Thursday, May 30, 2013

Children with temporal lobe epilepsy and depression

Psychiatric evaluation is shown to be important for children with temporal lobe epilepsy.

Depressive symptoms, behavioural problems and psychiatric illnesses are common among children and adolescents with temporal lobe epilepsy, a new study has shown.
Researchers at the Children's National Medical Centre in Washington DC, US, say their findings underline the importance of carrying out full psychiatric evaluations on children with epilepsy, particularly if they are not responding to anti-seizure medications and may be eligible for epilepsy surgery.
The research team looked at case records for 40 children, aged six to 17 years, who were not benefiting from anti-seizure medications.
Patients received psychiatric evaluations prior to undergoing epilepsy surgery, while their parents completed questionnaires aimed at assessing their children's behaviour.
Previous research suggests that up to 40 per cent of children with chronic epilepsy have mental illnesses, with depression, anxiety, attention issues and learning difficulties being most common.
However, the latest study found the rate of psychiatric and behavioural problems to be far higher.
Overall, nearly 80 per cent of the children had significant psychiatric symptoms.
The researchers also observed that children with temporal lobe epilepsy were more likely to have depressive symptoms and significant behavioural issues than those whose seizures originated in other parts of the brain.
Their study, which is published in the journal Epilepsia, is not the first to suggest a link between temporal lobe epilepsy and depression, as previous research in a 2009 issue of the same journal found an association in adult patients.
However, the latest study indicates that this link extends to children with epilepsy as well.
"Understanding the paediatric patient's mental health status is important, as the severity of psychiatric illness may impact the overall risk-benefit of epilepsy surgery," explained Dr Jay Salpekar, the study's lead author.
"Given that psychiatric illness, particularly depression, is so prominent in those with temporal lobe seizures, routine psychiatric evaluation appears to be important not only for adults, but also for children and adolescents prior to epilepsy surgery.
"In fact, it may be beneficial for most patients with medically refractory epilepsy to have a psychiatric assessment, regardless of seizure localisation, to improve quality of life."
Read more here

How to get rid of migraine headaches

This article discusses a few ways to reduce or get rid of migraine headaches.

Migraines are more than an occasional nuisance for some. Those suffering from chronic migraines know all too well the nausea, sensitivity, and unbearable pain that comes along with frequent attacks. Luckily, there are treatments available to reduce the frequency and severity of migraines.
Migraine treatment can be broken down into two categories; those that ease symptoms that have already started, and preventative measures that stop migraines before they start.
Pain-relieving medications can be taken during migraine attacks and are designed to stop symptoms that have already begun. These medications can include over-the-counters like ibuprofen and acetaminophen, but also prescription pain relievers such as indomethacin.
Preventative means can stop migraines from starting. Those suffering regularly from migraines might want to consider the following treatments.
Botox Treatments
Approved by the FDA for treating chronic migraines, injections are given around the head and neck once every 12 weeks. The Botox blocks pain signals as well as causes head and neck muscles to relax. By working on sensory pathways it reduces the sensory traffic from the head to the consciousness. 
Magnesium Deficiency
Studies have shown that up to 50 percent of migraine patients have lowered levels of magnesium during an attack, and an infusion of the mineral can provide rapid and sustained relief. Routine supplements can reduce the frequency and severity of such attacks. Eating magnesium-rich foods (such as nuts, whole grains, legumes, and chlorophyll-rich vegetables) can assist the body without overwhelming it. A magnesium supplement can also provide the needed boost.
As always, consult a certified pain physician before beginning any new treatment regimen.

Read more here

Information on SUDEP (Sudden Unexpected Death in Epilepsy)

The following information on SUDEP (Sudden Unexpected Death in Epilepsy) was provided by the CDC and gives risk factors of SUDEP and how to lower your risk.

For some people living with epilepsy, the risk of Sudden Unexpected Death in Epilepsy (SUDEP) is an important concern. SUDEP refers to such deaths in people with epilepsy that are not caused by injury, drowning, or other known causes.1
It is likely that most, but not all, cases of SUDEP occur during or immediately after a seizure.  The exact cause is not fully known or understood, but theories exist as to why SUDEP occurs.1-4
  • Breathing. A seizure may cause a person to have pauses in breathing (apnea).  If these pauses last too long, they can reduce the oxygen in the blood to a life-threatening level.  In addition, during a convulsive seizure a person’s airway sometimes may get covered or obstructed, leading to suffocation.
  • Heart Rhythm. Rarely, a seizure may cause a dangerous heart rhythm or even cardiac arrest.
  • Other Causes and Mixed Causes. SUDEP may result from more than one cause or a combination involving both breathing difficulty and abnormal heart rhythm.
Risk Factors for SUDEP
Estimates of SUDEP risk vary, but general population studies suggests that each year there is about 1 case of SUDEP for every 1,000 people with epilepsy.2 For some, this risk can be considerably higher, depending on several factors identified by researchers such as:
  • Uncontrolled or frequent seizures.1
  • Generalized convulsive (tonic-clonic or “grand mal”) seizures.1
Other possible risk factors may include the following:
  • Long duration of epilepsy and young age when seizures started.2
  • Not taking antiepileptic medication regularly as prescribed.4
  • Alcohol use.1

Steps to Reduce the Risk of SUDEP
If you have epilepsy, ask your doctor to discuss your risk of SUDEP with you. The first and most important step to reduce your risk of SUDEP is to regularly take your seizure medication as prescribed. If you are taking seizure medication and are still having seizures, discuss options for adjusting the medication with your doctor. If seizures continue, consider consulting an epilepsy specialist, if you are not already seeing a specialist. Other possible steps to reduce the risk of SUDEP might include:
  • Avoid seizure triggers, if these are known.2 Read more information about seizure triggersExternal Web Site Icon.
  • Avoid excessive alcohol use.1
  • Avoid sleep deprivation.1
If you have uncontrolled epilepsy, talk with your doctor about other possible ways to reduce your risk of SUDEP. If necessary, other ways to reduce risk might include having adults in the household trained in first aid for epilepsy seizuresExternal Web Site Icon.

How Do I Talk to My Doctor About SUDEP?
When you decide to talk with your doctor about SUDEP, possible questions to ask the following:
  • What is my risk for SUDEP?
  • If my risk of SUDEP is increased, what can I do to reduce my risk?
  • What should I do if I forget to take my anti-epileptic drug (AED)?
  • What steps should I take if it is decided to change my seizure medication?
  • What medications provide the best seizure control for me?
  • Are there any specific activities I should avoid?
  • What instructions should I give my family and friends if I have a seizure?

Read more here

Factors affecting a baby's naps and sleep at night

Genetics play a role in if a baby sleeps through the night, but sleep habits determine how well a baby naps during the day.

Genes play the biggest role in getting toddlers to sleep through the night, but environmental factors are more important for daytime naps, a twin study showed.
Genetic influences explained about half the variability in nighttime sleep duration from ages 6 months through 2 years, Jacques Montplaisir, MD, PhD, of Sacré-Coeur Hospital in Montreal, and colleagues reported in the June issue of Pediatrics.
There was a window of greater influence from surroundings and family habits at 18 months, which accounted for 48% of variability at that time. Environmental factors also accounted for up to almost 80% of variation in how long toddlers napped during the day by age 2.
Age 18 months may be a good opportunity to intervene for kids who don't sleep through the night, suggested Shalini Paruthi, MD, a pediatric sleep specialist at Saint Louis University in St. Louis.
"You really want to make sure your environment is as good as it can be," she told MedPage Today, which might include "keeping a dark and quiet room for them to sleep in and making sure they have their own sleep space so they're not bumping into a sibling on the mattress or on the bed."
"That doesn't mean every child in the same family is going to have the same sleep patterns," Paruthi noted, cautioning against overinterpretation.
The study also shouldn't be generalized to older children, she added.
Environment seems the biggest contributor to how long adults sleep at night, with a prior adult twin study suggesting less than 45% heritability.
Teens and pre-teens seem to follow adults in that pattern. However, young children haven't been followed longitudinally in the same way through the period when sleep is shifting toward a mature circadian rhythm.
Montplaisir's study included 995 sets of twins (405 identical) in the population-based Quebec Newborn Twin Study, which included pairs born without major medical conditions in the greater Montreal area from November 1995 through July 1998.
Mothers reported on their twins' sleep at 6, 18, 30, and 48 months of age, with a 2-week period between assessment for the two children to minimize homogenization of answers.
Genetics explained 47% of variability in how long kids slept without waking up their parents at 6 months of age, 58% at 30 months, and 54% at 48 months.
Sleep appeared to be more fragmented than parents were aware of, though, because video recordings in a subgroup showed that even "good sleepers" woke up three times a night on average.
With regard to daytime naps, environmental influences shared by the twins appeared to explain more of the variance in sleep duration as they got older.
These factors accounted for 33% of nap duration at 18 months of age, 48% at 30 months, and 79% at 2 years.
Nap duration seemed moderately stable through age 2 and declined gradually over time, with only 4% having a faster than normal trajectory in that regard.
Only 4% had stopped taking naps by age 2.
Little variation in either daytime or nighttime sleep appeared linked to environmental factors unique to one twin, not shared with the other.
However, the researchers cautioned that the heritability estimate may have been inflated by using a single "informant" for the twin pairs.
Another limitation was use of ordinal categories for daytime and nighttime sleep duration, so the study needs replication with quantitative measures, such as actigraphy or polysomnography, they noted.
Read more here

Effects of Artificial Light on Sleep

Artificial light from electronics and energy-saving lightbulbs may be negatively effecting your sleep.

"The use of electricity for lighting is in no way harmful to health, nor does it affect the soundness of sleep," wrote Thomas Edison. However, one sleep expert says the father of the modern light bulb got it wrong: artificial lighting is one of the worst things for getting a good night's rest.
Professor Charles Czeisler from the Division of Sleep Medicine at Harvard Medical School in the US warns that exposure to artificial light after sunset is contributing to the growing problem of insufficient sleep in modern society. Furthermore, he says that sleeplessness in children may be mistaken for attention-deficit hyperactivity disorder ( ADHD).
Writing in the journal Nature, he argues that our problems are set to get worse because of the push towards adopting energy-saving light bulbs and the proliferation of smart phones, tablets and laptops.
However, one UK expert cautions that there is no evidence that people in the UK are more sleep deprived than 20 years ago.

Circadian rhythms: Telling night from day

According to Professor Czeisler, our lack of sleep can be attributed to a number of factors, including caffeine, early starts to the school and working day and long commuting times. However, he believes we sometimes fail to appreciate how much the electric light bulb has disrupted our circadian rhythms.
"As a result, many people are still checking e-mail, doing homework or watching TV at midnight, with hardly a clue that it is the middle of the solar night," he writes. "Technology has effectively decoupled us from the natural 24-hour day to which our bodies evolved, driving us to go to bed later."
He argues that there has been a 10-fold rise in the number of working adults in the US averaging less than six hours of sleep each night over the last half-century. He says that sleep deficiency and sleep disorders increase the risk of obesity,diabetesheart diseasedepression and stroke.

Energy-saving light bulbs

According to Professor Czeisler, the situation is likely to get worse once we have abandoned the traditional incandescent light bulb and switched to energy-saving light-emitting diodes (LEDs).
LEDs are used to illuminate our laptop screens, smartphones and other electronic gadgets, and have recently become a popular choice for everyday lighting.
The problem, says Professor Czeisler, is that LED white light is typically rich in short-wavelength blue light, which is known to be more disruptive to the circadian rhythm.

Medium or media?

Professor Jim Horne from the Sleep Research Centre at Loughborough University tells BootsWebMD there is a danger in singling out artificial light and illuminated devices as the cause of sleep problems. "I don't see any hard evidence that we adults in the UK are sleeping any shorter or worse than we did 20 or so years ago before the advent of these visual media," he says.
The only exception to this may be in children, he adds. "Also attributing obesity to inadequate sleep is exaggerated well beyond the facts."
According to Professor Horne, it is not the little glowing LEDs under the screen of our TVs, computers, smart phones and hand-held games consoles that are likely to be the problem, "but the messages and excitement conveyed by these media, which in my opinion has a much more powerful effect in keeping people awake than do these forms of light".

Tips for sleeping well

The Sleep Council has a series of tips for helping you get a good night's rest. These include:
  • Make sure you have a good, supportive mattress
  • Keep your room completely dark, using blackout curtains or an eye mask if necessary
  • Make sure your room isn’t too hot or too cold (16-18°C is ideal)
  • Keep clutter out of your room
  • Avoid having a television or computer in the bedroom
  • Turn off your mobile phone and anything with an LED display (including clocks)
  • Only use your bedroom for sleep and sex, not as an extension to your living room or study.

Read more here

Tuesday, May 28, 2013

Benign Rolandic epilepsy (BRE) - The Basics and Resources

Keep in mind that this is a diagnosis made with "20/20" hindsight - AFTER seeing a specialist, EEG and imaging. I would just add that treatment may or may not be prescribed. JR

Benign Rolandic epilepsy (BRE)


Benign rolandic epilepsy is the most common form of childhood epilepsy. It is referred to as "benign"
because most children outgrow the condition by puberty, usually by 14 years of age. [1][2]

This form of epilepsy is characterized by seizures involving the part of the frontal lobe of the brain called the rolandic area.

The seizures associated with this condition typically occur during the nighttime. [1] Treatment is usually not prescribed, since the condition tends to disappear by puberty.[3]

Adapted from:

1. Blumstein MD, Friedman MJ. Childhood Seizures. Emerg Med Clin N Am. 2007.
2. Fountain NB. Evidence for FunctionalImpairment But Not Structural Disease in Benign Rolandic
Epilepsy. Epilepsy Curr. 2008 January .
3. Benign rolandic epilepsy. Epilepsy Action. Accessed
May 6, 2008.


  • Benign epilepsy of childhood with centrotemporal spikes (BECCT)
  • Benign epilepsy with centro-temporal spikes (BECTS)
  • Benign rolandic epilepsy of childhood (BREC)

General Information

  • The Epilepsy Foundation has an information page on benign rolandic epilepsy. Click on Epilepsy Foundation to view the information page.
  • MedlinePlus, a Web site designed by the National Library of Medicine to help you research your health questions, provides more information about this topic. Click on the link to view this information.
  • Medscape Reference provides information on this topic. Click on the link to view this information. You may need to register to view the medical textbook, but registration is free.
  • The National Institute of Neurological Disorders and Stroke (NINDS) offers information on this topic. You can contact NINDS by calling toll-free 800-352-9424 or by visiting their Web site.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Benign rolandic epilepsy (BRE). Click on the link to view a sample search on this topic.
  • The The Online Mendelian Inheritance in Man (OMIM) database contains genetics resources that discuss Benign rolandic epilepsy (BRE). Click on the link to go to OMIM and review these resources.

Sunday, May 26, 2013

Sleep Deficits In Texas Adults - CDC data

This article from the CDC discusses insufficient sleep issues specifically to adults in Texas. - JR

Read more on Texas adults here.
Read about sleep statistics for others states here.

Adenoid and tonsil removal may help pediatric sleep apnea symptoms

This article discusses how adenoid removal or a tonsillectomy can help pediatric sleep apnea symptoms. Important - the AAP and AAFP recommend PRE-OPERATIVE sleep studies at PEDIATRIC sleep Centers- JR

Adenotonsillectomy, or the removal of the adenoids and tonsils, is performed 500,000 times a year in the United States, often as a treatment for children with obstructive sleep apnea. However, the procedure's ability to improve a child's attention and executive functioning, behavior, sleep apnea symptoms, and quality of life has not been rigorously evaluated until now. 

A study led by Susan Redline, MD, MPH, director of the Program in Sleep and Cardiovascular Medicine and Associate Clinic Director of the Division of Sleep Medicine at Brigham and Women's Hospital finds that early adenotonsillectomy in children with mild to moderately severe sleep apnea does not improve attention and executive functioning when compared to watchful waiting with supportive care. However, the study also found that early adenotonsillectomy can be beneficial in improving behavior, sleep apnea symptoms and quality of life. The research will be presented at the American Thoracic Society's International Conference and published online in the New England Journal of Medicine on May 21.
"This new evidence should be carefully considered by physicians and parents who are deciding on the best approach for a child's sleep apnea problem," said Dr. Redline. 

"Our study provided evidence that surgical treatment can lead to early improvements in many health-related areas of importance to children and their families, including children's behavior. Beneficial effects of surgery were shown even among overweight children, in whom the effectiveness of surgery has been questioned....

.... However, the study also showed that many times sleep apnea resolved without surgery and that cognitive functioning did not improve more with surgery than with medical management. Thus, watchful waiting is also a reasonable option for some children with sleep apnea without many symptoms."
The study, which was conducted in partnership with eight other institutions, examined 397 children between the ages of five and nine who had obstructive sleep apnea syndrome without prolonged levels of low oxygen. The children were randomly placed in two groups. One hundred and ninety-four children had their adenoids and tonsils removed within four weeks of being randomized to the study. The remaining 203 children underwent watchful waiting with supportive care to see if their sleep apnea symptoms resolved without surgery.
Seven months later, both groups of children underwent the Developmental Neuropsychological Assessment, which showed no significant difference between the groups in the improvement of attention and executive functioning. However, other tests, including assessments by parents and teachers, showed significant improvements in the quality of life, sleep apnea symptoms and behavior in the children who had the early adenotonsillectomy.
Read more here

Saturday, May 25, 2013

People with asthma at higher risk for developing sleep apnea

Researchers find a link between asthma and the eventual development of sleep apnea.

Asthma may be a contributing factor to obstructive sleep apnea, according to researchers at the University of Wisconsin.

Using data from the Wisconsin Sleep Cohort Study, which was funded by the National Institutes of Health, researchers studied 773 participants who joined the study in 1988 when they were between the ages of 30 and 60. None of them had obstructive sleep apnea (OSA) when they joined the study. They found that during the eight year follow-up period, those who had asthma were 1.70 times more likely to develop OSA. The risk was even higher in patients who had asthma as children — they were 2.34 times more likely, according to a press release. 

They also found that for every five years a person had asthma, the likelihood of developing OSA increased by 10 percent.

"This is the first longitudinal study to suggest a causal relationship between asthma and sleep apnea diagnosed in laboratory-based sleep studies," Dr. Mihaela Teodorescu, assistant professor of medicine and lead author said. "Cross-sectional studies have shown that OSA is more common among those with asthma, but those studies weren't designed to address the direction of the relationship."

Obstructive sleep apnea occurs when a person's airway becomes blocked during sleep, forcing them to wake up in order to start breathing properly again. Lacking restful sleep, a person with OSA is typically drowsy throughout the day, which results in a higher risk for car crashes, work-related accidents, and a variety of health problems, according to the National Institutes of Health.

During the course of the study, researchers also made adjustments for variables that contribute to sleep apnea such as age, sex, changes in body mass index, smoking, number of alcoholic drinks per week, and nasal congestion.

They also accounted for the 45 participants who developed asthma during the eight years. They found that these people had a 48 percent higher chance of sleep apnea, however, they pointed out that the size of this group was too small to be statistically significant.

"Forty-eight percent represents a large difference," Paul Peppard, assistant professor of population health sciences and a principal investigator for the cohort study, said. "This is one result that calls for a follow-up study. If confirmed by a larger study with more asthma cases, the finding would have important clinical relevance."
Although he considers it to be a "strong observational study," Peppard stressed that the study falls short of establishing causality between asthma and sleep apnea. He suggested that clinicians consider asthma history in addition to "more traditional factors associated with OSA such as obesity, when deciding whether to evaluate patients for OSA with a sleep study."

A week ago, Peppard released a study based on the same data suggesting the obesity epidemic played a part in the rise of sleep apnea cases. He found that cases of sleep apnea had risen from 14 to 55 percent from 1988 to 1994, and estimated that 80 to 90 percent of the increase was due to the growth of obesity in the country.

Read more here 

How to tell if your child should be checked for ADD or ADHD

This article gives much information on ADD/ADHD including medicines and other treatment options.

Does the child have ADD/ADHD?
Attention Deficit Disorder (ADD) is a medical condition with problems in attention, focus, distraction, organization and impulse control. Attention Deficit Hyperactivity Disorder (ADHD) also has more motor hyperactivity than expected for children of similar age/maturity levels.
Valid, reliable screening forms for ADD, such as the Connors Scale or the free Internet-available Vanderbilt Scale, are much more accurate when filled out by multiple teachers observing children in groups, in addition to rating parental and therapist/nurse/doctor observations. These multiple observer’s rating scales do as well as specific “on/off task” computer tests especially now that kids are so familiar with video games.
Although we know that certain brain areas mediated by neurotransmitters dopamine and norepinephrine may be the source of impulse and focus problems, we have not been able to translate research into a clear ADD/ADHD test. No brain image, blood or neurological test is currently available. So parents and teachers use observations and rating forms to screen for possible ADD/ADHD.
What to try before medicines?
How helpful an active parent/school evaluation can be! It is important to find out the child’s academic ability as measured by cognitive and achievement tests. Are there specific areas of underachievement (eg., just the math) or is there general lack of success? It is necessary to diagnose defiant, manipulative, negative-attention-seeking behavior. Does the child do more homework than texting, video games and phone time?
Parental supports and consequences for school grades should be clarified. Is the student anxious, frustrated, sick, unable to see well, depressed, hungry, sleepy, worried about home life or using illegal substances? Once a parent/school evaluation has been done, parents and school can try accommodations to help needy students receive tutoring, prompts, sessions with school counselors and better communication with parents. Is there homework, and has the homework been done and brought to school?
School accommodations such as a 504 Plan and Individual Education Plan have helped many impatient, disorganized, distracted students, but these plans depend on 100 percent student and parent participation with the school.
Medicines for ADD/ADHD
Try school evaluations, academic extra help, therapy, and good pediatric evaluation first. Because there are potential benefits and possible major adverse side effects, all custodial “parents” need to be part of the medicine discussion. Today, this may include married, divorced, or never-married parents or custodial relatives.
Types of medicines
Stimulants are controlled substances. They are written on a special nonrefillable script for medicines with abuse and addiction potential. Each script is follow by the U.S. Department of Justice Drug Enforcement Administration. Urine drug screens and Kasper reports (indicate prescriptions from multiple doctors) follow controlled substance stimulant scripts. Stimulants are increasingly used inappropriately without prescriptions by older students who hope for “cognitive enhancement,” or a quick fix at the last minute as they cram for exams or finish papers.
Types of stimulants
Methylphenidates are Ritalin, Methylin, Focalin, Metadate, Concerta and Daytrana.
Mixed amphetamines are Dexadrine, Adderall and Vyvanse.
Possible adverse side effects
1. Cardiac risk, especially for unrecognized pre-existing heart problems.
2. Increased pulse and blood pressure.
3. Appetite suppression and rebound binge eating.
4. G.I. upset.
5. Decreased growth.
6. Transient tics or twitches
7. Insomnia
8. Rare brief psychotic reactions or obsessive over-focus.
Nonstimulant Strattera: It can be used with seizure disorder. Takes one to two months for maximum benefit.
Possible adverse side effects: Similar to stimulants except no tics.
Nonstimulants Intuniv (Tenex, Guanfacine) and Kapvay (Clonidine)
Possible adverse side effects:
1. Sedation
2. May lower pulse and blood pressure
3. Do not discontinue quickly!
Thanks for your attention, and I hope you were not reading this with one hand on your phone and the other on the steering wheel! Our whole society is distracted, hurried, overstimulated and overstressed.
First, try to set priorities in your own life. Limit the video games. Turn off the TV. Increase your child’s exercise and active learning time. Second, work with your school, child and therapist. See your child psychiatrist when you are already trying the nonmedical approaches and we will work with you to coordinate nonmedical and possible medical intervention.

Read more here

Epileptic seizures can be predicted by device implanted in brain

A small implant in the brain correctly predicts when an epileptic seizure will occur.

A small device implanted in the brain has accurately predicted epilepsy seizures in humans in  a world-first study led by Professor Mark Cook, Chair of Medicine at the University of Melbourne and Director of Neurology at St Vincent’s Hospital.
“Knowing when a seizure might happen could dramatically improve the quality of life and independence of people with epilepsy,” said Professor Cook, whose research was today published in the international medical journal, Lancet Neurology.
Professor Cook and his team, with Professors Terry O’Brien and Sam Berkovic, worked with researchers at Seattle-based company, NeuroVista, who developed a device which could be implanted between the skull and brain surface to monitor long-term electrical signals in the brain (EEG data). 
They worked together to develop a second device implanted under the chest, which transmitted electrodes recorded in the brain to a hand-held device, providing a series of lights warning patients of the high (red), moderate (white), or low (blue), likelihood of having a seizure in the hours ahead.
The two year study included 15 people with epilepsy aged between 20 and 62 years, who experienced between two and 12 seizures per month and had not had their seizures controlled with existing treatments.
For the first month of the trial the system was set purely to record EEG data, which allowed Professor Cook and his team to construct individual algorithms of seizure prediction for each patient.
The system correctly predicted seizures with a high warning, 65 percent of the time, and worked to a level better than 50 percent in 11 of the 15 patients. Eight of the 11 patients had their seizures accurately predicted between 56 and 100 percent of the time.
Epilepsy is the second most common neurological disease after stroke, affecting over 60 million people worldwide. Up to 40 percent of people are unable to control their seizures with existing treatments.
“One to two percent of the population have chronic epilepsy and up to 10 percent of people will have a seizure at some point in their lives, so it’s very common. It’s debilitating because it affects young people predominantly and it affects them often across their entire lifespan,” Professor Cook said.
“The problem is that people with epilepsy are, for the most part, otherwise extremely well. So their activities are limited entirely by this condition, which might affect only a few minutes of every year of their life, and yet have catastrophic consequences like falls, burns and drowning.”
Professor Cook hopes to replicate the findings of the study in larger clinical trials, and is optimistic the technology will lead to improved management strategies for epilepsy in the future.
Read more here

Friday, May 24, 2013

Asthma may cause poor sleep and academic performance

Research shows that uncontrolled asthma symptoms can result in poor sleep quality and poor performance in school for children.

The negative effects of poorly controlled asthma symptoms on sleep quality and academic performance in urban schoolchildren has been confirmed in a new study.

"While it has been recognized that missed sleep and school absences are important indicators of asthma morbidity in children, our study is the first to explore the associations between asthma, sleep quality, and academic performance in real time, prospectively, using both objective and subjective measures," said principal investigator Daphne Koinis-Mitchell, PhD, Associate Professor of Psychiatry & Human Behavior (Research) and Associate Professor of Pediatrics (Research) at Brown University's Alpert Medical School in Providence, Rhode Island. "In our sample of urban schoolchildren (aged 7 to 9), we found that compromised lung function corresponded with both poor sleep efficiency and impaired academic performance."
The results of the study will be presented at the American Thoracic Society's 2013 International Conference.
The study included data on 170 parent-child dyads from urban and African-American, Latino, and non-Latino white backgrounds who reside in Greater Providence, RI. These data are part of a larger 5-year study of asthma and allergic rhinitis symptoms, sleep quality and academic performance (which will include 450 urban children with persistent asthma and healthy controls) funded by The Eunice Kennedy Shriver National Institute of Child Health and Human Development. Project NAPS (Nocturnal Asthma and Performance in School) is administered through Rhode Island Hospital at The Bradley Hasbro Research Center.
Asthma symptoms were assessed over three 30-day monitoring periods across the school year by spirometry, which measures the amount and speed of exhaled air, and with diaries maintained by children and their caregivers. Sleep quality was assessed with actigraphy, which measures motor activity that can be used to estimate sleep parameters. Asthma control was assessed with the Asthma Control Test (ACT), a brief questionnaire used to measure asthma control in children. Academic functioning was assessed by teacher report during the same monitoring periods.
Compared with children with well-controlled asthma, those with poorly controlled asthma had lower quality school work and were more careless with their school work, according to teacher reports. Higher self-reported and objectively measured asthma symptom levels were associated with lower quality school work. Poorer sleep quality was also associated with careless school work. Increased sleep onset latency (the amount of time children take to fall asleep) was associated with more difficulty in remaining awake in class.
"Our findings demonstrate the detrimental effects that poorly controlled asthma may have on two crucial behaviors that can enhance overall health and development for elementary school children; sleep and school performance," said Dr. Koinis-Mitchell. "Urban and ethnic minority children are at an increased risk for high levels of asthma morbidity and frequent health care utilization due to asthma. Given the high level of asthma burden in these groups, and the effects that urban poverty can have on the home environments and the neighborhoods of urban families, it is important to identify modifiable targets for intervention."
"Family-level interventions aimed at asthma control and improving sleep quality may help to improve academic performance in this vulnerable population," Dr. Konis-Mitchell continued. "In addition, school-level interventions can involve identifying children with asthma who miss school often, appear sleepy and inattentive during class, or who have difficulty with school work. Working collaboratively with the school system as well as the child and family may ultimately enhance the child's asthma control."
Read more here

Taking catch-up naps may reduce risk of crashing for young tired drivers

An Australian study shows that young drowsy drivers who take catch-up naps reduce their risk of crashing.

Young drivers who get behind the wheel while drowsy run a higher risk of getting into car crashes, but Australian researchers have found that not catching up on missed sleep on weekends puts them in even greater danger of having an accident at night.
"This is another challenge to adolescents that comes with lack of sleep," said Dr. Flaura Winston, co-scientific director and founder of the Center for Injury Research and Prevention at Children's Hospital of Philadelphia.
"You have to be ready, body and mind, to drive," she said. "If you are exhausted, you are neither ready body nor mind."
In tackling this challenge, both parents and the community have roles to play, said Winston, who was not involved with the study.
"This is a safety concern," she said. "If the teen doesn't get enough sleep, then they are at increased risk for crashes, so parents need to step in."
Parents should see their role as one that helps their teenager stay safe without being controlling, Winston explained. They can encourage their children to get more sleep, and provide rides at night to ensure that their teens are not driving exhausted.
One of the more positive things parents can do is let their teen sleep late on the weekends, Winston noted. "Teens need their catch-up sleep," she said. "They do need to sleep late on the weekends."
There are also social factors that limit teens' sleep. For example, many high schools start classes very early, cutting into students' sleep time, Winston pointed out. "Studies have shown that later school start times are better for adolescents," she said.
Not only do they start school early, but "they have long days. They have sports, after-school activities and studying, so there are things that are way beyond the family that put these teens at risk when it comes to driving," Winston said.
The report was published online May 20 in the journal JAMA Pediatrics.
To look at what role sleep plays in teen car crashes, a team led by Alexandra Martiniuk, an associate professor at the George Institute for Global Health in Sydney, collected data on more than 20,000 drivers aged 17 to 24.
The investigators found that those who said they slept six or fewer hours a night had a 21 percent higher risk of having a car accident than those who got more than six hours of sleep.
Moreover, those who got less sleep on the weekends had a 55 percent increased chance of having a single-car accident, where the car drifts or swerves off the road, they added.
Most accidents (86 percent) happened between 8 p.m. and 6 a.m., the researchers noted.
"Sleeping six hours a night is enough to put young drivers at significant risk of having a car crash. With work, study and social commitments, especially on weekends, it is easy to miss out on the extra hours of sleep we need," Martiniuk said in a statement.
More than 3,000 people die every day in car crashes around the world -- that's more than 1.3 million car-related deaths a year, with between 20 million and 50 million people injured or disabled, the researchers noted.
In the United States alone, it is estimated that 20 percent of all car crashes are the result of drowsy driving, which adds up to 1 million crashes, 50,000 injuries and 8,000 deaths a year, the study found.
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Wednesday, May 22, 2013

NIH's Information on Concussions

The following was released by the National Institutes of Health on concussions. They discussed how serious concussions are, especially repeat concussions, and gave symptoms to take notice of.

Your brain is your body’s command center. Its soft, sensitive tissues float in a cushioning fluid within the hard and sturdy skull. But a swift blow to the head or violent shaking can override these protections and lead to a mild type of brain injury known as a concussion. 
More than 1 million mild traumatic brain injuries occur nationwide each year. These injuries can be caused by falls, car crashes or recreational activities like bike riding, skateboarding, skiing or even playing at the playground. More than half of concussions occur in children—often when playing organized sports such as football and soccer. 
“Although concussions are considered to be a mild brain injury, they need to be taken seriously. They should not be treated as minor injuries that quickly resolve,” says Dr. Beth Ansel, an expert on rehabilitation research at NIH. With proper care, most people recover fully from a concussion. “But in some cases, a concussion can have a lasting effect on thinking, attention, learning and memory,” Ansel adds. 
A single concussion is also known to raise your risk for having another concussion—and a second concussion may be more severe. It’s important to learn to recognize the causes and symptoms of concussion so you can take steps to prevent or treat these head injuries.
“The skull is designed to prevent most traumas to the brain, but it doesn’t really prevent the brain from moving around inside the skull,” says Dr. Frederick Rivara, a specialist in pediatric injuries and prevention at the University of Washington in Seattle. “A concussion can arise from the brain moving either rapidly back and forth or banging against the side of the skull.” This sudden movement can stretch and damage brain tissue and trigger a chain of harmful changes within the brain that interfere with normal brain activities. 
More serious brain injuries that involve skull fracture, bleeding in the brain or swelling of the brain can be detected with X-rays or other imaging methods. But concussions can be more difficult to identify. 
“A concussion isn’t visible from the outside, and you can’t see it with standard imaging tools like MRI and CAT scans,” says Dr. Christopher Giza, a pediatric brain specialist at the University of California, Los Angeles. “Instead we look for the signs and symptoms of abnormal brain function to make a diagnosis.”
Common symptoms include nausea, headache, confusion, dizziness and memory problems. Loss of consciousness occurs in about 1 in 10 concussions. A person with a concussion might have trouble answering basic questions and move in an awkward, clumsy way. 
“Symptoms can arise quickly, or they can be delayed and appear over the next day or two,” Rivara adds.
For about 9 in 10 people with concussions, symptoms disappear within 7 to 10 days. Scientists have been working to learn more about those who take longer to recover. In one NIH-funded study, Dr. Keith Yeates of Ohio State University looked at 8- to 15-year-olds treated in an emergency room for mild traumatic brain injury.
“We found that the majority of these kids recovered quite quickly or showed no increase in symptoms at all,” Yeates says. “But a subgroup of kids, about 10% or 20%, showed a dramatic onset of symptoms after their injury and persistent symptoms that in some cases remained even 12 months after the injury.” 
Body-related symptoms, such as headache and dizziness, tended to fade fairly quickly, the researchers found. But thinking-related symptoms, including problems with memory and paying attention, tended to linger in some kids throughout the year-long study. Children who had lost consciousness or had some additional abnormality that showed up on MRI scans after the injury had an increased risk for lasting problems. 
“These kids were also more likely to have what looked like significant reductions in overall quality of life. And there was some evidence they were more likely to have academic problems than the kids without persistent symptoms,” Yeates says.
Yeates and others continue to explore ways to predict a person’s response to concussion. Much remains unknown about the underlying biology and outcomes of mild head injuries. Some NIH-funded researchers are looking at how injury and recovery processes differ in immature and adult brains. Other scientists are examining the problems that can arise from repeated injuries to the brain. 
Researchers know that immediately after a concussion, the brain is especially vulnerable to having a second, more serious injury. But it’s not clear why—or how long that vulnerable period lasts. Giza and his colleagues have found that a single mild injury reduces the brain’s use of the sugar glucose as a fuel, at least in rats. A second mild injury 24 hours later leads to an even steeper drop in glucose use and memory problems that last longer. But when the brain has several days to recover, and the use of glucose returns to normal, a second mild brain injury seems to be no worse than the first.
“The finding suggests that when you superimpose 2 injuries on top of each other, the consequences can be greater,” Giza says. The brain’s use of glucose might be a way to assess risk and recovery time. “But we don’t yet have a clear understanding of what happens in the human brain after first and second injuries,” Giza adds.  
Studies have found that the risk for a second injury is greatest in the 10 days following an initial concussion. If you suspect that someone has a concussion, make sure they stop whatever activity they’re doing, especially if they’re involved in a sport. Their brain dysfunction might not only cloud their thinking. It can also slow reaction times and affect their balance so they become more likely to have another injury. 
“If someone has symptoms of concussion, they shouldn’t try to finish the quarter or finish the game. They need to be taken out of play right away and be seen by a health care provider,” Rivara says. “The current recommendations are to avoid physical activity for a period of time until all the symptoms have resolved, and then have a gradual return to play.” 
Take steps to avoid concussions. “Wear helmets when appropriate, such as if you’re bicycling, skate-boarding or riding a horse,” says Rivara. Athletes can decrease their risk of concussion by wearing proper headgear and following the rules of good sportsmanship. Make living areas safer for seniors by removing tripping hazards such as throw rugs and clutter in walkways, and install handrails on both sides of stairways. 
“The bottom line is that we still need to determine the best ways to prevent, accurately diagnose, treat and assess outcomes after mild traumatic brain injury,” says Ansel.
While this research continues, do what you can to prevent concussions. Learn to recognize the symptoms. And make sure that people with signs of concussion stop their activities and seek medical attention.
Stop activity if you have these symptoms. Athletes should not return to play until evaluated by a health care provider. 
  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light or noise
  • Feeling sluggish or groggy
  • Concentration or memory problems
  • Confusion
  • Feeling “down” or “not right”
  • Changes to sleep patterns
Adapted from the U.S. Centers for Disease Control and Prevention

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