Neurology for Children, Teens, Young Adults & Sleep Medicine for All Ages

Can some children simply 'grow out' of autism? One mother tells how her son's life has been transformed

2012-02-25T17:36:00.001-08:00

When Josh Tutin was three years old, he was diagnosed with autism so severe that experts believed it unlikely he would ever relate to other people.

Yet now the Bristol boy is a thoughtful, joyful nine-year-old who attends a mainstream school.

Has he grown out of his condition? New research by a prestigious American university claims that not only is this possible, it’s also common.

A new study in the respected journal Pediatrics reports that up to one third of children diagnosed with autism at a young age no longer display symptoms when they are older.

And the behavioural transformation seen in Josh over the past six years has certainly gone beyond the wildest hopes of his parents.

As a toddler, Josh seemed irretrievably trapped inside his own troubled world.

‘We couldn’t have a cot because he would fling himself against it,’ says Josh’s mother, Renitha, 39, a chartered accountant who teaches at Bristol University.

‘He just slept lying on me. When he was awake he would scream and scream.’

If Renitha wanted something as simple as a shower, her husband, Richard, a lecturer in accounting and finance, also at Bristol University, would have to be on hand.

‘I would pass Josh to Richard and he would have to hold him while he screamed,’ she remembers.

‘There was one day when Josh had tantrum after tantrum, and I was so upset I started crying, and Josh just looked at me without any awareness.

‘I remember thinking: “He will never feel what I’m feeling. He can’t understand emotion”.’

When Josh was three, a health visitor witnessed him having a violent tantrum and referred Josh to specialists at Frenchay hospital, where he underwent twice-weekly diagnostic tests over a six-week period.

‘At the end, the specialists gave me a depressing report explaining that Josh was seriously disabled with autism,’ says Renitha.

Autism is a developmental disorder that affects more than 100,000 children. It is not known what causes it, but it affects a child’s ability to communicate and relate to others.

They are often withdrawn, mute, unable to make eye contact and prone to disturbed sleep and tantrums.

Many never take part in mainstream education and some require full-time care.

Indeed, Josh’s specialists wanted him to be sent to a special school.

‘They did not think he would cope in mainstream school,’ says Renitha.

However, she and her husband decided to reject that advice.

‘We have nothing against special schools, but we thought we would see if mainstream school could work for him first,’ she says.

Nowadays, the difference in Josh would strike outsiders as a massive change.

‘He loves maths and can play Grade 3 pieces on the piano,’ says Renitha.

‘Last year, he made me a beautiful bracelet for Mother’s Day. It made me realise how much things had changed.

‘If anyone is hurt, he will go up to them and ask why and try to give them a cuddle or cheer them up.

'If he is unsure why someone is upset, he will ask questions to try to understand.’

Josh’s transformation is far from unique, according to the Pediatrics study.

The researchers questioned 1,366 parents of children aged 17 and younger who had been previously diagnosed with autism spectrum disorder.

Of these, 453 parents said that their children no longer had the condition and had grown out of it since the age of seven.

The lead researcher, Dr Andrew Zimmerman, from Massachusetts General Hospital for Children, accepts the findings might partly reflect the fact that some of the children may have been misdiagnosed.

But he stresses that these are only a minority, and his results should certainly not be put down to misdiagnosis alone.

Teens' concussion risk not limited to football

2012-02-24T10:53:00.004-08:00

Although football has been in the spotlight when it comes to high school athletes' concussions, other sports carry a risk as well, a new study shows. Between 2008 and 2010, researchers found, U.S. high school athletes suffered concussions at a rate of 2.5 for every 10,000 times they hit the playing field, for practice or competition.

Nearly half -- 47 percent -- happened in football. But girls' soccer and basketball, and boys' wrestling, ice hockey and lacrosse were among the other sports with a risk of head injury.

Just over eight percent of all concussions happened in girls' soccer, while girls' basketball and boys' wrestling accounted for almost six percent each.

Boys' ice hockey accounted for fewer total concussions, but it beat all other sports when it came to proportion: Of all injuries to boys in ice hockey, 22 percent were concussions.

Most of the head injuries happened when players collided with each other. But even some kids in non-contact sports -- like softball, gymnastics, cheerleading and swimming -- suffered blows to the head.

"They're not just occurring in full-contact sports," said lead researcher Natalie McIlvain, of the Research Institute at Nationwide Children's Hospital in Columbus, Ohio.

The findings are not meant to alarm parents, she and her colleagues say, since the benefits of sports far outweigh the risk of concussion.

But parents, coaches and kids alike should be aware of the risk, and the symptoms of concussion, said Christy Collins, a senior research associate at Nationwide Children's.

"It's very important for kids to be involved in sports," Collins said. "But at the same time we have to keep them safe."

The findings, reported in the American Journal of Sports Medicine, come at a time of increasing concern about concussions in young athletes.

Estimates of the number of Americans suffering sports-related concussions have been climbing in recent years. That's partly because more people are playing contact sports, young athletes are training more aggressively at an earlier age, and doctors are more aggressive about diagnosing concussions.

A recent study found that in 2008, there were five concussions for every 10,000 U.S. high school athletes who hit the playing field. That was up from just about one per 10,000 a decade earlier.

Last year, the American Academy of Pediatrics (AAP) recommended that kids with concussions get cleared by a doctor before they can get back on the playing field.

But that also means coaches, parents and kids need to know the signs of a concussion, McIlvain and Collins said.

Concussion symptoms include headache, dizziness, nausea, ringing in the ears, fatigue and confusion -- though these problems may not become noticeable until hours after the jolt to the head. And contrary to popular belief, concussions usually do not involve loss of consciousness.

Among the findings in the new study was a higher concussion risk among girls than boys.

In "gender-comparable" sports, girls had a 70 percent higher concussion rate than boys.

It's not clear why. But, Collins said, it may have to do with girls' lesser neck strength. Concussions happen when an impact is strong enough to jar the brain within the skull; it's thought that greater neck strength might offer some protection -- though that's still under study.

Once a concussion is recognized, the AAP says that kids should rest, both physically and mentally. Schoolwork and other mental tasks, even video game playing, can make symptoms worse -- so athletes with a concussion may need a break from non-physical activities as well.

The biggest concern is that injured kids not return to the game until their symptoms have fully passed.

If an athlete suffers another head injury before the initial concussion has healed, there's a risk of "second-impact syndrome" -- which can have severe consequences, including bleeding inside the skull, brain swelling and death.

"The real danger," Collins said, "is returning to play too soon."

New Treatment for Traumatic Brain Injury Shows Promise in Animals

2012-02-24T10:51:00.002-08:00

A new drug is showing promise in shielding against the harmful effects of traumatic brain injury (TBI) in rats, according to a study that was just released and will be presented at the American Academy of Neurology's 64th Annual Meeting in New Orleans April 21 to April 28, 2012.

"There are currently no primary treatments for TBI, so this research provides hope that effective treatments can be developed," said study author Michael Kaufman, a second year medical student at Wayne State University School of Medicine in Detroit and a member of the American Academy of Neurology. The principal investigator on the study is Christian Kreipke, MD, also with Wayne State University School of Medicine.

Traumatic brain injury causes a decrease in blood flow in the cerebrum of the brain, which if prolonged, can cause permanent cell dysfunction and death. A receptor in the brain called endothelin receptor A (ETrA) contributes to the restriction of blood flow as early as four hours after a brain injury. The new drug, called clazosentan, is thought to specifically block these receptors.

Researchers gave brain-injured rats the drug clazosentan through an intravenous (IV) line at several different points in time after the injury. Next, they measured the rat's blood flow in the hippocampus and sensory motor cortex with an MRI brain scan and tested their behavior in learning a maze.

Preliminary data from the study found that clazosentan decreased the effects of the traumatic brain injury on blood flow to the hippocampus by 25 percent at four hours and 23 percent at 48 hours after TBI. However, giving the rats the drug at 12 hours post-injury caused some to improve, while others worsened or remained the same. In the trial, the drug was most effective when given at two hours post-injury and again at 24 hours after the trauma. The rats also performed better on the maze test when given the drug at two and 24 hours post-injury.

"This research is the foundation for future clinical trials that will investigate the possibilities of using clazosentan in the treatment of TBI," said Kaufman.

Babies' Colic Linked to Mothers' Migraines

2012-02-24T10:48:00.002-08:00

A study of mothers and their young babies by neurologists at the University of California, San Francisco (UCSF) has shown that mothers who suffer migraine headaches are more than twice as likely to have babies with colic than mothers without a history of migraines.

The work raises the question of whether colic may be an early symptom of migraine and therefore whether reducing stimulation may help just as reducing light and noise can alleviate migraine pain. That is significant because excessive crying is one of the most common triggers for shaken baby syndrome, which can cause death, brain damage and severe disability.

"If we can understand what is making the babies cry, we may be able to protect them from this very dangerous outcome," said Amy Gelfand, MD, a child neurologist with the Headache Center at UCSF who will present the findings at the American Academy of Neurology's 64th Annual Meeting, which takes place in New Orleans in April.

Colic, or excessive crying in an otherwise healthy infant, has long been associated with gastrointestinal problems -- presumably caused by something the baby ate. However, despite more than 50 years of research, no definitive link has been proven between infant colic and gastrointestinal problems. Babies who are fed solely breast milk are as likely to have colic as those fed formula, and giving colicky babies medication for gas does not help.

"We've known about colic for a really long time," Gelfand said, "but despite this fact, no one really knows why these babies are crying."

How the Study was Conducted

In the UCSF study, Gelfand and her colleagues surveyed 154 new mothers bringing their infants to the pediatrician for routine check ups at two months, the age when colicky crying typically peaks. The mothers were surveyed about their babies' crying patterns and their own history of migraine, and those responses were analyzed to make sure the reported crying did indeed fit the clinical definition of colic.

Mothers who suffered migraines were found to be two-and-a-half times more likely to have colicky babies. Overall, 29 percent of infants whose mothers had migraines had colic compared to 11 percent of babies whose mothers did not have migraines.

Gelfand and her colleagues believe colic may be an early manifestation of a set of conditions known as childhood periodic syndromes, believed to be precursors to migraine headaches later in life.

Babies with colic may be more sensitive to stimuli in their environment just as are migraine sufferers. They may have more difficulty coping with the onslaught of new stimuli after birth as they are thrust from the dark, warm, muffled life inside the womb into a world that is bright, cold, noisy and filled with touchy hands and bouncy knees.

The UCSF team next plans to study a group of colicky babies over the course of their childhood to see if they develop other childhood periodic syndromes, such as abdominal migraine.

Gene Affecting the Ability to Sleep Discovered in Fruit Flies

2012-02-24T10:47:00.003-08:00

On the surface, it's simple: when night falls, our bodies get sleepy. But behind the scenes, a series of complex molecular events, controlled by our genes, is hard at work to make us groggy. Now, research suggests that a newly identified gene known as insomniac may play a role in keeping us asleep. By cloning and testing this gene in fruit flies, Rockefeller University researchers say they have discovered an entirely new mechanism by which sleep is regulated.

Nicholas Stavropoulos, a postdoc, and Michael W. Young, Richard and Jeanne Fisher Professor and head of the Laboratory of Genetics, conducted a genetic screen of approximately 21,000 fruit flies. Using a device that employs infrared beams to detect when the flies nod off, they discovered that mutations in the insomniac gene were associated with a dramatic reduction in sleep. While a typical fruit fly sleeps for average of 927 minutes a day, insomniac flies snoozed for just 317. The mutant flies also slept for shorter periods of time, and slept and woke more frequently.

"The results showed a dramatic loss of both the duration of the flies' sleep and their ability to remain asleep after they dozed off," says Stavropoulos. "But what's especially interesting is that the insomniacgene may function through homeostatic mechanisms. These are distinct from the well-studied circadian clock pathways linked to sleep, and have an effect on the body regardless of the time of day."

The scientists believe that insomniac works by engaging a specific series of protein degradation pathways in neurons through a complex known as Cul3. If correct, this would be the first time that a protein degradation pathway, in which specific proteins are eliminated within a cell, has been linked to sleep.

The researchers also examined the link between sleep and lifespan, finding that flies with mutations to the insomniac gene lived only about two-thirds as long as unaltered flies (other studies have suggested similar effects in both flies and rats that are deprived of sleep). But when the scientists eliminatedinsomniac only in neurons -- allowing it to remain in the rest of the flies' bodies -- this disparity was eliminated; the resulting animals slept poorly but lived just as long.

"This suggests that reduced sleep can be 'uncoupled' from reduced lifespan, supporting the idea that some disruptions of sleep do not affect overall health, at least as far as lifespan is concerned," Stavropoulos says.

Although flies and humans would appear to have little in common when it comes to lifestyle, scientists say that the mechanisms of sleep and wakefulness are likely to be quite similar.

"Sleep is a fundamental behavior in all animals, and it is poorly understood from a scientific standpoint," says Stavropoulos. "This work gives us several new clues about how sleep is controlled at the molecular level, and could prove useful in understanding and treating sleep disorders."

Teens With Autism Preoccupied With TV, Video Games: Study

2012-02-24T10:45:00.001-08:00

When given the opportunity to have screen time, children with autism spectrum disorders typically choose television and video games over social interactive media, such as email, a new study finds .

The preoccupation with video games could interfere with the children's socialization and learning, warned the researchers, whose study appears online in the Journal of Autism and Developmental Disorders.

Autism is a neurodevelopmental disorder characterized by problems with social interaction, communication and restricted interests and behaviors. Autism spectrum disorders, or ASDs, include Asperger syndrome, which is a milder form of autism.

In conducting the study, the researchers analyzed information on more than 1,000 teens in special education classes, including those with autism spectrum disorders, learning and intellectual disabilities, and speech problems.

About 60 percent of the teens with autism spectrum disorders spent most of their time watching TV or videos, the investigators found.

"This rate appears to be high, given that among typically developing adolescents, only 28 percent have been shown to be 'high users' of television," Paul Shattuck, an assistant professor at the Brown School at Washington University in St. Louis, said in a university news release. "Television viewing is clearly a preferred activity for children with ASDs, regardless of symptoms, functional level or family status."

Moreover, 41 percent of the teens with autism spent most of their free time playing video games, the study authors found.

"Given that only 18 percent of youths in the general population are considered to be high users of video games, it seems reasonable to infer based on the current results, that kids with ASDs are at significantly greater risk of high use of this media than are youths without ASDs," Shattuck added.

In contrast, the teens with autism spectrum disorders were less likely to use email or social media.

"We found that 64.4 percent of youth with ASDs did not use email or chat at all," Shattuck said. "Kids with speech and language impairments and learning disabilities were about two times more likely to use email or chat rooms than those with ASDs."

He noted, however, use of social media increased among the teens with autism spectrum disorders as they got older and their cognitive skills improved. Cognitive is a word used to describe brain-based functions such as memory, thinking, learning and processing information.

"This proclivity for screen time might be turned into something we can take advantage of to enhance social skills and learning achievement, especially [with] recent innovations in devices like iPads," Shattuck suggested.

Good Football Helmet Fit Key to Preventing Brain Injuries

2012-02-24T10:43:00.001-08:00

While football helmets don't prevent concussions, good helmet fit might help reduce loss of consciousness that can follow a blow to the head, a new study finds.

Expensive, high-tech helmets with air-lining systems aren't much better than vintage "leatherheads" for preventing concussions, the researchers said.

"The occurrence of concussion has been constant for the past 30 years: whether it was a leather helmet, whether it was a plastic helmet with web suspension, whether it was a plastic helmet with foam, or one with the new combination air cells and padding," said study author Dr. Joseph Torg, an adjunct professor of orthopedic surgery at Temple University in Philadelphia.

The researchers looked at data from the U.S. National High School Sports-Related Injury Surveillance System from 2005 to 2009. Of the nearly 1,400 kids who sustained a concussion, 44 lost consciousness and 267 experienced amnesia.

Injury reports addressed helmet fit, type of inner-helmet padding and whether the helmet was new or reconditioned.

"Youngsters who had a concussion, if the helmet fit, they had 82 percent less chance of loss of consciousness," Torg said. "Helmets -- and advanced helmet technology -- do not prevent against concussions or the severe intracranial injuries of hemorrhage [bleeding] and brain swelling."

The researchers also analyzed previous studies comparing types of helmets.

Older, reconditioned helmets did as well as new helmets. But unpublished data suggested that helmets with air-bladder linings might be a risk factor, because they tend to leak and can deflate if not maintained properly.

Wendy Norris, head athletic trainer at DeMatha Catholic High School in Hyattsville, Md., said her responsibility for player health includes gear safety, and it's standard practice to inspect helmets before each game.

"We have helmets certified every year, and the day before games we always check them to make sure they're fitting well," said Norris, a certified athletic trainer. "It's an ongoing process. Sometimes I'll see somebody on the field and say, 'Hmm, I don't like how that looks.' And we adjust it."

Higher-tech helmets with improved air-cell systems cost about $250 to $350 each, Norris said. An advantage is that company representatives come out to the schools and educate trainers and coaches on proper fit.

Torg said the big question is, beyond helmets, what sets apart the four to six football players who suffer catastrophic injuries from concussion each year?

"Our thesis: there's a combination of factors that predisposes those small numbers of youngsters," he said. The factors are mostly unidentified, he added, noting they could be congenital, anatomic, or even related to air temperature.

"A kid who has a severe concussion has a number of predisposing factors, one of which is probably a helmet that doesn't fit," Torg said. "If you remove that component, then maybe the problem is solved."

Torg's study was presented at this month's annual meeting of the American Orthopaedic Society for Sports Medicine in San Francisco.

Athletic trainer Norris suggested some "easy landmarks that parents can look for," with helmet fit:

Players' eyes should be visible.
Helmet ear holes should line up with players' ears.
Cheek pads should sit next to the skin, without a big gap.
The back of the skull should be covered.
Mouth guards shouldn't be chewed up and hanging out of players' mouths. They should fit past the second molar on both sides. Molded is better because that helps absorb the shock when players get hit in the head.
The helmet shouldn't shake or rattle. If you grab the facemask and the chin strap is tightened up all the way, you should not be able to move the facemask left or right. It should stay neutral.
Find out if helmets are recertified every year. "They should be," Norris said. "But a lot of schools can't afford that." One way you can tell: there should be a sticker at the back of the helmet with the year.

If you think something's wrong, ask the trainer or the coach, she advised.

Players also have a role, the trainer stressed.

"We tell them for sure not to customize the helmet in any way," Norris said. "A lot of them want to cut the forehead pads or cut the cheek pads to make them thinner. We definitely discourage that."

And, she added, "they should also have their coaches check their helmets at least every week or two weeks, just to make sure everything's good."

3-D TV Doesn't Raise Seizure Risk for Kids With Epilepsy: Study

2012-02-22T18:51:00.000-08:00

3-D TV Doesn't Raise Seizure Risk for Kids With Epilepsy: Study

Researchers note that certain patterns, colors, flickering images a greater threat

Monday, December 5, 2011URL of this page: HERE

SUNDAY, Dec. 4 (HealthDay News) -- Children with epilepsy do not appear to face an increased risk for seizures while watching 3-D TV, a new German-Austrian study suggests.

However, the results did reveal that about one in five of these children is vulnerable to other unpleasant reactions when viewing 3-D television, including nausea, headaches and dizziness.

"Normal people have a very low risk to get a seizure while watching 3-D," explained study author Dr. Herbert Plischke, executive director of the University of Munich's Generation Research Program. In contrast, he noted that people with epilepsy --particularly children -- could be expected to have a "higher vulnerability" in terms of overall seizure risk in such a setting.

However, among a group of young people with epilepsy, "we could not see any provoked seizure which was caused by 3-D," Plischke said.

He and his colleagues from the University of Salzburg in Austria are scheduled to present their findings Sunday at the American Epilepsy Society annual meeting in Baltimore.

As a concept, 3-D technology is hardly a cutting-edge idea, harkening back more than half a century to the 1950s Vincent Price classic film "House of Wax." But the experience of donning special glasses to view an "extra-dimensional" effect has undergone a cinematic renaissance in recent years, led by the box-office success of the movie "Avatar."

Jumping on the bandwagon, TV manufacturers have sought to bring the experience right into the living room, with TV sets that are hard-wired to provide 3-D viewing of properly formatted shows.

The move has raised concerns over how the technology may impact various audiences. Recently, some researchers cautioned that nearly one-third of all viewers may be prone to experiencing headaches and/or eye fatigue when viewing a 3-D movie because of poor eye coordination. The resulting strain, they said, could prompt an unpleasant experience equivalent to that of seasickness.

People with epilepsy are a more specific worry, given their sensitivity to the flashing lights and red and blue light alterations contained in certain TV programming and video games. As a result, some TV manufacturers (such as Samsung) have published public warnings, alerting viewers to the potential risk for epileptic seizures or stroke when viewing 3-D technology.

Against that backdrop, the current investigation set out to assess the impact of 3-D on children with epilepsy viewing the technology on TV.

The team focused on 100 children (average age 12) who had epilepsy or were deemed to be at risk for epilepsy.

All the kids underwent a standard test for photosensitivity. Each was then asked to wear 3-D glasses and sit about six-and-a-half feet away from a 50-inch plasma 3-D TV.

During 15 minutes of viewing, only one child experienced a seizure, and that particular child was noted as being prone to routinely experiencing three to four seizures per day.

Symptoms of nausea, headache and dizziness went up during both photosensitivity testing and 3-D TV-watching (in 15 percent and 20 percent of cases, respectively). But the near total absence of seizures, combined with the benign results of EEG readings taken during sensitivity testing and 3-D viewing, led the team to conclude that 3-D TV viewing posed little risk to children with epilepsy.

The team suggested that seizure risk is probably more a function of differences in TV content rather than TV technology, with certain patterns, colors and flickering images raising the threat of seizure more than 3-D images.

Dr. Orrin Devinsky, director of NYU Langone Medical Center's Epilepsy Center, agreed.

"It sounds perfectly in line with what I might expect," he said. "If there was to be a problem, it would be with the content, namely flashing imagery. And that would be a present concern in 2-D or 3-D."

"So I wouldn't expect 3-D TV to be a specific issue," said Devinsky, who is also a professor of neurology, neurosurgery and psychiatry at NYU School of Medicine. "I wouldn't say that no child in ten thousand would have a problem. But I would expect it to be very rare, if it occurs at all."

Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

SOURCES: Herbert Plischke, executive director, Generation Research Program, University of Munich, Germany; Orrin Devinsky, M.D., director, Epilepsy Center, New York University Langone Medical Center, and professor, neurology, neurosurgery and psychiatry, New York University School of Medicine, New York City; Dec. 4, 2011, presentation, American Epilepsy Society annual meeting, Baltimore

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Computerized Tests For Concussions May Be Unreliable

2012-02-21T04:10:00.000-08:00

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."

More here

Irregular Sleep Could Weaken Your Immune System

2012-02-20T18:00:00.001-08:00

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.

Epi-Pen to Stop Epileptic Seizures?

2012-02-20T17:42:00.000-08:00

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.

Brain Imaging Differences Evident at 6 Months in High-Risk Infants Who Later Develop Autism

2012-02-20T17:36:00.000-08:00

A new study led by the University of North Carolina at Chapel Hill found significant differences in brain development starting at age 6 months in high-risk infants who later develop autism, compared to high-risk infants who did not develop autism.

"It's a promising finding," said Jason J. Wolff, PhD, lead author of the study and a postdoctoral fellow at UNC's Carolina Institute for Developmental Disabilities (CIDD). "At this point, it's a preliminary albeit great first step towards thinking about developing a biomarker for risk in advance of our current ability to diagnose autism."

The study also suggests, Wolff said, that autism does not appear suddenly in young children, but instead develops over time during infancy. This raises the possibility "that we may be able to interrupt that process with targeted intervention," he said.

Joseph Piven, MD, director of the CIDD, is senior author of the study.

The study was published online on Feb. 17 at AJP in Advance, a section of the website of the American Journal of Psychiatry. Its results are the latest from the ongoing Infant Brain Imaging Study (IBIS) Network, which is funded by the National Institutes of Health and headquartered at UNC. Piven received an NIH Autism Centers of Excellence (ACE) program network award for the IBIS Network in 2007. ACE networks consist of researchers at many facilities in locations throughout the country, all of whom work together on a single research question.

Participants in the study were 92 infants who all have older siblings with autism and thus are considered to be at high risk for autism themselves. All had diffusion tensor imaging -- which is a type of magnetic resonance imaging (MRI) -- at 6 months and behavioral assessments at 24 months. Most also had additional brain imaging scans at either or both 12 and 24 months.

At 24 months, 28 infants (30 percent) met criteria for autism spectrum disorders while 64 infants (70 percent) did not. The two groups differed in white matter fiber tract development -- pathways that connect brain regions -- as measured by fractional anisotropy (FA). FA measures white matter organization and development, based on the movement of water molecules through brain tissue.

This study examined 15 separate fiber tracts, and found significant differences in FA trajectories in 12 of the 15 tracts between infants who did develop autism versus infants who did not. Infants who later developed autism had elevated FA at six months but then experienced slower change over time. By 24 months of age, infants with autism had lower FA values than infants without autism.

"This evidence, which implicates multiple fiber pathways, suggests that autism is a whole-brain phenomenon not isolated to any particular brain region," Wolff said.

Eighteen researchers are listed as co-authors of the study. Study co-authors with UNC affiliations include Wolff, Piven, Hongbin Gu,PhD; Guido Gerig,PhD; Jed T. Elison, PhD; Martin Styner, PhD; Geraldine Dawson, PhD and Heather C. Hazlett, PhD. Other institutions and organizations that took part in the study include the University of Utah, Washington University in St. Louis, University of Washington, McGill University, Children's Hospital of Philadelphia and the University of Alberta.

In addition to funding from the NIH, the IBIS Network receives support from Autism Speaks and the Simons Foundation Autism Research Initiative.

Vicious cycle of sleep apnea and obesity in kids

2012-02-18T10:59:00.000-08:00

Vicious cycle of sleep apnea and obesity in kids

Great advice: To summarize "

If your child is overweight, please consult a doctor to find out if he or she has the symptoms of sleep apnea, such as snoring, rough breathing, daytime sleepiness, poor academic performance, behavior issues and depression." JR

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs regularly on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

The classic pediatric sleep apnea patient is a skinny 6-year-old with chronic congestion and dark circles under his eyes.

We still see many kids in the sleep center who match this profile, but over the past 10 years, a new clinical picture has emerged. Coinciding with the dramatic rise in childhood obesity, there is a clear change in our younger patients.

We now see many overweight children in the sleep clinic who have obstructive sleep apnea that resembles the adult version.

The thin child with OSA does not usually act sleepy in the daytime. On the contrary, they often act hyperactive or inattentive. In fact, their symptoms can mimic attention deficit hyperactivity disorder.

Large tonsils and adenoids are the primary cause of OSA in thin children because these and surrounding tissues can relax during sleep and block the airflow to the lungs. In fact, 80 to 90% of such cases of pediatric OSA are cured by surgically removing the tonsils and adenoids.

Overweight or obese children are not such an easy fix. They usually present with loud snoring and significant daytime sleepiness. In obese children, the tonsils often become enlarged due to fatty tissues in the upper airway. Fat deposits in the neck and chest also add to the collapsibility of the upper airway during sleep.

Unfortunately, a tonsillectomy/adenoidectomy is curative in only about 50% of overweight kids who have OSA. The others are encouraged to try continuous positive airway pressure (CPAP) which is the most common treatment for severe OSA.

When adults have mild-to-moderate OSA, we offer them an alternative treatment called an oral appliance (also called a mandibular advancing device). However, we cannot use this treatment in children and teens whose mouth and jaw are still changing.

The important thing for pediatricians and parents to keep in mind is that the connection between weight and sleep is a two-way street.

It’s not just that excess weight increases the likelihood that kids have obstructive sleep apnea, but that having sleep apnea increases the risks of gaining weight.

Sleep deprivation due to poor sleep or too little sleep can cause hormonal havoc that leads to weight gain.

For example, when research subjects were allowed to sleep for only four hours per night, the hormones that control appetite got all out of whack. Leptin, which acts on the brain to make people feel full, was abnormally decreased and ghrelin, which makes people hungry, was unusually high.

These hormonal changes caused the research participants to be very hungry and eat more during the day.

Children and teens with sleep apnea might seem to be sleeping a lot, but their sleep is constantly disturbed by brief turbulence in their brain waves - what sleep experts call micro-arousals. In effect, these kids are as sleep deprived as people who only get four to five hours of sleep.

Not only do obese kids with OSA have a similar clinical presentation as adults, they unfortunately can have the same adverse outcomes if the sleep apnea is not treated. We are seeing pre-teens who have what we use to think of as adult diseases such as high blood pressure, pulmonary hypertension, heart disease and congestive heart failure.

OSA is easy to diagnose with an overnight sleep test and as I outlined above, there is more than one treatment option. Treating sleep apnea, if present,

read here

New Caffeine App Prevents Sleep Problems

2012-02-18T09:43:00.000-08:00

Researchers recently developed a new caffeine app to prevent caffeine-related sleep problems and help people predict their optimal performance window during caffeine stimulation.

Researchers from Penn State University announce that they have developed an app called “Caffeine Zone 2” that can prevent problems with sleeping by predicting the levels of caffeine in your body. In addition, the app shows the user when they are reaching their cognitive peak for optimal performance.

Dr. Frank Ritter, professor of information sciences and technology and Dr. Martin Yeh, assistant professor of computer science and engineering, have devised an app that is formulated on a pharmacokinetic model and the user’s input of their caffeine consumption to show the user how much caffeine is currently in their body. The function of this app is to primarily help coffee drinkers monitor and manage their coffee consumption and thereby prevent drinking coffee or other caffeinated drinks too soon before bedtime.

According to the researchers, managing your caffeine levels can be tricky and for many people mismanaging your caffeine consumption often results in sleepless nights due to consuming too much caffeine at the wrong time. However, drinking coffee and other caffeinated beverages does have benefits where staying awake and alert are necessary. Examples include working a job with changing shifts, long distance truck driving and staying up for that all-nighter in college or finishing a project in time for the morning meeting with the boss.

The good news about drinking caffeinated beverages is that they do work as a relatively safe nervous system stimulant and that your body metabolizes caffeine rather quickly.

Caffeine has a short half-life of approximately 5 to 7 hours. A half-life is the time it takes to eliminate 50% of the caffeine from your body. Therefore, 75% of the caffeine from the two cups of coffee you had this morning is pretty much gone by the time you hit the sack. Health experts typically recommend that you have your last cup of coffee no later than 6 hours before going to bed. However, caffeine affects some more than others, and the timing may need to be adjusted.

According to the researchers who created the caffeine app, many people are unaware of just how much caffeine they have in their body and some tend to operate over-caffeinated.

“We wanted to have a mobile tool so that [users] can see how much caffeine is in the body,” Dr. Yeh states.

Researchers Make Living Model of Brain Tumor

2012-02-18T09:40:00.000-08:00

Researchers have created a living 3-D model of a brain tumor and its surrounding blood vessels. In experiments, the scientists report that iron-oxide nanoparticles carrying the agent tumstatin were taken by blood vessels, meaning they should block blood vessel growth. The living-tissue model could be used to test the effectiveness of nanoparticles in fighting other diseases.

Brown University scientists have created the first three-dimensional living tissue model, complete with surrounding blood vessels, to analyze the effectiveness of therapeutics to combat brain tumors. The 3-D model gives medical researchers more and better information than Petri dish tissue cultures.

The researchers created a glioma, or brain tumor, and the network of blood vessels that surrounds it. In a series of experiments, the team showed that iron-oxide nanoparticles ferrying the chemical tumstatin penetrated the blood vessels that sustain the tumor with oxygen and nutrients. The iron-oxide nanoparticles are important, because they are readily taken up by endothelial cells and can be tracked by magnetic resonance imaging.

Previous experiments have shown that tumstatin was effective at blocking endothelial cell growth in gliomas. The tests by the Brown researchers took it to another level by confirming, in a 3-D, living environment, the iron-oxide nanoparticles' ability to reach blood vessels surrounding a glioma as well as tumstatin's ability to penetrate endothelial cells.

"The 3-D glioma model that we have developed offers a facile process to test diffusion and penetration into a glioma that is covered by a blood vessel-like coating of endothelial cells," said Don Ho, a graduate student in the lab of chemistry professor Shouheng Sun and the lead author of the paper in the journal Theranostics. "This assay would save time and money, while reducing tests in living organisms, to examine an agent's 3-D characteristics such as the ability for targeting and diffusion."

The tissue model concept comes from Jeffrey Morgan, a bioengineer at Brown and a corresponding author on the paper. Building on that work, Ho and others created an agarose hydrogel mold in which rat RG2-cell gliomas roughly 200 microns in diameter formed. The team used endothelial cells derived from cow respiratory vessels, which congregated around the tumor and created the blood vessel architecture. The advantage of a 3-D model rather than Petri-dish-type analyses is that the endothelial cells attach to the tumor, rather than being separated from the substrate. This means the researchers can study their formation and growth, as well as the action of anti-therapeutic agents, just as they would in a living organism.

"You want to see nanoparticles that diffuse through the endothelial cells, which is lost in 2-D because you just have diffusion into media," Ho said.

Treating Kid's Sleep Apnea May Improve Behavior

2012-02-14T18:13:00.000-08:00

Note - I see this all the time. The best psychiatrists ask about sleep.

Using positive airway pressure (PAP) to treat obstructive sleep apnea in children and teens appears to improve neurobehavioral outcomes, even with suboptimal adherence, researchers found.

After three months, PAP was associated with gains in symptoms of attention deficit hyperactivity disorder (ADHD), sleepiness, behavior, and quality of life (P≤0.005 for all), according to Carole Marcus, MBBCh, of the Children's Hospital of Philadelphia, and colleagues.

The benefits also were seen in children with developmental disabilities and in those younger than 7, the researchers reported online in the American Journal of Respiratory and Critical Care Medicine.

"These improvements occurred despite a mean use of only three hours per night, suggesting that clinicians should encourage any PAP use, and not be discouraged when adherence is suboptimal," they wrote.

"The time required for maximal improvements in behavioral function is unknown but may well be longer than three months, and further studies with long-term follow-up are needed."

Sleep apnea syndrome affects up to 4% of children, and can be associated with neurobehavioral disturbances. Most of the cases are associated with adenotonsillar hypertrophy and improve after adenotonsillectomy, although some of the children require PAP therapy.

To explore the benefits of PAP therapy on neurobehavioral outcomes, Marcus and colleagues turned to a randomized trial that compared two types of PAP delivery -- continuous PAP (CPAP) and bilevel pressure release (Bi-Flex) -- among pediatric patients with obstructive sleep apnea.

Because the two approaches had similar efficacy, the patients were combined for the current analysis, which included 52 children and teens (mean age 12).

Underlying medical conditions were common, and the most frequent were obesity (69%) and genetic syndromes (17%). Ten patients (19%) had developmental delays.

Adherence to PAP varied widely, but it was used for an average of 170 minutes per night for the three-month study. PAP improved respiratory and sleep parameters measured with polysomnography.

Despite the low overall adherence to therapy, PAP was associated with improvements in almost all of the neurobehavioral domains measured at baseline and at three months (P≤0.005 for all), including ADHD symptoms, the Epworth Sleepiness Scale, internalizing behavior symptoms and total behavior reported by caregivers, and quality of life reported both by caregivers and the patients.

The percentage of patients with scores in the abnormal range decreased significantly following three months of PAP therapy for sleepiness and quality of life.

The improvements were related to the degree of adherence for the Epworth Sleepiness Scale (P=0.0006), but not for the other outcomes.

"One reason for the lack of correlation between PAP use and other neurobehavioral outcomes in the current study may be the difference in physiologic sleep requirements over the age spectrum studied, and the differing degree of baseline neurobehavioral function in the subjects," the authors wrote.

"Thus," they wrote, "the effects of wearing CPAP for four hours a night may be less beneficial in a 2-year-old sleeping for 12 hours a night than in a 16-year-old sleeping eight hours a night."

They acknowledged some limitations of the study, including the lack of a placebo group, the inability to blind patients and caregivers to PAP treatment, and the inclusion of children and teens with a variety of ages and a variety of underlying medical conditions.

Study finds jolt to the brain boosts memory

2012-02-14T18:10:00.000-08:00

Neuroprosthetics are increasingly seen in practice.

In an experiment likely to raise new hopes for those with memory-robbing diseases such as Alzheimer’s, researchers have found that sending an electrical jolt to a part of the brain that plays a key role in memory improved people’s ability to learn — and remember — their way across an unfamiliar landscape.

The study, conducted at the University of California, Los Angeles and published in Thursday’s edition of the New England Journal of Medicine, was small and highly preliminary, involving just seven patients with epilepsy. But deep brain stimulation helped all seven subjects — including some who suffered memory impairment — navigate faster and more accurately through a virtual town.

Since the treatment also gave a boost to subjects with no signs of dementia, the study is likely to reignite a simmering debate over the ethics of enhancing the mental capacities of people in perfect cognitive health, experts said.

The new results build on animal studies that found deep brain stimulation not only boosted activity in the brain’s memory centers, but spurred the growth of new brain cells when those regions were damaged. The fact that the same technique improved memory performance in humans makes some researchers optimistic that it might be a way to block or reverse the destruction of brain cells in patients with Alzheimer’s.

Although physicians are now able to diagnosis Alzheimer’s disease earlier than ever — sometimes years before memory lapses and other cognitive changes become evident — they are still at a loss to alter the disease’s progress.

Deep brain stimulation involves the insertion of guide wires through the skull and into the brain, where they deliver electrical current to clusters of neurons that no longer function properly. It is widely used in the treatment of Parkinson’s disease, in which damage to regions of the brain’s motor cortex cause tremors, rigidity and unsteady gait. About 90,000 Americans have had the battery-powered, stopwatch-sized devices implanted in their brains, and they often show marked improvement. But the neurostimulator has not been found to slow or block the progression of that disease.

The technique is also being used for patients with epilepsy, to disrupt the storm of electrical current in the brain that causes seizures. The patients who took part in the memory trial were candidates for this treatment, and in preparation for surgery they had electrical probes inserted in their brains — giving researchers the opportunity to conduct their experiment.

Dr. Maria Carrillo, scientific director of the Alzheimer’s Association, agreed that electrically stimulating the brain’s memory centers may hold greater promise. But she cautioned that the complexity and breadth of destruction in Alzheimer’s make it resistant to simple fixes.

“It’s a little early to talk about deep brain stimulation as a treatment for Alzheimer’s disease,” she said. “But certainly it’s tantalizing."

Overeating May Double Risk of Memory Loss: Study

2012-02-14T18:06:00.000-08:00

Eat less and live longer. JR

Older people who eat too much are at risk for memory impairment, a new study contends.

People 70 and older who eat between 2,100 and 6,000 calories a day may be at double the risk of these deficits in memory, which can be an early sign of Alzheimer's disease, the study authors said.

"Excessive daily caloric consumption may not be brain-health friendly," said lead researcher Dr. Yonas Geda, an associate professor of neurology and psychiatry at the Mayo Clinic in Scottsdale, Ariz.

"It may sound like a cliche, but we need to be mindful of our daily caloric consumption," he said. "The bottom line is that eating in moderation, not in excess amount, may be good for your brain."

The results of the study are due to be presented in April at the annual meeting of the American Academy of Neurology, in New Orleans. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

For the study, investigators collected data on more than 1,200 people, aged 70 to 89, living in Olmsted County, Minn. Among these people, 163 had been diagnosed with the memory deficits known as "mild cognitive impairment."

Each person told the researchers how much they ate. One-third ate between 600 and 1,525 calories a day, one-third between 1,526 and 2,142 calories a day, and one-third ate between 2,143 and 6,000 calories a day.

Among those who ate the most, the odds of being diagnosed with the impaired-memory disorder was more than twice that of those who ate the least, the researchers found.

There was no significant increase in risk for memory problems among those in the middle group, the researchers added.

These findings remained the same after taking into account a history of stroke, diabetes, education and other risk factors for memory loss.

"We also looked at BMI and obesity," Geda said. BMI, or body mass index, is a measurement based on height and weight. "But there was no significant difference between the normal [participants] and mild cognitive impairment when it comes to these two variables," he said.

Why overeating affects the brain isn't clear, but "excessive caloric intake may lead to oxidative damage leading to structural changes in the brain," Geda suggested.

Commenting on the study, Dr. Neelum Aggarwal, an associate professor of neurological sciences at Rush University in Chicago, said that "as the population of the U.S. is aging at a rapid rate, in addition to becoming increasingly obese, physicians are being asked by their elderly patients about their risk for various diseases, specifically cognitive [mental] decline and dementia."

These findings allow doctors to start the discussion about the links between common healthy living practices -- eating a nutritious diet, limiting sugar -- to overall brain function, he said.

"This study furthers the discussion of what the possible mechanisms are for the development of cognitive decline and offers strategies for disease prevention through nutrition and caloric restriction," Aggarwal said.

Another expert, David Loewenstein, a professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine, said that "this makes a lot of sense because increased caloric intake is associated with obesity and metabolic syndrome, so it is not at all surprising that increased calories are associated with increased cognitive impairment." Metabolic syndrome is a group of risk factors linked to heart disease and other health problems.

"This study suggests that anything that's good for the heart -- like decreased calories -- is good for the brain," Loewenstein added.

While the study found an association between overeating and memory impairment, it did not prove a cause-and-effect relationship.

Read more: http://www.nlm.nih.gov/medlineplus/news/fullstory_121851.html

Scientists create brain cells from human skin in possible breakthrough for autism, Alzheimer's research

2012-02-14T18:03:00.000-08:00

Brain and skin from common stem cells. JR

Scientists who have generated brain tissue from human skin are claiming a major breakthrough.

The researchers wrote on the University of Cambridge website that their findings could speed up the hunt for new treatments for diseases of the cerebral cortex, such as epilepsy and autism, to neurodegenerative conditions such as Alzheimer’s disease.

"Today’s findings will enable scientists to study how the human cerebral cortex develops, how it ‘wires up’ and how that can go wrong (a common problem leading to learning disabilities)," they wrote.

Their findings were published in the journal Nature Neuroscience.

Created cerebral cortex cells – those that make up the brain’s grey matter -- will allow them to "recreate brain diseases, such as Alzheimer’s, in the lab," they wrote, providing "previously impossible insight."

It may also allow them to develop and test new drugs to stop the diseases progressing.

Britain's Sunday Telegraph reported that until now, it has only been possible to generate tissue from the cerebral cortex by using controversial embryonic stem cells, obtained by the destruction of an embryo.

...

''We can study brain development and what goes wrong when it is affected by disease in a way we haven't been able to before. We see it as a major breakthrough in what will now be possible.''

Kids have been sleep-deprived for more than 100 years: study

2012-02-14T18:00:00.000-08:00

Editor's note - This article has com under fire from a significant number of pediatric sleep specialists. Watch for a letter to the editor attacking the claims in the article and editorial. I am publishing this to raise awareness of this discussion. JR

Worried that your children aren’t getting enough sleep? You’re not alone. As one prominent educational psychologist put it, “physicians and writers on school hygiene agree that children are likely to receive less sleep than is needful to them.”

That assessment was offered way back in 1913, and it came from Lewis Terman, who went on to develop the Stanford-Binet IQ test. Terman certainly wasn’t right about everything, but his concern for sleep-deprived kids tapped into a longstanding source of parental angst.

It turns out that experts have been fretting about tired children since at least 1897. According to an article published online Monday by the journal Pediatrics, 32 sets of sleep guidelines for kids – containing 360 distinct recommendations for children of specific ages – were published between 1897 and 2009. During that time, the amount of recommended sleep fell by an average of 0.71 minutes per year. That added up to about 70 fewer minutes of suggested nightly sleep over the course of the 20th century.

And how well did parents of yore live up to those recommendations? Not very well, according to the Pediatrics article. Of the 360 sleep recommendations made over the years, Australian researchers found data that corresponded to 173 of them. In 83% of the cases, children were falling short of the ideal – and doing so by an average of 37 minutes. Overall, the actual amount of nightly sleep for children fell by an average of 0.73 minutes per year.

Among all the expert recommendations put forth, the researchers could find only one case for which the expert guidelines were rooted in medical evidence of a need for a particular amount of sleep. That was a 1926 study that measured the actual sleep of 500 kids between the ages of 6 and 15 who were deemed “healthy.” Other than that, it seems that experts simply looked at the amount of sleep children around them were getting and figured that they really needed a little bit more, the authors wrote.

And what’s to blame for all this pediatric sleep deprivation? Why, new technology and the increasingly rigorous demands of modern life, of course. “The hurry and excitement of modern life is quite correctly held to be responsible for much of the insomnia of which we hear,” according to an editorial published in the British Medical Journal way back in 1894.

....

Stem Cell Fraud for Cerebral Palsy, Epilepsy

2012-02-12T18:31:00.000-08:00

"60 Minutes" investigates online stem cell fraud

Dr. Joanne Kurtzberg of Duke University tells Scott Pelley that stem cells purchased from one of the hundreds of websites promising stem cell cures for incurable diseases could actually cause a patient serious harm. The chief scientific officer for Duke's stem cell research program spoke to Pelley as part of an eight-month investigation into the illicit stem cell industry.

In the report, "60 Minutes" cameras capture a disgraced doctor trying to sell an unproven stem cell treatment to the parents of a child with cerebral palsy. Pelley's investigation will be broadcast on "60 Minutes" on Sunday, Jan. 8 at 8 p.m. ET/PT.

Kurtzberg decries the websites offering unproven stem cell remedies for what are currently incurable diseases like autism, multiple sclerosis, Alzheimer's and every kind of cancer. She hears from patients who see those websites and has to inform them that thus far, stem cells have been used to successfully treat leukemia and a few rare genetic diseases and nothing else. "It's very dishonest to mislead people when there is nothing you can do," says Kurtzberg. "I believe stem cells have a lot of promise, but we are way at the infancy," she tells Pelley.

"60 Minutes" worked with Gary and Judy Susser, parents of Adam, who has cerebral palsy, to investigate one of the online purveyors of stem cell treatments, Stem Tech Labs of Ecuador. Such labs are offshore because what they are doing is mostly illegal in the U.S. The lab, run by an American doctor named Dan Ecklund whose license to practice medicine was revoked in Alabama, promises a "modern day miracle" and "treating or curing over 70 diseases." "60 Minutes" cameras captured Ecklund on a teleconference from Ecuador promising the Sussers that Adam would have a "75 percent chance...he would have a noticeable improvement." He would come to Florida to administer four stem cell transplants for which he would charge $5,000 each. In a Miami-area hotel room set with hidden cameras, Pelley confronts Ecklund about his intentions to treat the child.

"60 Minutes" purchased some stem cells from Ecklund's website and had Kurtzberg examine them in her lab at Duke. Dr. Kurtzberg discovered that only 100 of the 20 million umbilical cord blood stem cells bought for $5,000 were still alive. The dead cells are cellular debris and dangerous says Kurtzberg. "There are huge dangers if you inject that into someone's blood or spinal fluid because all these little fragments and debris would get trapped somewhere in the bloodstream and could cause a stroke...do a great deal of harm," Kurtzberg tells Pelley.

Adam, 11, did not get the treatments; his parents had been down that route before in 2003 when they took him to Mexico for similar treatments that produced no miracles. The Sussers want others to beware. "People are preyed upon by hucksters and charlatans... It's about getting rich at someone's expense," says Gary Susser. "And people with a special child don't need anymore expense...heartache...false promises. They need the truth and they need hope."

© 2012 CBS Interactive Inc.. All Rights Reserved.

Read more: http://www.cbsnews.com/8301-18560_162-57354200/60-minutes-investigates-online-stem-cell-fraud/#ixzz1mE0Et65X

The Internet is full of websites selling unproven stem cell treatments for incurable illnesses;

Read more: http://www.cbsnews.com/video/watch/?id=7394402n&tag=cbsnewsMainColumnArea.6#ixzz1mDzi7jO

video here

Why Brain Injuries Are More Common In Preemies

2012-02-11T20:46:00.000-08:00

Why Brain Injuries Are More Common In Preemies

The most common cause of brain injury in premature infants is a lack of oxygen in the days and weeks after birth, researchers say.

Scientists say they are beginning to understand why brain injuries are so common in very premature infants — and they are coming up with strategies to prevent or repair these injuries.

The advances could eventually help reduce the number of premature babies who develop cerebral palsy, epilepsy or behavioral disorders such as ADHD, researchers told the Society for Neuroscience meeting in Washington, D.C., this week.

Each year more than 60,000 babies are born weighing less than 3.3 pounds. And because of advances in neonatal medicine over the past several decades, most of those babies will survive. But researchers have had less success finding ways to prevent brain damage in these infants.

"That means that overall rates of cerebral palsy and other neurodevelopmental disabilities are on the rise," says David Rowitch, chief of neonatology at the University of California, San Francisco.

The most common cause of brain injury in premature infants is a lack of oxygen in the days and weeks after birth, Rowitch says. The lack of oxygen damages white matter, which provides the "communication highways" that carry messages around the brain and to distant parts of the body, he says.

And the babies at greatest risk of this sort of brain damage are those born after as little as six months of gestation, Rowitch says.

"Such a baby would weigh about a pound and would fit into the palm of your hand," he says. "As you can imagine, they're very fragile and vulnerable to stresses."

Those stresses often include periods when an infant's immature lungs are not delivering enough oxygen to the brain, even with help from a mechanical breathing device.

This lack of oxygen appears to damage the most common type of white matter, myelin, which acts like an insulator around the nerve fibers that carry messages in the brain and nervous system. Without enough myelin, short circuits can prevent these messages from getting through, Rowitch says.

He initially found evidence of white matter damage by studying brains from premature infants who died. But since then, he's been able to assess premature infants using a special incubator designed to fit in an MRI scanner.

"We've been able to now take over 250 babies who are very preterm to the MRI scanner safely to show that this is a feasible way to detect white matter injury early on," he says.

Now the question is how to prevent or repair that sort of injury.

Some studies show that it's important to act right away, says Vittorio Gallo from Children's National Medical Center in Washington, D.C.

"There is a very critical developmental time window right after birth," Gallo says. "If development is disturbed during this critical time window then the brain doesn't catch up."

Gallo is part of a team of scientists who have shown that it is possible to intervene — at least in mice. One approach involves giving the mice a drug that speeds up production of myelin, he says.

"We do this intervention right after the injury," he says. "And we found that by targeting specific targets we can recover and regenerate at least part of these cells right after the injury, during that critical developmental time window."

Any drug for people is still years off, Gallo says

But other scientists at the meeting say there are promising treatments available now. These include everything from the magnetic stimulation of certain areas of the brain to temporarily lowering the body temperature of premature infants to protect brain tissue.

Full story here

The temporal evolution of electrographic seizure burden in neonatal hypoxic ischemic encephalopathy.

2012-02-11T06:27:00.000-08:00

The temporal evolution of electrographic seizure burden in neonatal hypoxic ischemic encephalopathy

Epilepsia. 2012 Feb 6. doi: 10.1111/j.1528-1167.2011.03401.x. [Epub ahead of print]

Lynch NE, Stevenson NJ, Livingstone V, Murphy BP, Rennie JM, Boylan GB.

Source

Department of Paediatrics and Child Health, University College Cork, Cork, Ireland Neonatal Brain Research Group, University College Cork, Cork, Ireland Elizabeth Garrett Anderson Institute for Women's Health, University College London Hospitals, London, United Kingdom.

Abstract

Purpose: Hypoxic ischemic encephalopathy (HIE) accounts for 60% of all neonatal seizures. There is emerging evidence that seizures cause additional injury to the developing brain that has sustained hypoxic ischemic injury. Temporal evolution of clinical seizure burden in HIE has been characterized, with maximum clinical seizure burden (the period of maximum seizure activity) being observed between 12 and 24 h of age. The purpose of our study was to investigate the distribution of electrographic seizure burden (the accumulated duration of seizures over a defined time period), following the initial hypoxic ischemic insult.

Methods: Fifteen full-term newborns with HIE and seizures, and a minimum of 48 h of continuous video-electroencephalography (EEG), were included in this retrospective study. Medical records of the infants were reviewed and details of clinical seizures and antiepileptic drugs were recorded. The time of maximum seizure burden was defined as the midpoint of an hour-long window, shifted in time by 1 s across the full EEG recording, which contained the maximum duration of seizures. The degree of temporal evolution of seizure burden within this period was tested. Temporal evolution was further analyzed by segmenting the time series into two periods; the time between the first recorded seizure and the maximum seizure burden (T(1) ), and the time between the maximum seizure burden and the last recorded seizure (T(2) ). Seizure burden, duration, and number of seizures per hour were analyzed within each time period.

Key Findings: EEG was commenced at a median of 14 h of age. Maximum electrographic seizure burden was reached at a median age of 22.7 h. Time from first recorded seizure to maximum seizure burden (T(1) ) was significantly shorter than time from maximum seizure burden to last recorded seizure (T(2) ) (p-value = 0.01). Median seizure burden during T(1) was significantly higher than during T(2) (p-value = 0.007). There is temporal evolution of electrographic seizure burden in full-term newborns with HIE. There is a short period of high seizure burden (T(1) ) followed by a longer period of lower seizure burden (T(2) ).

Significance: Understanding the temporal evolution of seizure burden in HIE contributes further to our understanding of neonatal seizures, helps identify an optimal therapeutic window for seizure treatment, and provides a benchmark against which to measure the efficacy of new and innovative forms of neuroprotection and antiepileptic medication.

Editors note: Seizures are common in the NICU in babies with hypoxia. A common question for the neurologist in the NICU is "When are we out of the wood with seizures?"

Anesthesia in Early Childhood May Be Linked to ADHD

2012-02-10T10:31:00.000-08:00

Children who have more than one surgery with general anesthesia by their second birthday might be at higher risk for attention-deficit/hyperactivity disorder (ADHD), a new study suggests.

Mayo Clinic researchers looked through medical records of 341 children diagnosed with ADHD before age 19, to find who had undergone a surgical procedure with anesthesia before they were 2.

Nearly 18 percent of children exposed twice or more eventually developed ADHD. Children with only one exposure had an ADHD rate of nearly 11 percent, while never-exposed children had a rate of slightly more than 7 percent.

The researchers also looked at anesthesia given to mothers during childbirth.

"With Cesarean section with a general anesthetic, only a single anesthetic, we didn't find any effect," said study author Dr. Juraj Sprung, a professor of anesthesiology at the Mayo Clinic.

The study appears in the Feb. 2 issue of the journal Mayo Clinic Proceedings.

An earlier study conducted by the same team and published in Pediatrics last November found a connection between early multiple anesthesia exposures and a higher rate of learning disabilities in reading, language and math.

Data for both studies came from the Rochester Epidemiology Project, which analyzed education records of children born between 1976 and 1982 in Minnesota.

Nearly one in 10 children is estimated to have ADHD, which hampers attention and focus, and includes restless and impulsive behavior. Studies suggest that both genetic and environmental factors play a part in causing the neurodevelopmental disorder.

For human studies, it's difficult to separate the effects of anesthesia from those of surgery. "Essentially, we did an observational study and we examined whether there is association with exposure to anesthesia, but not only to anesthesia," Sprung said.

In earlier animal studies, rats given anesthesia developed nerve damage in the cortical areas of the brain and became hyperactive. Newborn monkeys exposed to the anesthetic ketamine for 24 hours had changes in their ability to perform tasks involving executive function.

While she was struck by the animal data, Dr. Tanya Froehlich, a specialist in developmental and behavioral pediatrics at Cincinnati Children's Hospital Medical Center, said the new study does not prove a cause-and-effect connection between surgical anesthesia and ADHD.

Any link "could be confounded by a lot of things," she said. "For instance, kids with ADHD are more prone to injury. They're more prone to breaking their bones, possibly having some kind of head trauma that might require surgery. A child who's under 2 is prone to being more active, getting into things, so they might have a propensity to have more accidents."

With ADHD's familial component, she said, it might also be that caregivers are more likely to have the condition themselves and "may be less adept at keeping track of what the kids are doing and putting those safety precautions in place."

Or, a child's surgery could be for a congenital malformation that itself may have affected the brain and increased the ADHD risk. "And it doesn't necessarily have to be the surgery or anesthesia per se," Froehlich said.

"When I read the study, I thought of a lot of reasons that anesthesia and ADHD may be associated but not necessarily causative. In the study they're only proving an association," she said.

The findings may not apply to children of all racial or ethnic groups, Sprung added. "The population in 1976 and 1982 was mostly white/Caucasian here in Minnesota."

However, Froehlich said, "the dataset that the Minnesota people have is a huge strength. Notably, they did account for birth weight, gestational age and maternal education in their analyses, so that all speaks very well for the study and strengths of the study."

Both experts stressed that parents should not avoid needed surgery for their young children.

"At the present time, we shouldn't make any recommendations based on the study, to do or don't do the surgery. If you need the surgery, if you need the procedure, you certainly should go for it," Sprung said. "What I would personally say: If it's the type of surgery, the type of procedure that can wait, maybe it's better to wait."

And Froehlich said, "Even though we can think of all these confounders we can't just dismiss the study. It's something that we as doctors should be aware of and should think about."

Read more: http://www.nlm.nih.gov/medlineplus/news/fullstory_121504.html

Older parents more likely to have an autistic child: study

2012-02-10T10:27:00.000-08:00

Children born to a parent over age 35 are at greater risk for developing an autism spectrum disorder -- but the risk is the same whether just one or both parents are older, according to a new study of Danish families.

"Parental age doesn't appear to be synergistic. That is having an older mom and an older dad doesn't increase risk more than having one or the other," said Marissa King, a professor at the Yale School of Management, who was not involved in the study.

"The data clearly demonstrate that older parents are more likely to have kids with autism, but it doesn't establish why that is the case," King told Reuters Health in an email.

The findings throw a monkey wrench into the idea that perhaps older sperm or eggs have more mutations that could increase the odds of having a child develop autism.

Erik Thorlund Parner at the University of Aarhus School of Public Health in Denmark said that if genetic problems arising from older sperm or eggs explain the results, then having both an older sperm and an older egg together should total up to an even higher risk of autism for the child.

Yet Parner, who led the study, and his colleagues did not find a higher risk of autism among kids with two older parents compared with just one.

The researchers collected information on more than 9,500 children in Denmark who had been diagnosed with an autism spectrum disorder.

These disorders range from mild Asperger's Syndrome to severe mental retardation and social disability.

In the new study, kids born to fathers in their late thirties had up to a 28 percent higher risk of being diagnosed with an autism spectrum disorder than kids born to dads under age 35. The increase in risk was not tied to the mother's age.

For kids born to dads over age 40, the risk for developing an autism spectrum disorder was 37 to 55 percent greater than for kids of dads under age 35, and the mother's age didn't seem to matter.

According to the Centers for Disease Control and Prevention, about 10 in 1,100 children have an autism spectrum disorder. A 55-percent increase in risk, for instance, would push that number up to about 15 out of every 1,100 children.

Similar to the findings on dads, children whose moms had them in their late 30s were 21 to 37 percent more likely to develop autism than kids with moms under age 35, and the dad's age did not change the numbers.

And just like with dads over age 40, kids born to moms over age 40 were 28 to 65 percent more likely to have autism than kids with moms under age 35, regardless of the age of their dad.

"The result was surprising in that there was no additive effect of maternal and paternal age," Parner said in an email to Reuters Health.

"We do not really have a qualified guess on the explanation to the non-additive effect," he said. "I don't believe that one can yet say anything conclusive about whether (having an) older parent is biologically related to autism."

Some earlier studies have also found that older parents are more likely to have a child with autism, but they have not had consistent results.

For example, one study found that having an older mother increases a child's risk of autism, but having an older father only increases the risk if the mom is under the age of 30 (see Reuters Health report of February 8, 2010).

Parner said he and his colleagues are planning on an even larger analysis of autism and parental age using data from Denmark, Finland, Israel, Norway, Sweden and Western Australia.

Obesity Is Associated With Altered Brain Function

2012-02-10T10:25:00.000-08:00

Researchers at the University of Turku and Aalto University have found new evidence for the role of the brain in obesity.

In most western countries the annual increase in the prevalence and the severity of obesity is currently substantial. Although obesity typically results simply from excessive energy intake, it is currently unclear why some people are prone to overeating and gaining weight.

Because the central nervous system is intimately involved in processing of hunger signals and controlling food intake, it is possible that the cause of weight gain and obesity might be in the brain.

Researchers at the University of Turku and Aalto University have now found new evidence for the role of the brain in obesity. The researchers measured the functioning brain circuits involved in with multiple brain imaging methods.

The results revealed that in obese versus lean individuals, brain glucose metabolism was significantly higher in the brain's striatal regions, which are involved in processing of rewards. Moreover, obese individual's reward system responded more vigorously to food pictures, whereas responses in the frontal cortical regions involved in cognitive control were dampened.

"The results suggest that obese individuals' brains might constantly generate signals that promote eating even when the body would not require additional energy uptake," says Adjunct Professor Lauri Nummenmaa from the University of Turku.

"The results highlight the role of the brain in obesity and weight gaining. The results have major implications on the current models of obesity, but also on development of pharmacological and psychological treatments of obesity," Nummenmaa says.

The participants were morbidly obese individuals and lean, healthy controls. Their brain glucose metabolism was measured with positron emission tomography during conditions in which the body was satiated in terms of insulin signalling. Brain responses to pictures of foods were measured with functional magnetic resonance imaging.

Study Produces New Findings on Autism and GI Dysfunction

2012-02-10T10:23:00.000-08:00

Pat Levitt, director of the Zilkha Neurogenetic Institute at the Keck School, served as principal investigator of the study, which was published on Jan. 9 on the website of Autism Research.

“This research shows that physicians should take parents seriously when they report GI problems,” said Levitt, who was joined in the study by first author Philip Gorrindo, a Ph.D. student in neuroscience at the Vanderbilt University Medical Center. “Doctors should be especially diligent inchecking children who have major language problems and who have not been identified previously with GID because there’s a higher likelihood that they could have GI problems, and these children may be less able to report their physical distress.”

The findings showed that parents and physician specialists are equally accurate in identifying GID in children with autism spectrum disorder (ASD). The behavior and communication problems in these children are more severe than in children with ASD only, and diet and medication do not appear to play a role in the gastrointestinal condition of ASD-GID children.

The study examined more than 120 children, mostly boys, both with and without ASD, whose average age was 11, at Vanderbilt in Nashville, Tenn. The most frequently reported GI problem was severe constipation, often accompanied by severe abdominal pain, and was common in both those with and without autism.

While earlier studies of the relationship between ASD and GID solely examined medical charts or previous parental reports, Levitt said this research was the first time that children with ASD have been recruited for a study in which a pediatric gastroenterologist actively was involved in diagnosing their medical condition.

All parents were asked to fill out a questionnaire to determine the accuracy of their reports of GI problems in their children, which was compared to diagnosis by a pediatric gastroenterologist. The study found that parents were 92 percent accurate in reporting such problems.

“This shows that when a pediatrician sees a mom with a child who says he has major gut problems, it’s an indication that the doctor should send the child to a specialist - a pediatric GI doctor,” Levitt said. “It dispels the myth that parents are over-reporting these types of problems.”

In addition, parents were asked to keep a seven-day diet diary for their children. The results found no difference in the kinds of food that any of the children with GID were eating. Researchers also looked at the behavioral medications taken by children with ASD and found no differences in medication use with or without GID.

The study also looked at the relationship between the severity of autism and GI symptoms. It found that six times as many children with GID had more severe language impairment than those without GID. Investigators also used a Social Responsiveness Scale (SRS), which indicated more social impairment among those with GI symptoms.

“Overall, the research is about changing the way we deal with the potential for medical problems in children with autism, a behaviorally diagnosed disorder,” Levitt said. “We think that improving a child’s GI function will have effects that reach far beyond their GI problems. It may make them more amenable to interventions focused on their autism because they’re not preoccupied with physical distress.”

The Urgent Need for More Public Awareness About Insomnia

2012-02-09T10:03:00.001-08:00

The Urgent Need for More Public Awareness About Insomnia

By Susan H. Scher

As many as 10 percent of adults suffer from the sleep disorder, and it leads to fatigue, anxiety, depression, and even congestive heart failure.

Insomnia is the most common sleep disorder. Approximately 25 percent of the adult population suffer from sleeping problems, and as many as 10 percent reach the threshold of insomnia. Insomniacs experience difficulty falling or staying asleep, a lack of restorative sleep, and daytime symptoms such as fatigue, mood disturbances, and difficulty concentrating.

For insomniacs, theirs is often a chronic condition. Nearly 70 percent continue to experience symptoms a year later, and half still have insomnia up to three years later. Compared to the general population, people with insomnia are more than five times as likely to experience anxiety anddepression, are at more than twice the risk of developing congestive heart failure and diabetes, and may have an elevated risk of death. Insomniacs may also be at significantly greater risk of alcohol and substance abuse.

But despite the large number of people affected, insomnia often goes unrecognized and untreated. "In view of the high prevalence and substantial morbidities of insomnia, patients should routinely be asked about sleep problems by health care providers," say the authors of a new review paper about chronic insomnia.

According to these experts, much more needs to be done to identify and treat insomnia early in its development. Furthermore, efforts must be made to ensure that patients are treated according to clinical guidelines and with treatments of proven effectiveness. Some of the most commonly prescribed drugs, notably antidepressants and antihistamines, have been poorly studied for treatment of insomnia and are not approved for this condition. The problem is more pronounced for non-prescription drugs. Despite the widespread use of over-the-counter products, such remedies have not been rigorously studied and there is little evidence to indicate which drugs, if any, work well and for whom.

The U.S. National Institutes of Health (NIH) emphasizes that only two treatments -- cognitive behavioral therapy (CBT) and hypnotic drugs cleared by the Food and Drug Administration (FDA) for use in insomnia -- have been adequately studied and proven effective.

article here

TMSS Welcomes Dr. Sarat Susarla, Pulmonologist for Children & Teens, Sleep Medicine for All Ages

2012-02-06T20:25:00.000-08:00

Sleep Right, Remember....what was that again?

2012-02-05T05:02:00.001-08:00

Sleep Right, Remember ...what was that again?

Sleep not only protects memories from outside interferences, but also helps strengthen them, according to research presented at the American Academy of Neurology’s 59th Annual Meeting in Boston, April 28 – May 5, 2007.

The study looked at memory recall with and without interference (competing information). Forty-eight people between the ages of 18 and 30 took part in the study. All had normal, healthy sleep routines and were not taking any medications. Participants were divided evenly into four groups—a wake group without interference, a wake group with interference, a sleep group without interference, and a sleep group with interference. All groups were taught the same 20 pairs of words in the initial training session.The wake groups were taught the word pairings at 9 am and then tested on them at 9 pm after 12 hours awake. The sleep groups were taught the word pairs at 9 pm and tested on them at 9 am after a night of sleep. Just prior to testing, the interference groups were given a second list of word pairs to remember. The first word in each pair was the same on both lists, but the second word was different, testing the brain’s ability to handle competing information, known as interference. The interference groups were then tested on both lists.The study found that people who slept after learning the information performed best, successfully recalling more words. Those in the sleep group without interference were able to recall 12% more word pairings from the first list than the wake group without interference.

With interference, the recall rate was 44% higher for the sleep group.“This is the first study to show that sleep protects memories from interference,” said study author Jeffrey Ellenbogen, MD, with Harvard Medical School in Boston, and Fellow of the American Academy of Neurology. “These results provide important insights into how the sleeping brain interacts with memories: it appears to strengthen them. Perhaps, then, sleep disorders might worsen memory problems seen in dementia.”

What is cerebral palsy? Helpful Information from a pediatric neurologist!

2012-02-05T04:43:00.000-08:00

CP treatment is a "team sport". I usually tell parents of a patient, "Let's assemble team Sally."

My site has CDC growth charts for kids with CP and other information

JR

Link to my site

From The CDC:

Facts about cerebral palsy

Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. CP is the most common motor disability in childhood.Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles. CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control his or her muscles.

The symptoms of CP vary from person to person. A person with severe CP might need to use special equipment to be able to walk, or might not be able to walk at all and might need lifelong care. A person with mild CP, on the other hand, might walk a little awkwardly, but might not need any special help. CP does not get worse over time, though the exact symptoms can change over a person's lifetime.

All people with CP have problems with movement and posture. Many also have related conditions such asintellectual disability ; seizures; problems with vision ,hearing, or speech; changes in the spine (such as scoliosis); or joint problems (such as contractures).

Types of Cerebral Palsy

Doctors classify CP according to the main type of movement disorder involved. Depending on which areas of the brain are affected, one or more of the following movement disorders can occur:

Stiff muscles (spasticity)
Uncontrollable movements (dyskinesia)
Poor balance and coordination (ataxia)

There are four main types of CP:

Spastic Cerebral Palsy

CP Fact Sheet

Download and print this fact sheet »

The most common type of CP is spastic CP. Spastic CP affects about 80% of people with CP.

People with spastic CP have increased muscle tone. This means their muscles are stiff and, as a result, their movements can be awkward. Spastic CP usually is described by what parts of the body are affected:

Spastic diplegia/diparesis―In this type of CP, muscle stiffness is mainly in the legs, with the arms less affected or not affected at all. People with spastic diplegia might have difficulty walking because tight hip and leg muscles cause their legs to pull together, turn inward, and cross at the knees (also known asscissoring).
Spastic hemiplegia/hemiparesis―This type of CP affects only one side of a person's body; usually the arm is more affected than the leg.

Spastic quadriplegia/quadriparesis―Spastic quadriplegia is the most severe form of spastic CP and affects all four limbs, the trunk, and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech.

Dyskinetic Cerebral Palsy (also includes athetoid, choreoathetoid, and dystonic cerebral palsies)

People with dyskinetic CP have problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk. The movements are uncontrollable and can be slow and writhing or rapid and jerky. Sometimes the face and tongue are affected and the person has a hard time sucking, swallowing, and talking. A person with dyskinetic CP has muscle tone that can change (varying from too tight to too loose) not only from day to day, but even during a single day.

Ataxic Cerebral Palsy

People with ataxic CP have problems with balance and coordination. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something.

Mixed Cerebral Palsy

Some people have symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.

Early Signs

The signs of CP vary greatly because there are many different types and levels of disability. The main sign that a child might have CP is a delay reaching motor or movement milestones (such as rolling over, sitting, standing, or walking). Following are some other signs of possible CP. It is important to note that some children without CP also might have some of these signs.

In a Baby Younger Than 6 Months of Age

His head lags when you pick him up while he’s lying on his back
He feels stiff

He feels floppy
When held cradled in your arms, he seems to overextend his back and neck, constantly acting as if he is pushing away from you
When you pick him up, his legs get stiff and they cross or scissor

In a Baby Older Than 6 Months of Age

She doesn’t roll over in either direction
She cannot bring her hands together
She has difficulty bringing her hands to her mouth
She reaches out with only one hand while keeping the other fisted

In a Baby Older Than 10 Months of Age

He crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg
He scoots around on his buttocks or hops on his knees, but does not crawl on all fours

Tell your child’s doctor or nurse if you notice any of these signs. Learn more about developmental milestones that children should reach from birth to 5 years of age »

Screening and Diagnosis

Diagnosing CP at an early age is important to the well-being of children and their families. Diagnosing CP can take several steps:

Developmental Monitoring

Developmental monitoring (also called surveillance) means tracking a child’s growth and development over time. If any concerns about the child’s development are raised during monitoring, then a developmental screening test should be given as soon as possible.

Developmental Screening

During developmental screening a short test is given to see if the child has specific developmental delays, such as motor or movement delays. If the results of the screening test are cause for concern, then the doctor will make referrals for developmental and medical evaluations.

Developmental and Medical Evaluations

The goal of a developmental evaluation is to diagnose the specific type of disorder that affects a child.

Learn more about screening and diagnosis »

Treatments and Intervention Services

There is no cure for CP, but treatment can improve the lives of those who have the condition. It is important to begin a treatment program as early as possible.

After a CP diagnosis is made, a team of health professionals works with the child and family to develop a plan to help the child reach his or her full potential. Common treatments include medicines; surgery; braces; and physical, occupational, and speech therapy. No single treatment is the best one for all children with CP. Before deciding on a treatment plan, it is important to talk with the child’s doctor to understand all the risks and benefits.

Visit the NINDS Cerebral Palsy Information Page to learn more about treatments for CP »

Intervention Services
Both early intervention and school-aged services are available through our nation’s special education law—the Individuals with Disabilities Education Act (IDEA). Part C of IDEA deals with early intervention services (birth through 36 months of age), while Part B applies to services for school-aged children (3 through 21 years of age). Even if your child has not been diagnosed with CP, he or she may be eligible for IDEA services.

Learn more about IDEA Services »

Causes and Risk Factors

CP is caused by abnormal development of the brain or damage to the developing brain that affects a child’s ability to control his or her muscles. There are several possible causes of the abnormal development or damage. People used to think that CP was mainly caused by lack of oxygen during the birth process. Now, scientists think that this causes only a small number of CP cases.

The brain damage that leads to CP can happen before birth, during birth, within a month after birth, or during the first years of a child’s life, while the brain is still developing. CP related to brain damage that occurred before or during birth is called congenital CP. The majority of CP (85%–90%) is congenital. In many cases, the specific cause is not known. A small percentage of CP is caused by brain damage that occurs more than 28 days after birth. This is called acquired CP, and usually is associated with an infection (such as meningitis) or head injury.

Learn more about causes and risk factors for CP »

If You’re Concerned

If you think your child is not meeting movement milestones or might have CP, contact your doctor or nurse and share your concerns.

If you or your doctor is still concerned, ask for a referral to a specialist who can do a more in-depth evaluation of your child and assist in making a diagnosis.

At the same time, call your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Findevaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

If your child is not yet 3 years old, contact your local early intervention system.

You can find the right contact information for your state by calling the National Dissemination Center for Children with Disabilities (NICHCY) at 1-800-695-0285.

Or visit the NICHCY website. Once you find your state on this webpage, look for “Programs for Infants and Toddlers with Disabilities”.

Learn more about early intervention »
If your child is 3 years of age or older, contact your local public school system.

Even if your child is not yet old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.

If you’re not sure who to contact, call the National Dissemination Center for Children with Disabilities (NICHCY) at 1.800.695.0285 or visit the NICHCY website. Once you find your state on this webpage, look for the heading “Programs for Children with Disabilities”.

Learn more about this process »

References

American Academy of Pediatrics. Caring for your baby and young child: Birth to age five. 5th ed. Shelov SP, editor. Elk Grove Village (IL): Bantam Books; 2009.

American Academy of Pediatrics Healthy Children / Cerebral Palsy
http://www.healthychildren.org/English/health-issues/conditions/developmental-disabilities/pages/Cerebral-Palsy.aspx

American Association on Intellectual and Developmental Disabilities
http://www.aaidd.org/content_100.cfm?navID=21

Honeycutt A, Dunlap L, Chen H, Homsi G. Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment: United States, 2003. MMWR Morb mital Wkly Rep. 2004;53(3): 57-59.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5303a4.htm

Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Pediatrics, July 2006.
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;118/1/405.pdf

March of Dimes. Cerebral Palsy.
http://www.marchofdimes.com/birthdefects_cerebralpalsy.html#

My Child Without Limits
http://www.mychildwithoutlimits.org/?page=home

National Institute of Neurological Disorders and Stroke. Cerebral Palsy: Hope Through Research. NIH Publication Number 10-159, updated 5/6/10.
http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm

Pellegrino, Louis. Cerebral Palsy, in Batshaw ML, Pellegrino L, Roizen NJ (eds.), Children with Disabilities, 6th Edition, Baltimore, MD, Paul H Brookes Publishing Company, 2007, pp 387-408.

UCP
http://www.ucp.org/ucp_channelsub.cfm/1/11/10427

Neurology for Children, Teens, Young Adults & Sleep Medicine for All Ages

Can some children simply 'grow out' of autism? One mother tells how her son's life has been transformed

Teens' concussion risk not limited to football

New Treatment for Traumatic Brain Injury Shows Promise in Animals

Babies' Colic Linked to Mothers' Migraines

Gene Affecting the Ability to Sleep Discovered in Fruit Flies

Teens With Autism Preoccupied With TV, Video Games: Study

Good Football Helmet Fit Key to Preventing Brain Injuries

3-D TV Doesn't Raise Seizure Risk for Kids With Epilepsy: Study

3-D TV Doesn't Raise Seizure Risk for Kids With Epilepsy: Study

Computerized Tests For Concussions May Be Unreliable

Irregular Sleep Could Weaken Your Immune System

Epi-Pen to Stop Epileptic Seizures?

Brain Imaging Differences Evident at 6 Months in High-Risk Infants Who Later Develop Autism

Vicious cycle of sleep apnea and obesity in kids

New Caffeine App Prevents Sleep Problems

Researchers Make Living Model of Brain Tumor

Treating Kid's Sleep Apnea May Improve Behavior

Study finds jolt to the brain boosts memory

Overeating May Double Risk of Memory Loss: Study

Scientists create brain cells from human skin in possible breakthrough for autism, Alzheimer's research

Kids have been sleep-deprived for more than 100 years: study

Stem Cell Fraud for Cerebral Palsy, Epilepsy

"60 Minutes" investigates online stem cell fraud

Why Brain Injuries Are More Common In Preemies

Why Brain Injuries Are More Common In Preemies

The temporal evolution of electrographic seizure burden in neonatal hypoxic ischemic encephalopathy.

The temporal evolution of electrographic seizure burden in neonatal hypoxic ischemic encephalopathy

Epilepsia. 2012 Feb 6. doi: 10.1111/j.1528-1167.2011.03401.x. [Epub ahead of print]

Source

Abstract

Anesthesia in Early Childhood May Be Linked to ADHD

Older parents more likely to have an autistic child: study

Obesity Is Associated With Altered Brain Function

Study Produces New Findings on Autism and GI Dysfunction

The Urgent Need for More Public Awareness About Insomnia

The Urgent Need for More Public Awareness About Insomnia

By Susan H. Scher

TMSS Welcomes Dr. Sarat Susarla, Pulmonologist for Children & Teens, Sleep Medicine for All Ages

Sleep Right, Remember....what was that again?

What is cerebral palsy? Helpful Information from a pediatric neurologist!

CP treatment is a "team sport". I usually tell parents of a patient, "Let's assemble team Sally."

My site has CDC growth charts for kids with CP and other information

JR

From The CDC:

Facts about cerebral palsy

Types of Cerebral Palsy

Spastic Cerebral Palsy

CP Fact Sheet

Dyskinetic Cerebral Palsy (also includes athetoid, choreoathetoid, and dystonic cerebral palsies)

Ataxic Cerebral Palsy

Mixed Cerebral Palsy

Early Signs

In a Baby Younger Than 6 Months of Age

In a Baby Older Than 6 Months of Age

In a Baby Older Than 10 Months of Age

Screening and Diagnosis

Developmental Monitoring

Developmental Screening

Developmental and Medical Evaluations

Treatments and Intervention Services

Causes and Risk Factors

If You’re Concerned

Related Pages

References