Covid-19 & Congenital Muscular Dystrophy - Preparation and Airway Clearance

Check with your pulmonologist if this advice is best for you / your child. I am just a pediatric neurologist. Please call them. JR

Is your pediatric neurologist board-certified?

It is important to ask if your physician, in my case, a child neurologist is board-certified.

New Pediatric Sleep & EEG Center in the Houston Texas Medical Center - Children and their Adults are Welcome!

Dear Friends,

Dr Susarla and Dr. Rotenberg are writing let you know about our new sleep and EEG facility in the Texas Medical Center.

Starting this week, we will offer EEG and sleep diagnostic services at our new location on the 4th floor of 7505 Fannin St -  across the street from The Woman's Hospital in the “Chase” building.

The facility will be dedicated to infants, children and teens….and their families.

We welcome teenagers and young adults in the practice, offering the same attention and care to adults as we do to the youngest of our patients.

This outpatient site joins Academy Diagnostics’ Kimberly Lane Location offering BOTH a West Side/Katy AND a central Medical Center alternative for our patients.

Please contact me or our office to speak to Miangela Kanaway or Shamile Morgan RPGST for more information.

Thank you for your patience this month as we transition from Healthbridge to our new home.

Warm Regards,

Dr. Joshua Rotenberg

LINK to Our Website

LINK to Academy Diagnostics Order Form for EEG or Sleep Studies

GOOGLE Map here

Those with sleep apnea are more likely to develop pneumonia

People who have sleep apnea are more likely to develop pneumonia.

People with sleep apnea may be at greater risk for developing pneumonia, according to a new study. And the more severe the sleep apnea, the greater the risk, the research suggests.

"This study showed that sleep apnea is an independent risk factor for incident pneumonia," wrote Dr. Vincent Yi-Fong Su and Dr. Kun-Ta Chou of the department of chest medicine at Taipei Veterans General Hospital in Taiwan. "Our results also demonstrated an exposure-response relation in that patients with more severe sleep apnea may have a higher risk of pneumonia than patients with sleep apnea of milder severity."

The sleep disorder causes the upper airway to become blocked, cutting off oxygen during sleep. The researchers said this increases the risk for aspiration, or inhaling contents or fluid from the throat into the lungs. This can put people at greater risk for pneumonia.

The 11-year study, published March 3 in CMAJ, involved 34,100 patients. Close to 7,000 of these participants had sleep apnea, and about 27,000 did not.

The researchers found that more than 9 percent of the sleep apnea group developed pneumonia, compared to less than 8 percent of those without the sleep disorder. The risk was higher among patients using continuous positive airway pressure (CPAP) therapy, considered the gold standard for treating sleep apnea.

However, those who developed pneumonia were older and had other health problems, such as heart disease, diabetes and dementia.

While the study showed an association between sleep apnea and pneumonia risk, it did not prove a cause-and-effect link.

Read more here

Younger siblings of children with autism show abnormal development

Research shows that younger siblings of children with autism show abnormal development and behavior early.

Younger siblings of children with autism may show signs of abnormal development or behavior as early as 1 year of age, according to a new study.

The findings suggest that parents and doctors should keep close watch for such symptoms at an early age among younger siblings of children with autism so problems can be addressed sooner, the researchers said.

The new study included nearly 300 infant siblings of children with autism and 116 infant siblings of children without the disorder. The children's development was assessed at 6 months, 12 months, 18 months, 24 months and 36 months of age.

Researchers found problems in nearly half of the siblings of children with autism, with 17 percent developing autism and 28 percent having delays in other areas of development or behavior.

Among that 28 percent, abnormalities in social, communication, thinking or movement development were apparent by the time they were 1 year old. The most common types of problems were extreme shyness with strangers, lower levels of eye contact and delayed pointing, according to the study, which was published online recently in the Journal of the American Academy of Child and Adolescent Psychiatry.

"This research should give parents and clinicians hope that clinical symptoms of atypical development can be picked up earlier, so that we can, perhaps, reduce some of the difficulties that these families often face by intervening earlier," study author Sally Ozonoff, a professor of psychiatry and behavioral sciences at the MIND Institute at the University of California, Davis, said in a university news release.

"Good clinical practice suggests that when children are showing atypical development they and their families should be provided with information about the child's difficulties, clinical reports when practical and referrals to local service providers," Ozonoff said.

Treatment will vary depending on the child and family, she added.

"The intervention approaches need to be chosen based on each child's profile of strengths and weaknesses and each family's goals and priorities," Ozonoff said.

Read more here

Vision tests may help spot concussions

Research shows that a vision testing on the sidelines at games can help determine if a player has had a concussion or not. Caution if the athlete has a reading disorder. JR

A simple vision test given on the sidelines can help identify athletes who've suffered a concussion, a new study finds.

Researchers found that the test -- known as the King-Devick, or K-D -- was able to detect 79 percent of concussions among college athletes who were followed over a season. When the results were combined with those of two other screening tests, all of the concussions were caught.

The findings were released Wednesday by the American Academy of Neurology (AAN), ahead of its annual meeting this spring.

Experts said the study bolsters evidence that the K-D is a reliable way to help spot athletes' head injuries -- though the test, by itself, is not enough.

"People have been looking for quick, on-the-field screening tests," said Steven Broglio, an athletic trainer and director of the NeuroSport Research Laboratory at the University of Michigan in Ann Arbor.

The new findings suggest the K-D is "one option," said Broglio, who was not involved in the study. "But it's not definitive, and you wouldn't want to rely on this alone," he added.

The K-D takes a minute or two, and it can be given by an athletic trainer, coach or even a parent right on the sidelines. It requires test-takers to read a few rows of single-digit numbers that are unevenly spaced, as quickly and accurately as possible. If they are slower to finish than they were on their "baseline" test -- taken before the season starts -- that's a potential sign of a concussion.

There are other sideline screening tests already in use, including ones that test balance and short-term memory.

But the K-D test "fills a gap" by looking for vision-related problems, explained study co-author Dr. Steven Galleta, chair of neurology at NYU Langone Medical Center in New York City.

Concussions can cause a wide range of symptoms that are often subtle at first. Symptoms like worsening headache, dizziness, nausea, fatigue and confusion might not become obvious until hours after the knock to the head. Plus, even when athletes are suffering immediate problems, they might not tell anyone.

"Some athletes don't recognize the symptoms, and some try to hide them because they want to stay in the game," Galleta said.

A number of professional groups, such as the AAN and National Athletic Trainers' Association, say that athletes who've potentially suffered a concussion should be taken out of the game or practice immediately.

For the new study, Galleta and his colleagues followed 217 athletes at the University of Florida -- including male football players, and female lacrosse and soccer players.

At the start of the season, they all took the K-D, as well as two other sideline screening tests: the BESS, which measures balance; and the SAC, which measures abilities such as short-term memory (asking the athlete to memorize and recall five words) and "orientation" (asking the player to name the day, month and year).

Over one season, 30 athletes were diagnosed with a concussion. And when the researchers looked at their sideline test results, 79 percent showed slower times on the K-D, compared with their pre-season performance. Adding the SAC and BESS results improved the detection rate to 100 percent.

Part of the appeal of the K-D is its simplicity; it can be used by "laypeople," including coaches and parents, Galleta noted. That raises the question of whether it can be used in high school and youth sports -- where there is often no athletic trainer or other health professional on the sidelines.

Studies are currently testing the K-D's usefulness for kids as young as 6, said Dr. Laura Balcer, a professor of neurology at NYU Langone who also worked on the study.

But regardless of what the K-D or other screening test shows on the sidelines, Balcer said there is "no substitute" for parents' judgment. If they notice any potential signs of concussion after a game or practice, they should take their child to the doctor immediately, she said.

"Parents know their kids best," Broglio agreed. "If you notice a change in their behavior, it's probably worth it to have them evaluated."

According to the U.S. Centers for Disease Control and Prevention, more than 173,000 U.S. children and teens land in the ER each year because of a concussion suffered during sports or recreational activities, like bike riding.

But the overall number -- including kids not seen in the ER -- is probably much larger: the CDC estimates that across age groups, up to 3.8 million Americans sustain a sports-related concussion each year.

In general, experts say kids with concussions should be symptom-free and get a doctor's OK before returning to sports. The biggest concern is that, if they sustain another knock to the head while they are still recovering from the first concussion, they could suffer so-called second-impact syndrome -- which can cause potentially fatal bleeding inside the skull and brain swelling.

The data and conclusions of research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

Read more here

Study: Treating youth anxiety has long lasting benefits

A study shows that treating youth anxiety has many beneficial long-lasting benefits for the child. - JR

A study published in the March 2014 issue of the Journal of the American Academy of Child and Adolescent Psychiatry found that the majority of youth with moderate to severe anxiety disorders responded well to acute treatment with cognitive behavioral therapy (CBT), medication (sertraline), or a combination of both. They maintained positive treatment response over a 6 month follow-up period with the help of monthly booster sessions.

As part of the NIMH Child/Adolescent Anxiety Multimodal Study (CAMS), a group of researchers led by Dr. John Piacentini of the UCLA Semel Institute for Neuroscience and Human Behavior, followed 412 children and adolescents ages 7-17 after they completed 12 weeks of acute treatment. Treatment responders were offered 6 additional monthly booster sessions, with those initially on medication continuing this treatment; all youth, regardless of status at week 12, were re-evaluated 3 and 6 months later by trained clinicians. Twenty-seven percent of study participants also reported receiving outside (e.g. nonstudy) psychotherapy and/or medication for mental health symptoms over the 6 month follow-up period.

The study found that over 80% of youth rated as positive responders to one of the three CAMS treatments at Week 12 were also rated as responders at both the 3 and 6 month follow-up evaluations. Conversely, only 5% of youth who received combined CBT plus sertraline, and 15-16% of youth receiving either CBT-only or sertraline-only, failed to achieve responder status at any time during the study. Youth in the combined CBT+sertraline group showed greater treatment benefits on some but not all outcome measures and used less nonstudy treatments than those in the CBT-only and sertraline-only groups.

Collectively, anxiety disorders are the most common mental disorders in children and adolescents. Often overlooked, severe anxiety can significantly impair children's school, social, and family functioning, and if untreated, can increase the risk of depression, alcohol and substance abuse, and occupational difficulties in adulthood.

CAMS is the largest randomized controlled comparative treatment trial for child/adolescent anxiety disorders ever conducted. Participants were recruited at six regionally dispersed sites throughout the United States (UCLA, Duke University, Columbia University/New York University, Johns Hopkins University, Temple University, and the Western Psychiatric Institute and Clinics/University of Pittsburgh) and randomly assigned to 12 weeks of treatment with cognitive behavioral therapy (Coping cat), the selective serotonin reuptake-inhibiting [SSRI] medication sertraline, cognitive behavioral therapy combined with sertraline, or pill placebo. All participants had moderate to severe separation anxiety disorder, generalized anxiety disorder or social phobia, with most having multiple anxiety or other mental health disorders..

"The results of this study provide further evidence of the benefits of cognitive behavioral therapy and SSRI medication, alone or in combination, for treating clinically significant anxiety in children and adolescents," said Dr. Piacentini. "A separate project by the CAMS researchers is now gathering information on how study participants are doing up to 10 years after study participation."

Read more here

Study: Asthma medications can raise risk of sleep apnea

I have had questions on this one. This is a very small study n=18. Association does not imply causation. 

Call your pulmonologist to optimize your asthma management.

JR

A study shows that using common asthma medications can raise a person's risk of sleep apnea.

Medicines commonly used to control asthma may increase the risk of a potentially serious sleep problem in some people, a small, early study suggests.

"Inhaled corticosteroids may predispose to sleep apnea in some asthma patients," said study author Dr. Mihaela Teodorescu, an associate professor of medicine at the University of Wisconsin School of Medicine and Public Health, in Madison.

In sleep apnea, breathing periodically stops during sleep, for a few seconds or even minutes at a time, according to the U.S. National Heart, Lung, and Blood Institute. The pauses can occur as often as 30 times or more in a single hour. In the most common type of apnea, the airway becomes blocked or collapses during sleep. If untreated, apnea can increase the risk of high blood pressure, heart attack, stroke and other problems.

However, the new study linking asthma medicines with an increased apnea risk was very small -- including just 18 patients. And the researchers found a link, not cause and effect, and don't yet know what that connection means.

An expert not involved in the study was skeptical of the findings, emphasizing that more work is needed.

Teodorescu agreed, and is continuing to look at the medicines.

In the new study, the 18 men and women evaluated were taking 1,760 micrograms a day of inhaled fluticasone (Flovent). (Another inhaled corticosteroid is budesonide, or Pulmicort.)

The researchers monitored the men and women for changes in the "collapsibility" of their upper airways during sleep and their tongue function. Three patients had the amount of fat in their soft palates measured with MRIs, which found a redistribution of fat to the neck area, which can narrow the airway.

All the patients had changes in their tongue function and upper airway consistent with sleep apnea, said Teodorescu, who is also the director of the James B. Skatrud Pulmonary Sleep Research Laboratory at the Middleton Memorial Veterans Hospital, in Madison, Wisc.

Some patients were more affected than others, Teodorescu said. More vulnerable, she said, were the patients who were mid-30s or older, men and those whose asthma was poorly controlled at the start.

Teodorescu decided to study the effect of the corticosteroids after she said she found growing evidence that sleep apnea is more prevalent among people with more severe asthma. The current study is a pilot study.

The study appears in the February issue of the Journal of Clinical Sleep Medicine.

One expert called for more research into the link.

"We need a larger study," said Dr. Len Horovitz, a pulmonologist and internist at Lenox Hill Hospital in New York City. The steroids studied by the Wisconsin researchers are a mainstay of treatment for moderate asthma, he said, and can work well to control the asthma.

The findings cited by the researchers -- floppiness of the tongue and oral membranes -- would typically also be linked with noticeable speech changes and vocal quality changes, he said. The researchers should consider including evaluations by a speech pathologist and ear-nose-throat specialists, he added.

"Time will tell when we look at a larger study," Horovitz said.

Michele Meixell, a spokesperson for AstraZeneca, said that her company's Pulmicort (budesonide) is safe and effective "when used in accordance with the FDA-approved indications."

Meanwhile, Teodorescu said if asthma patients are getting control of their asthma on prescribed steroids, "they should continue." She suggested the medicine and dose be tailored to each patient's needs.

"If people with asthma are told they snore, they should talk to their physician about the possibility of sleep apnea," she added.

Fibromyalgia may be a sleep disorder

A neurologist can detect alpha intrusion on a sleep study. JR

A study claims that fibromyalgia syndrome may be a sleep disorder, or at least linked to one.

Nobody says, "I don't believe hypertension exists," or "I don't believe 'stroke' is a real thing." People with fibromyalgia syndrome (FMS) suffer not only from constant widespread pain, but they also sometimes face judgment and distrust from medical professionals who doubt if their condition is real. They are labeled as annoying and needy. In the literal sense, insult is added to injury.

The root cause of FMS is poorly understood, which may explain why its legitimacy is questioned by some healthcare professionals. FMS is characterized by chronic widespread musculoskeletal pain, stiffness, and tenderness at multiple points. The prevalence of FMS ranges from 2 percent to 3 percent of the general population, with women affected six to nine times more frequently than men.

In addition to pain symptoms from head to toe, people with FMS also complain of poor sleep, chronic fatigue, depressed mood, headaches, and many other symptoms. However, complaints of poor sleep and chronic fatigue may be more significant to individuals with FMS than pain symptoms. Analysis of slow-wave sleep in individuals with FMS often demonstrates characteristic alpha-wave intrusions in slow wave sleep, which are thought to contribute to poor sleep in this population. Furthermore, a trial using sodium oxybate, a medication known to increase slow-wave sleep, demonstrated improvement in fibromyalgia symptoms.

As the association between FMS and sleep has been further studied, more evidence has mounted that FMS in many cases is a byproduct of a sleep disorder. A 2006 study demonstrated a more than ten-fold increase in FMS in subjects with sleep-disordered breathing (SDB) compared to the normal population.

Research suggests that FMS is a disorder of hypersensitivity of the central nervous system (CNS). The peripheral nervous system (PNS) is constantly sending signals from various areas of the body to the CNS. The CNS then filters these signals, ignoring the insignificant while responding to the more pressing. Due to the hypersensitivity of the CNS in FMS, those lesser signals are not filtered, leading to widespread pain.

Poor sleep quality has a similar effect on CNS signal filtration. Many with chronic pain syndromes (e.g., arthritis) describe improvement in pain with a good night's sleep and vice versa. It is a well-known phenomenon in the neurology community that sleep deprivation is a powerful trigger for seizures. Seizures are caused by inappropriate hyperexcitation of certain neurons leading to a cascade of electrical discharges in the cerebral cortex that overcome (or "seize") the function of that region of the brain.

Diagnosis and treatment of SDB and other chronic sleep conditions can lead to significant improvement in FMS independent of any other therapy. However, since the overwhelming majority of FMS sufferers are women, and many women with SDB have more subtle airflow disruptions than their male counterparts, it is essential that testing be sensitive enough to detect these less obvious changes. Those who have had a prior negative sleep study or who do not snore should seek a sleep center that focuses on diagnosing and treating subtle SDB, such as Upper Airway Resistance Syndrome. Esophageal manometry can be used to measure intrathoracic pressure during sleep. This metric can help detect increased respiratory effort and subtle changes in airflow during sleep that can cause sleep fragmentation and that otherwise would be missed.

FMS sufferers with poor sleep may experience frequent nighttime arousals, tossing and turning in bed, morning headaches, nasal congestion in the morning that was not present upon going to bed, dry mouth during the night, episodes of waking up with palpitations, teeth clenching or grinding at night, temperomandibular joint (TMJ) or jaw pain in the morning, and acid reflux during the night or in the morning. While these are not specific signs independently, they all are suggestive of irregular breathing during sleep.

So for the four to six million Americans suffering from FMS, perhaps it's time to see a sleep specialist. A proper night's sleep just might cure what ails you.

Read more here

Dysautonomia after pediatric brain injury - Not rare!

Developmental Medicine and Child NeurologyDev Med Child Neurol 2012; 54(8)

Dysautonomia after pediatric brain injury.

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 University of Pittsburgh School of Medicine, Pittsburgh, PA;  The Division of Pediatric Critical Care Medicine, The Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO;  Department of Biostatistics, The University of Pittsburgh School of Public Health, Pittsburgh, PA;  Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA;  The Children's Institute of Pittsburgh, Pittsburgh, PA;  University of Pittsburgh Medical Center, Departments of Critical Care Medicine and Pediatrics, and the Safar Center for Resuscitation Research, Pittsburgh, PA, USA.

Abstract

Aim  Dysautonomia after brain injury is a diagnosis based on fever, tachypnea, hypertension, tachycardia, diaphoresis, and/or dystonia. It occurs in 8 to 33% of adults with brain injury and is associated with poor outcome. We hypothesized that children with brain injury with dysautonomia have worse outcomes and prolonged rehabilitation, and sought to determine the prevalence of dysautonomia in children and to characterize its clinical features. Method  We developed a database of children (n=249, 154 males, 95 females; mean [SD] age 11 years 10 months [5y 7mo]) with traumatic brain injury, cardiac arrest, stroke, infection of the central nervous system, or brain neoplasm admitted for rehabilitation to The Children's Institute of Pittsburgh between 2002 and 2009. Dysautonomia diagnosis, injury type, clinical signs, length of stay, and Functional Independence Measure for Children (WeeFIM) testing were extracted from medical records, and analysed for differences between groups with and without dysautonomia. Results  Dysautonomia occurred in 13% of children with brain injury (95% confidence interval 9.3-18.0%), occurring in 10% after traumatic brain injury and 31% after cardiac arrest. The combination of hypertension, diaphoresis, and dystonia best predicted a diagnosis of dysautonomia (area under the curve=0.92). Children with dysautonomia had longer stays, worse WeeFIM scores, and improved less on the score's motor component (all p≤0.001). Interpretation  Dysautonomia is common in children with brain injury and is associated with prolonged rehabilitation. Prospective study and standardized diagnostic approaches are needed to maximize outcomes.

© The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.

Adults with ADHD report childhood abuse

30% of adults who have ADHD reported that they also were abused as children.

Thirty percent of adults with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD/ADHD) report they were physically abused before they turned 18. This compares to seven per cent of those without ADD/ADHD who were physically abused before 18. The results were in a study published in this week's onlineJournal of Aggression, Maltreatment, and Trauma.

"This strong association between abuse and ADD/ADHD was not explained by differences in demographic characteristics or other early adversities experienced by those who had been abused," says lead author Esme Fuller-Thomson, Professor and Sandra Rotman Chair at University of Toronto's Factor-Inwentash Faculty of Social Work. "Even after adjusting for different factors, those who reported being physically abused before age 18 had seven times the odds of ADD/ADHD."

Investigators examined a representative sample of 13,054 adults aged 18 and over in the 2005 Canadian Community Health Survey including 1,020 respondents who reported childhood physical abuse and 64 respondents who reported that they had been diagnosed by a health professional with either ADHD or ADD.

"Our data do not allow us to know the direction of the association. It is possible that the behaviors of children with ADD/ADHD increase parental stress and the likelihood of abuse," says co-author Rukshan Mehta, a graduate of the University of Toronto's Masters of Social Work program. "Alternatively, some new literature suggests early childhood abuse may result in and/or exacerbate the risk of ADD/ADHD."

According to co-author Angela Valeo from Ryerson University, "This study underlines the importance of ADD/ADHD as a marker of abuse. With 30 per cent of adults with ADD/ADHD reporting childhood abuse, it is important that health professionals working with children with these disorders screen them for physical abuse."

Read more here

Children with autism face more health complications when obese

Children who have autism and are obese are more likely to suffer from other health complications, such as anxiety, depression, and sleep problems.

Adding to the complications of autism, overweight and obese children with the disorder are prone to a host of other troubles, including depression, anxiety and sleep problems, reports a study published 2 February in the Journal of Autism and Developmental Disorders.

The findings suggest that excess weight can signal, or even trigger, less obvious conditions in autism, and that variations in weight may affect results about the prevalence of sleep, mood and anxiety problems in behavioral research studies.

In the new study, researchers calculated the body mass index (BMI), a measure of body fat based on weight and height, of 376 children with autism living in Oregon. (The healthy range for a BMI is between 18 and 25.) The participants, ranging in age from 2 to 18 years, are part of the Autism Treatment Network, a group of collaborating hospitals organized by the research and advocacy group Autism Speaks.

The researchers then analyzed the relationship between parent and clinician reports and the children’s BMI. The reports documented the children’s behavior and other conditions.

Roughly 18 percent of the children in the study were overweight — with a BMI between 25 and 30 — and 17 percent were obese, with a BMI above 30. For comparison, about 32 percent of typically developing children are overweight or obese.

Among teenagers with developmental disabilities, those with autism are the most likely to be obese, according to a study published 20 February in Maternal and Child Health Journal. The study found that 32 percent of adolescents with autism are obese, compared with 20 percent of those with developmental disabilities such as intellectual disability and attention deficit hyperactivity disorder. In contrast, 13 percent of typical teenagers are obese.

Studies have suggested that depressive symptoms may be both a cause and a consequence of childhood obesity. The Oregon study found that obese children younger than 6 years are more likely to suffer from anxiety and mood problems, such as depression, than are children who weigh less.

Obese children older than 6 years do not show this trend, but that may be because their version of the test poses different questions.  

Roughly 85 percent of overweight and obese children with autism under 11 years also struggle with sleep. Children with the disorder tend not to sleep well in general.

The new study found that roughly 75 percent of the children with autism under 11 years of age with a healthy weight don’t sleep well.

Possibly as a consequence, one in three obese children with autism take the sleep-promoting hormone melatonin, compared with one in five children with autism who have a healthy BMI.

Interestingly, however, some symptoms of autism are less severe among children carrying extra weight. The study found that children with the disorder who are overweight, but not those who are obese, have lower levels of repetitive behaviorsthan their slender peers do.

This relationship is difficult to interpret, the researchers note. It’s possible that repetitive behaviors burn many calories, contributing a healthy BMI, but that does not explain the severity of the behavior among obese children with autism. The researchers also suggest that children with severe repetitive behaviors may take medications, such as risperidone, that cause them to gain weight.

Read more here

Study shows that more stress means more headaches

A study shows that having more stress in your life means you get more headaches.

A new study provides evidence for what many people who experience headache have long suspected—having more stress in your life leads to more headaches. The study released today will be presented at the American Academy of Neurology's 66th Annual Meeting in Philadelphia, April 26 to May 3, 2014.

For the study, 5,159 people age 21 to 71 in the general population were surveyed about their stress levels and headaches four times a year for two years. Participants stated how many headaches they had per month and rated their stress level on a scale of zero to 100.

A total of 31 percent of the participants had tension-type headache, 14 percent had migraine, 11 percent had migraine combined with tension-type headache and for 17 percent the headache type was not classified. Those with tension-type headache rated their stress at an average of 52 out of 100. For migraine, it was 62 out of 100 and 59 for those with migraine and tension-type headache.

For each type of headache, an increase in stress was associated with an increase in the number of headaches per month. For those with tension headache, an increase of 10 points on the stress scale was associated with a 6.3-percent increase in the number of headache days per month. For migraine, the number of headache days per month went up by 4.3 percent, and 4 percent for those with migraine and tension headache. The results were adjusted to account for factors that could affect the number of headaches, such as drinking, smoking and frequent use of headache drugs.

"These results show that this is a problem for everyone who suffers from headaches and emphasize the importance of stress management approaches for people with migraine and those who treat them," said study author Sara H. Schramm, MD, of University Hospital of University Duisburg-Essen in Germany. "The results add weight to the concept that stress can be a factor contributing to the onset of headache disorders, that it accelerates the progression to chronic headache, exacerbates headache episodes, and that the headache experience itself can serve as a stressor."

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DNA may explain why more boys are affected by autism than girls

A study that looks at genetics and DNA to determine why more boys are affected by autism than girls are.

A new DNA study begins to explain why girls are less likely than boys to have an autism spectrum disorder.

It turns out that girls tend not to develop autism when only mild genetic abnormalities exist, the researchers said. But when they are diagnosed with the disorder, they are more likely to have more extreme genetic mutations than boys who show the same symptoms.

"Girls tolerate neurodevelopmental mutations more than boys do. This is really what the study shows," said study author Sebastien Jacquemont, an assistant professor of genetic medicine at the University Hospital of Lausanne, in Switzerland.

"To push a girl over the threshold for autism or any of these neurodevelopmental disorders, it takes more of these mutations," Jacquemont added. "It's about resilience to genetic insult."

The dilemma is that the researchers don't really know why this is so. "It's more of an observation at a molecular level," Jacquemont noted.

In the study, the Swiss researchers collaborated with scientists from the University of Washington School of Medicine to analyze about 16,000 DNA samples and sequencing data sets from people with neurodevelopmental disorders, including autism spectrum disorders.

The investigators also analyzed genetic data from almost 800 families affected by autism for the study, which was released online Feb. 27 in the American Journal of Human Genetics.

The researchers analyzed copy-number variants (CNVs), which are individual variations in the number of copies of a particular gene. They also looked at single-nucleotide variants (SNVs), which are DNA sequence variations affecting a single nucleotide. Nucleotides are the basic building blocks of DNA.

The study found that females diagnosed with any neurodevelopmental disorder, including attention-deficit/hyperactivity disorder and intellectual disability, had more harmful CNVs than males who were diagnosed with the same disorder. Females with autism also had more harmful SNVs than males with the condition.

"There's a well-known disparity when it comes to developmental disorders between boys and girls, and it's been puzzling," Jacquemont said. "And there have been quite a bit of papers trying to investigate this bias that we've seen in the clinic."

The study authors pointed out that autism affects four boys for every one girl. The ratio increases to seven-to-one when looking at high-functioning autism cases.

It's an interesting study, said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven & Alexandra Cohen Children's Medical Center of New York.

"It's not an easy study to read, but certainly the take-away suggests it tries to lend further support to the assumption that the ratio of males to females [who have autism] is affected by genetic vulnerabilities -- that it has a genetic underpinning," Adesman said.

What do the findings mean for parents and patients?

Adesman said there are no immediate benefits, but the knowledge can help direct future research.

"This isn't going to lead to a breakthrough in treatment, but from a clinical standpoint it may help researchers and academics understand why it is that developmental disorders seem to be more common in boys than girls," he noted.

The new research also reinforces that genetic differences -- or vulnerabilities -- aren't limited to sex chromosomes, Adesman added.

"The presumption has been, 'Well gee, boys have a Y chromosome and girls don't, so are there problems with the Y chromosome that explain it?'" Adesman noted.

"The bottom line is that there are a lot of different genetic abnormalities and atypicalities that result in developmental disorders in children and adults," Adesman explained. "Women seem to be a little more resilient in terms of being able to have minor abnormalities without having a developmental problem."

Jacquemont agreed that the team's discovery opens the door for new avenues of study.

The findings provide ideas "for deciphering the issue further," said Jacquemont. "One study that might be helpful would be trying to understand what are the symptoms that appear a lot faster in males than females. There are a lot of alleys that could be explored."

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Study: ADHD in children linked to tylenol use in pregnancy

A recent study claims that women who took tylenol (acetaminophen) while pregnant may have a higher chance of having a child with ADHD.

If you were pregnant, did you ever take a Tylenol?

If not, you have unreal levels of tolerance for discomfort but if you did, and you think your child is hyperactive, a new study may have some answers. Not 'why' answers, just a 'perhaps' answer. But look for mainstream media to declare that Tylenol causes attention-deficit/hyperactivity disorder (ADHD) in kids.

Acetaminophen is the most commonly used medication for pain and fever during pregnancy. But some studies have suggested that acetaminophen has effects on sex and other hormones, which can in turn affect neurodevelopment and cause behavioral dysfunction. The authors of a new paper in JAMA Pediatrics studied 64,322 children and mothers in the Danish National Birth Cohort (1996-2002). Parents reported behavioral problems on a questionnaire, and hyperkinetic disorders (HKDs, a severe form of ADHD) diagnoses and ADHD medication prescriptions were collected from Danish registries.

They found that more than half of the mothers reported using acetaminophen while pregnant. No surprise there. But then they also found that the use of acetaminophen during pregnancy appeared to be associated with a higher risk of HKD diagnosis, of using ADHD medications or of having ADHD-like behaviors at age 7 years. The risk increased when mothers used acetaminophen more than one trimester during pregnancy.

“Maternal acetaminophen use during pregnancy is associated with a higher risk for HKDs and ADHD-like behaviors in children. Because the exposure and outcomes are frequent, these results are of public health relevance but further investigations are needed,” they conclude.

In an accompanying editorial (JAMA Pediatr doi:10.1001/jamapediatrics.2013.5292), Miriam Cooper, M.R.C.Psych, M.Sc., of Cardiff University School of Medicine, and colleagues write, “Indeed, causation cannot be inferred from the present observed associations, and Liew et al are right to point out that a replication of their study is needed. 

“In summary, findings from this study should be interpreted cautiously and should not change practice. However, they underline the importance of not taking a drug’s safety during pregnancy for granted, and they provide a platform from which to conduct further related analyses exploring a potential relationship between acetaminophen use and altered neurodevelopment.”

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Reaching My Autistic Son Through Disney

What an amazing story about meeting a child where he is. JR

In our first year in Washington, our son disappeared.

Just shy of his 3rd birthday, an engaged, chatty child, full of typical speech — “I love you,” “Where are my Ninja Turtles?” “Let’s get ice cream!” — fell silent. He cried, inconsolably. Didn’t sleep. Wouldn’t make eye contact. His only word was “juice.”

I had just started a job as The Wall Street Journal’s national affairs reporter. My wife, Cornelia, a former journalist, was home with him — a new story every day, a new horror. He could barely use a sippy cup, though he’d long ago graduated to a big-boy cup. He wove about like someone walking with his eyes shut. “It doesn’t make sense,” I’d say at night. “You don’t grow backward.” Had he been injured somehow when he was out of our sight, banged his head, swallowed something poisonous? It was like searching for clues to a kidnapping.

After visits to several doctors, we first heard the word “autism.” Later, it would be fine-tuned to “regressive autism,” now affecting roughly a third of children with the disorder. Unlike the kids born with it, this group seems typical until somewhere between 18 and 36 months — then they vanish. Some never get their speech back. Families stop watching those early videos, their child waving to the camera. Too painful. That child’s gone.

In the year since his diagnosis, Owen’s only activity with his brother, Walt, is something they did before the autism struck: watching Disney movies. “The Little Mermaid,” “Beauty and the Beast,” “Aladdin” — it was a boom time for Disney — and also the old classics: “Dumbo,” “Fantasia,” “Pinocchio,” “Bambi.” They watch on a television bracketed to the wall in a high corner of our smallish bedroom in Georgetown. It is hard to know all the things going through the mind of our 6-year-old, Walt, about how his little brother, now nearly 4, is changing. They pile up pillows on our bed and sit close, Walt often with his arm around Owen’s shoulders, trying to hold him — and the shifting world — in place.

Photo

Owen at 18 months, before signs of autism.CreditFrom the Suskind family

Then Walt slips out to play with friends, and Owen keeps watching. Movie after movie. Certain parts he rewinds and re-watches. Lots of rewinding. But he seems content, focused.

We ask our growing team of developmental specialists, doctors and therapists about it. We were never big fans of plopping our kids in front of Disney videos, but now the question seemed more urgent: Is this good for him? They shrug. Is he relaxed? Yes. Does it seem joyful? Definitely. Keep it limited, they say. But if it does all that for him, there’s no reason to stop it.

So we join him upstairs, all of us, on a cold and rainy Saturday afternoon in November 1994. Owen is already on the bed, oblivious to our arrival, murmuring gibberish. . . . “Juicervose, juicervose.” It is something we’ve been hearing for the past few weeks. Cornelia thinks maybe he wants more juice; but no, he refuses the sippy cup. “The Little Mermaid” is playing as we settle in, propping up pillows. We’ve all seen it at least a dozen times, but it’s at one of the best parts: where Ursula the sea witch, an acerbic diva, sings her song of villainy, “Poor Unfortunate Souls,” to the selfish mermaid, Ariel, setting up the part in which Ursula will turn Ariel into a human, allowing her to seek out the handsome prince, in exchange for her voice.

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