Monday, April 28, 2014

Lost sleep increases risk of stroke

A study shows that losing sleep can significantly increase a person's risk of having a stroke.

People with insomnia may be more likely to have a stroke than people who don’t have trouble sleeping, according to a new study.

Study participants who had insomnia had a 54 per cent higher risk of stroke over four years than the people who were not diagnosed with the sleep disorder. 

They also found that, among people with insomnia, stroke was eight times more common in people ages 18 to 34 than in those older than 34.

“Our results add support to the prior findings on the link between insomnia and a wide range of health risks,” said study author Ya-Wen Hsu, an assistant professor at Chia Nan University of Pharmacy and Science in Taiwan.

“Though insomnia is the most common sleep complaint, it should be perceived more as a symptom of another disease,” Hsu told Live Science. People with insomnia should be treated early to prevent other conditions, he said.

Although the number of deaths from stroke in the United States declined by 22.8 per cent between 2000 and 2010, about 795,000 people have a stroke each year, according to the American Heart Association. In 2010, stroke was responsible for one out of every 19 deaths in the US.

In the study, the researchers followed a group of 21,438 people with insomnia and 64,314 healthy people for four years. During the study, 583 (2.7 per cent) of those with insomnia were admitted to a hospital for stroke, whereas 962 (1.5 per cent) of those without insomnia were admitted for stroke.

The link was strongest in people who’d had trouble sleeping for up to six months, according to the study.

The researchers said they don’t know how or why insomnia may be linked with an increased risk of stroke. 

However, they speculated that the sleeping disorder may contribute to inflammation, increase blood pressure and deregulate metabolism and, therefore, affect people’s cardiovascular health, Hsu said.

“We feel strongly that individuals with chronic insomnia, particularly younger persons, see their physician to have stroke risk factors assessed and, when indicated, treated appropriately,” Hsu said in a statement.

Read more here

Sunday, April 27, 2014

Osteoporosis linked to sleep apnea

A study shows that poor bone health and osteoporosis are linked with sleep apnea.

People with sleep apnea, a common sleep disorder, may be at increased risk for the bone-thinning disease osteoporosis, especially women and older people, a new study suggests.
Sleep apnea causes repeated, brief interruptions in breathing during sleep. Untreated sleep apnea can increase a person’s risk of heart disease, heart attack and stroke.
“Ongoing sleep disruptions caused by obstructive sleep apnea can harm many of the body’s systems, including the skeletal system,” said study co-author Dr. Kai-Jen Tien, of Chi Mei Medical Center in Tainan, Taiwan.
“When sleep apnea periodically deprives the body of oxygen, it can weaken bones and raise the risk of osteoporosis,” Tien said. “The progressive condition can lead to bone fractures, increased medical costs, reduced quality of life and even death.”
For the study, published April 15 in the Journal of Clinical Endocrinology & Metabolism, researchers analyzed the medical records of nearly 1,400 people in Taiwan diagnosed with obstructive sleep apnea between 2000 and 2008. They compared them with more than 20,600 people who did not have the sleep disorder.
Over six years of follow-up, people with sleep apnea were 2.7 times more likely to be diagnosed with osteoporosis. The risk for the bone-thinning disease was highest among women and older people with sleep apnea, according to the study.
“As more and more people are diagnosed with obstructive sleep apnea worldwide, both patients and health care providers need to be aware of the heightened risk of developing other conditions,” Tien said in a journal news release. “We need to pay more attention to the relationship between sleep apnea and bone health so we can identify strategies to prevent osteoporosis.”
However, the study only noted an association between sleep apnea and osteoporosis. It does not prove that one causes the other.
Read more here

Autism Screening for 9-Month Olds

A screening method for autism works for nine-months olds.

Researchers, including a team from Children's National Health System, have identified head circumference and head tilting reflex as two reliable biomarkers in the identification of autism spectrum disorders (ASD) in children that are between 9 and 12 months of age.
According to the U.S. Centers for Disease Control and Prevention, ASD is identifiable as early as two years old, although most children are not identified until after the age of four. While a number of studies have reported that parents of children with ASD notice developmental problems in children before their first birthday, there has yet to be a screening tool to identify those children.
"While the 'gold standard' screening tool is the M-CHAT questionnaire, it must be read and completed by parents and then interpreted by a health care provider," said lead author Carole A. Samango-Sprouse, EdD, and Associate Clinical Professor of Pediatrics at the George Washington University School of Medicine and Health Sciences. "What physicians are missing is a quick and effective screening measure that can easily be given to all infants regardless of background and identify ASD before 12 months. This screening is also helpful in identifying those babies who may not initially appear to be at risk and would otherwise be missed until much later in life."
This study looked at the use of head circumference and head tilting reflex as two biomarkers that can be used during their well-baby visits by their primary care providers. Both screenings were given to nearly 1,000 patients at the four, six, and nine-month well-baby visits.
At the end of nine months, those infants with a head circumference above or equal to the 75th percentile, a head circumference that was in 10 percent discrepancy with the height of the baby, or those who failed the head tilting reflex test were considered at risk for ASD or a developmental language delay. These infants were then evaluated by a neurodevelomental specialist and pediatric neurologist to differentiate between these disorders.
Of the 49 infants that displayed abnormal results, without previous diagnosis, 15 were identified at risk for ASD and 34 at risk for developmental language delay. Of the 15 children who were identified at risk for ASD between 9 and 12 months of age, 14 (93 percent) sustained the diagnosis when it was made clinically at the age of three.
"We will continue looking at the efficacy of the head circumference and head tilting reflex as a screening tool for these disorders," said Andrea Gropman, MD, a contributor to the study and Division Chief of Neurogenetics at Children's National. "As with all developmental delays, especially ASD, the sooner we can identify those children who are at risk, the sooner we can intervene and provide appropriate treatment. In other words, the sooner we identify these delays, the better the outcome for those affected."
Read more here

What does your sleeping position say about your relationship?

A study looked into what a person's sleeping position says about their relationship.

Research carried out at the Edinburgh International Science Festival has discovered what people’s preferred sleeping position reveals about their relationships and personality.
The work, carried out by University of Hertfordshire psychologist Professor Richard Wiseman, involved asking over 1000 people to describe their preferred sleeping position and to rate their personality and quality of their relationship.
The research revealed the most popular sleep positions for couples, with 42% sleeping back to back, 31% sleeping facing the same direction and just 4% spending the night facing one another.  In addition, 12% of couples spend the night less than an inch apart whilst 2% sleep over 30 inches apart.
Professor Wiseman commented: “One of the most important differences involved touching, with 94% of couples who spent the night in contact with one another were happy with their relationship, compared to just 68% of those that didn't touch.”
In addition, the further apart the couple spent the night, the worse their relationship, with 86% of those who slept less than an inch apart from their partner being happy with their relationship, compared to only 66% of those who slept more than 30 inches apart. 
The work also revealed that extroverts tended to spend the night close to their partners, and more creative types tended to sleep on their left hand side.
Professor Wiseman noted: "This is the first survey to examine couples' sleeping positions, and the results allow people to gain an insight into someone's personality and relationship by simply asking them about their favourite sleeping position."
Professor Richard Wiseman is the author of Night School, which examines the science of sleep and dreaming. 

He returns to the Edinburgh International Science Festival on Thursday 17 April, 2014 to talk about the power of the sleeping mind.
Read more here

Social skills could suffer after head injuries in children

A study shows that after children have a head injury, their social skills could suffer.

Serious head injuries may be linked to children's lack of ability to interact with others, a new study indicates.
Researchers looked at a group of children who had suffered a traumatic brain injury three years earlier, most often in car crashes.
Those with lingering damage in the brain's frontal lobes had lower-quality social lives, according to the Brigham Young University (BYU) study in the April 10 issue of the Journal of Head Trauma Rehabilitation. The study did not determine a cause-and-effect relationship, only an association.
"The thing that's hardest about brain injury is that someone can have significant difficulties but they still look OK," neuropsychologist and study author Shawn Gale said in a university news release.
"But they have a harder time remembering things and focusing on things as well, and that affects the way they interact with other people. Since they look fine, people don't cut them as much slack as they ought to," Gale explained.
The researchers found that the problem may be something called cognitive proficiency, a combination of short-term memory and brain-processing speed.
"In social interactions we need to process the content of what a person is saying in addition to simultaneously processing nonverbal cues," study co-author Ashley Levan, a doctoral student at BYU, said in the news release. "We then have to hold that information in our working memory to be able to respond appropriately. If you disrupt working memory or processing speed, it can result in difficulty with social interactions."
Attention-deficit/hyperactivity disorder also affects the frontal lobes, and previous research has shown that therapy can improve working memory in children with ADHD.
"This is a preliminary study, but we want to go into more of the details about why working memory and processing speed are associated with social functioning and how specific brain structures might be related to improve outcome," Gale said.
Read more here

Saturday, April 26, 2014

CPAPs can help people with asthma

A study looks into how CPAP machines can help people with asthma

More than 25 million Americans suffer from asthma. They use steroids, inhalers, and pills to help control symptoms. But soon there may be a new way: it’s not a drug but a device used for sleep disorders.

Professor Kurt Stoecker spends many late nights grading papers, but some nights his asthma gets the best of him.

"You can't sleep, that kind of thing. It's a tightness in your chest, and then you cough," Stoecker said.

He was diagnosed with asthma at age 16. He's used steroids and inhalers, but now he's trying something new.

As part of a clinical trial, doctors are testing whether treatment with a CPAP machine can improve symptoms in asthma patients by making their airways less reactive.

"At nighttime, their muscles that are around their windpipes are not being allowed to relax. In essence, they're working almost 24 hours a day," Mario Castro, MD, MPH, Professor of Medicine and Pediatrics, Washington University School of Medicine said.

The CPAP pushes gentle air down the windpipe, forcing the muscles to relax. It's typically used for patients with sleep apnea, but doctors say it could be the first drug-free option for asthma.

In the 12-week study, patients used the device for at least four hours a day with no serious side effects.

"The most exciting thing is that it's not a drug. This is a device," Dr. Castro said.

Read more here

Antipsychotic drugs being used to treat foster children with ADHD

A study shows that more and more foster children with ADHD are being treated with antipsychotic drugs.

Antipsychotic drugs are increasingly being prescribed to treat attention-deficit/hyperactivity disorder (ADHD) in children and teens in foster care, according to a new study.
The use of these drugs to treat ADHD has not been approved by the U.S. Food and Drug Administration, and is known as an "atypical" use, the researchers explained.
But their study found that antipsychotics were used to treat nearly one-third of foster care youth aged 2 to 17 who had been diagnosed with ADHD. The most common types of antipsychotics used were risperidone, aripiprazole and quetiapine.
The study looked at administrative data on more than 260,000 youths aged 2 to 17, enrolled in one state's Medicaid program in 2006, to determine the average number of days of atypical antipsychotic use in kids. Researchers also looked specifically at a subgroup of kids with ADHD who were not diagnosed with any other mental health conditions.
The findings by researcher Julie Magno Zito, at the University of Maryland at Baltimore, and colleagues were published online recently in theJournal of Child and Adolescent Psychopharmacology.
"This study adds critical hard data to our understanding of a persistent and unacceptable trend in pediatric psychiatry," Dr. Harold Koplewicz, journal editor-in-chief and president of the Child Mind Institute in New York City, said in a journal news release.
"Our poorest, most vulnerable children, lacking access to evidence-based care, are receiving potentially harmful treatment with little oversight. The highlight of [the] paper for any reader should be the simple but necessary recommendations for antipsychotic prescribing and monitoring in these populations," he added.
Read more here

Friday, April 25, 2014

Families with autistic children see benefits from dog ownership

A study found that dog ownership is extremely beneficial for children with autism.

Many families face the decision of whether to get a dog. For families of children with autism, the decision can be even more challenging. Now, a University of Missouri researcher has studied dog ownership decisions in families of children with autism and found, regardless of whether they owned dogs, the parents reported the benefits of dog ownership included companionship, stress relief and opportunities for their children to learn responsibility.
"Children with autism spectrum disorders often struggle with interacting with others, which can make it difficult for them to form friendships," said Gretchen Carlisle, aresearch fellow at the Research Center for Human-Animal Interaction (ReCHAI) in the MU College of Veterinary Medicine. "Children with autism may especially benefit from interacting with dogs, which can provide unconditional, nonjudgmental love and companionship to the children."
Carlisle interviewed 70 parents of children with autism. Nearly two-thirds of the parents in the study owned dogs, and of those parents, 94 percent reported their children with autism were bonded to their dogs. Even in families without dogs, 70 percent of parents said their children with autism liked dogs. Many dog-owning parents said they specifically chose to get dogs because of the perceived benefits to their children with autism, Carlisle said.
"Dogs can help children with autism by acting as a social lubricant," Carlisle said. "For example, children with autism may find it difficult to interact with other neighborhood children. If the children with autism invite their peers to play with their dogs, then the dogs can serve as bridges that help the children with autism communicate with their peers."
Parents of children with autism should consider their children's sensitivities carefully when choosing a dog in order to ensure a good match between pet and child, Carlisle said.
"Bringing a dog into any family is a big step, but for families of children with autism, getting a dog should be a decision that's taken very seriously," Carlisle said. "If a child with autism is sensitive to loud noises, choosing a dog that is likely to bark will not provide the best match for the child and the family. If the child has touch sensitivities, perhaps a dog with a softer coat, such as a poodle, would be better than a dog with a wiry or rough coat, such as a terrier."
Carlisle recommends parents involve their children with autism when choosing a dog.
"Many children with autism know the qualities they want in a dog," Carlisle said. "If parents could involve their kids in choosing dogs for their families, it may be more likely the children will have positive experiences with the animals when they are brought home."
Although her study only addressed dog ownership among families affected by autism, Carlisle said dogs might not be the best pet for every child with autism.
"If you know one child with autism, you know one child with autism," Carlisle said. "Dogs may be best for some families, although other pets such as cats, horses or rabbits might be better suited to other children with autism and their particular sensitivities and interests."
"This research adds scientific credibility to the benefits of human-animal interaction," said Rebecca Johnson, a professor at the MU College of Veterinary Medicine, director of ReCHAI, and the Millsap Professor of Gerontological Nursing in the MU Sinclair School of Nursing. "This research helps us understand the role of companion animals in improving the lives of children with autism and helps health professionals learn how to best guide families in choosing pets for their families."
The study, "Pet Dog Ownership Decisions for Parents of Children With Autism Spectrum Disorder," was published in the Journal of Pediatric Nursing earlier this year.
Read more here

Girls suffer worse concussions than boys do

A study looked into how gender affects concussion and showed that girls suffer worse concussions than boys do.

Girls who suffer a concussion may have more severe symptoms that last longer compared to boys, according to new research that builds on other studies finding gender differences.
"There have been several studies suggesting there are differences between boys and girls as far as [concussion] symptom reporting and the duration of symptoms," said Dr. Shayne Fehr, a pediatric sports medicine specialist at Children's Hospital of Wisconsin.
In his new study, Fehr also found those differences. He tracked 549 patients, including 235 girls, who sought treatment at a pediatric concussion clinic.
Compared to the boys, the girls reported more severe symptoms and took nearly 22 more days to recover, said Fehr, also an assistant professor of pediatric orthopedics at the Medical College of Wisconsin.
He was due to present the findings this week at the annual meeting of the American Medical Society for Sports Medicine, held in New Orleans. Studies presented at medical meetings are typically viewed as preliminary until published in a peer-reviewed journal.
A concussion is any brain injury that disturbs normal functioning. Concussions are typically caused by a jolt or blow to the head, often in collision sports such as hockey or football, according to the American Academy of Pediatrics (AAP).
In recent years, experts have advised coaches, players and parents that athletes should not return to play until they are seen by a doctor if a concussion is suspected.
In the new study, Fehr tracked patients aged 10 to 18, all treated between early 2010 and mid-2012. Each patient reported on their symptoms, how severe they were and how long it took from the time of the injury until they were symptom-free.
In addition to reporting more severe symptoms, girls took an average of 56 days to be symptom-free. In comparison, the boys took 34 days. Overall, the time to recovery was 44 days when boys and girls were pooled.
That duration of symptoms, Fehr said, is much longer than what people commonly think. "Commonly you hear that seven to 10 days [for recovery] is average," he said.
Fehr did not find age to be linked with severity of symptoms. Most of the injuries -- 76 percent -- were sports-related, with football accounting for 22 percent of the concussions.
The top five reported symptoms were headache, trouble concentrating, sensitivity to light, sensitivity to sound and dizziness. Boys and girls, in general, reported the same types of symptoms, Fehr said, but the girls reported more severity and for a longer time period.
"This confirms what has been reported before," said Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children's Hospital, who reviewed the findings.
While he said the 44-day recovery seems lengthy, he added that it probably reflects the boys and girls studied. They all went to a concussion clinic, so their injuries may have been more severe.
What's not known, Fehr said, is why the differences exist and whether they are related to more reporting of symptoms right after the injury by girls or if girls are truly more significantly affected.
"I wouldn't treat girls any differently than boys,'' he said.
For both genders, it's important to be seen by a doctor and not return to play prematurely, which can be dangerous or even fatal, according to the AAP. Anyone with a history of concussion is at higher risk for another injury.
Read more here

Children with epilepsy at higher risk of injury

A study looks at epileptic children and found that they are at a significantly higher risk of injury than children without epilepsy.

Children and young adults with epilepsy are more likely to suffer broken bones, burns and poisonings compared to those without the neurological disorder, new research has found.
The study, led by academics at The University of Nottingham and funded by the National Institute for Health Research, shows that young people with the condition are at significantly greater risk of being poisoned by medication, leading the authors to call for further research into whether these poisonings are intentional.
The results, taken in tandem with previous research findings, highlight the need for further research into whether young people with the condition are at greater risk from an overdose, accidental or intentional, of their epilepsy drugs or other medication. And the researchers say that doctors and other healthcare professionals should use the results of the study to help warn epilepsy patients of the increased risk associated with their illness.
The study, published in the latest edition of the journal Pediatrics, found that young people with epilepsy were more than twice as likely to be poisoned by medication. This jumped to four times the risk in patients aged between 19 and 24 years old.
The patients, all aged between 12 months and 24 years old at the time of their diagnosis, were also almost one and a half times more likely to suffer a burn-related injury and almost 25 per cnet more at risk of breaking an arm or leg.
Dr Vibhore Prasad, of the University’s Division of Primary Care, said: “More research is needed to understand why people with epilepsy have a greater number of medicine-related poisonings and whether the poisonings are intentional or accidental. This is the first study in the UK population to estimate the risk of fractures, burns and poisonings. The risk of a poisoning in the next five years for 1,000 people with epilepsy is about 20 extra poisonings compared to people who do not have epilepsy.”
Epilepsy is a chronic condition caused by a sudden burst of electrical activity in the brain, causing a temporary interruption in the way the brain normally works and resulting in a seizure. In the UK alone there are more than 600,000 people with epilepsy.
Previous studies into the condition have suggested that these seizures — and the side effects caused by some anti-epilepsy drugs — put patients at a greater risk of accidental injuries.
However, most research may have overestimated this risk because they focused primarily on people with more severe epilepsy, such as institutionalised adults or those being treated in epilepsy clinics.
This latest study is the first to investigate the potential risk of injury exclusively in children and young people with and without epilepsy.
The research, which was carried out in association with academics at the London School of Hygiene and Tropical Medicine, used GP records from almost 12,000 patients with epilepsy to study the incidence of injury over an average of two and a half years and compared it with the records of around 47,000 non-epileptic people.
The authors say that doctors and other healthcare professionals can use the findings of the research to make children and young adults diagnosed with epilepsy, and their parents, more aware of the risk of injury and to inform existing guidelines on treatment. In particular, they cite the need for more information relating to the safe storage of medicines and the supervision of children while taking their medication to be given by doctors at the time of prescribing and by pharmacists when dispensing prescriptions.
Read more here

Tuesday, April 22, 2014

Management of sleep apnea in the neurology patient

What all neurologists should know about sleep apnea

Who has SDB in your neurology clinic?

Stroke and SDB.
While OSA affects 2%–4% of the general population, it is observed in 73.7% of ischemic stroke patients.e3 Sleep apnea may cause considerable nocturnal perturbations and has been identified as an independent risk factor for both cardiovascular and cerebrovascular disorders.5,e4 Aside from the direct effect on stroke risk, SDB can also predispose patients to develop other comorbid conditions commonly associated with increased risk of stroke, such as hypertension, diabetes, obesity, and cardiovascular diseases. Several studies have investigated the potential mechanisms underlying this relationship. Heart rate variability may be altered during sleep as well as wakefulness in patients with sleep apnea.e4 Atrial fibrillation and other autonomic and electrophysiologic cardiac dysfunction may also occur during sleep in patients with OSA, increasing the risk for stroke.5,e5 Further, sleep apnea patients who do not experience typical blood pressure “dipping” during sleep are at an increased risk for stroke.5,13,,15,e6 Extreme dipper, nondipper, or reverse dipper patterns in patients with or without apnea have all been associated with intracranial hemorrhages, ischemic strokes, silent brain infarcts, and stroke deaths.5 Patients with OSA are also more likely to suffer their stroke event while sleeping, suggesting that factors specifically related to the dynamics of the SDB event itself may also play a role. For instance, during an obstructive apnea event there is a reduction in cerebral blood flow and impaired cerebral autoregulation.5,e7
While OSA is more commonly associated with stroke, it is important to remember that CSA has also been linked to stroke. CSA may be a consequence rather than a cause of stroke and can be a major symptom of vascular disease.e8 Development of CSA is heightened immediately following an acute stroke. It improves during the subacute phase and typically resolves within months after stroke.e8 CSA is also associated with congestive heart disease, a risk factor of cardioembolic strokes.e9
Headaches and SDB.
Rates of headaches are higher among patients with OSA than in the general population. Chronic daily headaches or frequent headaches upon awakening are more common in patients with OSA than the general population.e10 The relative risk of headache, especially daily headache, increases 2–3 times for those with SDB.e11 Patients with OSA are 8 times more likely to develop cluster headaches.e11 Patients with OSA who are overweight are 24 times more likely to develop cluster headaches.e11 Identification and treatment of OSA has been shown to improve cluster headaches.e12 Evidence also suggests that headaches may be a symptom of upper airway resistance,e13 and inadequate SDB treatment may result in morning headaches.e14 The frequency of SDB in migraine is reportedly comparable to the general population.e15 However, a small study suggests that treatment of OSA in those with migraine may improve migraine itself.e16
Epilepsy and SDB.
A bidirectional relationship has been demonstrated between seizure frequency/severity and presence of SDB.e17,e18Between 20% and 80% of patients with epilepsy have SDB (variation secondary to the degree of severity of epilepsy and criteria for SDB), with some evidence suggesting increased risk of seizures during sleep in those with apnea.e19Intermittent hypoxia and altered sympathetic activity experienced by patients with OSA is believed to activate epileptogenic regions of the brain, potentially lowering the seizure threshold.e18 Interestingly, treatment of OSA has been shown to reduce the frequency of seizures.e20,e21 Lastly, rates of central apnea in patients with epilepsy are comparable to the general population.e22
Neurodegenerative disorders and SBD.
The association between SDB and neurodegenerative disease has recently garnered increasing attention in the neuroscience research arena. The SDB prevalence varies depending on the specific neurodegenerative disorder. There is a particularly strong association between Alzheimer disease (AD) and OSA.e23,e24 Possible mechanisms underlying the SDB and neurodegenerative disorder relationship include cell loss in brainstem regions responsible for central respiratory regulation and diaphragmatic muscle control.e25
The evidence surrounding Parkinson disease (PD) as a direct risk factor for SDB is unclear. For one, patients with PD have other confounding risk factors, such as age, which increases risk of OSA. On the other hand, patients with PD may be at lower risk of sleep apnea since they have lower weights than controls.e26 Mechanisms potentially predisposing patients with PD to OSA may be related to the manifestation of hypokinesia and rigidity that may be associated with airway obstruction, restrictive lung disease, and autonomic dysfunction that subsequently results in SDB pathology.e27
Recognizing and treating SDB in patients with neurodegenerative diseases could improve quality of life.20 When considering all the relevant potential factors involved in this association, neurologists must also be aware of the potential effects on SBD of medications used in this patient population. For example, anxiolytics and pain medications may worsen SDB. Conversely, donepezil has been shown to improve OSA in patients with AD.e27
Neuromuscular disease and SDB.
Sleep-related ventilatory difficulties such as diaphragmatic weakness or restrictive lung disease also occur in patients with neuromuscular disease.e28 For example, 40%–60% of clinically stable patients with myasthenia gravis are diagnosed with SDB. Given the extraordinary prevalence of clinically significant but routinely underdiagnosed SDB, this figure may be an underestimate of the true prevalence of SDB in patients with neuromuscular disease. Oropharyngeal muscle weakness, tonsillar hypertrophy, obesity, and craniofacial dysmorphias may represent some of the underlying factors increasing risk for SDB.e28,e29
Similar to patients under management for neurodegenerative disease, patients with neuromuscular disease are often placed on medications that can indirectly affect their SDB. Thus, it is important to evaluate these patients for underlying SDB because not only can the SDB affect them clinically, but the medications used for their neurologic disorder may also further negatively affect manifestation and management of SDB.

Association Between SSRI Use During Pregnancy and Autism and Developmental Delays in Boys

Interesting. High powered study. Association is not necessarily causation - JR

Johns Hopkins Bloomberg School of Public Health Researchers Find Association Between SSRI Use During Pregnancy and Autism and Developmental Delays in Boys


In a study of nearly 1,000 mother-child pairs, researchers from the Bloomberg School of Public health found that prenatal exposure to selective serotonin reuptake inhibitors (SSRIs), a frequently prescribed treatment for depression, anxiety and other disorders, was associated with autism spectrum disorder (ASD) and developmental delays (DD) in boys. The study, published in the online edition of Pediatrics, analyzed data from large samples of ASD and DD cases, and population-based controls, where a uniform protocol was implemented to confirm ASD and DD diagnoses by trained clinicians using validated standardized instruments.
The study included 966 mother-child pairs from the Childhood Autism Risks from Genetics and the Environment (CHARGE) Study, a population-based case-control study based at the University of California at Davis’ MIND Institute. The researchers broke the data into three groups: Those diagnosed with autism spectrum disorder (ASD), those with developmental delays (DD) and those with typical development (TD). The children ranged in ages two to five. A majority of the children were boys – 82.5% in the ASD group were boys, 65.6% in the DD group were boys and 85.6% in the TD were boys. " While the study included girls, the substantially stronger effect in boys alone suggests possible gender difference in the effect of prenatal SSRI exposure.
“We found prenatal SSRI exposure was nearly 3 times as likely in boys with ASD relative to typical development, with the greatest risk when exposure took place during the first trimester,” said Li-Ching Lee, Ph.D., Sc.M., psychiatric epidemiologist in the Bloomberg School’s Department of Epidemiology. “SSRI was also elevated among boys with DD, with the strongest exposure effect in the third trimester.”
Serotonin is critical to early brain development; exposure during pregnancy to anything that influences serotonin levels can have potential effect on birth and developmental outcomes. The prevalence of ASD continues to rise. According to the Centers for Disease Control and Prevention, an estimated 1 in 68 children in the U.S. is identified with ASD, and it is almost five times more common among boys than girls.  One may question whether the increased use of SSRI in recent years is a contributor to the dramatic rise of ASD prevalence.

"This study provides further evidence that in some children, prenatal exposure to SSRIs may influence their risk for developing an autism spectrum disorder,” said Irva Hertz-Picciotto, Ph.D., M.P.H., chief of the Division of Environmental and Occupational Health in the UC Davis Department of Public Health Sciences and a researcher at the UC Davis MIND Institute.  “This research also highlights the challenge for women and their physicians to balance the risks versus the benefits of taking these medications, given that a mother’s underlying mental-health conditions also may pose a risk, both to herself and her child.”

Regarding treatment, the authors note that maternal depression itself carries risks for the fetus, and the benefits of using SSRI during pregnancy should be considered carefully against the potential harm. The researchers also note that large sample studies are needed to investigate the effects in girls with ASD. Limitations of the study acknowledged include the difficulty in isolating SSRI effects from those of their indications for use, lack of information on SSRI dosage precluded dose-response analyses, and the relatively small sample of DD children resulted in imprecise estimates of association, which should be viewed with caution.
Prenatal SSRI Use and Offspring With Autism Spectrum Disorder or Developmental Delay” was written by Rebecca A. Harrington, PhD, MPH; Li-Ching Lee, PhD, ScM; Rosa M. Crum, MD, MHS; Andrew W. Zimmerman, MD; and Irva Hertz-Picciotto, PhD, MPH.
Data collection of this research was supported by U.S. National Institute of Environmental Health Sciences (NIEHS (#P01-ES11269 and #R01-ES015359), UC Davis MIND Institute and Autism Speaks.
# # #
Media contact for Johns Hopkins Bloomberg School of Public Health: Susan Sperry at 410-955-6919

Sunday, April 20, 2014

Brain Tumors Respond To Ketogenic Diet And Radiation Therapy

Brain Tumors Respond To Diet And Radiation Therapy

Thursday 6 December 2012 - 3am PST

Featured ArticleAcademic Journal

Brain cancer researchers have successfully treated mice with malignant gliomas, a type of aggressive and deadly brain tumor, with a unique combination of radiation therapy and ketogenic diet, a high fat, low carbohydrate and minimal protein regime that forces the body to use fat instead of sugar for energy. Should the approach succeed in human trials, they say the diet could quickly and easily be added to current human brain tumor treatments.

The researchers, led by Adrienne C. Scheck, from Barrow Neurological Institute at St. Joseph's Hospital and Medical Center in Phoenix, Arizona, in the US, reported the results of using the combination therapy on mice in PLoS ONE.

Theirs is thought to be the first study of its kind to look at the effects of the ketogenic diet with radiation.

In a press statement released this week, Scheck says their study shows promise for treating human malignant gliomas:

"We found that the ketogenic diet significantly enhances the anti-tumor effect of radiation, which suggests that it may be useful as an adjuvant to the current standard of care for the treatment of human malignant gliomas," she explains.

Ketogenic Diet

The ketogenic diet is a high fat, low carbohydrate, controlled protein diet that has been used since the 1920s to treat epilepsy. The word ketogenic means the body produces ketones (keto = ketone, genic = producing). 

Usually the body converts carbohydrates (from foods like sugar, bread, pasta) into glucose (a type of sugar) to use for energy. In the ketogenic diet, because of the restriction in carbohydrate intake, the body can't use glucose and is forced to use fats as its source of energy: a process known as "ketosis".

In a recent study, scientists showed it may be possible to use specific fatty acids from the ketogenic diet to make a pill, so epilepsy patients can have the benefit of the diet without its side effects, which include constipation, hypoglycaemia, retarded growth and bone fractures

There is also evidence that the diet's effect on brain regulation or homeostasis has potential for treating other brain disorders.

Increased Survival

For their study, Scheck and colleagues used two groups of mice with high-level malignant gliomas. They kept one group on a standard diet and the other group on a ketogenic diet. 

The ketogenic diet they used was KetoCal (KC) a nutritionally complete, commercially available formula used in the treatment of epilepsy in children. The formula has a 4:1 ratio of fat to carbohydrate plus protein.

Both groups received radiation therapy and regular brain scans to monitor tumor growth.

The results showed that the median survival for the mice on the ketogenic diet was about five days longer than the mice on the standard diet, and the vast majority of them survived with no sign of tumor recurrence, even when they switched back to a standard diet, for over 200 days.

None of the mice on the standard diet survived more than 33 days.

Adjuvant Therapy in Human Brain Tumor Treatment

The authors conclude that the ketogenic formula "significantly enhances the anti-tumor effect of radiation".

They suggest the changes to cell metabolism induced through the diet may make it a useful "adjuvant to the current standard of care for the treatment of human malignant gliomas".

Speculating on the reason why the ketogenic diet is effective when combined with radiation therapy, they suggest it stops tumor growth by reducing the stimulation of growth factor hormones, and it may also reduce inflammation and edema around the tumors.

Sheck is currently planning to set up clinical trials in humans.

She says the diet could easily and quickly be incorporated as an adjuvant therapy in current human brain tumor treatments without having to seek approval from regulators.