Children of pregnant women who use anti-epileptic drug may have increased risk of autism

Pregnant mothers who use valproate, an anti-epilepsy drug, may have children with an increased risk of autism. Dont jump to assume causation.  With the finding that autism is noted in families with other neuro-psychiatric illness, there may be some confounding variables in this observation. - JR

Maternal use of valproate (a drug used for the treatment of epilepsy and other neuropsychological disorders) during pregnancy was associated with a significantly increased risk of autism in offspring, according to a study in the April 24 issue of JAMA. The authors caution that these findings must be balanced against the treatment benefits for women who require valproate for epilepsy control.

"Anti-epileptic drug exposure during pregnancy has been associated with an increased risk for congenital malformations and delayed cognitive development in the offspring, but little is known about the risk of other serious neuropsychiatric disorders," according to background information in the article.

Jakob Christensen, Ph.D., of Aarhus University Hospital, Aarhus, Denmark, and colleagues evaluated the association between maternal use of valproate during pregnancy and the risk of autism spectrum disorder and childhood autism in offspring. The population-based study included all children born alive in Denmark from 1996 to 2006. National registers were used to identify children exposed to valproate during pregnancy and diagnosed with autism spectrum disorders (childhood autism [autistic disorder], Asperger syndrome, atypical autism, and other or unspecified pervasive developmental disorders). Data were analyzed and adjusted for potential confounders (factors that can influence outcomes) such as maternal age at conception, paternal age at conception, parental psychiatric history, gestational age, birth weight, sex, congenital malformations, and parity. Children were followed up from birth until the day of autism spectrum disorder diagnosis, death, emigration, or December 31, 2010, whichever came first.

The analysis included 655,615 children born from 1996 through 2006. The average age of the children at end of follow-up was 8.8 years. During the study period, 5,437 children were diagnosed with autism spectrum disorder, including 2,067 with childhood autism. The researchers identified 2,644 children exposed to antiepileptic drugs during pregnancy, including 508 exposed to valproate. The authors found that use of valproate during pregnancy was associated with an absolute risk of 4.42 percent for autism spectrum disorder and an absolute risk of 2.50 percent for childhood autism.

"In this population-based cohort study, children of women who used valproate during pregnancy had a higher risk of autism spectrum disorder and childhood autism compared with children of women who did not use valproate. Their risks were also higher than those for children of women who were previous users of valproate but who stopped before their pregnancy," the researchers write.

"Because autism spectrum disorders are serious conditions with lifelong implications for affected children and their families, even a moderate increase in risk may have major health importance. Still, the absolute risk of autism spectrum disorder was less than 5 percent, which is important to take into account when counseling women about the use of valproate in pregnancy."

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Tips for living with epilepsy

This article discusses five tips that are helpful for those living with epilepsy.

For people with epilepsy, the onset of recurring seizures can be frightening. While many people with the condition live full and active lives, including driving a vehicle, working outside the home and playing sports, it may be necessary to make some lifestyle changes.

“The goal is to make sure the patient is seizure free with minimal side effects,” says Shaila Gowda, M.D., director, Epilepsy Program, Beaumont Hospital, Royal Oak. “Avoiding seizure triggers such as lack of sleep, alcohol and stress will help.”

In addition to following a supervised treatment plan with medication, it’s just as important to establish good habits to manage or avoid seizures. Once triggers have been identified, exposure can be limited.

According to the Epilepsy Foundation, epilepsy and seizures affect more than 2 million Americans of all ages. Nearly 200,000 new cases occur each year.

Epilepsy is a brain disorder. When clusters of brain nerve cells, or neurons, signal abnormally they can cause unusual sensations, emotions and behavior; or convulsions, muscle spasms, seizures and loss of consciousness. Epilepsy can have many causes including illness, brain damage and abnormal brain development.

Dr. Gowda provides 5 helpful tips to follow when living with epilepsy:

Keep a healthy diet

A balanced diet should consist of a wide variety of carbohydrates, fats and proteins. Yet, there are some foods and beverages that should be avoided as they may trigger or worsen seizures. Foods with monosodium glutamate, the food additive commonly known as MSG, is an “excitatory neurotransmitter” meaning it is a brain stimulant which can increase the severity of the seizure. Other foods and beverages with stimulants, like caffeine, should also be avoided. Dr. Gowda explains that an occasional drink will not cause a seizure, but prolonged alcohol consumption should be avoided. “Studies suggest that alcohol withdrawal seizures most often occur seven hours after heavy drinking has stopped,” explains Dr. Gowda.

Get to bed

Poor sleep habits can lead to increased frequency of seizures. It’s important to get seven to nine hours of restful sleep each night. But, getting too much sleep is not good either. If you are feeling drowsy and not feeling energized during the day, make sure you’re not experiencing side effects of the medication. Discuss the dosage with your physician. “Sometimes, if not diagnosed properly, sleep issues get dismissed as part of epilepsy,” says Dr. Gowda.

Exercise regularly

Those with epilepsy can experience fatigue and symptoms of depression. Getting regular, moderate amounts of exercise will improve overall physical health and fitness. An added benefit of exercise is that it indirectly boosts self-esteem – keeping mood disorders and depression at bay.

Manage your stress

While it’s important to learn how to handle stress on a regular basis, excessive stress in never a good thing. Undue stress increases hormones which have been shown to cause seizures. “To avoid getting overwhelmed, create an agenda of daily activities and prioritize tasks. It is important to keep some time aside for relaxation at the end of each day,” advises Dr. Gowda.

Choose the right doctor 

Find a doctor who specializes in epilepsy. Those with epilepsy should be able to discuss any concerns freely, and work together with an expert to find a treatment program that works for them. People with epilepsy who understand their condition will be able to make informed decisions about lifestyle changes that are needed.

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Texting children with asthma improves health outcomes

Providing information to children with asthma through text messages resulted improved health outcomes.

Simply sending children with asthma a text message each day asking about their symptoms and providing knowledge about their condition can lead to improved health outcomes.

In a study by the Georgia Institute of Technology, pediatric patients who were asked questions about their symptoms and provided information about asthma via SMS text messages showed improved pulmonary function and a better understanding of their condition within four months, compared to other groups.

"It appears that text messages acted as an implicit reminder for patients to take their medicine and by the end of the study, the kids were more in tune with their illness," said study leader Rosa Arriaga, senior research scientist in the College of Computing's School of Interactive Computing at Georgia Tech.

T.J. Yun, former Georgia Tech Ph.D. student, and Arriaga will present their research, "A Text Message a Day Keeps the Pulmonologist Away", today at the ACM SIGCHI Conference on Human Factors in Computing Systems 2013 in Paris.The research won a best paper award in the Replichi category, which highlights best practices in study methodology.

It is also a replication study of an SMS health intervention for pediatric asthma patients originally published in early 2012 in the Proceedings of the 2^nd ACM SIGHIT International Health Informatics Symposium.

The results of the research hold promise for the future of mHealth studies, a trend based on the idea that mobile devices can be used to improve health and wellness.

Asthma is the most prevalent chronic respiratory disorder in the U.S., affecting about 17.3 million individuals, including more than 5 million children. Medication is the main way patients manage symptoms, but research shows less than 30 percent of teens use their inhalers regularly.

Texting, on the other hand, is something teens do regularly and enjoy. Nearly 75 percent of American teens have mobile devices. Georgia Tech researchers were interested in seeing if this ubiquitous, easy-to-use technology could help young patients manage their asthma.

In both studies, the researchers randomly assigned 30 asthmatic children from a private pediatric pulmonology clinic in Atlanta into three groups -- a control group that did not receive any SMS messages; a group that received text messages on alternate days and a group that received texts every day. The children were between 10 and 17 years old, owned a mobile phone and could read at least at a fifth grade level.

Over four months, the intervention groups received and responded to SMS messages 87 percent of the time, and the average response time was within 22 minutes. After the study, the research team analyzed patients who had follow-up visits with their physician and found that sending at least one text message a day, whether it was a question about symptoms or about asthma in general, improved clinical outcomes.

"The results indicate that both awareness and knowledge are crucial to individuals engaging in proactive behavior to improve their condition," Arriaga said.

In another mHealth study that highlighted the role that online social networks can have on wellness, Arriaga, Georgia Tech Regents Professor of Interactive Computing Gregory Abowd and graduate student Hwajung Hong investigated whether social networking could help individuals with autism improve their social connectedness.

One of the challenges individuals with autism face is not having a large enough network of people who can provide advice about everyday situations, such as home upkeep, financial planning or relationships. They tend to over-rely on a primary caregiver, which limits their independence and may burden the caregiver.

The study involved three individuals with Asperger's Syndrome, a diagnosis that reflects average or above average language skills, but impaired social skills and patterns of behaviors and interests. Individuals with Asperger's Syndrome can have difficulty using traditional social networking sites such as Facebook because it requires a degree of social nuance. They also may be vulnerable to users trying to take advantage of them.

To address this issue, Georgia Tech researchers set up a specialized social network for participants using the commercial cross-platform service, GroupMe. Each participant was linked with a small, pre-determined number of family and friends that he or she could reach out to about everyday life issues and questions.

Over four weeks, GroupME motivated each participant to communicate with this trusted circle of members and reduce reliance on his or her primary caregiver. The circle actively engaged and shared the responsibility for responding to the participant's queries. Primary caregivers gave positive reviews of the specialized social network, saying that they were happy with the diversity of feedback that the system provided and that the load felt lighter thanks to the help of the circle members. Results indicate that positive online interactions lead to real-life interactions between the individuals and their circle members.

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Children with Autism and Video Games

This article discusses why children and teenagers with autism may use video games and other screen-based technologies more than other children.

Children and teens with autism spectrum disorder (ASD) use screen-based media, such as television and video games, more often than their typically developing peers and are more likely to develop problematic video game habits, a University of Missouri researcher found.

"Many parents and clinicians have noticed that children with ASD are fascinated with technology, and the results of our recent studies certainly support this idea," said Micah Mazurek, an assistant professor of health psychology and a clinical child psychologist at MU. "We found that children with ASD spent much more time playing video games than typically developing children, and they are much more likely to develop problematic or addictive patterns of video game play."

Mazurek studied screen-based media use among 202 children and adolescents with ASD and 179 typically developing siblings. Compared to typically developing children, those with ASD spent more time playing video games and less time on social media, such as Facebook. Children with ASD also spent more time watching TV and playing video games than participating in pro-social or physical activities. Conversely, typically developing children spent more time on non-screen activities than on TV or video games.

In another study of 169 boys with ASD, problematic video game use was associated with oppositional behaviors, such as refusing to follow directions or engaging in arguments. Mazurek says carefully controlled research is needed to examine these issues in the future.

"Because these studies were cross-sectional, it is not clear if there is a causal relationship between video game use and problem behaviors," Mazurek said. "Children with ASD may be attracted to video games because they can be rewarding, visually engaging and do not require face-to-face communication or social interaction. Parents need to be aware that, although video games are especially reinforcing for children with ASD, children with ASD may have problems disengaging from these games."

Even though Mazurek cautions that too much screen time could be detrimental for children with ASD, she says tapping into what children with ASD enjoy about video games could help researchers and clinicians develop therapies using the technology.

"Using screen-based technologies, communication and social skills could be taught and reinforced right away," Mazurek said. "However, more research is needed to determine whether the skills children with ASD might learn in virtual reality environments would translate into actual social interactions."

The study, "Television, Video Game and Social Media Use among Children with ASD and Typically Developing Siblings," will be published in an upcoming issue of theJournal of Autism and Developmental Disorders. "Video Game Use and Problem Behaviors in Boys with Autism Spectrum Disorders," was published in Research in Autism Spectrum Disorders. Mazurek also authored an article forThe Scientist Magazine about the benefits and possible negative consequences of using screen-based technologies in interventions for children with autism.

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Rare sleep disorder causes woman to eat 2,500 calories while asleep

An interesting article about a sleep disorder causing a woman to eat 2,500 calories in her sleep.

Lesley Cusack, 55, has Nocturnal Sleep-Related Eating Disorder. She said that she only finds out what she’s eaten at night when she looks through the leftovers and trash in the morning.

Csack, who is from Warrington, Cheshire in the UK, binge-eats, chops up food, and tries to cook it while sleeping. She also says she’s tried to eat paint, Vaseline and washing powder. She’s even broken some teeth and bruised herself while trying to cook while sleeping.

"I tend to find opened tins of things or packets and I’ve no idea whether I’ve eaten some of them cold or not,” she said.

‘I’ve found soup in pans, but also in bowls. It all can get rather messy. I’ve put alarms on my doors in the hope it will wake me up. I simply turn it off in my sleep. I’m trying to lose weight but it’s a constant battle. I can follow a diet to the letter but it goes to pot at night,” she added.

"One weekend, I came down to find the cake slice covered in butter. I’d used it while making cheese sandwiches"

"The worst things that I know I’ve eaten are emulsion paint, Vaseline, cough syrup, raw potatoes and soap powder. The night I ate paint was the only time I’ve ever woken up. I can still remember standing in the kitchen touching my mouth and being very confused,” she said.

Due to her night eating, Cusack has gained weight and now weighs about 230 lbs. As a result, she eats fruits and salads during the day and joined a diet club.

Cusack’s doctors have not been able to find an explanation, but Cusack believes she has Nocturnal Sleep-Related Eating Disorder (NSRED).

"I had started to find bits of mess downstairs, but I didn’t realize it was me. It was a while before I worked it out, but when I did, I felt very embarrassed and guilty,” she said.

"There were times when I felt extremely depressed through trying to hide it,” she added.

Cusack, a retired department store manager and divorced mother of three, says she only recently told her family of her disorder. The turning point was the realization that she was going outside to raid the freezer in her shed.

"I was terrified at the thought of leaving the door open or having an accident outside," she said.

"Using the cooker, kettle and sharp knives means it’s only a matter of time before something more serious happens,” she added.

Cusack lives alone.

"My bedding and night clothes are constantly getting stained and need washing. I’m always finding a trail of food leading downstairs,” she said.

‘"The disturbed nights, waking exhausted with stomach cramp, feeling sick and finding food in the bed has become almost normal,” she added.

Dr. Paul Reading, President of the British Sleep Society, said that cases like Cusack’s are rare but not unknown.

"A proportion of adult sleep-walkers will eat and even cook during apparent sleep, often consuming foods they would not normally enjoy," he said.

"Weight gain and guilt are common consequences."

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Abnormal placentas can increase autism risk

New research shows that an abnormal placenta can indicate an increased risk of a child developing autism.

Researchers at the Yale School of Medicine have figured out how to measure an infant's risk of developing autism by looking for abnormalities in his/her placenta at birth, allowing for earlier diagnosis and treatment for the developmental disorder. The findings are reported in the April 25 online issue of Biological Psychiatry.

One out of 50 children are diagnosed with an autism spectrum disorder in the United States each year, according to the Centers for Disease Control and Prevention (CDC), but the diagnosis is usually made when these children are 3 to 4 years of age or older. By then the best opportunities for intervention have been lost because the brain is most responsive to treatment in the first year of life.

Senior author Dr. Harvey Kliman, research scientist in the Department of Obstetrics, Gynecology & Reproductive Sciences at the Yale School of Medicine, and research collaborators at the MIND Institute at the University of California, Davis, have found that abnormal placental folds and abnormal cell growths called trophoblast inclusions are key markers to identify newborns who are at risk for autism.

Kliman and his team examined 117 placentas from infants of at-risk families, those with one or more previous children with autism. These families were participating in a study called Markers of Autism Risk in Babies -- Learning Early Signs. Kliman compared these at-risk placentas to 100 control placentas collected by the UC Davis researchers from the same geographic area.

The at-risk placentas had as many as 15 trophoblast inclusions, while none of the control placentas had more than two trophoblast inclusions. Kliman said a placenta with four or more trophoblast inclusions conservatively predicts an infant with a 96.7% probability of being at risk for autism.

Currently, the best early marker of autism risk is family history. Couples with a child with autism are nine times more likely to have another child with autism. Kliman said that when these at-risk families have subsequent children they could employ early intervention strategies to improve outcomes. "Regrettably couples without known genetic susceptibility must rely on identification of early signs or indicators that may not overtly manifest until the child's second or third year of life," said Kliman.

"I hope that diagnosing the risk of developing autism by examining the placenta at birth will become routine, and that the children who are shown to have increased numbers of trophoblast inclusions will have early interventions and an improved quality of life as a result of this test," Kliman added.

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Everything you should know about migraines

This article discusses many aspects of migraines such as what causes them and how to treat them.

Migraines can loosely be described as recurrent moderate to severe headaches that is typically unilateral, that is, pain occurring on side of the head. Associated symptoms may include nausea, vomiting, photophobia (increased sensitivity to light), phonophobia (increased sensitivity to sound) and the pain is generally aggravated by physical activity. Up to one-third of people with migraine headaches perceive an aura: a transient visual, sensory, language, or motor disturbance which signals that the headache will soon occur. Occasionally an aura can occur with little or no headache following it.

What causes migraines?

The underlying causes of migraines are unknown. However, they are believed to be related to a mix of environmental and genetic factors. They run in families in about two-thirds of cases and rarely occur due to a single gene defect.

There have been stipulations that migraines are caused by expanded blood vessels in the brain. However, the pain of migraine headaches might not be caused by expanded blood vessels in the brain, as previously thought. Instead, the real culprit may be overactive pain-signal firing in brain cells, new research suggests. These findings were published on April 9th in the journal Lancet Neurology, come from studying the brain scans of patients as they were suffering from a migraine.

Moreover, there are several treatments being developed that could address this signaling and, in turn, help treat migraine pain. However, further studies are needed to confirm that the overactive signaling is a cause of migraine pain.

How can migraines be cured?

Preventive migraine medications are considered effective if they reduce the frequency or severity of the migraine attacks by at least 50%. Common drugs used in Ghana to help with the pain are Cafergot (combination of drugs; ergotamine tatrate and caffeine), topiramate, propranolol, and metoprolol. Other household methods that can help are as follows:

a. Getting a good night’s sleep

b. Keep the room dark

c. Take Caffeine; it's a paradox of headaches: ingest too much caffeine and you may get a headache, but take a little bit and it can help make the pain disappear

d. Ice packs. Lie down and put an ice pack or cold compress on your head. Close your eyes while doing that.

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Vaccine to Help Control Autism Symptoms

This article discusses a new vaccine that was developed to help control the symptoms of autism.

A first-ever vaccine created by University of Guelph researchers for gut bacteria common in autistic children may also help control some autism symptoms.

The groundbreaking study by Brittany Pequegnat and Guelph chemistry professor Mario Monteiro appears this month in the journalVaccine.

They developed a carbohydrate-based vaccine against the gut bugClostridium bolteae.

C. bolteae is known to play a role in gastrointestinal disorders, and it often shows up in higher numbers in the GI tracts of autistic children than in those of healthy kids.

More than 90 per cent of children with autism spectrum disorders suffer from chronic, severe gastrointestinal symptoms. Of those, about 75 per cent suffer from diarrhea, according to current literature.

"Little is known about the factors that predispose autistic children toC. bolteae," said Monteiro. Although most infections are handled by some antibiotics, he said, a vaccine would improve current treatment.

"This is the first vaccine designed to control constipation and diarrhea caused by C. bolteae and perhaps control autism-related symptoms associated with this microbe," he said.

Autism cases have increased almost sixfold over the past 20 years, and scientists don't know why. Although many experts point to environmental factors, others have focused on the human gut.

Some researchers believe toxins and/or metabolites produced by gut bacteria, including C. bolteae, may be associated with symptoms and severity of autism, especially regressive autism.

Pequegnat, a master's student, and Monteiro used bacteria grown by Mike Toh, a Guelph PhD student in the lab of microbiology professor Emma Allen-Vercoe.

The new anti- C. bolteae vaccine targets the specific complex polysaccharides, or carbohydrates, on the surface of the bug.

The vaccine effectively raised C. bolteae-specific antibodies in rabbits. Doctors could also use the vaccine-induced antibodies to quickly detect the bug in a clinical setting, said Monteiro.

The vaccine might take more than 10 years to work through preclinical and human trials, and it may take even longer before a drug is ready for market, Monteiro said.

"But this is a significant first step in the design of a multivalent vaccine against several autism-related gut bacteria," he said.

Monteiro has studied sugar-based vaccines for two other gastric pathogens: Campylobacter jejuni, which causes travellers' diarrhea; and Clostridium difficile, which causes antibiotic-associated diarrhea.

The research was supported by the Natural Sciences and Engineering Research Council.

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Chili peppers may help develop next migraine medicine

This article discusses chili peppers as a potential treatment for migraines and compares it with the success of botox injections used to treat migraines.

Chili peppers and migraines have traits in common, a fact scientists are exploiting to develop drugs capable of preventing the debilitating headache’s painful symptoms before they attack.

The link between how skin reacts when rubbed with chili oil and what happens in the brain during a migraine has attracted the world’s largest biotechnology company, Amgen Inc. (AMGN), and other companies seeking to create medicines for the more than 36 million Americans who suffer from migraines.

Symptoms include nausea, vomiting, dizziness and sensitivity to touch, yet treatment options are limited. Some pharmaceutical companies that have tried recently to develop migraine therapies, such as Bristol-Myers Squibb Co. (BMY)and Merck & Co. (MRK), have abandoned their efforts while the few drugs on the market are ineffective for many people and carry the danger of serious side effects for those at risk of heart attack or stroke.

“Migraines are an extremely common disorder, and it affects people really in the prime of their lives,” Rob Lenz, who is leading Amgen’s migraine drug development, said in an interview. Still, no drugs have been “developed specifically for the treatment of migraines,” he said. “They were developed as anti-epileptics, or blood pressure lowering agents.”

That may soon change. Amgen, based in Thousand Oaks,California, and other biotechnology companies such as Alder Biopharmaceuticals Inc., Arteaus Therapeutics LLC, and Labrys Biologics Inc. are targeting a chemical released during a migraine that carries a “pain” signal from nerve to nerve. By blocking a receptor from receiving the message, these companies aim to create drugs that cut off developing migraines before symptoms start.

Targeted Injections

Similar pain-signal transmission occurs when chili oil touches the skin. In that situation, the capsaicin in the pepper causes the body to release calcitonin gene-related peptides, or CGRP, leading to an increase in blood flow to the affected area. To show the Amgen drug works, researchers injected it under the skin of patients who had chili oil on their skin. The therapy blocked the CGRP that causes increased blood flow.

“It sounds simple, but it’s important -- it tells us that our drug is getting into the body in relative concentrations that are generally well tolerated and that block CGRP,” Lenz said.

The new class of drugs under development are biologics, often delivered by injection, and are more complex, targeted and longer lasting in the body than the earlier failed attempts, Lenz said.

Sales Potential

Amgen’s AMG 334 and Alder’s ALD 403 are being tested in the second of three clinical trials typically required for U.S. regulatory approval.

“We’ll have data on this before the year is out,” Randall Schatzman, chief executive officer of closely held Alder, based in Bothell, Washington, said in an interview.

If those trials yield results, the sales potential for these drugs will be significant. Michael Yee, an analyst with RBC Capital Markets in San Francisco, said Amgen’s new migraine treatment may reach $1 billion in sales should it gain approval.

Allergan Inc. (AGN)’s Botox, used primarily for cosmetic treatments, is also approved as a preventative therapy for migraines, though only for severe sufferers who have attacks lasting four hours or more at least 15 days a month. That means only about 10 percent of migraine patients qualify for that option. Sales for Botox as a migraine treatment alone could reach $1 billion during the next decade, Anne-Elise Tobin, an analyst with Burlington, Massachusetts-based Decision Resources, said in an interview. The new class of drugs would be for a bigger patient population with less frequent migraines.

Botox Success

“Botox demonstrates the market potential for a new emerging prophylaxis therapy,” said Tobin, who estimates the global market for all migraine treatments should increase 87 percent to $5.8 billion in 2021 from $3.1 billion in 2011.

Amgen gained 1.8 percent to $113.42 in New York. The stock gained 34 percent in 2012, its best annual increase since 1999, as investors rewarded the company for its buyback program, dividend and sales increase.

Currently, the most popular migraine treatments are oral drugs called triptans, first introduced in the 1990s, such as GlaxoSmithKline Plc’s Imitrex, which constrict blood vessels in the brain to relieve swelling and pain.

Pain Blockers

Those medicines attempt to halt migraines once they begin. The new therapies aim to eliminate the need to wait for attacks to occur, said John Latham, chief scientific officer at Alder.

“Once the migraine symptoms flair, it’s very hard to resolve them, and most of the people at that stage of the game let it run its course,” Latham said in a phone interview. “You can go into a dark room, turn the lights off, put ear plugs on, use an ice pack, but there’s not much you can do pharmaceutically to kick the migraine back in its place.”

That’s why the new pain blocker approach holds so much promise. By blocking a receptor in the brain from receiving the message, migraines could be avoided completely, said Peter Goadsby, director of the University of California, San Francisco’s Headache Center. Goadsby helped discover CGRP’s connection to migraines and has consulted with drug companies working on developing his findings into medicines.

“What these antibody approaches hope to do is to either block the receptor or mop up the CGRP itself,” he said.

This isn’t the first time drugmakers have targeted CGRP to stop migraines. Bristol-Myers and Merck were working a few years ago on so-called small molecule therapies, taken orally, to prevent headaches. While Merck’s drug, telcagepant, worked better than a placebo in a study, the company shelved development on concerns about liver damage. Bristol-Myers also said it wouldn’t continue development of its drug.

“The whole migraine world was thrown into a tizzy because this was supposed to be the next big thing,” Cathy Glaser, president and co-founder of the Migraine Research Foundation, said in an interview. “We’re all looking for the next magic pill.”

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Diagnosing the Wrong Deficit - A Great Read about ADD-ADHD & Sleep from the NYTimes

Diagnosing the Wrong Deficit

By VATSAL G. THAKKAR

IN the spring of 2010, a new patient came to see me to find out if he had attention-deficit hyperactivity disorder. He had all the classic symptoms: procrastination, forgetfulness, a propensity to lose things and, of course, the inability to pay attention consistently. But one thing was unusual. His symptoms had started only two years earlier, when he was 31.

Though I treat a lot of adults for attention-deficit hyperactivity disorder, the presentation of this case was a violation of an important diagnostic criterion: symptoms must date back to childhood. It turned out he first started having these problems the month he began his most recent job, one that required him to rise at 5 a.m., despite the fact that he was a night owl.

The patient didn’t have A.D.H.D., I realized, but a chronic sleep deficit. I suggested some techniques to help him fall asleep at night, like relaxing for 90 minutes before getting in bed at 10 p.m. If necessary, he could take a small amount of melatonin. When he returned to see me two weeks later, his symptoms were almost gone. I suggested he call if they recurred. I never heard from him again.

Many theories are thrown around to explain the rise in the diagnosis and treatment of A.D.H.D. in children and adults. According to the Centers for Disease Control and Prevention, 11 percent of school-age children have now received a diagnosis of the condition. I don’t doubt that many people do, in fact, have A.D.H.D.; I regularly diagnose and treat it in adults. But what if a substantial proportion of cases are really sleep disorders in disguise?

For some people — especially children — sleep deprivation does not necessarily cause lethargy; instead they become hyperactive and unfocused. Researchers and reporters are increasingly seeing connections between dysfunctional sleep and what looks like A.D.H.D., but those links are taking a long time to be understood by parents and doctors.

We all get less sleep than we used to. The number of adults who reported sleeping fewer than seven hours each night went from some 2 percent in 1960 to more than 35 percent in 2011. Sleep is even more crucial for children, who need delta sleep — the deep, rejuvenating, slow-wave kind — for proper growth and development. Yet today’s youngsters sleep more than an hour less than they did a hundred years ago. And for all ages, contemporary daytime activities — marked by nonstop 14-hour schedules and inescapable melatonin-inhibiting iDevices — often impair sleep. It might just be a coincidence, but this sleep-restricting lifestyle began getting more extreme in the 1990s, the decade with the explosion in A.D.H.D. diagnoses.

A number of studies have shown that a huge proportion of children with an A.D.H.D. diagnosis also have sleep-disordered breathing like apnea or snoring, restless leg syndrome or non-restorative sleep, in which delta sleep is frequently interrupted.

One study, published in 2004 in the journal Sleep, looked at 34 children with A.D.H.D. Every one of them showed a deficit of delta sleep, compared with only a handful of the 32 control subjects.

A 2006 study in the journal Pediatrics showed something similar, from the perspective of a surgery clinic. This study included 105 children between ages 5 and 12. Seventy-eight of them were scheduled to have their tonsils removed because they had problems breathing in their sleep, while 27 children scheduled for other operations served as a control group. Researchers measured the participants’ sleep patterns and tested for hyperactivity and inattentiveness, consistent with standard protocols for validating an A.D.H.D. diagnosis.

Of the 78 children getting the tonsillectomies, 28 percent were found to have A.D.H.D., compared with only 7 percent of the control group.  

Even more stunning was what the study’s authors found a year after the surgeries, when they followed up with the children. A full half of the original A.D.H.D. group who received tonsillectomies — 11 of 22 children — no longer met the criteria for the condition. In other words, what had appeared to be A.D.H.D. had been resolved by treating a sleeping problem.

But it’s also possible that A.D.H.D.-like symptoms can persist even after a sleeping problem is resolved. Consider a long-term study of more than 11,000 children in Britain published last year, also in Pediatrics. Mothers were asked about symptoms of sleep-disordered breathing in their infants when they were 6 months old. Then, when the children were 4 and 7 years old, the mothers completed a behavioral questionnaire to gauge their children’s levels of inattention, hyperactivity, anxiety, depression and problems with peers, conduct and social skills.

The study found that children who suffered from sleep-disordered breathing in infancy were more likely to have behavioral difficulties later in life — they were 20 to 60 percent more likely to have behavioral problems at age 4, and 40 to 100 percent more likely to have such problems at age 7. Interestingly, these problems occurred even if the disordered breathing had abated, implying that an infant breathing problem might cause some kind of potentially irreversible neurological injury.

Full article here

Epilepsy drug Potiga linked to skin and eye abnormalities

Epilepsy Update- Drug Warning - JR

Epilepsy drug Potiga linked to skin and eye abnormalities 

On April 26, 2013, the U.S. Food and Drug Administration (FDA) issued a safety alertregarding the anti-seizure medication Potiga (ezogabine). Potiga is used to treat partial-onset seizures in adults with epilepsy.

Epilepsy is a brain disorder that causes recurring seizures. Approximately 60,000people in Connecticut have epilepsy. One out of every ten people will experience a seizure at some point in their lives.

The FDA reports that Potiga may cause blue skin discoloration and eye abnormalities (such as changes in the color of the retina). Pigment changes in the retina can cause serious eye disease with loss of vision. It is not yet known if these changes are reversible. The skin discoloration is blue, predominantly on the lips or in the nail beds of the fingers or toes. Eye discoloration can occur in thesclera and conjunctiva of the eye as well as on the white of the eye and inside eyelids.

Potiga (ezogabine) can cause blue skin discoloration, including in the nail beds of the fingers.

Article here

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FDA

It is recommended that anyone taking Potiga have a baseline eye exam and periodic eye exams. Anyone taking Potiga, who develops changes in vision or discoloration of skin, should contact their doctor immediately. Also, report any side effects to the FDA MedWatch program (online or by calling 1-800-332-1088). It is important that patients should not stop taking Potiga without talking to their doctor. Stopping treatment suddenly can cause serious and life-threatening medical problems, such as withdrawal seizures.

The FDA is working with the manufacturer to better understand these events and will update the public when more information is available.

Study: Sleep Apnea Symptoms Vary by Race

This new study adds to our knowledge of the effect of race/ethnicity on sleep disorders and the PERCEPTION of sleep problems. 

We have known for some time that certain groups are more susceptible. 

Sleep apnea is another possible element of the study of the prevalence of hypertension and vascular disorders in certain ethnic groups. - JR

From the Huffington Post.....

"Risk factors for obstructive sleep apnea -- the sleep disorder in which breathing repeatedly stops and starts -- run the gamut, from smoking and high blood pressure, to the most common, high body mass index (BMI). But a recent study by researchers at Wayne State University School of Medicine reveals that even with BMI accounted for, one key risk factor remains -- race.

In the study of 512 patients observed at the Detroit Receiving Hospital Sleep Disorders Center between July 1996 and February 1999, the severity of sleep apnea was shown to be higher among African-American men under 40 years old and between 50 and 59 years old. No difference was found between African-American and white women, however.

Lead researcher, James Rowley, PhD, professor of medicine at Wayne State Medical Director of the sleep disorders center, says that the mechanism for a racial difference in sleep apnea severity is unclear, but potential mechanisms include anatomic differences that affect the way the upper airway open and close, as well as differences in the neurochemical control of breathing.

According to the Mayo Clinic, there are two main types of sleep apnea:

Obstructive sleep apnea, the more common form that occurs when throat muscles relax

Central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing

Rowley's research isn't the first to identify differences in how race affects the quality of sleep.

In two presentations at the annual meeting of the Associated Professional Sleep Societies in Boston last year, scientists reported that the amount and quality of sleep people get each night vary across racial and ethnic lines, with one study showing that blacks and Asians don’t sleep as much as whites do, and another study showing thatforeign-born Americans are less likely to report having sleep problems than those born in the U.S.

Unlike Rowley's study, however, the authors of last year's research surmise that the majority of the differences in sleep patterns between races can be chalked up to environmental or even geographical factors — rather than genes or physical characteristics like variations in facial structure that could interfere with breathing and sleep, TIME's Alice Park noted.

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This is an evidence-based article on autism treatment. JR

New Hope for Autistic Children Who Never Learn to Speak

Apr. 24, 2013 — An Autistica consultation published this month found that 24% of children with autism were non-verbal or minimally verbal, and it is known that these problems can persist into adulthood.

Professionals have long attempted to support the development of language in these children but with mixed outcomes. An estimated 600,000 people in the UK and 70 million worldwide have autism, a neuro-developmental condition which is life-long.

Today, scientists at the University of Birmingham publish a paper in Frontiers in Neuroscience showing that while not all of the current interventions used are effective, there is real hope for progress by using interventions based on understanding natural language development and the role of motor and "motor mirroring" behaviour in toddlers.

The researchers, led by Dr Joe McCleery, who is supported by autism research charity Autistica, examined over 200 published papers and more than 60 different intervention studies, and found that:

• Motor behaviours, such as banging toys and copying gestures or facial expressions ("mirroring"), play a key role in the learning of language.
• Children with autism show specific motor impairments, and less "mirroring" brain activity, particularly in relation to strangers in whom they show very little interest. This finding may hold the key to language problems overall.
• Despite extensive use of sign language training to improve speech and communication skills in non-verbal children with autism, there is very little evidence that it makes a positive impact, potentially due to the impairments in motor behaviours and mirroring.
• Picture exchange training can lead to improvements in speech. Here, children gradually learn to "ask" for things by exchanging pictures. This may work well because it does not depend on complex motor skills or mirroring.
• Play-based approaches which employ explicit teaching strategies and are developmentally based are particularly successful.
• New studies involving a focus on motor skills alongside speech and language intervention are showing promising preliminary results. This is exciting because these interventions utilise our new understanding of the role of motor behaviours in the development of speech and social interaction.

...

Christine Swabey, CEO of Autistica, says: "80% of the parents in our recent consultation wanted interventions straight after diagnosis. Dr McCleery's work shows how critical it is for all intervention to be evidence-based, and that the best approaches are based on a real understanding of the development of difficulties in autism. We are proud to be supporting the next steps in this vital research which will improve the quality of life for people with autism."

Alison Hardy, whose son Alfie is six, says: "As a parent of an autistic child, who is non-verbal, I feel quite vulnerable. People are always saying "try this, it worked wonders for us." But you can't try everything. We need a proper, scientific evidence base for what works and what does not. Then we can focus our time and our effort, with some confidence that we have a chance of helping our children."

link here

Colic in infants may be an early sign of migraines

Colic in infants may be an indicator of migraine headaches.

Colic has long been believed to be gastrointestinal pain in babies, say doctors, but new research suggests it may actually be related to migraine headaches instead.

Could colic — bouts of frequent, inconsolable crying during an infant's first months of life — be an early symptom of a migraine? A study out today is the latest to suggest that the two common pain conditions may be connected.

According to the study in the Journal of the American Medical Association, children diagnosed with migraine headaches were more likely to have experienced colic as infants (72.6%) than those who did not have migraine (26.5%).

And the increased odds existed for the two major migraine subtypes, as well: migraines preceded or accompanied by an "aura" — sensory warning symptoms such as flashes of light or blind spots (69.7%) and migraine without aura (73.9%). This association was not found for children with tension-type headaches (35%).

Researchers analyzed health records and questionnaires completed by parents for 208 children ages 6 to 18 who were diagnosed as having migraines and compared them with information on 471 kids and teens who were not. A comparison group of 120 children diagnosed with tension headaches also was studied.

A study published last year found that mothers who suffer from migraines are more than twice as likely to have babies with colic than mothers without a history of migraines.

Often thought of as a disorder of adulthood, migraine is "one of the most common causes of primary headaches in children," according to the article, written by Silvia Romanello of the APHP-Hospital Robert Debré, Paris, and colleagues.

An accompanying editorial notes that the prevalence of migraine headache by age groups is 1% to 3% from ages 3 to 7; 4% to 11% from ages 7 to 11; and 8% to 23% from ages 11 to 15 years old. Colic occurs in about 16% to 20% of infants.

Much more than a headache, a migraine is a "brain condition that can produce a variety of neurological symptoms," ranging from nausea and vomiting to sensitivity to light, sound, touch and smell, to dizziness and extreme fatigue, says Andrew Charles, a professor of neurology and director of the Headache Research and Treatment Program at UCLA School of Medicine. He was not involved in the new study.

"We've assumed for some time that colic was a gastrointestinal phenomenon, but in fact, that may not necessarily be true," says Charles. "That's one of the things that may surprise people about this study. It points out the possibility that this may be more of a brain issue than a gut issue."

Brain chemicals that are also shared by the gastrointestinal tract may be involved, but the actual mechanism at work "remains quite a mystery," he says.

Read more here

How exercise helps sleep

This article discusses the positive influences exercise has on your sleep.

We all know exercise is good for us. Good for our health, good for our waistlines, good for stress and for our clarity of mind. Exercise is also very—very—good for sleep. Research has shown that exercise can improve sleep, including for people with sleep disorders and other sleep-related illnesses. And now there’s even more evidence of the sleep benefits that can come with regular physical activity.

The National Sleep Foundation devoted its annual Sleep in America poll to exploring the relationship between exercise and sleep. Their results found that people who exercise regularly experience better quality and more consistent sleep than those who do not. People who exercise are also significantly less likely to feel sleepy during the day, and to experience symptoms of sleep disorders such as insomnia and obstructive sleep apnea. And the news gets better: while more vigorous exercise is best, people participating in light exercise—as little as 10 minutes of walking a day—reported substantially better sleep than non-exercisers.

The NSF interviewed a nationally representative sample of 1,000 adults between the ages of 23-60. Participants were asked to report on their physical activity in the past week, providing details on the frequency, duration, and intensity of their exercise. They also were asked to report on the quantity and quality of their sleep, as well as sleep problems including symptoms of disordered sleep and daytime drowsiness. Participants provided information about their overall health, and personal habits including alcohol and smoking.

Based on the reports of physical activity, respondents were divided into four categories, according to their exercise habits:

1. Vigorous: These people participated in activities like running, biking, swimming, and other pursuits that require significant physical exertion.
2. Moderate: Respondents in this category spent time doing activities that included higher-than-normal levels of physical exertion, including yoga and weight training.
3. Light: People in this category were physical active at normal levels of exertion, getting their exercise primarily by walking.
4. No activity: The respondents in this category did not engage in exercise.

The results were striking. All respondents—from vigorous exercisers to non-exercisers—reported getting roughly the same amount of sleep on a nightly basis, an average of 6 hours and 51 minutes on workdays, and 7 hours and 37 minutes on non-workdays. All groups also reported needing about the same amount of sleep to meet the demands of their daily lives: an average of 7 hours and 17 minutes. But exercisers at all levels reported sleeping substantially better than those who did not exercise:

• More than half of exercisers (56-67%) reported getting a good night’s sleep every night or almost every night, compared to 39% of non-exercisers.
• Exercisers at all levels also reported higher quality of sleep than non-exercisers. More than three-quarters (76-83%) said their sleep was “very good” or “fairly good,” compared to 56% of non-exercisers.
• More than half of exercisers at all levels also reported feeling their quality of sleep improve on days they engaged in physical activity.

While all exercisers reported significantly better sleep, the highest quality sleep was reported by those who engaged in the most vigorous physical activity. Vigorous exercisers reported the highest sleep quality, and the most robust daytime energy levels. And they were least likely to have problems with their sleep:

• 26% of vigorous exercisers said their quality of sleep was “very good,” compared to 16% of light exercisers.
• 66% of vigorous exercisers said they got more sleep than they needed, compared to 53% of moderate and light exercisers.
• Vigorous exercisers had fewer sleep problems than moderate and light exercisers, including less difficulty falling asleep and staying asleep, waking too early and not being able to fall back asleep. All exercisers reported fewer of these problems than people who did not exercise at all.
• 50% of vigorous exercisers said they had no problems maintaining enthusiasm for the demands of their daily lives, compared to 40% of moderate and light exercisers and 33% of non-exercisers.

People who engaged in no exercise didn’t just report lower quality sleep, they also reported in greater numbers a range of difficulties with their health and their daily lives:

• Non-exercisers were significantly more likely to say they experienced “very bad” sleep than exercisers. Fourteen percent of non-exercisers categorized their sleep as very bad, compared to 3-4% of exercisers.
• More than half—61%–of non-exercisers reported “rarely” or “never” getting a good night’s sleep on workdays, compared to 29% of vigorous exercisers.
• Non-exercisers were more likely to feel sleepy during the day. Nearly twice as many non-exercisers reported daytime sleepiness as exercisers.
• Daytime sleepiness interfered with non-exercisers daily activities and their safety more often than for those who exercised. 14% of non-exercisers reported having trouble staying awake while driving, eating, or engaging in social activity 1 or more times in the previous two weeks, compared to 4-6% of exercisers.
• Non-exercisers were significantly more likely to have symptoms of sleep disorders including obstructive sleep apnea. Forty-four percent of non-exercisers demonstrated a moderate risk for sleep apnea, based on standard clinical indications for the sleep disorder. This number was more than twice as high as for vigorous exercisers, only 19% of whom indicated a moderate risk of sleep apnea.

The message here is clear: put some time every day toward exercise, and when bedtime comes around you’ll sleep better. For those trying to juggle a regular exercise routine amid busy schedules, there’s some more good news in these poll results. The survey found that exercise at any time of day was good for sleep, including within 4 hours of bedtime. It’s been a common recommendation—including from the National Sleep Foundation itself—to avoid exercise during the final 4 hours of the waking day, in order to prevent physical exertion from interfering with sleep. Based on these results, the NSF has revised its recommendation, and encourages normal sleepers to exercise at any time of day, provided that their exercise does not interfere with their sleep. People with insomnia and other sleep disorders should continue to schedule their exercise earlier in the day. And anyone who finds their sleep diminished by late-day exercise should do the same.

So, where do you fit in the sleep-exercise picture that these survey results illustrate? Are you sleeping as much, and as well, as you need? If you’re looking for ways to improve your sleep, your daily exercise routine is a great place to start.

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