Saturday, March 30, 2013

10 Reasons Babies Wake Up At Night

Most babies wake up at night, and this article discusses 10 common reasons why they do.

Most babies wake up at night. And although some superhero babies sleep 10-12 hours straight starting around 3-4 months of age, most infants wake up during the night and cry out for their parents. There are scientific reasons and some developmental and behavioral explanations for these awakenings. I spoke with my friend Dr. Maida Chen, a pediatric pulmonologist, mother to three and director of the Pediatric Sleep Disorders Center in Seattle. I put this list together regarding why babies wake up at night. I'll author a follow-up blog on ways you can help your baby when they wake up, too.
10 Reasons Babies Wake Up At Night:
1. Sleep Cycle: Babies wake up during the night primarily because their brain waves shift and change cycles as they move from REM (rapid eye movement) sleep to other stages of non-REM sleep. The different wave patterns our brains make during certain periods define these sleep cycles or "stages" of sleep. As babies move from one stage of sleep to another during the night, they transition. In that transition, many babies will awaken. Sometimes they call out or cry. Sometimes they wake hungry. It's normal for babies (and adults) to wake 4-5 times a night during these times of transition. However, most adults wake up and then fall back to sleep so rapidly that we rarely remember awakening. At 4 months of age, many parents notice awakenings after a first chunk of deeper sleep. This is normal, and often due to development of delta wave sleep (deep sleep). The trick for parents is to do less and less as each month of infancy unfolds during these awakenings; we want to help our babies self-soothe more and more independently (without our help) during these awakenings so that sleeping through the night becomes a reality.
2. Brain Waves: The majority of babies are really capable of sleeping for a prolonged 6+ hour period of time 1/2 way through infancy, around 6 months. As Dr. Chen explains, "When doing sleep studies we follow brain wave activity." After 6 months of age she says, "We see brain waves at 6 months of age and up that are similar in pattern to that of adults." Now that doesn't mean that babies that wake throughout the night have abnormal brain waves, but it does mean as they progress through infancy, they get more and more mature when it comes to sleep. Dr Chen says, "If you look at sleep studies on newborns and infants, they will look very different compared to older children. But by 6 months of age, the baby's brain wave patterns will look much like an 18-year-olds." That being said, unlike an 18-year-old, once some babies are awakened during transitions, they may call out for your help!
3. "Good Sleepers" Versus "Bad Sleepers": Some babies are just better sleepers right out of the gate. Dr Chen reminded me, "There are good sleepers and there are bad sleepers. Part of that is organically hard-wired. But there are also good sleepers with bad habits." Our job as parents is to do the best we can in creating good sleep habits. Most of that has to do with consistency from one night to the next. Some babies make habitual associations like always nursing to sleep, always being rocked to sleep or always being held to fall asleep. Then, when they have awakenings at night, they may cry out to have those associations (bottle, nursing or rocking to sleep) to get back to sleep. These associations can cause a good sleeper to have bad sleep, because of the habit.
4. Crying Is Part Of Being A Baby: There is a pretty serious ongoing debate and national dialogue between parents, psychologists, pediatricians, lactation consultants and scientists about letting babies cry-it-out versus not cry-it out. I'll not delve into much of the debate here, but if you're worried that letting your baby cry-it-out will damage them, try to relax. Dr Chen says, "We don't think that some crying is bad for a baby. The evidence to support long-term damage from crying at night is nil." Many pediatricians recommend letting your baby gradually learn to self-soothe or cry-it-out once they have self-soothing skills (turning over, sucking on fingers or hand, and more mobility) starting somewhere around 4-6 months of age.
5. Mom or Dad's Role At Night: Studies have evaluated how parents can change an infant's sleep. Studies have found that infant sleep disorders are affected by how many times a parent comforts them at night. The more parents camp out (remain in the room until baby is asleep), the more parents transfer the baby into the crib after asleep and the more they picked the baby up at night, the more likely the baby has sleep challenges. And although most studies have evaluated a mother's role in overnight awakenings, a2010 Tel Aviv study found that when fathers were more involved in infant care (day and night), in addition to mothers, their babies had fewer overnight awakenings. Take turns!
6. Development: Developmental milestones shift and change sleep. As described in the video, after 4 months of age, most babies have a prolonged period of sleep and then wake up every couple of hours because of sleep cycle changes. Sometimes they will wake up and roll over and then freak out and cry when they get stuck or move into a new position. The rolling milestone may translate into awakenings. At 6 months of age, babies are exploring the world, putting all sorts of objects and germs in their mouths, and subject to more infection. They're also learning to sit at 6 months of age and this milestones often triggers awakenings. At 9 months of age, babies learn how to pull themselves up in the crib and stand-up -- don't be surprised if they are awake more. Most parents are unpleasantly surprised to find their 9-month-old up and awake in the middle of the night standing up, ready to rock and roll.
7. Teething: There's no question that teething wakes children at night and disrupts sleep. Teething typically commences around 6 months of age but I hear about teething waking babies all the way through their toddlerhood. Acetaminophen is the only medication I recommend for teething.
8. Behavioral Changes: Many babies will have more frequent awakenings around 6 or 9 months of age due to advancing sense of independence and self-awareness. At 6 months of age, I often hear from parents their babies will wake up in the middle of the night and start talking, just go through their different sounds. No need to go to them if they are not fussing! When babies develop separation anxiety around 9 months of age, they will often change their sleep patterns. Often during those times of behavior change they will wake and scream out when they realize you're not at their side.
9. Infection: Infants and children typically have an upswing in infections after 6 months of age. This occurs primarily because once a baby reaches 6 months, they are capable of putting lots of new objects (including their hands) in their mouths, so their exposure to germs increases dramatically. Many babies who have colds or upper respiratory infections will wake due to congestion or coughing. Fever, vomiting and diarrhea will awaken babies at night, too. Hang on and support your baby with a little TLC. Sleep schedules typically go back to normal within a few weeks after the illness began, especially if you can keep up good sleep routines.
10. Pacifiers/Bottle: Many babies are conditioned to fall asleep (or fall back to sleep) while sucking on something. This starts just after birth, when newborns instantly fall asleep with breastfeeding or a bottle in their mouth. Many infants who use a pacifier will wake up between 6-12 months of age when the pacifier falls out. The easiest solution is to get rid of it all together! But remember, big habits die hard, if a baby learns to fall asleep sucking and does so for 6+ months, it can take awhile to unlearn the habit.
Read more here

CDC study shows Autism is not caused by too many vaccines

The idea that 'too many vaccines too soon' causes autism has been proven false by research done by the Centers for Disease Control and Prevention.

Although scientific evidence suggests that vaccines do not cause autism, approximately one-third of parents continue to express concern that they do; nearly 1 in 10 parents refuse or delay vaccinations because they believe it is safer than following the Centers for Disease Control and Prevention's (CDC) schedule. A primary concern is the number of vaccines administered, both on a single day and cumulatively over the first 2 years of life. In a new study scheduled for publication in The Journal of Pediatrics, researchers concluded that there is no association between receiving "too many vaccines too soon" and autism.

Dr. Frank DeStefano and colleagues from the CDC and Abt Associates, Inc. analyzed data from 256 children with autism spectrum disorder (ASD) and 752 children without ASD (born from 1994-1999) from 3 managed care organizations. They looked at each child's cumulative exposure to antigens, the substances in vaccines that cause the body's immune system to produce antibodies to fight disease, and the maximum number of antigens each child received in a single day of vaccination.
The researchers determined the total antigen numbers by adding the number of different antigens in all vaccines each child received in one day, as well as all vaccines each child received up to 2 years of age. The authors found that the total antigens from vaccines received by age 2 years, or the maximum number received on a single day, was the same between children with and without ASD. Furthermore, when comparing antigen numbers, no relationship was found when they evaluated the sub-categories of autistic disorder and ASD with regression.
Although the current routine childhood vaccine schedule contains more vaccines than the schedule in the late 1990s, the maximum number of antigens that a child could be exposed to by 2 years of age in 2013 is 315, compared with several thousand in the late 1990s. Because different types of vaccines contain varying amounts of antigens, this research acknowledged that merely counting the number of vaccines received does not adequately account for how different vaccines and vaccine combinations stimulate the immune system. For example, the older whole cell pertussis vaccine causes the production of about 3000 different antibodies, whereas the newer acellular pertussis vaccine causes the production of 6 or fewer different antibodies.
An infant's immune system is capable of responding to a large amount of immunologic stimuli and, from time of birth, infants are exposed to hundreds of viruses and countless antigens outside of vaccination. According to the authors, "The possibility that immunological stimulation from vaccines during the first 1 or 2 years of life could be related to the development of ASD is not well-supported by what is known about the neurobiology of ASDs." In 2004, a comprehensive review by the Institute of Medicine concluded that there is not a causal relationship between certain vaccine types and autism, and this study supports that conclusion.
Read more here

Rapper Lil Wayne discusses his epilepsy

Rapper Lil Wayne tells that his recent seizures are caused by epilepsy which he has had for years.

Lil Wayne wants to set the record straight about his seizures: He has epilepsy.
The rapper called in to radio station Power 106 on Thursday to discuss his new album, "I Am Not a Human Being II," and to address concerns raised when he had a series of seizures two weeks ago. Histrip to the ICU at Cedars-Sinai Medical Center, coupled with a lack of info from Camp Weezy and a TMZ story that had him in a medically induced coma, getting his stomach pumped and receiving last rites, had fans worried for his life.
"The bad news is, I'm an epileptic. I'm prone to seizures," he said on the radio. "This isn't my first, second, third, fourth, fifth, sixth, seventh seizure. I've had a bunch of seizures. Y'all just never hear about 'em." 
So why did we hear about it so spectacularly this time?
"This time it got real bad because I had three of them in a row and then after the third one my heart rate went down to, like, 30%. Basically, I could have died. That's why it was so serious."
He said getting to the hospital from his house high in the hills made things a little dicey as well.
"The reason being for the seizures is just plain old stress, no rest and overworking myself," he said, contradicting rumors that blamed the seizures on excessive indulgence in sizzurp, a sort of codeine cocktail. "That's just typical me though."
Lil Wayne didn't directly address any details of the TMZ story, but instead seemed to give the website a pass after all the drama.
"That's what they do," he said. "I can't be upset at that.... I can't get upset at TMZ for doing what they do."
Read more here

Higher risk of behavioral issues in children with sleep apnea

This article discusses how children with obstructive sleep apnea have more behavioral issues that can present as ADHD-type symptoms.

A new study found that obstructive sleep apnea, a common form of sleep-disordered breathing (SDB), is associated with increased rates of ADHD-like behavioral problems in children as well as other adaptive and learning problems.

"This study provides some helpful information for medical professionals consulting with parents about treatment options for children with SDB that, although it may remit, there are considerable behavioral risks associated with continued SDB," said Michelle Perfect, PhD, the study's lead author and assistant professor in the school psychology program in the department of disability and psychoeducational studies at the University of Arizona in Tucson. "School personnel should also consider the possibility that SDB contributes to difficulties with hyperactivity, learning and behavioral and emotional dysregulation in the classroom."
The five-year study, which appears in the April issue of the journalSLEEP, utilized data from a longitudinal cohort, the Tucson Children's Assessment of Sleep Apnea Study (TuCASA). The TuCASA study prospectively examined Hispanic and Caucasian children between 6 and 11 years of age to determine the prevalence and incidence of SDB and its effects on neurobehavioral functioning. The study involved 263 children who completed an overnight sleep study and a neurobehavioral battery of assessments that included parent and youth reported rating scales.
Results show that 23 children had incident sleep apnea that developed during the study period, and 21 children had persistent sleep apnea throughout the entire study. Another 41 children who initially had sleep apnea no longer had breathing problems during sleep at the five-year follow-up.
The odds of having behavioral problems were four to five times higher in children with incident sleep apnea and six times higher in children who had persistent sleep apnea. Compared to youth who never had SDB, children with sleep apnea were more likely to have parent-reported problems in the areas of hyperactivity, attention, disruptive behaviors, communication, social competency and self-care. Children with persistent sleep apnea also were seven times more likely to have parent-reported learning problems and three times more likely to have school grades of C or lower.
The authors report that this is the first sleep-related study to use a standardized questionnaire to assess adaptive functioning in typically developing youth with and without SDB.
"Even though SDB appears to decline into adolescence, taking a wait and see approach is risky and families and clinicians alike should identify potential treatments," said Perfect.
Read more here

CDC claims one in 50 school-aged children has Autism

The CDC claims that currently, 1 in 50 school-aged children has autism. This is a huge jump from the rates seen in 2007.

The number of children in the United States with autism spectrum disorder has jumped dramatically since 2007, federal health officials reported Wednesday.
As of 2012, one in 50 kids between the ages of 6 and 17 has some form of autism, compared with one in 88 only five years earlier, according to the U.S. Centers for Disease Control and Prevention.
"This estimate was a bit surprising," said report author Stephen Blumberg, a senior scientist at the CDC's National Center for Health Statistics. "There may be more children with autism spectrum disorder than previously thought."
The average school bus holds about 50 children, so there is typically one child with autism spectrum disorder on every full school bus in America, Blumberg noted.
Michael Rosanoff, associate director for Public Health Research and Scientific Review at Autism Speaks, said that "this study added to the evidence suggesting that we are underestimating the prevalence of autism in the United States."
This report, however, underestimated the real prevalence of autism, Rosanoff said. "It's probably much higher," he said.
The main reason for the increase in the prevalence of autism appears to be better diagnoses, especially in older children, Blumberg said.
In addition, boys were more than four times more likely to be diagnosed with autism than girls, which has been the historical trend, Blumberg said.
"For the most part, the increase in the prevalence is largely due to an increase in the prevalence in reported autism spectrum disorder for boys," he said.
None of the other factors, such as survey bias, could explain the increase, he added. Most of the children who were diagnosed with autism spectrum disorder were diagnosed since the last survey in 2008, Blumberg noted.
"By ruling out other explanations and noting the increase in recent diagnoses, that suggests to us that improved ascertainment -- recognizing children who were previously unrecognized as having autism spectrum disorder -- is the reason," he said.
This may be the reason most of those newly diagnosed children tend to have milder forms of autism, Blumberg said.
"It would certainly make sense that those with unrecognized autism spectrum disorder may have symptoms that are milder than children who have been diagnosed earlier," he said.
Rosanoff agreed that more children with milder autism are being diagnosed.
"What we are seeing is that children who have not been diagnosed in the past are now being diagnosed," he said. "That is likely due to doctors and other health care providers being better at recognizing the more milder symptoms of autism and being able to diagnose those."
These children are most likely having trouble with social skills, which limits their ability to interact with others in the classroom and in social situations, Rosanoff said.
Diagnosing these children is important, Rosanoff said, because even though they may be doing well in the classroom they could benefit from help with their autism.
"With appropriate diagnosis and access to services, a child with autism can improve in the way they function and how they are able to be successful in life," he said.
To reach their conclusions, researchers gathered data from the National Survey of Children's Health, which is a national telephone survey of nearly 96,000 American households. As part of the survey, parents are asked whether they have a child diagnosed with autism.
Read more here

Zebrafish research promises new epilepsy treatment

Research on zebrafish shows compounds that help suppress seizures showing promise for future epilepsy treatment.

The prospect of developing new treatments for epilepsy sufferers has been given a boost by a pioneering discovery at a leading international centre of research into human disease in the University of Sheffield.
Researchers at the University’s Medical Research Council Centre for Developmental and Biomedical Genetics (CDBG), in the Department of Biomedical Science, screened a collection of 2,000 biologically active compounds to identify molecules that suppressed epileptic seizures in two day old epileptic zebrafish.
Within this collection, 46 compounds – including some which are used to treat infectious, psychiatric and inflammatory disorders – were found to exhibit anticonvulsant activity and could represent starting points for the development of new drugs for treating epilepsy.
Approximately one out of every 140 people in the UK has epilepsy – more than 400,000 people – of which about 30 per cent do not respond favourably to the available anti-epileptic drugs.
Consequently, many patients live with the disruptive and often devastating effects of untreatable seizures in their daily lives, whilst other patients who receive medication for their seizures experience side-effects that can result from taking some of these drugs.
The University of Sheffield team’s innovative approach to identifying small molecules with potential as anti-epileptic therapies offers new prospects of reducing the burden of suffering from this devastating illness.
Dr Vincent Cunliffe of the University of Sheffield’s Department of Biomedical Science, who led the project, said: “We took advantage of a unique set of features of the zebrafish to look for new anticonvulsant agents within a library of many different types of compounds with a wide range of known biological activities.
“We found that a small number of them had previously-unknown anti-convulsant effects. Some of the identified compounds already have a variety of different medical uses in treating conditions such as fungal infections, as well as psychiatric and inflammatory disorders.”
The research, published in the journal Disease Models & Mechanisms, suggests that some of these existing drugs could be re-purposed for treatment of epilepsy.
Nerve cells communicate with one another by passing electrical impulses along their lengths, leading to the release of a variety of chemical signals known as neurotransmitters at nerve endings, which may then stimulate or inhibit neighboring cells.
Epileptic seizures occur as a result of imbalances in the types of neurotransmitters produced within the brain, causing the simultaneous activation of abnormally large numbers of nerve cells, some of which may then stimulate body muscles to contract vigorously, resulting in convulsions.
Observing these processes at the level of individual nerve cells and molecules is especially difficult because the brains of mammals such as humans and mice, are so large, complex and relatively inaccessible.
However, the three milimetre-long, microscopic zebrafish larva develops rapidly, independently of its parents, and it is structurally simple, transparent and accessible, which allows the behaviours of nerve cells within the brain to be easily viewed in a remarkable level of detail. To study the effects of drugs on the zebrafish brain, they are simply diluted into the water in which the zebrafish develop, which then allows them to be readily absorbed by the body.
Dr Cunliffe added: “The zebrafish is proving to be a remarkably powerful in vivo system for gene function analysis and drug discovery. Over the last ten years our zebrafish research has helped us to understand how the nervous system is built and how faults in this construction process may cause neurological and psychiatric diseases.
“Three years ago we began to explore the usefulness of the zebrafish for drug discovery and we have been surprised by the success we have had in a relatively short period of time.”
More traditional approaches to identifying and developing new pharmaceuticals are slower and more costly, so adopting the zebrafish – a small tropical fish of the minnow family – for this type of research, could help to shorten the timescales and reduce the overall costs of drug development.
Read more here

Rising number of children with sleep disorders

This article discusses how sleep issues in children are rising through stories of specific children and the stories of their sleep issues.

When it came to her son's sleeping habits Sherrie Sharlow considered herself lucky. It was common for her 1-year-old son Ethan Cain to sleep for a solid 12 hours, providing a respite for his parents.


Sleep Tips for Children and Infants 

Babies up to 1 year old should always be placed on their backs on a firm surface to reduce the risk of Sudden Infant Death Syndrome.
Establish a routine by setting your child's bedtime at the same time each night and doing similar activities before bed.
All children and adolescents who snore regularly should be tested for sleep apnea. Additional symptoms can include labored breathing during sleep, gasps, snorts or pauses in breath.
Create a technology curfew by requiring children to hand over devices such as laptops, tablets, cellphones and turning off television before bedtime.

SOURCE: American Academy of Pediatrics
But despite the child's long slumbers, he was always tired. Sharlow, 44, also noticed that her son would gasp for air while sleeping and would frequently snore. A doctor confirmed Ethan Cain had obstructive sleep apnea, a condition in which breathing slows or decreases during sleep due to a narrow or blocked airway.
"He was such a good baby," the Port Orange resident recalled. "He would just fall asleep on me or we'd be out and the next thing I knew, he was sleeping. Everyone said I was so lucky, but the whole while sleep was doing damage to my child and I had no idea."
Like the majority of children diagnosed with sleep apnea, Ethan Cain had surgery to remove his tonsils and adenoids. Sharlow said her son, now 9, is able to sleep throughout the night and she's seen an improvement in his behavior and mood.
Sleep disorders affect 20 to 25 percent of children and adolescents, according to the American Academy of Pediatrics. While childhood obesity is a contributing factor to disorders like sleep apnea, sleepless nights also appear to be intensified by modern life's hectic schedules and dependence on technology, said Dr. Mary Wagner, director of the pediatric sleep lab at the University of Florida.
"Sometimes there are other disruptions that are causing kids to stay up late," Wagner said. "Maybe they are on their phones or texting. Because there is so much fun stuff do to 24/7, sometimes it's hard to get in bed, turn the lights off and go to sleep."
Edgewater resident Kimberly Adams believes that placing her 1-year-old daughter, Zoe, and 4-year-old son, Zane, on a strict bedtime schedule has made a difference in their behavior. Because her husband wakes up for work each morning at 4:30, the entire family goes to bed at 8 p.m., she said.
"We try not to do a lot of running around during the week," Adams said. "We sit down to dinner every night at 6, and then shower and get ready for bed. We have always had a consistent schedule from when my son was first born."
The AAP recommends children ages 5 to 13 receive 10 hours of sleep per night, and eight to nine hours each night for 14- to 18-year-olds. Irregular or disrupted sleep in children can cause side effects such as lack of concentration, impulsiveness and irritability. Researchers are studying the correlation between sleep disorders and attention deficit hyperactivity disorder because of the similar side effects.
"We are seeing an increase in children and teens with sleep disorders, especially with obstructive sleep apnea because of obesity and weight issues," said Amy Korn-Reavis, program director of the neurodiagnostic technology program at Concorde Career Institute in Orlando. "We don't know if there is a correlation but the symptoms of sleep disorders and ADHD are exactly the same."
A 2007 study published in the Journal of the AAPfound that 50 percent of parents of children and adolescents with ADHD reported sleep problems but the relationship is not well understood.
"It's unclear whether the sleep problem or the psychiatric disorder is the primary problem," researchers wrote in the study.
Joellen Salce Rogers, a licensed school psychologist and behavioral analyst in Daytona Beach, said the ADHD screenings she conducts with her patients evaluate habits such as eating and sleeping.
"If they don't sleep well or fitfully there is a possibility that there is a correlation and it warrants looking into," Rogers said. "There is no question that our lives are crazier now and we are running in different directions. But there is also a huge genetic component associated with ADHD."
Wagner said that education among doctors, parents and psychologists is important for making sure a child is receiving the best treatment for sleep and behavioral disorders. She also recommends that children who are being tested for ADHD are also screened for sleep disorders.
"We are getting better at making diagnoses, but the people who know children best are the parents," Wagner said. "They should bring concerns to the attention of a primary care provider."
Read more here

Differences in brains of people with migraines

A new study shows there are differences in the brains of people who have migraine headaches and the brains of people who do not.

People who suffer migraines may have certain structural differences in pain-related areas of the brain, a new study suggests.
Using MRI scans, researchers found that in specific brain regions related to pain processing, migraine sufferers showed a thinner and smaller cortex compared to headache-free adults. The cortex refers to the outer layer of the brain.
It's not clear what it all means. But the researchers suspect that certain aspects of brain development may make some people more vulnerable to developing migraines -- and that migraine attacks create further changes in the brain.
The surface area of the brain "increases dramatically" during fetal development, while the thickness of the cortex changes throughout life, explained senior researcher Dr. Massimo Filippi.
"We speculate that migraine patients might have a sort of cortical 'signature' -- abnormal cortical surface area -- which could make them more susceptible to pain and abnormal processing of painful stimuli," said Filippi, a professor of neurology at the University Vita-Salute's San Raffaele Scientific Institute in Milan.
Once migraines develop, they may alter the thickness of the brain's cortex, Filippi explained.
A neurologist who was not involved in the study said it "adds to the growing body of knowledge that patients with migraine have brains that not only function differently, but may actually look different structurally as well."
That's important because it helps "legitimize" migraine as a neurological disorder associated with "real structural changes in the brain," said Dr. Matthew Robbins, of the Albert Einstein College of Medicine and Montefiore Headache Center, in New York City.
Worldwide, an estimated 11 percent of people have had a migraine in the past year. Migraines typically cause intense, throbbing pain on one side of the head, along with sensitivity to light and sound, and sometimes nausea and vomiting.
About 30 percent of people with recurrent migraines also have sensory disturbances right before their head pain hits. Those disturbances, known as "aura," are usually visual -- like seeing flashes of light or blind spots.
No one knows precisely what causes migraines, but they do seem to involve abnormal brain activity and -- like the new study suggests -- abnormal brain structure.
The findings, published online March 26 in Radiology, come from MRI scans of 63 adults with migraines, and 18 migraine-free men and women.
Filippi's team found that the migraine brain was complicated. In some areas, the cortex was thicker, but in others -- including pain-processing areas -- the cortex was thinner, versus migraine-free adults.
And there were also differences among migraine sufferers. The exact location of the cortex abnormalities tended to differ between the half of patients who had aura and the half who did not.
According to the researchers, those structural differences might help explain why the two forms of migraine manifest differently.
Filippi said it's important to understand the structural brain changes linked to migraines because that could give insight into the cause of people's pain and other symptoms.
But whether any of this will help in managing migraines remains to be seen. According to Filippi, it's possible that doctors could eventually monitor structural changes in the brain's cortex to gauge migraine patients' response to treatment, for example.
Robbins, of Montefiore Headache Center, said that right now, it's "very hard to say" whether that will happen.
He pointed out that the study participants had one MRI scan, so it's not known what happens later on. "It is unclear if these changes in the brain are dynamic -- meaning, do they change over time?" Robbins said.
Filippi said his team is now following these patients to see whether the structural patterns in their brains are "stable" or tend to shift. They are also doing a similar study of children with migraines.

Read more here

AAP suggests avoiding specific activities before sleep

The American Academy of Pediatrics suggest that adults and children avoid certain activities before bedtime listed below. Avoiding these activities will lead to better sleep.

Your behavior and activities before bedtime can affect how well you're sleeping at night.
The American Academy of Pediatrics offers suggestions for better sleep:
  • Don't drink alcohol within at least four hours of bedtime.
  • Cut out all caffeine at least four hours before bedtime.
  • Stop eating spicy, heavy foods at least four hours before bedtime.
  • Don't exercise heavily at least two hours before bedtime.
  • In the hour before bedtime, avoid activities such as watching TV, playing video games or having in an argument.
Read more here

NFL approved new rule to reduce concussions

Last week, the NFL adopted a new rule that penalizes players for hitting another player with the top of their helmets in effort to reduce concussions.

In an effort to reduce the number of head injuries that occur on the field, NFL owners approved a new rule this week that will penalize players for striking opponents with the crown of their helmets.

The rule will prohibit runners and defenders from lowering their heads and hitting with their helmets when outside of the tackle box — the area of the field between the two offensive tackles. Such hits will result in a 15-yard penalty from the spot of the foul. Hits inside the tackle box, however, will not fall under the new guidelines.

The change comes as the NFL is facing concussion litigation from nearly 4,000 former players. Amid growing concern over player safety, the new rule marks the league’s most high-profile initiative of the offseason to address head and neck injuries. Owners approved the proposal by a vote of 31 to 1, with Cincinnati Bengals owner Mike Brown the lone holdout.

Despite the overwhelming approval of owners, the rule change fueled a barrage of criticism from current and former players alike. Running backs — who accounted for nearly one in nine concussions last season –  were among the most vocal, complaining the rule would limit their ability to protect themselves and safeguard the ball.

“Last time I checked football was a contact sport, said Chicago Bears running back Matt Forte on Twitter. “Calling bank now to set up my lowering the boom fund.”

Hall of Fame back Emmitt Smith said the rule “sounds like it’s been made up by people who have never played the game of football. Meanwhile, Cleveland Browns running back Trent Richardson told The Plain Dealer he felt responsible for the change. Richardson’s Week 1 hit on Kurt Coleman of the Philadelphia Eagles was shown to owners during deliberations over the rule. (Watch the hit below) Coleman was cut under his lower lip and across his nose on the play, but stayed in the game.

“I feel like I made it bad for all the backs,” Richardson said. “I feel like it’s my fault.”

Others voiced concern that the rule would be too difficult for referees to officiate. A study by the league office of two weeks of the 2012 season found that 11 hits would have drawn a flag under the new rule.

Criticism aside, league officials stressed the importance of reducing head injuries, saying players and coaches will need to adapt.

“This is a very important step in our continuing efforts to emphasize player safety,” said St. Louis Rams coach Jeff Fisher, a member of the NFL Competition Committee. “The players’ habits, their reactions, their responses to rule changes, you see it on the field. This is just another step in that direction.”

Read more here

New technologies utilized for epilepsy treatment

This article claims that developing new technologies is the best way to treat epilepsy. It also goes over a few of the technologies currently utilized for epilepsy treatment.

Speaking in the lead up to Purple Day for Epilepsy Awareness (Tuesday 26 March), geneticist Professor Jozef Gecz says advances in DNA sequencing have been a huge leap forward in understanding epilepsy. 

This, combined with the use of stem cells in laboratory research, will lead to further advances in epilepsy treatment, he says. 

However, he cautions that the same technology has also helped to reveal that epilepsy is a far more complex condition than previously thought. 

"Scientists used to believe that epilepsy was just one condition, possibly with one main cause. But now we know it is a very complex series of neurological disorders – it is many epilepsies, instead of just one epilepsy, with multiple causes and various symptoms," says Professor Gecz, from the University of Adelaide's School of Paediatrics and Reproductive Health. 

Epilepsy is common, with up to 3% of the Australian population experiencing epilepsy at some stage in their lives. Genetic and environmental factors, and trauma, can all play a role in the development of epilepsy. Most (but not all) forms cause sufferers to experience seizures, which vary in severity. 

Research in Adelaide has played an important role in the understanding of epilepsy in recent years. 

"It's really thanks to the pioneering work of Dr John Mulley (Women's and Children's Hospital and University of Adelaide), who discovered the first gene for idiopathic epilepsy almost 20 years ago. Since then, almost 40 idiopathic epilepsy genes have been discovered, many of them by researchers here in Adelaide," Professor Gecz says. 

"There are more than 300 genes known today in which DNA mutations can give rise to some form of epilepsy, in addition to other problems like intellectual disability, autism or psychiatric problems. 

"Thanks to genetic sequencing technology, in most cases we are now able to solve the mystery about what kind of epilepsy a patient has, and we can do this very quickly, very accurately, and cost effectively. 

"Molecular diagnosis is making a huge impact on treatment – it's really taken off in the last few years, and it has the potential to be even more effectively used in the future. Clinicians can now be guided by genetic information when considering treatment of patients with specific epilepsies." 

Professor Gecz and colleagues are currently involved in a major national study of epilepsy, with his lab focusing on the "genetic architecture" of the condition.

Read more here

Tuesday, March 26, 2013

What does Seder night offer the autistic child?

The 1,000-year-old educational philosophy at the heart of the Hagadda is recognized as the most effective tool for autism.

Alut's Pessah Haggada
Alut's Pessah Haggada Photo: Courtesy of Alut

Seder night is an experience that links generations, creating a common thread of memory going right back to Egypt. During the Seder, we witness a masterful night of education as we understand that this chain has only survived due to the extreme attention we give to each and every link; to each and every child.

What is remarkable is that the 1,000-year-old educational philosophy at the heart of the Hagadda is fast becoming recognized as the most effective tool we have to meet the challenge of autism, the world’s fastest-growing serious developmental disability.

It is estimated that 1 in 88 children have some kind of autism today, and while there is no known cure, thousands of children have shown significant improvement resulting from early diagnosis and use of effective interventions that seek to understand to and respond to the individual symptoms and behaviors of each child.

Through Applied Behavioral Analysis (ABA), a wide spectrum of autistic disorders are today being treated by applying Independent Treatment Plans (IDPs) for children through careful real-time monitoring and responding to the individual characteristics of each child.

However, this “ABA” approach was pioneered first by Judaism in the Hagadda thousands of years ago. The Torah teaches, “And thou shalt tell thy son in that day, saying: It is because of that which the LORD did for me when I came forth out of Egypt.” The rabbis were precise in their understanding of the word , “your son,” as the Mishna in Pesachim teaches: “A father should teach his son according to his own level.”

The famous four sons of the Hagadda emphasize that no children are the same and that each requires a different approach to reach them. For some children a highlevel discussion is the ticket, and for others we need to be more creative. The Gemara relates that one famed rabbi would move the table away at random moments throughout the meal simply to spark a reaction among the children – perhaps those children whose attention was fading.

The message of Passover is literally “peh sach,” the “mouth that speaks.” By spotlighting four very different sons, the Haggada reminds us that not all children communicate easily.

Around a third to half of individuals with autism do not develop enough natural speech to meet their daily communication needs. Difficulties in communication can be present from the first year of life, and may include delayed onset of speech along with unusual gestures, signs and social cues that a child may adjust according to the social context they find themselves in.

Within the wide spectrum of conditions in the diagnostic realm of autism, it is even possible to find some that parallel the four children we read about in the Hagadda. Perhaps we meet the wise son in the child with Asperger’s Syndrome, who although deemed to have a higher-than-normal IQ has significant difficulties with social interaction.

We can see children who display behavior which can be anti-social and disruptive, sparked by angry frustration at not being able to communicate what they are feeling. Indeed, the simple son can find his parallel with the child trapped inside a body that hears the question, but cannot respond. Many autistic children carry this badge: of the “child who cannot ask,” slow to develop and sometimes introverted an unable to communicate well, if at all, with the world around them.

The Seder night is well known for being a long evening; the Gemara teaches that Rabbi Akiva would hand out nuts throughout the day to keep the children awake and excited for the experience. At least one answer for why this is such a long evening is that the process of reaching children each at their own level takes time, commitment, patience and belief. It is here that Passover and autism share a common thread.

THE TISHMA School & Center for Autism in Jerusalem is one of a handful of autism schools and treatment programs in Israel which specialize in utilization of the ABA method of autism intervention. In the US, Canada and the UK, ABA treatment for children with autism is considered to be the intervention/education and treatment methodology of first choice.

Saturday, March 23, 2013

Migraine Severity May Be Determined by Blood Protein

Research has shown that measuring the level of adiponectin, a protein in your blood can predict the severity of migraines. Not clear about clinical use of this- JR

In a small, preliminary study of regular migraine sufferers, scientists have found that measuring a fat-derived protein called adiponectin (ADP) before and after migraine treatment can accurately reveal which headache victims felt pain relief.

A report on the study of people experiencing two to 12 migraine headaches per month, led by researchers at Johns Hopkins, is published in the March issue of the journalHeadache.

"This study takes the first steps in identifying a potential biomarker for migraine that predicts treatment response and, we hope, can one day be used as a target for developing new and better migraine therapies," says study leader B. Lee Peterlin, D.O., an associate professor of neurology and director of headache research at the Johns Hopkins University School of Medicine. She cautioned that larger, confirmatory studies are needed for that to happen.

Experts estimate that roughly 36 million Americans, or 12 percent of the population, suffer from debilitating migraine headaches that last four hours or longer. Migrainesare defined as headaches with at least two of four special characteristics: unilateral or one-side-of-the-head occurrence; moderately to severely painful; aggravated by routine activity and of a pounding or throbbing nature. Sufferers generally also feel nauseated or are sensitive to light and sound. Women are three times as likely to get migraines as men.

Such complicated diagnostic criteria mean that diagnosis is tricky, a fact driving efforts, Peterlin says, to find better diagnostic tools.

For the study, Peterlin and her colleagues collected blood from 20 women who visited three headache clinics between December 2009 and January 2012 during an acute migraine attack. Blood was taken before treatment with either sumatriptan/naproxen sodium (a drug routinely given to people with migraines) or a placebo. The investigators re-drew blood at 30, 60 and 120 minutes after the study drug was given. Eleven women received the drug and nine got the placebo.

The researchers measured blood levels of ADP, a protein hormone secreted from fat tissue and known to modulate several of the pain pathways implicated in migraine. The hormone is also implicated in sugar metabolisminsulin regulation, immunity and inflammation, as well as obesity, which is a risk factor for migraines.

Peterlin and her colleagues looked at total adiponectin levels and two subtypes or fragments of total ADP in circulation in the blood: low molecular weight (LMW)-adiponectin and high molecular weight (HMW)-adiponectin. LMW is comprised of small fragments of ADP and it is known to have anti-inflammatory properties, while HMW is made up of larger fragments of ADP and is known to have pro-inflammatory properties. Inflammatory pathways in blood vessels in the head are at work inmigraine headache.

The researchers found that in all 20 participants when levels of LMW increased, the severity of pain decreased. When the ratio of HMW to LMW molecules increased, the pain severity increased.

"The blood tests could predict response to treatment," Peterlin says.

At onset of pain -- even before study drug was given - the researchers could identify who would be a responder to treatment and who would not, as there was a greater ratio of HMW to LMW in those who would be responders as compared to those who were not.

After study treatment changes in adiponectin were also seen. Interestingly, in those patients who reported less pain after receiving study drug to treat the migraine - whether they got the active migraine medication or a placebo -researchers were able to see a decrease in total levels of ADP in the blood.

Peterlin says the findings indicate it may be possible to develop a treatment that would reduce levels of ADP or parts of adiponectin such as HMW or LMW adiponectin. She says should ADP prove to be a biomarker for migraine, it could help physicians identify who has migraine and know who is likely to respond to which type of medication. It also may help doctors make better medication choices and try alternate drugs sooner.

Read more here

Thursday, March 21, 2013

Knowledge and resource gap in Africa between malaria and epilepsy

This article discusses the interesting gap between knowledge and resources for both malaria and epilepsy. It also discusses a link between the two conditions.

It is common knowledge that malaria is the major cause of deaths in sub-Saharan Africa, that simple preventative methods like mosquito nets save lives, and that 85% of those who die from malaria are children under 5. In response, billions of dollars have been raised for free medication and awareness raising projects.
So what next? What happens to the children who survive malaria? Most will go home anaemic and a little worn out, but up to one third of childrenwith cerebral malaria will leave hospital with a neurological disability likeepilepsy.
In the developed world, where a wide range of drugs and support is available, many people with epilepsy achieve reasonable control of their seizures and manage to complete school, have careers, drive cars, have families and so on. Sadly the story is very different in north-westCameroon. Going home with epilepsy is only the beginning of a life-long nightmare.
Epilepsy is highly stigmatised, many believe it to be a spiritual rather than medical illness. It is also thought to be contagious, transmitted by touching someone during a seizure. So many people with epilepsy suffer fatal or debilitating injuries from falling into open fires or bodies of water, and being abandoned in these dangerous environments during their seizure. You can often spot someone with epilepsy by their numerous wounds and scars.
Mothers with epilepsy are advised not to breastfeed their children for fear of transmitting the illness. Children with epilepsy are not sent to school, neither are they taught any household tasks for fear that they might contaminate the food they cook or water they fetch. As adults, they find themselves with no independent living skills and terrible self-esteem. For many, the only source of money is to beg. Few marry and many girls are told that having sex with a traditional healer will cure them of their epilepsy. This results in several young single mothers with epilepsy and no means to support themselves or their children.
Though treatment is available in the region – in the form of three highly effective drugs, phenobarbitone, carbamezipine and sodium valproate – unlike malaria treatment, these drugs are not subsidised. The estimated cost for a year's supply of phenobarbitone is 150CFA (just under £2), carbamazepine 36,000 CFA (£45) and sodium valproate 144,000 (£180). From HIV surveys conducted in the region, we know that the average monthly income of a family in the north-west is 70,000CFA (£88), so while on the face of it, epilepsy treatment (for the cheapest option at least) seems within the reach of most families, those that can afford it are the ones with two working adults. Those who have epilepsy have no income, they have no skills and because of the stigma many employers would not employ them. Medication is a luxury they cannot afford.
Adequate diagnosis and accessibility of treatment is another problem. The nearest EEG (electroencephalogram) is a six-hour bus ride away and costs 17,000 CFA (£21). Often patients will opt not to have the investigation and decide to go on a trial of various anticonvulsants instead. With no diagnostic information to guide management, selection of the appropriate antiepileptic drug is difficult and this trial and error approach often results in poor seizure control which frustrates patients and confirms their suspicion that epilepsy cannot be treated by western medicine.
Treatment itself is available at a few sparsely located health centres and even then the availability of the drugs is interrupted during periods of limited stock, with the larger cities getting priority. It is estimated that only 10% of people living with epilepsy in the north-west are on treatment. The challenge is considerable: over 80% of the world's 50 million people with epilepsy are in the developing world. However the treatment gap (the percentage of people not taking treatment who should be on treatment) is largest in developing countries (up to 90% compared with 10% in high income countries).
We need to start making epilepsy a public health priority now. In order to make a difference, action needs to be taken at several levels.

Community health

We need more community education programmes that address the stigma and explain the impact of anti-epileptic drugs. We need to empower people living with epilepsy to advocate for better services and government support. We need to work with religious leaders, traditional healers and health care workers and train them to spot people with epilepsy and advise appropriate investigation and treatment.

Academic and public health

We should first establish a community of multidisciplinary professionals with an interest in tackling this problem so we can develop goals and strategies, be accountable to each other and learn from experiences. There are community-based approaches and local government projectsin Kenya, India, Malawi and China. We need to work closer with infectious diseases teams to improve the management of central nervous system infections thereby preventing more cases of epilepsy. We also need more open access to clinical research. In August 2012, Lancet Neurology published a paper about a study that reduced the epilepsy treatment gap in a community in Kenya through a series of successful interventions. These are golden nuggets of wisdom which, unfortunately, I and many other health professionals in the developing world cannot access because of subscription rights.

Government policy

Policies need to be put in place to improve the affordability and availability of drugs. Where government funded schemes are not an option, pressure needs to be put on pharmaceutical companies and development organisations to subsidise the cost of these drugs.
The focus on malaria has for so long been on prevention, never extended to helping those who have survived malaria – with or without complications. Yet as we get better at diagnosing and treating malaria this problem will only grow: less children will die, more will survive and more may go home with epilepsy. Already the number of people with epilepsy in developing countries is more than twice that in high income countries.
As the developed world raises awareness on 'Purple Day' on 26 March, we need to start thinking about how we can improve the lives of people living with epilepsy in the developing world.
I met a young filmmaker in Cameroon, who grew up seeing a family member suffer with epilepsy. This compelled him to make a documentary about the lives of those living with epilepsy. He hopes this will start an international conversation and create pressure on pharmaceuticals and governments to make treatment for this condition more accessible.
Read more here