Study: Alternative Medicine Use High Among Children With Chronic Conditions

This study discusses how the use of alterative medicine is very high (71%) among children with chronic health conditions. This may pose an issue if the alternative medications and therapies are not discussed with a doctor.

Children who regularly see specialists for chronic medical conditions are also using complementary medicine at a high rate, demonstrates recently published research from the University of Alberta and the University of Ottawa.

About 71 per cent of pediatric patients attending various specialty clinics at the Stollery Children's Hospital in Edmonton used alternative medicine, while the rate of use at the Children's Hospital of Eastern Ontario in Ottawa was 42 per cent. Nearly 20 per cent of the families who took part in the study said they never told their physician or pharmacist about concurrently using prescription and alternative medicine.

Sunita Vohra, a researcher with the Faculty of Medicine & Dentistry at the U of A, was the lead investigator on the study, which was recently published in the peer-reviewed journal Pediatrics. Her co-investigator was W. James King from the University of Ottawa.

"The children in this study are often given prescription medicines," says Vohra, a pediatrician who works in the Department of Pediatrics and the School of Public Health at the U of A.

"And many of these children used complementary therapies at the same time or instead of taking prescription medicine. We asked families if they would like to talk about the use of alternative medicine, more than 80 per cent of them said, 'yes, please.'

"Right now, these families are getting information about alternative medicine from friends, family and the Internet, but a key place they should be getting this information from is their doctor or another member of their health-care team, who would know about possible drug interactions with prescription medicines." Vohra said the study "identified a gap in communications" in dealing with pediatric patients and their families.

"It's important to get these conversations going with every patient, especially when you consider it's not widely recognized how common it is for children with chronic illnesses to use alternative medicine," says the Alberta Innovates-Health Solutions scholar.

"We need to make sure these families are comfortable telling their specialists they are taking other therapies," she said. Right now, Vohra and her colleagues at the U of A have developed curricula for undergraduate medical students about the use of alternative medicine by pediatric patients, which is considered innovative and novel. Ensuring medical students receive information about alternative medicine is key because it arms them with more knowledge about potential interactions with prescription medicine, says Vohra.

"Considering parents are saying they want this information, we have an obligation to ensure future physicians have the education and resources they need for these conversations," Vohra says.

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Study: Research Lacking on Drugs for Older Children With Autism

A new study claims that there is a lack of research in the effect of medication and drugs for older children who have autism.

More and more children are growing up with autism, and although many treatments and interventions are now available, clinical studies on the use of medications in teens and young adults are lacking, according to new research.

"The majority of (older) individuals with autism spectrum disorders appear to be taking medications that we have very little evidence for," said the study's lead author, Dr. Jeremy Veenstra-VanderWeele, medical director of the Treatment and Research Institute for Autism Spectrum Disorders at the Vanderbilt Brain Institute in Nashville, Tenn.

"In the absence of sufficient evidence, parents and people with autism should find a clinician who tells you what's known and unknown about the potential benefits and risks of any medication," he said. "It should be a shared decision-making process."

Results of the study were published online on Sept. 24 in the journal Pediatrics.

Autism spectrum disorders are neurodevelopmental disorders that impair social development and communication. Autism spectrum disorders also may cause repetitive movements and even self-abusive behavior, such as head banging, according to the U.S. National Institute of Neurological Disorders and Stroke (NINDS).

It is estimated that about one in 88 American children has been identified with an autism spectrum disorder

As children with autism age, some do experience significant improvements, according to NINDS, but many do not. There is no cure for autism, although there are many treatments available, including education and behavioral interventions and medications.

Medications usually are used to treat some of the symptoms associated with autism, rather than the core symptoms of the condition, according to background information in the new study. For example, the medication risperidone (brand name Risperdal) may be used to treat behavioral symptoms associated with autism, such as aggression, outbursts and irritability, said Dr. Melissa Nishawala, medical director of the Autism Spectrum Disorders Clinical and Research Program at the NYU Child Study Center in New York City.

"Medications like risperidone and aripiprazole don't address the cause of autism, but they help calm down [people with autism]," Veenstra-VanderWeele said.

For the new study, the researchers reviewed medical literature from 1980 through 2011 to find clinical trials on drugs for people with autism between the ages of 13 and 30 years old. They found eight studies with at least 20 participants. Two investigators independently assessed the quality of the studies.

The researchers said they found four studies of fair quality while the other four were poor. The studies included reviews of antipsychotic medications, such as risperidone and haloperidol (Haldol); serotonin reuptake inhibitors, such as fluvoxamine (Luvox) and clomipramine (Anafranil); and opioid receptor agonists, such as naltrexone (Depade).

The researchers felt that, overall, there wasn't enough data on medications in the teen and young adult autism population. Risperidone wasn't well studied in teens and young adults, but there was evidence for its use if the entire pediatric population was considered, the study said.

Although behavioral and educational interventions weren't included in the new study, Veenstra-VanderWeele said he suspects there's a lack of evidence for these types of treatments in older children and young adults too.

"We really don't know if intensive behavior interventions continue to benefit individuals as they get older," he said.

NYU's Nishawala said: "The most important thing for parents to take away is that we know there are a few medications that have been studied that can help. Certain symptoms like irritability, agitation and aggression can be controlled with medications, but there's lesser evidence that repetitive behaviors can be treated."

Nishawala added that although she and others who treat older children and young adults with autism would love to have more evidence-based research on the medications they use, it can be difficult to get parents and older children to participate in clinical trials when medications are already available to them for what's known as "off-label" use. That's when doctors prescribe medications for a condition for which the drug has yet to receive U.S. Food and Drug Administration approval.

In addition, she said, it's difficult to get funding for trials, particularly when a drug already has been approved.

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Reflux and Sleep Apnea in Children - Its a two way street!

This is a very interesting article. For years we have known that sleep apnea exacerbates reflux. Also, we know the treatment of reflux reduces fragmentation of sleep. This is exciting article showing an improved response  in sleep apnea due to reflux treatment. JR

Original Article

Respiratory response to proton pump inhibitor treatment in children with obstructive sleep apnea syndrome and gastroesophageal reflux disease

• Jolanta Wasilewska^a, , , 
• Janusz Semeniuk^a, 
• Beata Cudowska^a, 
• Mark Klukowski^b, 
• Katarzyna Dębkowska^c, 
• Maciej Kaczmarski^a

• ^a Department of Pediatrics, Gastroenterology and Allergology, Medical University of Bialystok, Waszyngtona Street 17, 15-274 Bialystok, Poland
• ^b Department of Pharmacology, Medical University of Bialystok, Waszyngtona Street 17, 15-274 Bialystok, Poland
• ^c Department of Business Informatics and Logistics, Technical University of Bialystok, Tarasiuka Street 2, 16-001 Kleosin, Poland

• Received 31 December 2011. Revised 8 April 2012. Accepted 25 April 2012. Available online 20 June 2012.

• http://dx.doi.org/10.1016/j.sleep.2012.04.016 , How to Cite or Link Using DOI

• Permissions & Reprints

 Link to abstract

Abstract

Objective

Evaluation of the respiratory response to proton pump inhibitors (PPI) in children with obstructive sleep apnea syndrome (OSAS) and gastroesophageal reflux disease (GERD).

Methods

Of 131 children diagnosed with OSAS (Apnea Hypopnea Index, AHI >1/h), 37 children (6.9 years; 28.24%) with GERD symptoms (>3 times/week) were included. Overnight polysomnography with 24 h pH-metry was performed before and after 4–8 weeks of PPI treatment (omeprazole once a day, 1 mg/kg).

Results

Of 37 children, 21 were diagnosed with acid GERD where pre- and post-treatment reflux indexes were 14.09 ± 1.47 vs. 7.73 ± 1.36; (p < 0.001). The number of obstructive apneas and hypopneas decreased after PPI treatment, resulting in an AHI reduction from 13.08 ± 3.11/h to 8.22 ± 2.52/h; (p < 0.01). Respiratory response to PPI ranged from complete resolution of OSA (three children with mild OSA; AHI < 5/h; 10.31 years; 14.29%) to lack of significant AHI change (six children with severe OSA; AHI > 10/h; 3.62 years; 28.57%). Post-treatment AHI was predicted by pre-treatment reflux index (adjusted R² = 0.487;p < 0.001).

Conclusions

Reduction of obstructive respiratory events following short-term PPI treatment in children with both GERD and OSAS may suggest a causal relationship between apnea and reflux in some children. Questionnaire screening for GERD in children with OSAS may be of benefit.

Keywords

• Obstructive sleep apnea syndrome; 
• Gastroesophageal reflux disease; 
• Omeprazole; 
• Polysomnography; 
• pH metry; 
• Reflux Index

Study claims 1 in 26 may develop epilepsy

A landmark study from the Institute of Medicine (IOM) reports that your chance of developing epilepsy at some point in your life is one in 26. Onset is highest in children and older adults. But epilepsy knows no boundaries—it can strike at any age and across all socio-economic levels and ethnicities. There is no known cure and one-third of people with epilepsy have treatment-resistant or refractory epilepsy.

With more than 150,000 new epilepsy cases diagnosed in the U.S. annually, epilepsy is the fourth most prevalent neurological disorder after migraine, stroke and Alzheimer's disease. Despite being so common, epilepsy gets less public recognition than some neurological disorders that affect fewer people.

In introducing the report, IOM President Harvey Fineberg, M.D., Ph.D. described epilepsy as "a problem remarkably hidden for such a visible illness," and later commented that the condition is "a very serious problem that has been too long neglected as a public health concern. We hope that this report will begin to change the way in which we as a nation come to understand, embrace, deal with and solve the problem of epilepsy."

Alarmingly, the number of epilepsy cases is much higher than many people realize. Thus, the IOM report highlights the vast need for better surveillance and data collection, including through electronic health records, to more precisely define the scope of the problem. "Current data sources provide a patchwork of surveillance activity," it says, "and substantially limit the ability to understand, plan and guide the provision of policies."

"Epilepsy's high rate of occurrence and heavy burden on patients and families is in stark contrast with the highly insufficient attention the disease gets at all levels of our health care system and our society at large," says Frances Jensen, M.D., president of the American Epilepsy Society and chair of Vision 20/20, a cooperative group of more than 20 consumer, health professional, and advocacy organizations concerned with the broad spectrum of the epilepsies. "Gaps in the nation's ability to deal with epilepsy and its consequences prevail in so many spheres that vigorous action is urgently needed to affect change and create a system that will assure accessible, comprehensive, high-quality optimal care for every person who has the condition."

Epilepsy is a spectrum of more than 25 seizure syndromes—sometimes called the epilepsies—that affects more than 2.2 million Americans in a variety of ways. The disorder is characterized by unpredictable seizures in which the brain produces sudden bursts of electrical energy that can interfere with a person's consciousness, movements and sensations. Seizures differ widely in type, cause, severity, and treatment.

The impact that epilepsy has on physical health and quality of life spans another spectrum, with individuals experiencing different health outcomes. In addition, people with epilepsy often experience quality of life issues, including but not limited to impaired memory and cognitive functions, difficulty in social interactions and achieving gainful employment, and driving restrictions.

Access to care varies with significant disparities along racial, ethnic, and socioeconomic lines in diagnosis and treatment of patients. A significant challenge for people with epilepsy, according to the IOM report, has been the way epilepsy is misunderstood and misperceived, leading to the perpetuation of age-old stigma.

The report further underscores that epilepsy is associated with substantially higher rates of mortality than experienced in the population as a whole, with sudden unexpected death in epilepsy (SUDEP) being the most common cause of epilepsy-related deaths. Estimates in the report indicate that 2-10 years of life are lost for people who have epilepsy.

Given the current gaps in epilepsy knowledge, care and education, the IOM report emphasizes the urgent need to take action-across multiple dimensions-to improve and save lives. The IOM report provides the research priorities and action-oriented steps needed to enable short- and long-term improvements for people with epilepsy.

"This new report will serve as a roadmap for real progress in the next few years to improve the lives of individuals with epilepsy, increase access to medical care and social services, increase public awareness, reduce stigma, and work towards better education of healthcare professionals around epilepsy care and research," adds Jensen.

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