “epilepsy,” while 48 described a non-epileptic diagnosis, such as “migraine,” “behavioral problems,” and “chronic pain.”
AED prescribers recorded their designation and immediate contact details in just 41.6% of all AED prescriptions. Of those detailed prescriptions, 65.1% were written by a senior doctor, 17.4% were prescribed by a specialist trainee or junior doctor, and another 17.4% were illegible or not recorded.
Among all epilepsy diagnoses, the most commonly prescribed AED was sodium valproate, followed by a tie between carbamezapine and levetiracetam. For prescriptions with a designated non-epileptic diagnosis, the most commonly prescribed medication was gabapentin.
Pharmacists contacted physicians concerning 44 prescriptions (16.8%), 15 (34%) of which were due to errors in dosage or frequency of administration. Such dosing errors were identified by pharmacists for carbamazepine, gabapentin, lamotrigine, and topiramate, among other AEDs. According to the researchers, all AED prescriptions with dosing errors were amended prior to being dispensed.
“Although there were high numbers of incomplete or inadequate prescriptions in the current study, no patients had their medication incorrectly dispensed, (which) reflects the pharmacists’ review of each prescription prior to the drug being dispensed,” the study authors concluded. “Clearly, it is the clinician’s responsibility to prescribe the most appropriate AED, but it might be reasonable to have the choice of drug confirmed by a clinical pharmacist.”
Read more here
Monday, September 29, 2014
Thursday, September 25, 2014
Among infants as young as 6 months old who exhibited symptoms of autism, therapy provided by parents seemed to prevent developmental delays by age 3 in most of the tots, a small new study suggests.
Researchers from the University of California, Davis MIND Institute found that six of the seven infants in the study had caught up in language and other learning skills between the ages of 2 and 3 -- before the age most children with autism are usually diagnosed.
But the therapy program used in the study -- administered by parents during daily feeding, diapering and play routines -- needs to be researched in larger, randomized trials, the study authors cautioned.
"These data do not prove this intervention either prevented autism or ... changed the course," said study author Sally Rogers, a professor of psychiatry and behavioral sciences. "We were really testing a proof of concept: Could the infants' developmental patterns be changed?" she explained.
"Parents are hearing more and more about autism and the early signs for it. We don't have diagnostic tools or validated treatments for this age group. So parents and pediatricians are sort of in limbo on this, which is why we're working so hard on it," Rogers said.
The study was published online Sept. 9 in the Journal of Autism and Developmental Disorders.
As many as one in 68 children in the United States has an autism spectrum disorder (ASD), according to the U.S. Centers for Disease Control and Prevention. ASDs are characterized by deficits in typical behavior, communication and social skills, and are about five times more common among boys than girls, the CDC reports.
Children with autism are diagnosed at an average age of 4, though some children can be diagnosed as early as age 2, according to the CDC.
Rogers and her colleagues researched the effects of "Infant Start" therapy on seven infants who were between 6 and 15 months old at the start of the study. Four had siblings with autism, but all seven were highly symptomatic for an ASD, exhibiting issues such as reduced eye contact, social engagement and intentional communication. All infants were otherwise healthy, with normal vision and hearing.
Parent participants underwent one-hour training sessions for 12 weeks that coached them to support their infants' attention to faces and voices, and helped them interpret and improve their babies' interest in social interactions.
Typically, children diagnosed with autism begin therapy between the ages of 3 and 4 years, six to eight times later than the children in this study, Rogers noted.
"Within six to eight weeks, parents were carrying out interactions at the same skill level as trained therapists," Rogers said. "It was framed all through play and pleasurable interactions through parents and children."
After follow-up assessments at 24 and 36 months of age, all but one of the infant participants tested normally for learning skills and language. These "very preliminary results" were compared to a similar group of four symptomatic infants who didn't receive the therapy -- all of whom continued to show significant developmental delays by the age of 3, Rogers said.
Dr. Paul Wang, senior vice president and head of medical research for the research and advocacy group Autism Speaks, called the study results "promising" but said much more research is needed to determine effective autism therapies for younger children.
"The goal of early autism screening is early treatment," Wang said. "Unfortunately, we're in a situation where we're really pushing early screening ... and now really need to invest in treatment research to show what are the most effective treatments at that early age. We need to come up to speed."
Rogers agreed, saying randomized, clinical trials are needed that enroll dozens of young children showing symptoms of autism and then follow them for several years. But the parent-driven Infant Start therapy would be inexpensive to implement, she noted.
"Whenever parents are delivering it and there's one visit a week with a therapist rather than 20, 30 or 40 hours with someone [else], you're saving a lot of money," she said.
But, "it doesn't mean parents should be drafted into the role of therapist," Rogers noted. "The reason we moved to this model is because babies are so young and don't respond well to strangers. They know their family and prefer their parents."
Wang said that the absence of official guidelines for screening infants symptomatic for autism doesn't mean parents and doctors can't act on early suspicions.
"If there are significant symptoms that have drawn the parents' attention, and the pediatrician or other referral source is concerned about it, we should not dismiss that," Wang said. "We should not say, 'The kid is too young, there's nothing we can do.' We don't know yet what's going to be best but we have early intervention services at this young age that can be started."
Using caffeine to treat premature newborns for apnea - dangerous pauses in breathing during sleep - does not have long-term harmful effects on their sleep or breathing patterns, according to research led by Children's Hospital of Philadelphia.
Significantly lower levels of a key estrogen receptor may play a role in autism spectrum disorders, according to a new study.
This link between autism and sex hormones could help explain why the condition is about four times more common among men than women, the researchers noted.
"Our study is the first indicator that estrogen receptors in the brain of autism spectrum disorder patients may be different to controls," study author Anilkumar Pillai, from Georgia Regents University, said in a news release. "Though this suggests a possible reason for the gender bias, we still need to determine what causes the reduced production of estrogen-related proteins."
Autism spectrum disorders refer to a group of disorders that affect brain development. Signs and symptoms of autism include impaired social interaction and communication skills as well as restricted and repetitive behavior.
For the study, published Sept. 9 in the journal Molecular Autism, the researchers compared the brains of 13 people with autism to 13 people who didn't have the condition. The difference they found was in the brain's estrogen signaling.
Specifically, the researchers measured levels of an estrogen receptor molecule known as ERβ in the participants' brains. They also measured levels of aromatase, an enzyme that converts testosterone to estradiol, the most potent estrogen.
The study revealed the brain tissue of those who had autism had 35 percent less ERβ mRNA and 38 percent less aromatase mRNA. This could affect the conversion of testosterone to estradiol, increasing testosterone levels.
The researchers noted their study was small, and said more research is needed to explore how changes in estrogen signaling are related to autism.
"It is worth looking at whether drugs which modulate estrogen reception, but do not cause feminization, could allow for the long-term treatment of male patients with autism spectrum disorders," said Pillai. "Current treatment involves the use of antipsychotics, which has long been a major concern as these patients are typically still in a stage of life where brain development is very rapid. However, additional studies are needed to test the estrogen mechanism."
Monday, September 22, 2014
Epilepsia. 2003 Mar;44(3):372-8.
Abnormal neuroimaging in patients with benign epilepsy with centrotemporal spikes.
- 1Centre Saint Paul, Marseille, France. email@example.com
PURPOSE:Neuroimaging procedures are usually unnecessary in benign epilepsy of childhood with centrotemporal spikes (BECTS) but are often performed before a specific diagnosis has been reached. By definition, BECTS occurs in normal children; however, recent reports have shown that it also can affect children with static brain lesions. We evaluated the prevalence of abnormal neuroimaging in BECTS and assessed whether the lesions had influenced the clinical and EEG expression of this epilepsy.
RESULTS:Among 98 consecutive cases first referred between 1984 and 1999, neuroimaging had been performed in 71 (72%) [magnetic resonance imaging (MRI), 20; computed tomography (CT), 59; MRI+CT, eight]. In ten (14.8%), neuroradiologic procedures were abnormal: enlargement of lateral venticles in five cases including a shunted hydrocephalus in two (no etiology in one, neonatal intraventricular hemorrhage in one), a moderate ventricular dilation in one (neonatal distress), a slight ventricular dilation and hypersignal intensities in the white matter in one (premature birth at 27 weeks), and a moderate enlargement of the right temporal horn in one. A right hippocampal atrophy, a biopercular polymicrogyria, a cavum septum pellucidum, a small cystic lesion located in the epiphysis, and an agenesis of the corpus callosum with macrocrania also were observed once each. The outcome was benign in all, in accordance with the overall prognosis of BECTS.
CONCLUSIONS:This study confirms that neuroimaging may be abnormal in patients with BECTS and shows that the presence of brain lesions has no influence on the prognosis. Conversely, BECTS can be diagnosed in patients with brain lesions with or without significant neurologic history or abnormalities.
- Benign epilepsy of childhood with malformations of cortical development. [Epilepsia. 2003]
- [PubMed - indexed for MEDLINE]
Epilepsy Res. 2010 Jun;90(1-2):91-8. doi: 10.1016/j.eplepsyres.2010.03.012. Epub 2010 Apr 24.
Neuroimaging findings in children with benign focal epileptiform discharges.
- 1Epilepsy Center/Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA. firstname.lastname@example.org
PURPOSE:To determine reasons for neuroimaging and neuroimaging findings in children with benign focal epileptiform discharges (BFEDs).
METHODS:We performed a retrospective chart review of children who had BFEDs on routine EEG and underwent brain MRI.
RESULTS:We identified 97 patients with BFEDs and MRI. Forty-five of these 97 patients also had seizures consistent with benign focal epilepsy of childhood with centrotemporal spikes (BECTS). Rationale for imaging in the 45 BECTS patients included historical features such as headaches (14), increase in seizure frequency (5), and new events (5). Nine MRIs were obtained prior to referral and 12 for unspecified reasons. MRI findings were not significantly different between BECTS and BFEDs patients. Fourty-one patients (42%) had abnormal findings on MRI, including T2 hyperintensities (10), hippocampal atrophy (6), malformation of cortical development (4), volume loss (5), Chiari malformation (4), and others (18).
CONCLUSION:MRIs are not routinely recommended in patients with BECTS unless atypical features are present. Atypical features which may prompt MRI include change in clinical seizure types or frequency, historical features such as headaches, abnormal neurological exam, and atypical EEG features. 42% of our selected patients had intracranial abnormalities, most of which were of unclear clinical significance. Remote infarcts and early lesions accounted for most MRI findings suggesting they may be related to BFEDs.
Copyright (c) 2010 Elsevier B.V. All rights reserved.
Sunday, September 14, 2014
By Nancy Szokan September 8
People who suffer migraines know that not even the best medicines may get rid of all the pain all the time. “Preventive medications help 50 percent of patients by about 50 percent,” Sheena Aurora, an associate professor of neurology at Stanford, tells writer Aviva Patz. In September’s edition of Health magazine, Patz suggests three of the “more promising, less traditional” alternative therapies that can be used along with drugs or by themselves as part of a migraine-relief strategy. And she includes comments from both clinical specialists and migraine sufferers. They are:
Cefaly: This is an FDA-approved band, worn across the forehead, that electrically stimulates the trigeminal nerve, said to be where migraine pain begins. Worn for 20 minutes a day (whether the user has a headache or not), Cefaly reduced monthly migraine days by 30 percent among participants in a study published in the journal Neurology last year. A tester for the magazine reported she used to get three to five migraines a week; in the four months after she started using Cefaly, she had only two.
Elimination diet: Some foods are known to activate an inflammation response that triggers migraines. The most common of these triggers are red wine, aged cheese, cured meats, MSG, dairy, artificial sweeteners, chocolate and gluten. Clinics typically recommend cutting out all these foods for six weeks, see if you feel better, then add them back into your diet one at a time to see which ones may cause pain. “Not all migraine sufferers have food sensitivities, but for those who do, eliminating a problem food can cut headaches by 50 to 60 percent,” says Merle Diamond of the Diamond Headache Clinic in Chicago. Consult a doctor before beginning this.
Botox: If it can relax facial muscles to smooth wrinkles, scientists wondered, could Botox also dull migraine pain? Studies published in early 2010 reported that migraine sufferers who received Botox injections experienced a major decrease in the number of headache days; later that year, the FDA approved the drug as a treatment for chronic migraine. A tester for the magazine reported that not only did Botox help her headaches, but the effect lasted longer after successive treatments. Insurance should cover the costs, Patz says. Warning: Potential side effects include bruising and neck pain.
Interesting effect of epilepsy on personality...
Dr. Rotenberg, Pediatric Epilepsy specialist, Houston TX
The case of a woman who began compulsively writing poems after being treated for epilepsy offers a rare glimpse into the ‘inner’ dimension of a neurological disorder. Here’s the paper in Neurocase from British neurologists Woollacott and colleagues.
The story in a nutshell: the patient, age 76, had been suffering from memory lapses and episodic disturbances of consciousness. An electroencephalography (EEG) test “revealed left anterior temporal sharp and slow waves”, and the patient was diagnosed with Transient Epileptic Amnesia (TEA).
She was prescribed the anti-epileptic drug lamotrigine (25 mg daily), which completely stopped the memory-loss and episodes of unconsciousness. However, this wasn’t the end of the matter:
Several months after starting lamotrigine, the patient suddenly began to write original verse. Whereas poetry had never previously been among her pastimes, she now produced copious short poems (around 10–15 each day).
These poems often had a wistful or pessimistic nature, but did not have a moral or religious focus. Her husband characterized them as “doggerel” because they were generally rhyming and often featured puns and other wordplay… she became irritated if attempts were made to disengage her. However, she appeared to derive pleasure from the activity and there was no evidence of distress.
Full article here...
Saturday, September 13, 2014
Teenagers who don't get enough sleep may wake up to worse consequences than nodding off during chemistry class. According to new research, risk of being obese by age 21 was 20 percent higher among 16-year-olds who got less than six hours of sleep a night, compared with their peers who slumbered more than eight hours. (The Centers for Disease Control and Prevention recommends nine to ten hours of sleep for teenagers.)
Researchers at the Mailman School of Public Health at Columbia University and the University of North Carolina Gillings School of Public Health are the first to examine the effect of sleeplessness on obesity in teenagers over time, providing the strongest evidence yet that lack of sleep raises risk for an elevated BMI. Results appear in Journal of Pediatrics.
Shakira F. Suglia, ScD, assistant professor of Epidemiology at the Mailman School, and colleagues analyzed health information from more than 10,000 American teens and young adults, ages 16 and 21, as part of the National Longitudinal Study of Adolescent Health. Information on height and weight and sleep was collected during home visits in 1995 and 2001.
Nearly one-fifth of the 16-year-olds reported getting less than six hours of sleep. This group was 20 percent more likely to be obese by age 21, compared to their peers who got more than eight hours of sleep. While lack of physical activity and time spent watching television contributed to obesity, they did not account for the relationship between sleeplessness and obesity.
"Lack of sleep in your teenage years can stack the deck against you for obesity later in life," says Suglia. "Once you're an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer."
"The message for parents is to make sure their teenagers get more than eight hours a night," adds Suglia. "A good night's sleep does more than help them stay alert in school. It helps them grow into healthy adults."
Daytime sleepiness and fatigue are known to affect what and how people eat, by altering appetite and stimulating cravings. Energy levels may also play a role. For the sleep-deprived, ordering calorie-dense fast food is easier than preparing a nutritious meal. Information on what the teens ate was not captured in the surveys, although it could play a role. Future research may look whether, for example, soda consumption is a factor in sleeplessness and, in turn, obesity. (A 2013 study by Suglia found young children who drink soda are more likely to have behavioral problems.)
Fish Oil Might Ease Tough-to-Treat Epilepsy: Study
People taking the low-dose omega-3 supplements had fewer monthly seizures, but more research is needed
By Robert Preidt
MONDAY, Sept. 8, 2014 (HealthDay News) -- Low doses of fish oil may help reduce the number of seizures experienced by people with a form of tough-to-treat epilepsy that no longer responds to drugs, a small new study suggests.
The research was led by Dr. Christopher DeGiorgio, of the University of California, Los Angeles, and included 24 people with epilepsy that could no longer be controlled using medications.
One expert not connected to the study said many people with epilepsy remain without adequate treatment.
"Although medications remain the primary treatment for newly diagnosed epilepsy, more than 35 percent of patients continue to haveseizures despite taking antiepileptic drugs," said Dr. David Friedman, director of the Comprehensive Epilepsy Center at Winthrop University Hospital in Mineola, N.Y.
Friedman said that in these cases, patients often resort to alternative treatments such as epilepsy surgeries, special diets or brain-stimulating devices. So the new study using a common nutrient is intriguing, he said.
In the study, the UCLA team gave the patients three separate treatments, each lasting 10 weeks and separated by a period of six weeks.
The treatments were: the "low-dose" intervention of three capsules offish oil (about 1,080 milligrams) a day plus three "dummy" capsules containing corn oil only; the "high-dose" involving six capsules of fish oil a day, and a placebo treatment of three capsules of corn oil taken twice a day.
The average number of seizures while taking the low dose of fish oil was about 12 a month, compared with just over 17 when taking a high dose of fish oil, and just over 18 when taking the corn oil only.
Two people were completely free of seizures while taking a low dose of fish oil. This did not occur while patients were taking a high dose of fish oil or corn oil....
Friday, September 12, 2014
Lack of sleep not only puts teens at risk for poor grades, it also puts them at increased risk for obesity, researchers warn.
The study authors analyzed data collected from more than 10,000 Americans when they were aged 16 and 21. Nearly one-fifth of them got less than six hours of sleep a night when they were age 16, and this group was 20 percent more likely to be obese at age 21 than those who got more than eight hours of sleep per night at age 16, the investigators found.
Although lack of exercise and too much time spent watching television were also risk factors for obesity, these behaviors did not account for the link between lack of sleep and obesity, according to the study published online recently in the Journal of Pediatrics.
"Lack of sleep in your teenage years can stack the deck against you for obesity later in life. Once you're an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer," study author Shakira Suglia, an assistant professor of epidemiology at the Mailman School of Public Health at Columbia University in New York City, said in a university news release.
"The message for parents is to make sure their teenagers get more than eight hours a night. A good night's sleep does more than help them stay alert in school. It helps them grow into healthy adults," Suglia added.
Teens should get nine to 10 hours of sleep a night, according to the U.S. Centers for Disease Control and Prevention.
It's known that daytime sleepiness and fatigue affect what and how people eat by triggering cravings and altering appetite. For example, sleep-deprived people find it easier to buy calorie-laden fast food rather than preparing a healthy meal.