Saturday, February 28, 2015

Predicting surgery outcomes for epilepsy

This article explains two studies that try to predict surgery outcomes for kids with epilepsy.

Anti-epileptic drugs control seizures and improve quality of life for most people with epilepsy. But for those who find medical treatment ineffective or intolerable, brain surgery is sometimes the next best option. Two studies to be presented at the 68th AES Annual Meeting in December explore the outcomes of brain surgery for children with severe epilepsy.
One study created a decision analysis model to compare how two treatment strategies -medical treatment alone versus brain surgery -- influenced the life expectancy of pediatric patients with refractory epilepsy. Researchers at Boston Children's Hospital developed a decision analysis model with data from the literature. Their findings suggest that surgery increases the odds of a longer life expectancy, compared with medical treatment alone. For example, in a cohort of 10-year old patients, epilepsy surgery in patients with temporal lobe epilepsy yielded 55.2 years of life expectancy, while medical treatment yielded 49.3 years of life expectancy. In extratemporal epilepsy, surgery yielded 54.9 years of life expectancy while medical treatment only yielded 49.3 years. Authors note that the findings suggest that brain surgery is significantly more advantageous than medical treatment alone for eligible children with refractory epilepsy.
A second study examined the effectiveness of resective epilepsy surgery on seizure frequency in children with refractory epilepsy with features of Lennox-Gastaut Syndrome (LGS). Researchers studied 36 patients with LGS who had epilepsy surgery at the Cleveland Clinic for focal, lobar, multilobar resection or hemispherectomy between June 1, 2002 and June 31, 2012. Patients in this study developed epilepsy due to brain lesions or injuries sustained before they were born (17), immediately before or after they were born (10), or between the ages of 2 months and 3 years (9). At the time of surgery, the patients ranged in age from newborn to 18 years, and were experiencing multiple seizures per day.
At follow-up visits conducted 6 months to 6.6 years after surgery, 19 patients were seizure-free. Of the patients still experiencing seizures, two entered late remission 2 years after surgery and five became almost seizure-free, with an average of nine seizures per month. At the last follow-up visit, 24 patients were either seizure-free or had experienced a major reduction in seizure frequency.
"In the past, children with features of Lennox Gastatut syndrome were not considered to be candidates for epilepsy surgery that involves removal of the seizure focus," said Dr. Ahsan Moosa Naduvil, M.D., Staff, section of pediatric epilepsy, Cleveland Clinic Epilepsy Center. "Our study confirms that selected children with early brain lesions may be rendered seizure free with epilepsy surgery."
The authors performed a survival analysis based on the duration of time between seizures, and determined the chance of seizure freedom as 60.1% at 12 months, 51% at 24 months and 40.8% at 30 months or more. According to the authors, the findings suggest that resective epilepsy surgery is an effective treatment option for selected children with LGS secondary to early focal brain lesion or injury.
Read more here

Study: Children's Neck-to-Waist ratio is predictor of sleep apnea!

This index has been used for adults for many years....

A study shows that a neck-to-waist ratio in children  0.41 is a predictor of sleep apnea.

Adults are not the only ones who develop sleep apnea. The condition occurs frequently in children as well. The statistics are quite staggering -- up to 66% of obese children are diagnosed with apnea compared with 5.7% of non-obese children. This is another reason to keep children active and help them make better food choices.
Just as with adults, the consequences ofsleep apnea can lead to other health issues. In children, learning and behavioral problems can be the first symptoms that suggest there is something happening in their sleep.
In adults, obstructive sleep apnea is the collapse of the pharyngeal tissue which causes obstruction of breathing during sleep. Children often develop sleep apnea because of large tonsils and adenoids. When a child is not sleeping well, ask his or her parents about snoring or if they can hear their child breathing from across the room. These are indications that tonsils and adenoids are hypertrophic.
As a provider, keep a measuring tape in your drawer can be helpful in determining whether your pediatric patient has obstructive sleep apnea. Research from Canada suggests that a neck-to-waist ratio of >0.41 has sufficient sensitivity and specificity to be considered a predictor of obstructive sleep apnea. The neck circumference is measured at the most prominent part of the thyroid cartilage and the waist circumference equidistant between the iliac crest and the lowest rib.
Of course, if you believe a child has obstructive sleep apnea it is important to order a polysomnogram to confirm the diagnosis. As it is often a concern, assure your patient that sleep labs have rooms set up for parents to stay with their child. Treatment may be as simple as removal of tonsils and adenoids, however, some children may need continuous positive airway pressure (CPAP) therapy. 
Children are not able to always put into words what they are feeling physically. As adults, we can say we are tired or fatigued, while children might not be able to do so. Ask parents how the child is interacting with other children or siblings. Are they falling asleep if not active? How are they doing in school? How is their behavior at home?
On your pediatric patient's next visit, remember to measure their neck and waist to see if they might need to a sleep study to assess for obstructive sleep apnea.
Read more here

STAAR Testing for Kids with Disabilities - Link to TEA.

Assessments for Students with Disabilities

A student with a disability can be a student:
  • with an identified disability who receives special education services;
  • with an identified disability who receives services under Section 504 of the Rehabilitation Act of 1973; or
  • with a disabling condition who does not receive special education or Section 504 services.
The Texas Assessment Program is a statewide testing program that includes the STAAR©, STAAR Spanish, STAAR ASTAAR L, and STAAR Alternate 2. Although most students will take STAAR with or without allowable accommodations, a student with a disability may have choices regarding which of these assessments is most appropriate. 
Information about the Texas Assessment of Knowledge and Skills (TAKS) or the Texas English Language Proficiency Assessment System (TELPAS) appears on their websites.  

Students not Receiving Section 504 or Special Education Services  

Students not receiving section 504 or special education services are required by Texas Education Code (TEC) §28.025(c) to meet all curriculum requirements and pass all five STAAR end-of-course (EOC) assessments in order to receive a Texas high school diploma.

Students Receiving Section 504 Services 

Students are required by TEC §28.025(c) to meet all curriculum requirements and pass all five EOC assessments in order to receive a Texas high school diploma:  
  • Most students will take STAAR with or without allowable accommodations. 
  • Review the eligibility requirements for STAAR A for students identified with dyslexia or related disorders as defined in TEC §38.003.

Students Receiving Special Education Services 

The admission, review, and dismissal (ARD) committee makes educational decisions for a student, including whether satisfactory performance on an EOC assessment shall also be required for graduation per Texas Administrative Code (TAC) §89.1070(b):
  • Most students will take STAAR with or without allowable accommodations.
  • For students who need more significant accommodations, review the STAAR A eligibility requirements.
  • Review the participation requirements for STAAR Alternate 2 for students with significant cognitive disabilities who access the grade-level Texas Essential Knowledge and Skills (TEKS) curriculum through prerequisite skills. 

 English Language Learners

Students are required by TEC §28.025(c) to meet all curriculum requirements and pass all five EOC assessments in order to receive a Texas high school diploma. 
  • Most students will take STAAR with or without allowable accommodations. 
  • STAAR Spanish is available for students receiving instruction in Spanish in grades 3-5. 
  • STAAR L mathematics, science, and social studies assessments are available for students who need a higher degree of linguistic accommodation and who meet eligibility requirements.
  • The ARD committee and the language proficiency assessment committee (LPAC) make all educational decisions, including whether satisfactory performance on an EOC assessment shall be required for graduation per TAC §89.1070(b), for students with disabilities who are also English language learners (ELL).

Teenagers in the US are getting less sleep than ever

A study showed that teenagers in the US are getting less sleep than they ever have.

American teens don't get enough sleep, and the problem has only gotten worse since the 1990s, new research shows.
Just 63 percent of 15-year-olds reported getting seven or more hours of sleep a night in 2012. That number is down from 72 percent in 1991, according to the study.
Regardless of the time period studied, the number of teens reporting seven or more hours of sleep nosedives between the ages of 13 and 18, the study showed. At 13, roughly two-thirds of teens get at least seven hours of sleep a night; by 18 that percentage drops to about one-third.
"After age 16, the majority are not meeting the recommended guidelines," said study author Katherine Keyes, an assistant professor of epidemiology at Columbia University's Mailman School of Public Health in New York City.
Sleep experts have noted that too little sleep boosts the risk of weight gain, poor school performance, depression and other problems.
The study is published online Feb. 16 in Pediatrics.
For the study, researchers from Columbia University looked at sleep data from a national survey of more than 270,000 teens from 1991 to 2012. Each year, teens reported how often they got seven or more hours of sleep, as well as how often they got less sleep than they need.
The most recent recommendation from the National Sleep Foundation says teens aged 14 to 17 need eight to 10 hours a night and people aged 18 to 25 need seven to nine hours.
The largest declines in those getting enough sleep occurred between 1991 through 2000; then the problem plateaued, Keyes said.
The researchers also found gender differences in sleep. "Girls are less likely to get an adequate amount of sleep compared to boys," she said.
Both boys and girls whose parents had less education were not as likely to get enough sleep. Keyes found racial differences, too, with black and Hispanic teens less likely than others to get enough sleep.
One worrisome finding, she said, was that some teens who weren't getting enough sleep often thought their sleep duration was fine.
Keyes did not have access to information about the teens' use of electronic media, a factor often blamed for lack of sleep as teens text, check social media, play video games and work on laptops late into the night. However, that might be a factor, she said.
"On an individual level, excessive use of technology may impair an adolescent's ability to sleep," Keyes said.
The study findings aren't surprising, said Dr. Marcel Deray, a pediatric neurologist and director of the sleep disorders center at Miami Children's Hospital.
Deray said that while this study didn't offer information about whether electronic use is to blame for teens' lack of sleep, an American Academy of Pediatrics report in 2014 cited technology, along with caffeine use and other habits, as contributing factors in teen sleep deprivation. Deray said instructing teens to stop all electronic media use by at least an hour before bed might help.
Another issue? Early school start times can play havoc with teens' sleep, according to Deray.
Like some other experts, Deray said later school start times -- even an hour later -- could help teens get more sleep. Teens naturally go to sleep later, he said, due to their sleep cycles and the release of the hormone melatonin. "When we fall asleep, melatonin goes up. Teens make it later, so they tend to be night owls," Deray said.
Left alone, he said, teens would go to sleep later and get up later. Starting school an hour later, for instance at 8:30 a.m., is an approach favored by the American Academy of Pediatrics and would likely help, he added.
Lack of sleep is linked with many other health problems for teens, he said, including obesity, car accidents, depression and a drop in school performance.
Parents of teens can educate their children about not overscheduling, limiting caffeine before bed and having a bedtime routine, just as they did when they were younger, Keyes said.
Deray said teens can also try to get up by 9 a.m. on the weekend and to expose themselves to sunlight in the morning, helping to make them sleepier earlier at night.
Read more here

Migraines in children

This article discusses how migraines manifest themselves in children.

Migraines aren't just a problem for adults -- about 6 percent of children and more than one-quarter of teens aged 15 to 17 have migraines, according to the American Migraine Foundation (AMF).
"There are many things that can be done if your child suffers from migraine, or if you suspect that he or she does," foundation chair Dr. David Dodick, a professor of medicine at the Mayo Clinic College of Medicine in Scottsdale, Ariz., said in an AMF news release.
If you suspect your child has migraines, take him or her to a doctor to be assessed and receive treatment if necessary. Options include treatment to stop the pain and prevent a migraine from getting worse, along with measures to prevent or reduce the frequency, severity and duration of migraines.
If your child is prescribed a migraine medication, it's important for you to make sure he or she takes the medicine as directed. Inform your doctor if there are changes in your child's migraines, such as becoming more frequent or severe. A new treatment approach may be required, according to the headache experts.
A number of factors may contribute to your child's migraines, such as too little or too much sleep or stress. Parents need to help their children follow healthy lifestyles and cope with stress. Recent research in stress management suggests that a type of counseling called cognitive behavioral therapy can benefit children with chronic headache, according to the AMF.
Other potentially helpful stress-control techniques include relaxation therapy and biofeedback.
Keeping a migraine diary can help youngsters understand why they get migraines and how to prevent them. The diary tracks migraines, the severity, how long they last, what patients were doing before and during the migraine, and what foods they ate.
Mobile phone apps may be an ideal way for children and teens to tracks their migraines and to take their medications as prescribed, the experts suggested.
Read more here

Study: Mutations causing autism are linked to brain development

A study shows that specific mutations that cause autism are linked to how the child's brain develops.

Scientists at the University of California, San Diego School of Medicine have found that mutations that cause autism in children are connected to a pathway that regulates brain development. The research, led by Lilia Iakoucheva, PhD, assistant professor in the Department of Psychiatry, is published in the February 18 issue of Neuron.
The researchers studied a set of well-known autism mutations called copy number variants or CNVs. They investigated when and where the genes were expressed during brain development. "One surprising thing that we immediately observed was that different CNVs seemed to be turned on in different developmental periods," said Iakoucheva.
Specifically, the scientists noted that one CNV located in a region of the genome known as 16p11.2, contained genes active during the late mid-fetal period. Ultimately, they identified a network of genes that showed a similar pattern of activation including KCTD13 within 16p11.2 and CUL3, a gene from a different chromosome that is also mutated in children with autism.
"The most exciting moment for us was when we realized that the proteins encoded by these genes form a complex that regulates the levels of a third protein, RhoA," said Iakoucheva. Rho proteins play critical roles in neuronal migration and brain morphogenesis at early stages of brain development. "Suddenly, everything came together and made sense."
Further experiments confirmed that CUL3 mutations disrupt interaction with KCTD13, suggesting that 16p11.2 CNV and CUL3 may act via the same RhoA pathway. RhoA levels influence head and body size in zebrafish, a model organism used by geneticists to investigate gene functions. Children with 16p11.2 CNV also have enlarged or decreased head sizes and suffer from obesity or are underweight. "Our model fits perfectly with what we observe in the patients," said Guan Ning Lin, PhD, a fellow in Iakoucheva's laboratory and co-first author with Roser Corominas, PhD.
Interestingly, the RhoA pathway has recently been implicated in a rare form of autism called Timothy syndrome, which is caused by the mutation in a completely different gene. "The fact that three different types of mutations may act via the same pathway is remarkable," said Iakoucheva. "My hope is that we would be able to target it therapeutically."
Iakoucheva and colleagues are planning to test RhoA pathway inhibitors using a stem cell model of autism. "If we can discover the precise mechanism and develop targeted treatments for a handful of children, or even for a single child with autism, I would be happy," she said.
Read more here

The link between not getting enough sleep and diabetes

Not getting enough sleep causes changes in the body which can mimic diabetes thus explaining the link between the two.

Lack of sleep can elevate levels of free fatty acids in the blood, accompanied by temporary pre-diabetic conditions in healthy young men, according to new research published online February 19, 2015, in Diabetologia, the journal of the European Association for the Study of Diabetes.
The study, the first to examine the impact of sleep loss on 24-hour fatty acid levels in the blood, adds to emerging evidence that insufficient sleep -- a highly prevalent condition in modern society -- may disrupt fat metabolism and reduce the ability of insulin to regulate blood sugars. It suggests that something as simple as getting enough sleep could help counteract the current epidemics of diabetes and obesity.
"At the population level, multiple studies have reported connections between restricted sleep, weight gain, and type 2 diabetes," said Esra Tasali, MD, assistant professor of medicine at the University of Chicago and senior author of the study. "Experimental laboratory studies, like ours, help us unravel the mechanisms that may be responsible."
The researchers found that after three nights of getting only four hours of sleep, blood levels of fatty acids, which usually peak and then recede overnight, remained elevated from about 4 a.m. to 9 a.m. As long as fatty acid levels remained high, the ability of insulin to regulate blood sugars was reduced.
The results provide new insights into the connections, first described by University of Chicago researchers 15 years ago, between sleep loss, insulin resistance and heightened risk of type 2 diabetes.
The researchers recruited 19 healthy male subjects between the ages of 18 and 30. These volunteers were monitored through two scenarios in randomized order. In one, they got a full night's rest -- 8.5 hours in bed (averaging 7.8 hours asleep) during four consecutive nights. In the other, they spent just 4.5 hours in bed (averaging 4.3 hours asleep) for four consecutive nights. The two studies were spaced at least four weeks apart.
Each subject's sleep was carefully monitored, diet was strictly controlled and blood samples were collected at 15 or 30 minute intervals for 24 hours, starting on the evening of the third night of each study. The researchers measured blood levels of free fatty acids and growth hormone, glucose and insulin, and the stress hormones noradrenaline and cortisol. After four nights in each sleep condition, an intravenous glucose-tolerance test was performed.
They found that sleep restriction resulted in a 15 to 30 percent increase in late night and early morning fatty acid levels. The nocturnal elevation of fatty acids (from about 4 a.m. to 6 a.m.) correlated with an increase in insulin resistance -- a hallmark of pre-diabetes -- that persisted for a nearly five hours.
Cutting back on sleep prolonged nighttime growth hormone secretion and led to an increase in noradrenaline in the blood, both of which contributed to the increase in fatty acid levels.
Although glucose levels were unchanged, the ability of available insulin to regulate blood glucose levels decreased by about 23 percent after a short sleep, "suggesting," the authors note, "an insulin-resistant state."
"It definitely looks like a packaged deal," said the study's lead author, Josiane Broussard, PhD, a former graduate student at the University of Chicago who is now a post-doctoral research scientist at Cedars-Sinai Medical Center's Diabetes and Obesity Research Institute in Los Angeles.
"Curtailed sleep produced marked changes in the secretion of growth hormone and levels of noradrenaline -- which can increase circulating fatty acids," Broussard said. "The result was a significant loss of the benefits of insulin. This crucial hormone was less able to do its job. Insulin action in these healthy young men resembled what we typically see in early stages of diabetes."
Plasma free or non-esterified fatty acids are an important energy source for most body tissues. The demand for fatty acids goes up during exercise, for example, where they are used by cardiac and skeletal muscle; this preserves glucose for use by the brain. But constantly elevated fatty-acid levels in the blood are usually seen only in obese individuals as well as those with type 2 diabetes or cardiovascular disease. A 2012 study by a related research team emphasized the connections between sleep loss and the disruption of human fat cell function in energy regulation.
"This study opens the door to several intriguing questions," according to a Commentary in the journal by sleep specialists Jonathan Jun, MD, and Vsevolod Polotsky, MD, PhD, of Johns Hopkins University School of Medicine. Could variations in individual responses to short sleep explain susceptibility to metabolic consequences? Could dysregulation of fatty acid metabolism represent a common pathway linking various sleep disorders to metabolic syndrome? And why don't clinicians routinely ask their patients about sleep?
The study provides evidence for "potential mechanisms by which sleep restriction may be associated with insulin resistance and increased type 2 diabetes risk," the authors conclude. It supports the growing sense that insufficient sleep may disrupt fat metabolism. And it suggests that an intervention as simple as getting enough sleep could counteract the current epidemics of diabetes and obesity.
Read more here

At what age should a child stop napping?

This article discusses at what age a child should stop napping.

Whether you’re a helicopter, free-range, or pro-attachment parent, one thing most moms and dads can agree upon is that young kids need daily naps. But that blessed hour or so of peace and quiet may not actually be such a great thing, according to a new report. 
The study, published online Sunday in the Archives of Disease in Childhood by lead author Karen Thorpe of Queensland University of Technology, posits that daytime snoozing after the age of two can actually have a negative impact on kids’ nighttime sleep. Researchers arrived at their findings after analyzing 26 studies to assess “evidence regarding the effects of napping” on child development and health. 
“The evidence suggests that beyond the age of 2, when cessation of napping becomes more common, daytime sleep is associated with shorter and more disrupted night sleep,” Thorpe, a professor in development science, told Today. In other words, so much for that “sleep begets sleep” mantra.

Just keep in mind that “as children will crawl, walk and talk at different times, so too will sleep patterns differ for each child,” Thorpe tells Yahoo Parenting. “The age of cessation of napping varies considerably for individual children typically between 2 and 5 years and likely reflects individual differences in development.” What this study suggests she explains “is that is important for parents to respond to their individual sleep need.”
Two is a pivotal age for sleep, Heidi Connolly,  M.D., director of pediatric sleep medicine services at the University of Rochester Medical Center’s Pediatric Sleep Disorders Center tells Yahoo Parenting, but that’s because “around two is when most toddlers stop napping twice a day and consolidate to once a day,” not because napping becomes a negative practice for all kids at that age. “There are still a lot of kids who nap at age 4 and 5.” 
The aim for children under five should be to get between 11 and 14 hours of shuteye during a 24-hour period, she says, also acknowledging that “the more a child is sleeping during the day, the less they need to sleep at night.” 
To determine if a child of any age needs a nap, observe how they behave in the morning. “If he doesn’t wake up on his own, or is very hard to wake up, he isn’t getting enough sleep and likely needs a daytime nap,” she says. Likewise, if he’s having afternoon meltdowns on daily basis, he may need naps. “But if he’s functioning fine during the day and chipper in the morning, a nap just is not needed,” says Connolly. 
For the restless snoozers, Connolly says to first consider whether a nap is needed, then change behaviors around bed- and naptimes to help kids become better sleepers. For example, establish consistent evening routines and a cool, quiet, dark environment for optimal shuteye. Without help, “Some kids are just good sleepers,” she says, “and some just aren’t, regardless of their age.” 
Read more here

Premature babies predisposed to depression

A recent study claims that premature babies have a high risk of depression later in life.

People born extremely premature have a significantly higher risk of developing psychiatric problems later in life, a new Canadian study says.
Researchers at McMaster University in Hamilton, Ont., studied 174 people born in Ontario between 1977 and 1982 — 84 of whom weighed less than 1 kg (2.2 lbs.) at birth, and 90 of whom fell into the range of normal birth weight.
The low-birth-weight babies were 2.5 times more likely to develop a mental health problem such as depression, an anxiety disorder or attention-deficit/hyperactivity disorder (ADHD), the study found.
The likelihood is even higher — nearly 4.5 times — for those whose mothers received a high dose of steroids before giving birth.
At the same time, the research found a positive outcome: the low-birth-weight babies were nearly three times less likely to develop an alcohol or substance abuse disorder.
The study was published in the journal Pediatrics.
Read more here

Brain imaging study of youth hockey players shows early markers for concussion damage.

A brain imaging study of youth hockey players shows early markers for concussion damage.

James Hudziak, M.D., has two children who love ice hockey. His son skates for his college team and one of his daughters plays in high school.
As a pediatric neuropsychiatrist and director of the Vermont Center for Children, Youth and Families at the University of Vermont (UVM) College of Medicine, Hudziak believes in the benefits of ice hockey and other sports for kids. Athletic activities help a young person build organizational skills, improve motor and emotional control, reduce anxiety and boost confidence.
Now, though, Hudziak is looking into the potential dangers of ice hockey for young athletes. He and UVM colleagues Matthew Albaugh, Ph.D., Catherine Orr, Ph.D., and Richard Watts, Ph.D., have published a groundbreaking study in the February issue of TheJournal of Pediatrics that shows a relationship between concussions sustained by young ice hockey players and subtle changes in the cortex, the outer layer of the brain that controls higher-level reasoning and behavior.
Each year, more than 300,000 sports-related concussions (SRC) occur across all sports and all levels in the United States, according to a 2013 "Ice Hockey Summit II" report to which Hudziak and Boston University (BU) School of Medicine's Ann McKee, M.D., contributed. The report's authors advised the elimination of head hits from all levels of hockey, a change in body-checking policies and the elimination of fighting in all amateur and professional hockey. "Ice hockey SRC prevalence is high," the report states. "Hockey players compete at high speeds as they mature, risking injury from intentional and accidental collisions, body checks, illegal on-ice activity and fighting."
The UVM team used advanced imaging technology and cognitive testing to assess 29 Vermont ice hockey players between ages 14 and 23, some diagnosed with a sports-related concussion. As the severity of the athletes' concussion symptoms increased, the researchers found, the cortex got thinner in areas where it should be dense at those players' ages -- areas that relate to attention control, memory, and emotion regulation.
"We believe that injury to a developing brain may be more severe than injury to an adult brain," Hudziak says.
What the study indicates for the future health and function of an ice hockey player is unclear. The researchers hope to do further studies, ideally following the brains of these athletes over a couple of decades and factoring for their involvement and time in the sport as well as other influences, such as smoking and alcohol use.
"The concern is that what we are finding may be an early marker of brain damage," Albaugh says. "Years of playing contact sports and repeatedly getting your head knocked around probably isn't good for the brain, especially in young children whose brains are still maturing" he adds.
Their findings contribute to research into the consequences of brain injury in other sports, including the brain damage discovered in older professional football players by McKee, a neurology and pathology professor at BU and director of the "brain banks" in various centers of study for the university and the Veterans Administration. Her work was a cornerstone of "League of Denial: The NFL's Concussion Crisis," an investigative report by the public television program "Frontline" on the National Football League's response to players' brain trauma.
"It just adds to our information base about young athletes playing contact sports," McKee says of Hudziak's study. "It's a first step. It needs to be looked at longitudinally. We need to know if these athletes recover."
McKee says she wouldn't necessarily expect the brain changes in young hockey players to lead to chronic traumatic encephalopathy (CTE), a serious but uncommon disease that she found prevalent in retired NFL players. Instead, she expects that further study in the ice hockey arena will show that young players' brains can recover from early blows. Brains have a chance for rehabilitation after injury, she says.
"We're hopeful that these changes can be reversed," she says of the cortex thinning observed in Hudziak's study. "I would look at this as an opportunity to make a difference, and not a cause of irrevocable damage in these players."
Hudziak and his UVM colleagues would like to help the organizations running professional, collegiate, junior and youth hockey leagues make better decisions about how best to treat players' head injuries; how and when to return players to the ice after an injury; when to pull them from the sport entirely; and how to prevent injuries from occurring. Players and coaches at the national, college and youth levels of hockey have talked to Hudziak about his findings, he says.
In Hudziak's study, he and his colleagues cite research indicating "that cerebral concussion accounts for 15 to 22.2 percent of all reported injuries" in hockey.
The key challenges for them, says Hudziak, are that the definition of "concussion" is so slippery and reports of the incidence of concussions are inconsistent. Some people think a concussion happens when someone is hit in the head or gets dizzy; others think a person has to be "knocked out" to have a concussion.
His study focuses on the symptoms recorded after a diagnosed concussion. But Hudziak wonders whether lesser head injuries, what he calls sub-concussive events, could have as many or more consequences for the brain over time as a single major blow.
On the computer in his office, Hudziak shows a video of a professional hockey game during which a player gets body checked. It doesn't look like a very serious hit, though he's carried off the ice.
Then, the video reverses to just a few minutes earlier in the game, when that same player collides with another and flips violently backwards, throwing off his helmet before his head hits the ice. That suggests the potential harm inside a person's skull that can occur from cumulative assault.
As Hudziak puts it, "The sum is greater than the individual parts."
That player flew into Burlington, Vt. to meet with Hudziak and his team, so they can learn more from his brain.
Ideally, Hudziak says, they want to apply their current study to female and male ice hockey players ages 8 to 14, then to college-age skaters of both genders and finally to retired professional hockey players. They'd like to compare their findings at each age group to nonathletes and to the same groups in soccer -- a sport typically involving less-severe head injuries.
"We don't have any sense that hockey's going to be worse than soccer," Hudziak points out.
Already, in a follow-up study, Hudziak's team has found more evidence of increased problems in the brains of athletes, compared with nonathletes. This work focuses on "hyperintensities," which look like little bright white spots on a brain image. His research suggests a higher volume of these bright spots may correlate with decreased thickness in the cortex.
"As a general rule of thumb, you're allowed one of these bright spots every 10 years of your life," Albaugh says.
So a 50-year-old should have about five of these bright spots. One of the college-age athletes in the study has 18 spots, Albaugh says. Hudziak now has to call some parents to tell them of the "clinically concerning findings" in their children's brain images.
Hudziak doesn't want to warn parents to keep their kids out of hockey or other team play. As the founder of the unique Vermont Family-Based Approach, which incorporates all aspects of a child's life to address emotional and behavioral problems, he prescribes hockey, soccer and other sports to help eliminate behavior, attention and psychological disorders. It is his hope that through brain training and health promotion the brain may recover.
"My goal is not to rid the world of these sports," Hudziak says. "My goal is to make these sports safer, so that more people can play them."
Read more here

Sleep apnea linked to bone loss, study claims

A study shows that sleep apnea is linked to bone loss and osteoporosis.

Sleep apnea is tied to osteoporosis and bone fractures, new research finds. 
About 54 million Americans over the age of 50 are affected by low bone mass, and about 10 million of them have osteoporosis, which leads to brittle bones and fractures. 
Obstructive sleep apnea is a sleep disorder that occurs commonly in this population as well, and has been linked to multiple adverse health effects, including high blood pressure, heart disease. and depression.
Researchers at Oregon Health and Science University in Portland theorize that sleep apnea may be an unrecognized cause of osteoporosis because it seems to affect bone remodeling, a process necessary for bone health. During remodeling, mature bone is removed from the skeleton and new bone tissue is rebuilt, even while we sleep.
The authors of the new study reviewed research that deals with bone metabolism and found important indications that sleep apnea interrupts the bone remodeling process.
"If sleep disorders like obstructive sleep apnea affect bone metabolism, they may have diagnostic and therapeutic implications for many patients, including those affected by sleep apnea in their early, bone modeling years," said lead author Dr. Christine Swanson.
The study is published in the Journal of Bone and Mineral Research.

Read more here

Study: Why students shouldn't stay up all night

This study explains why students should not pull all-nighters to study.

Memory neurons lull us to sleep in order to consolidate what we've learned, say researchers from Brandeis University, who advise students against pulling all-nighters to prepare for tests.

Knowing that sleep, memory and learning are deeply intertwined, the Brandeis team set out to find out whether memory is consolidated during sleep simply because the brain happens to be at rest or whether those neurons provoke sleep in order to do their job.

In the study, which was published in the journal eLife, the researchers focused on a specific group of neurons called the dorsal paired medial (DPM), which are well known to implant memories in fruit flies.

In what's thought to be a first-of-its-kind observation, the flies slept more when the DPM neurons were activated, yet continued to buzz about when these neurons were switched off.

As these neurons start to convert short-term memory to long-term memory, they do their best to make sure you stay sleeping and actually hinder wakefulness, according to the study.

In the case of the fruit flies, the part of their brain in charge of memory and learning — called the mushroom body — The is also what determines wakefulness and, consequently, it's where the DPM are housed.

"It's almost as if that section of the mushroom body were saying 'hey, stay awake and learn this,'" says co-author Bethany Christmann, a graduate student at Brandeis. "Then, after a while, the DPM neurons start signaling to suppress that section, as if to say 'you're going to need sleep if you want to remember this later.'"

Christmann points out that knowing how sleep, memory and learning work together in the fruit fly brain can help researchers know what to look for when working with human participants.

"Eventually, it could help us figure out how sleep or memory is affected when things go wrong, as in the case of insomnia or memory disorders," she says.

Read more here

Saturday, February 14, 2015

Autism missed in pediatric exams... even by experts watching 10 minute well-child visits!


This article explains that autism symptoms can be missed in routine pediatric exams.

39% of experts could not identify the children with autism in a typical well-child exam setting.

Please schedule a separate appointment to discuss developmental concerns.


As the rate of children with autism continues to grow, a new study authored by a BYU professor shows that a typical pediatric exam may not be adequate to detect autism risk. It was published in the journal Pediatrics this week.

For the study, autism experts analyzed 10-minute videos of children aged 15 to 33 months being evaluated in a clinical setting. They found that the brief window of time wasn’t enough to reliably identify those children with autism. The study’s lead author and BYU assistant professor Terisa Gabrielsen says many children with autism display mostly typical behavior.

For some kids with autism, 10 minutes may be plenty of time to let you know that they have autism and you need to refer them, or that you suspect they may have autism, but for 39 percent of the kids in our study, even our experts did not pick up on the autism symptoms,” Gabrielsen says.

She says many children aren't identified until they reach the school system, and a delayed diagnosis can mean missing out on some prime years for intervention. “There’s a lot we don’t know about autism, but one thing we do know for sure is that early intervention can be very effective and can change the outcome of a person’s life.”

Gabrielsen says the study backs up the American Academy of Pediatrics recommendation that doctors should screen all children for autism between 18 and 24 months, regardless of whether the child displays symptoms.

Read more here

Wednesday, February 11, 2015

Does a bilingual environment impact language development in children with autism?

Had this question in the office recently. ... 

Does bilingualism impact language development in autism? No evidence of this.

Can it harm a child?

Note that the study found (though not the primary intention) that simultaneous exposure from infancy INCREASED social interaction scores!

The opposite may be true.

Thank you. Gracias. Merci. Danke. Dalu. Eshe.


 2012 Jul;42(7):1342-52. doi: 10.1007/s10803-011-1365-z.

The impact of bilingual environments on language development in children with autism spectrum disorders.


The impact of bilingual exposure on language learning has not been systematically studied in children with Autism Spectrum Disorders. This study compared the social abilities and language levels of children (mean age = 56 months) with ASDs from bilingual (n = 45) and monolingual (n = 30) environments. Bilingually-exposed children were subgrouped based on simultaneous bilingual exposure from infancy (SIM, n = 24) versus sequential post-infancy bilingual exposure (SEQ, n = 21). Despite significantly different amounts of bilingual exposure across all groups (p = <0 .001="" adaptive="" and="" behavior="" class="highlight" compared="" differences="" group="" in="" interaction="" interpersonal="" nbsp="" no="" on="" p="0.025)," scales-ii="" scores="" seq="" significant="" significantly="" sim="" social="" span="" stronger="" subdomain="" the="" there="" to="" vineland="" were="">language
 level. Bilingually-exposed children with ASDs did not experience additional delays in language development.
[PubMed - indexed for MEDLINE]

Study: Children in institutions have a higher risk of autism

Children placed in institutions have a higher risk of developing autism according to a new study.

A recent study published in the February 2015 issue of the Journal of the American Academy of Child and Adolescent Psychiatry demonstrates that children who were abandoned to institutional care have an increased risk for behaviors similar to those seen in children with autism, including impaired social communication. When these children were moved into child-centered foster family care at a young age, their social behaviors improved.
As part of the Bucharest Early Intervention Project, 136 children abandoned at birth and raised in institutions in Bucharest, Romania were randomly assigned to either continued care as usual in the institution, or high quality foster care created and maintained by the investigators. The children averaged 23 months of age at the time of randomization.
At 10 years of age, 117 children were assessed. Each child's primary caregiver filled out the Social Communication Questionnaire (SCQ), which assesses for symptoms associated with autism, including social communication skills. Children with concern for possible autism were then referred for a full neurodevelopmental evaluation to determine whether they met the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for autism.
Five children with a history of institutional care (three in the institutional care as usual group and two in the foster care group) met the DSM diagnostic criteria for autism spectrum disorder. In a comparison group of 100 age-matched, never-institutionalized children living in Bucharest, Romania, no child met criteria for autism spectrum disorder. Based on SCQ scores, children in the foster care group were identified as having more typical social behaviors compared to children in the institutional care as usual group.
These findings suggest that children with a history of institutional care are at increased risk for behaviors associated with autism, including social communication difficulties. These behaviors improved with an early intervention of quality foster care.
The authors strongly emphasize that in the vast majority of autism cases in the general population, children are raised in caring families, and psychosocial deprivation plays no role. "Although the institutionalized children with autism resemble children with autism in the general population, the origins of their symptoms are very different," says Charles A. Nelson PhD of Boston Children's Hospital and Harvard Medical School, who is senior author on the paper. "We believe that both groups suffer deprivation, but of different types: In institutionalized children, the deprivation comes from their environment, while in the general population, the autism itself causes a kind of deprivation, making it harder for children to perceive and understand social cues."
Read more here

Eye tracking to help determine concussion severity

Using an eye-tracking method may help spot concussions and help determine their severity.
A new eye-tracking method might help determine the severity of concussions, researchers report.They said the simple approach can be used in emergency departments and, perhaps one day, on the sidelines at sporting events.
"Concussion is a condition that has been plagued by the lack of an objective diagnostic tool, which in turn has helped drive confusion and fears among those affected and their families," said lead investigator Dr. Uzma Samadani. She is an assistant professor in the departments of neurosurgery, neuroscience and physiology at NYU Langone Medical Center in New York City.
"Our new eye-tracking methodology may be the missing piece to help better diagnose concussion severity, enable testing of diagnostics and therapeutics, and help assess recovery, such as when a patient can safely return to work following a head injury," she explained in an NYU news release.
According to researchers, it's believed that up to 90 percent of patients with concussions or blast injuries have eye movement problems. But the current method of assessing eye movement is asking a patient to track a doctor's finger, Samadani said.
The new method was originally developed by Samadani and her colleagues to assess eye movement in U.S. military personnel believed to have concussion or other types of brain injuries.
The researchers compared 75 trauma injury patients and a control group of 64 healthy people. The movements of the participants' pupils were tracked while they watched a music video for a few minutes.
Thirteen trauma patients who hit their heads and had CT scans showing new brain damage, and 39 trauma patients who hit their heads and had normal CT scans, were much less able to coordinate their eye movements than trauma patients who hadn't hit their heads and those in the control group.
The more severe the concussion, the worse a patient's eye movement problems, according to the study. Results were published online Jan. 29 in the Journal of Neurotrauma.
Dr. M. Sean Grady, chair of the neurosurgery department at the University of Pennsylvania's Perelman School of Medicine in Philadelphia, said, "The importance of this study is that it establishes a reliable test and a 'biological' marker for detecting concussion." He was not involved in the study.
"Since concussion can occur without loss of consciousness, this can be particularly important in sideline evaluations in athletics or in military settings where individuals are highly motivated to return to activity and may minimize their symptoms. More work is needed to establish its sensitivity and specificity, but it is very promising," Grady said.
Read more here