Dr Josh Rotenberg Houston Top Child Neurologist - 6 Years in a Row

Gratified to be chosen as a Top Doctor for the Houston Texas Region. 

Dr. Rotenberg selected by peers for top pediatric neurology in Houston Texas

2020 Top Pediatric Neurology Houston TX

2018 Top Child Neurology - Houston

2019 Top Child Neurologist - Houston Texas

Are Pediatric Concussion Rates Under-Counted?

A growing concern that pediatric concussions may be consistently under-counted and not being properly addressed? -JR

Are Pediatric Concussion Rates Undercounted?

​BY FRAN KRITZ

The number of pediatric concussions in the United States each year may be undercounted by as much as 80 percent, according to a study by researchers from both the Children's Hospital of Philadelphia (CHOP) and the US Centers for Disease Control and Prevention (CDC). The study, published last month in JAMA Pediatrics, also found that many concussions occur in children under age 12, younger than had been thought.

Study Parameters

Researchers reviewed data from CHOP's electronic health records, identifying and analyzing more than 8,000 concussion diagnoses from July 2010 to June 2014 among children up to age 17 who received their primary care in the CHOP healthcare network. During that period, primary care visits for pediatric concussions increased by 13 percent, while emergency department (ED) visits for concussions decreased by 16 percent.  Eighty-two percent of the pediatric patients had their first concussion visit at a primary care site, 12 percent at the ED, 5 percent with a specialist such as a sports medicine physician, neurologist, or trauma specialist, and 1 percent were directly admitted to the hospital.

"We learned two important things from this study," says Kristy Arbogast, PhD, lead author of the study and co-scientific director of CHOP's Center for Injury Research and Prevention. "First, four in five of this diverse group were diagnosed at a primary care practice—not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems."

Advice for Parents

(Relative - JR) Rest—both physical and cognitive—is key to recovery from a concussion, but parents often need guidance as to what activities their child can and cannot do while resting to help speed recovery, says Dr. Giza. Both the American Academy of Neurology  and the American Academy of Pediatrics have issued guidelines for assessment of and recovery from concussions in the last few years.

The CDC has an online concussion treatment and recovery information called Heads Up, which includes a fact sheet for parents.

FULL ARTICLE HERE:  

Are Pediatric Concussion Rates Under-Counted?

A growing concern that pediatric concussions may be consistently under-counted and not being properly addressed? -JR

Are Pediatric Concussion Rates Undercounted?

​BY FRAN KRITZ

The number of pediatric concussions in the United States each year may be undercounted by as much as 80 percent, according to a study by researchers from both the Children's Hospital of Philadelphia (CHOP) and the US Centers for Disease Control and Prevention (CDC). The study, published last month in JAMA Pediatrics, also found that many concussions occur in children under age 12, younger than had been thought.

Study Parameters

Researchers reviewed data from CHOP's electronic health records, identifying and analyzing more than 8,000 concussion diagnoses from July 2010 to June 2014 among children up to age 17 who received their primary care in the CHOP healthcare network. During that period, primary care visits for pediatric concussions increased by 13 percent, while emergency department (ED) visits for concussions decreased by 16 percent.  Eighty-two percent of the pediatric patients had their first concussion visit at a primary care site, 12 percent at the ED, 5 percent with a specialist such as a sports medicine physician, neurologist, or trauma specialist, and 1 percent were directly admitted to the hospital.

"We learned two important things from this study," says Kristy Arbogast, PhD, lead author of the study and co-scientific director of CHOP's Center for Injury Research and Prevention. "First, four in five of this diverse group were diagnosed at a primary care practice—not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems."

Advice for Parents

(Relative - JR) Rest—both physical and cognitive—is key to recovery from a concussion, but parents often need guidance as to what activities their child can and cannot do while resting to help speed recovery, says Dr. Giza. Both the American Academy of Neurology  and the American Academy of Pediatrics have issued guidelines for assessment of and recovery from concussions in the last few years.

The CDC has an online concussion treatment and recovery information called Heads Up, which includes a fact sheet for parents.

FULL ARTICLE HERE:  

Houston Top Docs Child - Adolescent Neurology - Dr. Joshua Rotenberg

Thank you to patients and colleagues who voted Dr. Rotenberg to Houston Top Doctors 2013!

Online version here

Child-Pediatric Neurology
Adolescent Neurology
Sleep Disorders

Serving:

Houston Bellaire Cypress Memorial City
Katy Cinco Ranch
Sugar land Rosenberg
The Woodlands

Children with ADHD and sleeping issues

This article discusses the challenges children with ADHD have with falling asleep.

One of the challenges of parenting can involve helping children maintain healthy sleep habits. Children with conditions like ADHD may need even more help with sleep.

A recent study looked at sleeping patterns among children with attention-deficit hyperactivity disorder (ADHD).

The researchers found that children with ADHD often have a difficult time falling asleep at night and during the day, regardless of how well they slept the night before.

It's possible that children with ADHD may need more time spent in quiet activities before bedtime to help them get to sleep.

The study, led by Sabrina Wiebe, a research assistant at the Attention, Behavior and Sleep Lab at Douglas Mental Health University Institute in Montreal, Canada, looked for information about sleep among children with ADHD.

The researchers studied the sleep patterns of 82 children, aged 7 to 11, for six days. The 26 children with ADHD and the 56 children with typical mental development underwent a sleep study at their homes for one night.

For the other five nights, the children wore a watch-like device called an actigraph that measured their movement and provides an estimation of the amount of sleep they got.

The researchers also measured the children's daytime sleepiness with a questionnaire and by testing how long it took the children to fall asleep during a series of nap opportunities at a lab during the daytime.

The children were asked not to take medication or have products with caffeine for at least two days before the study began.

When the researchers compared the results, they found that there were no major differences between the two groups on the daytime sleepiness questionnaire or in how many children chose to nap during the day when given the opportunity.

However, there were some other differences between the two groups.

Children with ADHD who spent more time in the slow wave sleep phase also took longer to fall asleep during the day, therefore showing less sleepiness. Further, based on their actigraphs, these children also took longer to fall asleep if they spent more time awake each day.

Meanwhile, the typically developing children only took longer to fall asleep during the day if they also took longer to fall asleep at night.

"These findings suggest problems [among ADHD children] with initiating and/or maintaining sleep affect both nighttime and daytime sleep," the researchers wrote.

Basically, kids with ADHD took longer to fall asleep, regardless of whether they were well rested or if they slept restlessly the previous night.

"It is possible that children experiencing restless sleep are overtired, thereby further contributing to increased difficulties sleeping," the researchers proposed. "In children, symptoms of sleepiness include increased activity likely compensating for increased fatigue. Thus, increased activity may be difficult to shut off when given a sleep opportunity."

The researchers said their study means that children with ADHD may require quiet activities to help calm them down before bedtime. Children who continue to struggle with getting to sleep may need other interventions, they wrote.

The study was published in the February issue of the Journal of Sleep Research. The research was funded by the Canadian Institutes of Health Research and the Fonds de la recherche en santé. The authors declared no conflicts of interest.

Read more here

Cause of epilepsy in cats identified

Scientists have determined the cause behind a certain type of epilepsy in cats.

There is something sinister about epilepsy: the disease affects the very core of our being, our brain. Epileptic attacks can lead to seizures throughout the body or in parts of it. Clouding of consciousness or memory lapses are also possible. The causes are still only partially understood but in some cases brain tumours, infections, inflammations of the brain or metabolic diseases have been implicated.

Epilepsy is not confined to humans and many animals also suffer from it. Together with partners in Oxford and Budapest, Akos Pakozdy and his colleagues at the University of Veterinary Medicine, Vienna have managed to identify the cause of a certain form of epilepsy in cats, in which the body's own immune system attacks particular proteins in the cell membranes of nerve cells. The symptoms include twitching facial muscles, a fixed stare, chewing motions and heavy dribbling. Based on their clinical experience, the researchers believe that this form of epilepsy is fairly widespread in cats. Interestingly, a highly similar type of epilepsy occurs in humans: an inflammation in the brain, known as limbic encephalitis, leads to epileptic seizures that generally manifest themselves in the arm and the facial muscles on only one side of the body.

Pakozdy and his colleagues have found antibodies in the blood of epileptic cats that react to proteins in the cell membranes of nerve cells. The proteins form the building blocks of ion channels that are involved in the production of nerve signals. The same ion channels are affected in the corresponding human form of epilepsy. They control the membrane's permeability to potassium ions based on the electric potential across the membrane, thereby helping generate the rapid nerve signals of the so-called action potential.

Immunotherapy for cats?

If the immune system attacks components of these ion channels, the production of nerve signals is disrupted. There is an increased release of neurotransmitters, which leads directly to the symptoms of epilepsy. Previous work - in another group - on human patients has shown that normal anti-epilepsy medication has hardly any effect on this form of epilepsy. However, immunotherapy has proven to be relatively effective. Pakozdy's work now shows that "limbic encephalitis in cats has the same cause as it does in humans, where the origins have been known for years. It is important that cats with epilepsy are diagnosed early, so that the correct form of therapy can be started. We believe this will dramatically increase the chances of a successful treatment. It seems as though epileptic cats might benefit from treatment with immune preparations."

Read more here

Helmets can never be concussion-proof

This article discusses why helmets can never be completely concussion-proof, and what the NFL can do to make football safer for its players.

Imagine that you drive a car straight into a building at 40 mph. Despite airbags and seatbelts, you’d probably feel lucky to be alive. But when an NFL wide receiver meets a safety head-on, we expect them both to get back up to play second down.

What’s the difference?

“In a car crash, you stop in a matter of feet. In an NFL impact, you stop in inches,” one expert tells me.

In the eyes of physics, a big hit on the field can be just as devastating as a car crash--or in many cases, worse. We’re expecting a mere 1.5 inches of foam and candy shell to decelerate a player’s head gently enough to prevent their brain from bouncing around inside their skull and causingpoorly understood, but permanent and devastating injury. After talking to some of the brightest minds in helmet design, helmet testing and football physics, the elephant in the room became clear: A concussion-proof helmet is a pipe dream. If the NFL wants concussion-free football, they’ll need to redesign football.

That said, conditions have never been riper for disruptive technologies to increase player safety. And for the first time in football’s 200+ year history, we’re finally developing the methodology to separate our best helmets from the decorative chunks of plastic.

TESTING EVOLUTION

Just two years ago, a team led by Dr. Stefan Duma from Virginia Tech released the first ever five-star crash rating for football helmets (PDF). It’s one reason that Duma likens the NFL of today to the auto industry in the 1970s. Originally, all cars were rated by a basic pass/fail crash test, and it wasn’t until Congress passed legislature for a five-star crash rating system that car companies had the impetus to do better.

Before Duma’s testing, the same was true for helmets. The industry’s only concern was whether football players could take a hit without fracturing their skull or sustaining subdural hematoma. Concussions--or any other traumas--weren’t part of testing. So designing helmets became a limbo bar. If a manufacturer came in anywhere below crushed skull territory, their helmet was thrown in the approved pile.

“Our rating system is the first that actually shows people that some helmets are better,” Duma says. “One of the things we wanted to do was provide a mechanism for improved design. You’ll never have a concussion-proof helmet because injury is all about risk. But the better helmets lower your risk. That can be substantial. We found the best helmet lowered risk of concussion by 85%.”

THE WORLD’S BEST HELMET

Duma’s top-rated helmet today is the Riddell 360. Priced at about $400, it features a hard polycarbonate shell to bounce off an impact and an energy absorbing foam lining to absorb the aftershock. The pièce de résistance is its huge, spring-like facemask optimized for forward-facing collisions. The entire ensemble is so effective that it can cut the peak force of a head-on-head impact in half when compared to the league’s worst helmets. (And it just so happens, Riddell’s VSR-4, discontinued in 2010 but still supported for factory refurbishing, is one of football’s worst rated helmets.)

But why should players wear helmets at all, one might ask. In the mid 20th century, as many as 30 players were dying a year due to head injuries. Helmets were the byproduct of the NFL’s first head-trauma scandal. The first were thin, hard leather. Then they adopted plastics, padding, and face masks. As we learned more, the focus quickly became, not just hard protection, but the shock absorption of softer materials. This approach worked. Since the 1980s, we haven’t had a single skull fracture in the NFL. Today’s Riddell helmet is bigger than its predecessors, but it’s ostensibly the same design we’ve been building on for decades.

Each product Riddell releases follows about two years of R&D. They create a prototype. They fill it with a human head surrogate (complete with a brain-like liquid center) used in pass/fail certification testing. They smash it to simulate a head hitting the ground. Then they use another human head surrogate called the Hybrid III (found commonly in the auto industry’s crash test dummies), then they pummel the helmet again, focusing on specific angles of impact more like one might expect in an NFL game. Following that, Riddell seeds their new line to teams to test out in real-world conditions.

But with all this research and testing, can Riddell promise a concussion-free helmet?

“I wish we could,” says Thad Ide, SVP of Research and Product Design at Riddell. “With current technology and understanding, we’re just not there.”

The problem is ultimately one of physics. All helmets work under the same principle. The force striking one’s head--acceleration mixed with mass--can’t actually be prevented. Physics says that energy has to go somewhere, right? What good helmets do is lengthen the duration of the impact itself (in the hundredths of a second range), reverberating energy through various structures and materials, to smooth a hit from a sharp, high-g strike to a relatively smooth curve of deceleration. Consider landing on a concrete floor or a pile of pillows. Which impact takes longer and which impact hurts more?

“I think that it’s true that football helmets are 85% as good as they’re ever going to get,” Dr. Timothy Gay, University of Nebraska physics professor, writer, and industry helmet consultant tells me. “The optimal football helmet won’t be much better than the helmet you can buy right now because there are just physics restraints on the kind of padding you can use. We have a pretty good micro, nanotechnological understanding of how materials work. And basically, there are limits on what padding materials can do for a given thickness.”

That’s an interesting point--what if we just increase the padding’s thickness?

MAYBE WE NEED A NEW PARADIGM

“You can certainly make a helmet that’s concussion-proof,” Gay tells me later, countering his own argument that had just sounded so convincing. “All you have to do is put 15 inches of foam rubber on the outside of the helmet.” This idea may seem as ludicrous as wrapping a fully padded football player in one of those novelty sumo suits. But it just so happens, there’s a company doing pretty much just that.

ProCap is a soft wrapper for football helmets that’s actually been around since the late 1980s. Most famously adopted by San Francisco 49ers offensive tackle Steve Wallace, this extra layer of padding is a means to further slow the impact of the blow. Its known downfall? The soft outer padding can look a bit silly. There are also claims--though no studies that I could find--that the friction generated by a soft outer shell could lead to a neck injury.

ProCap’s inventor wasn’t available for comment, but when I asked Duma about the potential of foam-wrapped helmets, he said that his lab hasn’t tested any, as the ProCap has generally existed as an add-on, not a self-contained helmet in its own right. But he did have the first reasoned red flag to this cult-worshipped design. In the 1990s, Duke researched the possibility of adding padding to the ceiling of cars to protect passengers in the case of a rollover. What they found was precisely on-point with football’s current fear, that the softness actually distributes pressure to the neck, which can cause horrendous spinal injuries. “The notion was out there, ‘Let’s put 4 inches of foam in the ceiling!’” Duma says, “but you may just end up with a bunch of quadriplegic people.” It makes sense. Just look at your car. You have side doors full of foam or even airbags, but the ceiling is covered by a glorified sheet.

SO … ANOTHER NEW PARADIGM

Another, equally enticing possibility is to model football helmets, not after football helmets, but after motorcycle helmets. Most football helmets are designed to be reworn until they’re refurbished. They have to serve play after play. But motorcycle helmets are designed differently. They use a more drastic energy-absorbing foam and a hard shell that isn’t afraid to crack. The downfall is that these helmets completely disintegrate upon impact--they’re totally ruined--with the interest of absorbing every bit of energy possible.

But David Rogers, VP of Concept Development at Gentex, the leading manufacturer of helmets for the Air Force (that owns companies that have designed everything from football helmets to special ops helmets), argues that single-use helmets are not the panacea they appear to be. Beyond the fact that players would need to pause each play to swap out helmets, even our best motorcycle helmets are only designed for 18 mph impacts (not our theoretical 40 mph maximum hit of two players running 20 mph). And as Rogers puts it, should you have a head-on collision in a motorcycle helmet at 18 mph, “you probably still have a concussion, but you’re not dead.”

“Not dead” isn’t really any sort of improvement.

THE NFL CAN DO WHAT HELMETS CAN’T

After going back and forth with experts with every conceivable conspiracy theory I could imagine, the consensus was obvious: A concussion-proof helmet is either impossible, or its requirements would affect play so drastically that it would either impair the sport or lead to other injuries. Even if we can mitigate the impact of the average tackle (and current helmets actually do this exceedingly well), the worst hits in the NFL are exponentially harder than the baseline. I’ve heard estimates that 5 to 10 hits in any given professional game are of concussion caliber. It’s no wonder so many of our players have been out this year with brain injuries.

“The helmet is the third barrier of defense,” Dr. Duma tells me, when I ask what can change. “You have to work on the rules, and you have to work on the coaching.”

Football is a brutal sport, and it always has been. The hits seem big only because they are. Sooner or later, driving a car into a wall at 40 mph is going to hurt you, with or without a $400 piece of plastic on your head. Every single helmet expert agreed that we can redesign football much more quickly and effectively than we can redesign the football helmet--in fact, most suggested the idea to me. The only question that remains is, are we actually willing to change football? Or do we value the spirit of the game more than the lives of the people playing it?

Read more here

Lightning may trigger migraines

Researchers found that people are more likely to have a migraine headache on days when lightening is striking somewhere around their home.

Weather has long been considered one of many potential migraine triggers, but a new study links lightning, specifically, to the onset of the severe headaches that plague more than 28 million Americans.

Based on headache logs and weather data for Ohio and Missouri, researchers found that people were 28 percent more likely to experience a migraine on days when lightning struck within 25 miles of their home.

"We're very surprised and very happy with the results in that this is the first study to link lightning to migraines," said Dr. Vincent Martin, the study's senior author from the University of Cincinnati College of Medicine in Ohio.

Migraines are severe headaches - sometimes accompanied by light sensitivity, visual hallucinations or nausea - that can disable a person for hours or even days at a time. The majority of migraine sufferers are women.

Martin told Reuters Health that a migraine may result from a person experiencing certain "triggers," such as stress, lack of sleep and dehydration.

Previous research has also found links between the onset of migraines and high barometric pressure, high temperatures and high humidity.

Most of the past studies looking at weather and migraines, however, relied on an individual's observations and did not always account for other, possibly unseen, local weather conditions, the researchers write in the journal Cephalalgia.

For the new study, they used information collected from three sensors that track lightning near Cincinnati, Ohio, and five sensors near St. Louis, Missouri. Those sensors allowed the researchers to know where and when lightning struck and the intensity of each strike.

They also used the headache diaries from two previous studies of 90 migraine sufferers in those areas who were between 18 and 65 years old. In those diaries, the participants recorded their headaches for three to six months.

After comparing the weather data with the headache journals, the researchers found that a lightning strike within 25 miles of a person's house was linked to a 31 percent increased risk of any kind of headache, and a 28 percent increased risk of the more severe migraine headache.

Martin said that could mean an extra one to three migraines per month for an individual, but he added that it depends on the person and the weather.

As for how lightning might affect migraine occurrences, Martin said it could be that the electromagnetic waves and ozone created by the lightning have something to do with it.

"The other theory is that when these thunderstorms roll in they can create more allergy spores in the environment," he said, which could create a problem for some people.

But the researchers cannot say for certain that lightning causes migraines, even though they used a computer model to account for other meteorological changes that occur during a thunderstorm.

In an accompanying editorial, Dr. Hayrunnisa Bolay of Gazi University in Ankara, Turkey, cautioned that the study had limitations, including its failure to account for the participants' own individual risk factors.

"In brief, one can only conclude that weather conditions associated with lightning have the potential to induce headache in migraine patients," she wrote.

Read more here

ER visits increase for adults with ADHD

This article discusses the possible link between ADHD medication and the increase in emergency room visits for people with ADHD.

U.S. emergency department visits involving attention-deficit/hyperactivity disorder (ADHD) drugs more than doubled from 2005 to 2010, with the largest hike occurring among adults, says a new government report.

In that period, such ER visits rose from about 13,400 to 31,200, according to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).

"ADHD medications, when properly prescribed and used, can be of enormous benefit to those suffering from ADHD, but like any other medication they can pose serious risks -- particularly when they are misused," SAMHSA administrator Pamela Hyde said in an agency news release.

In adults, cases rose from about 2,100 to 8,100 among those aged 18 to 25, from about 1,750 to 6,100 among those aged 26 to 34 and from roughly 2,500 to nearly 8,000 among those over 35, during the time period.

Rates among children and teens remained largely unchanged from 2005 to 2010, according to the findings published Jan. 24 in SAMHSA's DAWN Report.

The investigators also found that the number of ER visits involving the nonmedical use of ADHD medications nearly tripled during this time, from about 5,200 to nearly 15,600. In 2010, nonmedical use of ADHD drugs made up half of all ER visits involving ADHD medications.

The gap between males and females in the number of ER visits related to nonmedical use of the drugs narrowed during the study period. In 2005, the numbers were about 3,800 for males and about 1,400 for females. In 2011, numbers reached 8,650 for males and about 6,900 for females.

According to Hyde, "this study indicates that a better job has to be done alerting all segments of society -- not just the young -- that misuse of these medications is extremely dangerous."

There were 2.3 million U.S. emergency department visits related to the misuse of all drugs in 2010, according to background information in the news release.

Read more here

Parent treating child's autism with medical marijuana

This article discusses the controversy going on in Oregon over a family treating their autistic child with medical marijuana.

An Oregon family has turned to medical marijuana to manage their son's severe autistic rage, KPTV reported.

Alex Echols, 11, is severely autistic, and his doctor said Alex's self-destructive behavior is brought on by tuberous sclerosis, a rare, genetic disorder that affects about 50,000 people in the U.S.  

The disorder causes unregulated growth of non-malignant tissue in organs. In Alex's case, his neurologist said growths in Alex's brain have led to seizures and autism.

Echols said by the time Alex was 5, he exhibited intense, self-directed rage. Echols showed us home videos of the rage. He said they videotaped the episodes to show doctors the injuries were self-inflicted.

His parents got him a helmet to protect his head, swaddled him like a newborn and tried mood-altering drugs to control the behavior, with little success. When he was eight years old, the Echols made the heartbreaking decision to move Alex into a state-funded group home.

But was there a way to help him? In late 2009, the Echols said they saw a television news story about a California woman who was using medical marijuana to treat her autistic son. The Echols researched Oregon's medical marijuana program, and in 2010, a doctor approved Alex for medical marijuana use.

Alex is now one of 58 minors currently protected under the Oregon Medical Marijuana Act. While autism is not a qualifying medical condition like cancer or severe pain, in Alex's case, his seizures were.

And after a few months of treatment, the Echols said they saw a dramatic improvement. 

Echols said Alex's group home will not administer the marijuana, so, about three times a week off-site, his parents give Alex a liquid form of the drug by mouth.

While Dr. Colin Roberts, Alex's doctor and a pediatric neurologist at Doernbecher Children's Hospital in Portland, did not condone the treatment, he said he understood the family's desire to help their child.

The American Academy of Pediatrics has circulated a resolution that opposes the use of medical marijuana in children. Dr. Sharon Levy, an assistant professor of pediatrics at Boston's Children's Hospital and chairwoman of the AAP's committee on substance abuse, told FOX 12 marijuana is toxic to children's developing brains. She also said enough isn't known about the drug's long-term effects.

The Echols have set up a Facebook page that chronicles Alex's journey. You can find their blog at www.facebook.com/alex.autism.rage.mmj.

Read more here

What causes epilepsy? In Africa: Parasites, Trauma, Birth Complications

Parasites, Trauma Causes of Epilepsy

What causes epilepsy? In Africa, the burden of epilepsy is substantial. Read more and listen to VOA report on this problem. JR

by Joe DeCapua

A new study said it’s possible to substantially reduce the number of epilepsy cases in Africa. The neurological disorder, which is characterized by seizures, is much more common in poor countries and rural areas.


The study is the largest ever done on epilepsy in Sub-Saharan Africa. Nearly 600,000 people were evaluated in five countries: Kenya, South Africa, Uganda, Tanzania and Ghana.

“Epilepsy is an abnormal discharge within the brain, such that the person who has it experiences abnormal convulsive movements as a result of this abnormal discharge. There’s a strong genetic component to it. In some cases a strong family history. There are genes which have been associated with it,” said Psychiatry Professor Charles Newton of the Welcome Trust and Oxford University, who led the research.

Epilepsy can cause not only physical suffering, but emotional pain as well.

“In many African communities the cause is attributed to ancestors, spiritual causes and even witchcraft. There’s a lot of stigma attached to epilepsy. The people who have epilepsy are less likely to go to school; are less likely to marry; are less likely to get jobs,” he said.

Newton and his team said the study is the “first to reveal the true extent of the problem and the impact of different risk factors.” And it’s not just genetics. One big risk factor is parasites. The study found that adults, who had been exposed to a parasitic disease, were up to three times more likely to develop epilepsy.

“The ones that we identified were onchocerciasis, which is a parasite associated with river blindness; Toxocara and taxoplasmosis – both of which are transmitted by cats; neurocysticercosis, which is transmitted by pigs. And we have some evidence to suggest that malaria may also be contributing to this,” he said.

The adults were actually exposed to parasitic diseases during childhood. However, it took many years for the parasites to damage the brain enough to trigger epilepsy.

As for children, the study cited different factors

“In the children under 18 years of age, we found that although the parasitic causes were there they weren’t as important as the abnormal pregnancies of their mothers – and particularly events that occurred around their birth. So it looks like that these children are suffering from birth trauma. So, for example, if the mother has a prolonged second-stage labor or if the child comes out and is not breathing and hasn’t got any oxygen going to the brain, these may be responsible or factors in the pathway for developing brain damage,” said Newton....

Article and report here

Working Alone Won't Get You Good Grades

Collaboration appears to help improve grades. JR

Working Alone Won't Get You Good Grades

enlarge

A graph showing interactions between 82 students during the last week of a course. High performing students are in dark blue and form a core where the highest density of persistent interactions can be observed. Mid-performing students are in red and low-performing student sin green. Persistent interactions are shown in thick blue edges, while dotted thin grey edges indicate transient interactions. (Credit: Image courtesy of University of California - San Diego)

Jan. 31, 2013 — Students who work together and interact online are more likely to be successful in their college classes, according to a study published Jan. 30 in the journal Nature Scientific Reports and co-authored by Manuel Cebrian, a computer scientist at the Jacobs School of Engineering at the University of California San Diego.

Cebrian and colleagues analyzed 80,000 interactions between 290 students in a collaborative learning environment for college courses. The major finding was that a higher number of online interactions was usually an indicator of a higher score in the class. High achievers also were more likely to form strong connections with other students and to exchange information in more complex ways. High achievers tended to form cliques, shutting out low-performing students from their interactions. Students who found themselves shut out were not only more likely to have lower grades; they were also more likely to drop out of the class entirely.
"Elite groups of highly connected individuals formed in the first days of the course," said Cebrian, who also is a Senior Researcher at National ICT Australia Ltd, Australia's Information and Communications Technology Research Centre of Excellence. "For the first time, we showed that there is a very strong correspondence between social interaction and exchange of information -- a 72 percent correlation," he said "but almost equally interesting is the fact that these high-performing students form 'rich-clubs', which shield themselves from low-performing students, despite the significant efforts by these lower-ranking students to join them. The weaker students try hard to engage with the elite group intensively, but can't. This ends up having a marked correlation with their dropout rates."

http://www.sciencedaily.com/releases/2013/01/130131144454.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

Study: No proof that medications ease migraines in children

A recent study showed that many medications that adults use to ease migraines may not have any effect on children with migraines. In fact, the placebos seemed just as effective as the medications in children.

Medicines to prevent or treat migraines in adults aren’t effective in stopping the headaches in children, according to two studies that suggest doctors may want to re-evaluate the use of the drugs in pediatric patients.

An analysis of 21 trials published in JAMA Pediatrics showed that Johnson and Johnson’s seizure medicine Topamax and the antidepressant trazodone “have limited evidence” to support use in children’s migraines occurring fewer than 15 times a month. Other drugs, including some medicines for hypertension are no better than a placebo, the research found.

About 8 million kids, or 1 of 20 in the U.S., get migraines, according to Jacksonville, Florida-based Nemours, a nonprofit children’s health organization. The results show that more studies are needed to look at the use of adult migraine medicines in kids and what role placebos have in helping children and adolescents, researchers said

“Pediatric clinical trials are different than trials conducted in adults for many reasons,” William Rodriguez, Pediatric Science Director of the Food and Drug Administration Office of Pediatric Therapeutics, said in an e-mail. “One of the issues is that a failed pediatric trial seldom motivates a sponsor to conduct additional pediatric trials. This is in contrast to what happens with failed adult trials. It has to do with the fact the sponsor is usually much more interested in the adult market as the pediatric populations with diseases are small.”

FDA Analysis

Rodriguez was an author on a second analysis by the FDA of trials of children given a commonly used class of migraine drugs called triptans. It found that many children got better without the medication.

In the first study from the Medical College of Wisconsin in Milwaukee, the researchers analyzed 21 trials of migraine medicines that included children and adolescents. Of those, 13 included a group that received a placebo rather than study drug.

They found that Topamax and trazodone reduced episodic migraines more than placebo, less than one headache a month when compared to placebo, while clonidine, for high blood pressure; flunarizine, a calcium channel blocker; pizotifen, a migraine drug; propranolol, for high blood pressure; and valproate, an anticonvulsant, were no more effective than placebo.

The analysis also showed that children taking a placebo, rather than the study drugs, reduced their migraines by an average of about three headaches a month. The high placebo response suggests more studies of pediatric headaches should include a placebo group, the authors said.

Few Studies

“There were surprisingly few studies on treating headaches in children, particularly compared to the hundreds that have been done in adults,” said Jeffrey Jackson, a study author and professor of medicine at the Medical College of Wisconsin, in a Jan. 28 e-mail. “Most of the drugs that are effective in adults do not have evidence of effectiveness in children.”

The FDA analysis found that high placebo response rates were consistent across the migraine trials studied and pose a challenge to those who design the research. When putting together clinical trials, researchers need to take into account those children who feel better after taking a placebo.

“These studies clearly demonstrate why we cannot assume what works in adults will work in kids and why children need their own studies,” Rodriguez said. “There are many -- over 50 percent in most studies -- of children who do not need a drug for the migraine to resolve in a couple of hours. Drug therapy appears to be effective in a certain subset of children with migraine.”

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Yoga may help with depression and sleep problems

A review of studies on yoga shows that yoga may benefit those with depression and sleep problems. People with ADHD or schizophrenia may also benefit.

Some people with certain psychiatric conditions may benefit from yoga, according to a new review.

The review, which examined results from 16 well-designed studies of yoga's effect on mental illness, concluded that yoga may have positive effects for people with depression and sleep complaints even if they don't take medication, as well as for people suffering from schizophrenia and ADHD who are taking medication.

However, the review did not find a benefit for people with eating or cognitive disorders.

Studies that have looked at yoga suggest the practice influences chemical messengers in the brain, inflammation in the body, and other biological factors in much the same way antidepressants and psychotherapy do, said study researcher Dr. P. Murali Doraiswamy, a professor of psychiatry and medicine at Duke University Medical Center in. [See The Science of Yoga and Why It Works.]

However, the studies in the review had limitations. Most of the studies on depression included patients with mild depression, so it's not clear if the results will apply to those with more severe forms of the disorder. Also, in many of the studies, people performed yoga in groups, and it's difficult to separate the effect of yoga from that of social interaction, Doraiswamy said.

In one study of 69 older adults with mild depression, weekly yoga sessions reduced depression scores by 40 percent at six months. A comparison group of adults who didn't take yoga, and a group that practiced a form of complementary medicine called Ayurveda, did not show changes in depression scores.

In another study of 39 adults who were sleeping poorly (they were receiving chemotherapy), seven weeks of yoga improved sleep quality and reduced the need for sleep aids. People who did not take the yoga sessions (control group) did not have an improvement in sleep.

The National Center for Complementary and Alternative Medicine (NCCAM) says people should not  replace conventional medical care with yoga. Nor should people who practice yoga postpone seeing a health care provider. Patients should tell their doctor about any complementary health practices they use. Anyone with a medical condition should check with a health care provider before starting yoga, NCCAM says.

Pass it on: Yoga may have positive effects for people with depression, complaints, schizophrenia or ADHD.

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Prenatal Inflammation Related to Autism Development

A new study claims that prenatal inflammation may be related to the development of autism.

Maternal inflammation during early pregnancy may be related to an increased risk of autism in children, according to new findings supported by the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health. Researchers found this in children of mothers with elevated C-reactive protein (CRP), a well-established marker of systemic inflammation.

The risk of autism among children in the study was increased by 43 percent among mothers with CRP levels in the top 20th percentile, and by 80 percent for maternal CRP in the top 10th percentile. The findings appear in the journal Molecular Psychiatry and add to mounting evidence that an overactive immune response can alter the development of the central nervous system in the fetus.

"Elevated CRP is a signal that the body is undergoing a response to inflammation from, for example, a viral or bacterial infection," said lead scientist on the study, Alan Brown, M.D., professor of clinical psychiatry and epidemiology at Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, and Mailman School of Public Health. "The higher the level of CRP in the mother, the greater the risk of autism in the child."

Brown cautioned that the results should be viewed in perspective since the prevalence of inflammation during pregnancy is substantially higher than the prevalence of autism.

"The vast majority of mothers with increased CRP levels will not give birth to children with autism," Brown said. "We don't know enough yet to suggest routine testing of pregnant mothers for CRP for this reason alone; however, exercising precautionary measures to prevent infections during pregnancy may be of considerable value."

"The brain develops rapidly throughout pregnancy," said Linda Birnbaum, Ph.D., director of NIEHS, which funds a broad portfolio of autism and neurodevelopmental-related research. "This has important implications for understanding how the environment and our genes interact to cause autism and other neurodevelopmental disorders."

The study capitalized on a unique national birth cohort known as the Finnish Maternity Cohort (FMC), which contains an archive of samples collected from pregnant women in Finland, where a component of whole blood, referred to as serum, is systematically collected during the early part of pregnancy. The FMC consists of 1.6 million specimens from about 810,000 women, archived in a single, centralized biorepository. Finland also maintains diagnoses of virtually all childhood autism cases from national registries of both hospital admissions and outpatient treatment.

From this large national sample, the researchers analyzed CRP in archived maternal serum corresponding to 677 childhood autism cases and an equal number of matched controls. The findings were not explained by maternal age, paternal age, gender, previous births, socioeconomic status, preterm birth, or birth weight. The work was conducted in collaboration with investigators in Finland, including the University of Turku and the National Institute for Health and Welfare in Oulu and Helsinki.

"Studying autism can be challenging, because symptoms may not be apparent in children until certain brain functions, such as language, come on line," said Cindy Lawler, Ph.D., head of the NIEHS Cellular, Organ, and Systems Pathobiology Branch and program lead for the Institute's extramural portfolio of autism research. "This study is remarkable, because it uses biomarker data to give us a glimpse back to a critical time in early pregnancy."

This work is expected to stimulate further research on autism, which is complex and challenging to identify causes. Future studies may help define how infections, other inflammatory insults, and the body's immune response interact with genes to elevate the risk for autism and other neurodevelopmental disorders. Preventative approaches addressing environmental causes of autism may also benefit from additional research.

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Mouth Guard to help with Sleep Apnea

A new mouth guard could replace CPAP for people who have mild to moderate sleep apnea.

Debbie Blenis doesn’t know yet if she has obstructive sleep apnea, but the Palm Bay woman knows all about the subject.

“My father has sleep apnea, and I understand what that can be like,” she said. “When he finally saw the doctor about it ... he was told he was a stroke waiting to happen.”

So, knowing sleep apnea runs in her family, aware of the dangers and already possessed of two of its classic symptoms, bruxism (grinding of the teeth) and snoring, she has agreed to be tested for the condition by her dentist, Dr. Lori Nelson of Ultimate Smile Design in Palm Bay.

Nelson and other dentists screen, and now, collaborating with sleep medicine specialists, treat patients for the potentially life-threatening disorder that causes breathing to stop during sleep.

So important is the subject to dentistry that the American Academy of Dental Sleep Medicine, a nonprofit professional society founded in 1991, has more than 2,800 members nationwide and is growing. It and other professional organizations, including the American Dental Association, now offer courses to better acquaint dentists with sleep medicine.

Last year, Dr. Gail Demko, president of AADSM and expert adviser to the Food & Drug Administration in oral appliance therapy, told the publication Dentistry IQ(dentistryiq.com) that dentists are particularly well-equipped to handle “sleep-disordered breathing.”

Once, sleep medicine was strictly the province of specialist physicians who tested and treated apnea and related conditions, often prescribing use of sometimes-cumbersome continuous positive airway pressure devices, which use mild air pressure to keep airways open while patients are sleeping. It involves wearing a mask or other device that fits over the nose and mouth, which is connected by tube to a machine that blows air into the airways.

Patients determined by their physicians to have severe cases of apnea still are prescribed CPAP treatment, but a patient with mild to moderate sleep apnea now may be fitted by his or her dentist with a small, custom-fitted, mouth guardlike appliance that maintains an open, unobstructed airway during sleep.

“The device, which is worn while sleeping, repositions the mandible (lower jaw), so that the airway remains open,” said Nelson, who has practiced dental sleep medicine since 2006.

But it is not simply a matter of fitting a mouthpiece. Potential wearers must first undergo testing and studies, and the dentist’s work is done in conjunction with the doctor’s.

“The important thing to convey is that a dentist cannot treat these conditions alone,” said Dr. Duongvannak Keo, who practices dentistry on Merritt Island. “We’re not allowed to diagnose sleep apnea, we only screen our patients for it. Then, we can treat them based on a physician’s referral and recommendation.”

But dentists, because of their training and the very nature of their profession, do notice the signs.

“The clinical aspect of treating sleep-disordered breathing, be it snoring or sleep apnea, requires basic skills that have been taught to dentists in their restorative dental training. The most important aspect is the academic knowledge required to become part of a team that is treating a medical disease,” Demko said.

It is less a procedure than a process, dentists add.

“We are looking for signs of dental disease, no doubt, but we’re also looking at a patient’s bite and its possible effect on his or her overall health,” Nelson said.

That means questions about sleeping habits as well as teeth.

Nelson said that when a patient reports he or she is not sleeping well, the Epworth Sleepiness Scale, which measures daytime sleepiness by asking a patient to rate his or her likelihood of falling asleep, is used at Ultimate Smile Design, followed by checks of oral and nasal airways.

“If we see something that possibly indicates sleep apnea, we will order a sleep study, coordinated with the patient and his or her physician,” she said.

Keo agreed: “We guide them through the process and refer them to a sleep physician.”

Only after mild to moderate sleep apnea is diagnosed will the dentist recommend the new device.

“A pharyngometer is used to measure the pharyngeal airway size to assess the patient for obstruction, so when the patient is fitted, (the jaw) is in a scientifically specified position,” Nelson said. “And we do confirm things with another sleep study, which we have read by a certified sleep medicine physician.”

Thus, physicians and others who work with sleep apnea patients in the traditional, medical setting say they welcome the involvement of dentists, who may be the first practitioners to notice potential problems

“We work primarily with Dr. Keo, who is certified (in dental sleep medicine and oral appliance therapy),” said Kristina Weaver, sleep center supervisor for Parrish Medical Center in Port St. John. “We will do a sleep consultation and a sleep study, and if the patient has mild sleep apnea, he does the consultation. He makes the mold, and he fits the patient with the device.”

Patients should not expect, however, that the dental device will work on all sleep apnea patients.

“These devices are intended primarily for people with mild sleep apnea,” Weaver said. “The CPAP still is always the first alternative, because we know without a doubt that it will correct the problem. (The mouthpiece) is not as good as the CPAP, but if the apnea is mild, it may help.”

Keo, who estimates he has made about 100 oral appliances for sleep apnea patients, called them “devices for people who cannot tolerate CPAPs; people who are looking for alternatives,” and referred to the CPAP as “the gold standard.”

Furthermore, dentists who screen patients for possible sleep apnea are by no means attempting to usurp anything from physicians.

“We tell every physician, ‘Look, I’m not taking your patient, I’m just screening for problems that you can help with. I’m not taking your patients, I’m giving you patients.’ ”

Most physicians don’t realize that such appliances even exist, he added, and so the dentist becomes a source of information as well.

“I think this is the way of the future,” Nelson said. “This is where medicine and dentistry are headed: working together for the good of our patients.

Blenis couldn’t agree more.

“I absolutely think sleep apnea is life-threatening,” she said. “It’s easy to ignore, especially if you don’t sleep with a partner who would notice that you are snoring loudly, or that your breathing has stopped. ... I feel a lot of comfort in that my dentist is watching out for my overall health and not just my teeth.”

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