Is their a link between autism and lyme disease? No.

Some patients have asked about a link between autism and lyme disease. There does not appear to be a significant link. - JR

Autism-Lyme 

Correlation Debunked

Researchers find zero evidence for Lyme-induced autism.

WIKIMEDIA, SCOTT BAUER, USDA

The hypothesized link between autism and Lyme disease loses ground with a new study that found no evidence of an infection in patients with the social development disorder. The results, published today (April 30) in the Journal of the American Medical Association, imply that antibiotics against the Lyme disease pathogen—a popular new strategy for autism—will not ameliorate most patients’ symptoms.

“The data don’t address whether a single case of autism was ever caused by Lyme disease, but it rules out the suggestion that it does so with any frequency,” said Armin Alaedini, an immunologist at Columbia University Medical Center in New York and an author on the study. “I think that for me, this is the end of looking into the link between autism and Lyme.”  

In recent years, some doctors have anecdotally noted that many of their autism patients have Lyme disease. Two small studies listed in a booklet from a 2007 meeting of the Lyme-Induced Autism Foundation, a Corona, California-based organization that advocates an “eclectic healing approach,” reported that 1 in 5 autistic patients had the tick-borne disease. Websites on the topic now put that number closer to 9 out of 10. These statistics, however, have not been peer-reviewed. Nonetheless, some doctors prescribe antibiotics to autistic children and say the therapy quells their symptoms.

To systematically assess the prevalence of Lyme disease among people with autism, Armin Alaedini, an immunologist at Columbia University Medical Center in New York, and his colleagues analyzed blood samples from 120 children and teens: 70 participants had autism, and 50 served as healthy controls. Alaedini looked for antibodies against the bacterium underlying Lyme, Borrelia burgdorferi, and found that not a single participant tested positive for the infection.

“This means that you wouldn’t see 20 percent of children with autism getting their disease from Lyme,” Alaedini said. He entered into the study objectively, he said, wanting to explore a correlation that had gained traction among doctors and the public. “Autism has become a hot topic, and a lot of people are publishing findings that are bogus but still alarm parents.”

M. Ajamian et al., “Serologic markers of Lyme disease in children with autism,” Journal of the American Medical Association, 309: 1771-72, 2013.

Link to article here

Autism PLUS other abnormalities? Think mitochondrial: Mitochondrial disease in autism spectrum disorder patients.

Autism PLUS other physical or neurologic abnormalities? Think mitochondrial disease.

Excess fatiguability was the most common symptom in this cohort of children with autism AND mitochondrial disease.

60% had other neurodevelopmental abnormalities. 

64% had gastrointestinal problems.

As the authors write:

"Although all patients' initial diagnosis was idiopathic autism, careful clinical and biochemical assessment identified clinical findings that differentiated them from children with idiopathic autism. 

These and prior data suggest a disturbance of mitochondrial energy production as an underlying pathophysiological mechanism in a subset of individuals with autism."

Sadly, there are many children who have autism and have NEVER seen a specialist.

JR

What were the features?

Twenty-one patients had histories of major non-neurological medical problems, most commonly of the gastrointestinal system, with gastroesophageal reflux affecting nine and constipation affecting eight subjects. 

Seven patients had structural or functional cardiovascular abnormalities. 

In addition, 17 patients had excessive fatigability or exercise intolerance and several children had abnormal physical exam findings including six with facial dysmorphism, four with microcephaly, four with macrocephaly, and five with growth retardation.

PLoS One. 2008;3(11):e3815. doi: 10.1371/journal.pone.0003815. Epub 2008 Nov 26.

Mitochondrial disease in autism spectrum disorder patients: a cohort analysis.

Weissman JR, Kelley RI, Bauman ML, Cohen BH, Murray KF, Mitchell RL, Kern RL, Natowicz MR.

Source

Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America.

Abstract

BACKGROUND:

Previous reports indicate an association between autism spectrum disorders (ASD) and disorders of mitochondrial oxidative phosphorylation. One study suggested that children with both diagnoses are clinically indistinguishable from children with idiopathic autism. There are, however, no detailed analyses of the clinical and laboratory findings in a large cohort of these children. Therefore, we undertook a comprehensive review of patients with ASD and a mitochondrial disorder.

METHODOLOGY/PRINCIPAL FINDINGS:

We reviewed medical records of 25 patients with a primary diagnosis of ASD by DSM-IV-TR criteria, later determined to have enzyme- or mutation-defined mitochondrial electron transport chain (ETC) dysfunction. 

Twenty-four of 25 patients had one or more major clinical abnormalities uncommon in idiopathic autism. 

Twenty-one patients had histories of significant non-neurological medical problems. 

Nineteen patients exhibited constitutional symptoms, especially excessive fatigability. 

Fifteen patients had abnormal neurological findings. Unusual developmental phenotypes included marked delay in early gross motor milestones (32%) and unusual patterns of regression (40%).

 Levels of blood lactate, plasma alanine, and serum ALT and/or AST were increased at least once in 76%, 36%, and 52% of patients, respectively. 

The most common ETC disorders were deficiencies of complex I (64%) and complex III (20%). Two patients had rare mtDNA mutations of likely pathogenicity.

CONCLUSIONS/SIGNIFICANCE:

Although all patients' initial diagnosis was idiopathic autism, careful clinical and biochemical assessment identified clinical findings that differentiated them from children with idiopathic autism. These and prior data suggest a disturbance of mitochondrial energy production as an underlying pathophysiological mechanism in a subset of individuals with autism.

PMID:

 

19043581

 

[PubMed - indexed for MEDLINE] 

PMCID:

 

PMC2584230

 

Full article here

More sleep could mean less pain. But what about quality sleep?

A study claims that getting more sleep each night could reduce a person's sensitivity to pain.

In fact, its also the quality and depth of sleep that is also important. I often see patients with fibromylagia or other painful conditions who improve vastly with better sleep.

JR

A new study suggests that extending nightly sleep in mildly sleepy, healthy adults increases daytime alertness and reduces pain sensitivity.

"Our results suggest the importance of adequate sleep in various chronic pain conditions or in preparation for elective surgical procedures," said Timothy Roehrs, PhD, the study's principal investigator and lead author. "We were surprised by the magnitude of the reduction in pain sensitivity, when compared to the reduction produced by taking codeine."

The study, appearing in the December issue of the journalSLEEP, involved 18 healthy, pain-free, sleepy volunteers. They were randomly assigned to four nights of either maintaining their habitual sleep time or extending their sleep time by spending 10 hours in bed per night. Objective daytime sleepiness was measured using the multiple sleep latency test (MSLT), and pain sensitivity was assessed using a radiant heat stimulus.

Results show that the extended sleep group slept 1.8 hours more per night than the habitual sleep group. This nightly increase in sleep time during the four experimental nights was correlated with increased daytime alertness, which was associated with less pain sensitivity.

In the extended sleep group, the length of time before participants removed their finger from a radiant heat source increased by 25 percent, reflecting a reduction in pain sensitivity. The authors report that the magnitude of this increase in finger withdrawal latency is greater than the effect found in a previous study of 60 mg of codeine.

According to the authors, this is the first study to show that extended sleep in mildly, chronically sleep deprived volunteers reduces their pain sensitivity. The results, combined with data from previous research, suggest that increased pain sensitivity in sleepy individuals is the result of their underlying sleepiness.

Read more here

Severity of Autism and Symptoms May Be Due to Fear

Research on autism shows that the severity of autism diagnoses may be due to anxiety. This could also explain some of the other symptoms and severity of autism's disability.  For many children with autism "My way IS the highway." 

Anxiety is disabling for families and impedes developmental progress.

JR

Most people know when to be afraid and when it's okay to calm down.

But new research on autism shows that children with the diagnosis struggle to let go of old, outdated fears. Even more significantly, the Brigham Young University study found that this rigid fearfulness is linked to the severity of classic symptoms of autism, such as repeated movements and resistance to change.

For parents and others who work with children diagnosed with autism, the new research highlights the need to help children make emotional transitions -- particularly when dealing with their fears.

"People with autism likely don't experience or understand their world in the same way we do," said Mikle South, a psychology professor at BYU and lead author of the study. "Since they can't change the rules in their brain, and often don't know what to expect from their environment, we need to help them plan ahead for what to expect."

In their study, South and two of his undergraduate neuroscience students -- Tiffani Newton and Paul Chamberlain -- recruited 30 children diagnosed with autism and 29 without to participate in an experiment. After seeing a visual cue like a yellow card, the participants would feel a harmless but surprising puff of air under their chins.

Part-way through the experiment, the conditions changed so that a different color preceded the puff of air. The researchers measured participants' skin response to see if their nervous system noticed the switch and knew what was coming.

"Typical kids learn quickly to anticipate based on the new color instead of the old one," South said. "It takes a lot longer for children with autism to learn to make the change."

The amount of time it took to extinguish the original fear correlated with the severity of hallmark symptoms of autism.

"We see a strong connection between anxiety and the repetitive behaviors," South said. "We're linking symptoms used to diagnose autism with emotion difficulties not usually considered as a classic symptom of autism."

The persistence of needless fears is detrimental to physical health. The elevated hormone levels that aid us in an actual fight or flight scenario will cause damage to the brain and the body if sustained over time.

And the families who participate in social skills groups organized by South and his students can relate to the new findings.

"In talking to parents, we hear that living with classic symptoms of autism is one thing, but dealing with their children's worries all the time is the greater challenge," South said. "It may not be an entirely separate direction to study their anxiety because it now appears to be related."

The complete study appears in the journal Autism Research.The project began when Newton received a university grant to conduct research with a faculty mentor. After graduating with a degree in neuroscience, she began working at a clinic in Michigan. Chamberlain is finishing his senior year at BYU and is currently interviewing with medical schools.

Read more here

Brain "Pacemaker" Implanted to Help Mitigate Alzheimer's Symptoms

I will watch this research. It may be helpful for adults with Trisomy 21/ Down Syndrome in the future. JR

Researchers have implanted a 'pacemaker' in a patient's brain who is in the early stages of Alzheimers. The hope is that the pacemaker will help alleviate the symptoms of Alzheimers and reverse cognitive decline.

Researchers at Johns Hopkins Medicine in November surgically implanted a pacemaker-like device into the brain of a patient in the early stages of Alzheimer's disease, the first such operation in the United States. The device, which provides deep brain stimulation and has been used in thousands of people with Parkinson's disease, is seen as a possible means of boosting memory and reversing cognitive decline.

The surgery is part of a federally funded, multicenter clinical trial marking a new direction in clinical research designed to slow or halt the ravages of the disease, which slowly robs its mostly elderly victims of a lifetime of memories and the ability to perform the simplest of daily tasks, researchers at Johns Hopkins say. Instead of focusing on drug treatments, many of which have failed in recent clinical trials, the research focuses on the use of the low-voltage electrical charges delivered directly to the brain. There is no cure for Alzheimer's disease.

As part of a preliminary safety study in 2010, the devices were implanted in six Alzheimer's disease patients in Canada. Researchers found that patients with mild forms of the disorder showed sustained increases in glucose metabolism, an indicator of neuronal activity, over a 13-month period. Most Alzheimer's disease patients show decreases in glucose metabolism over the same period.

The first U.S. patient in the new trial underwent surgery at The Johns Hopkins Hospital, and a second patient is scheduled for the same procedure in December. The surgeries at Johns Hopkins are being performed by neurosurgeon William S. Anderson, M.D.

"Recent failures in Alzheimer's disease trials using drugs such as those designed to reduce the buildup of beta amyloid plaques in the brain have sharpened the need for alternative strategies," says Paul B. Rosenberg, M.D., an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, and site director of the trial's Johns Hopkins location. "This is a very different approach, whereby we are trying to enhance the function of the brain mechanically. It's a whole new avenue for potential treatment for a disease becoming all the more common with the aging of the population."

Some 40 patients are expected to receive the deep brain stimulation implant over the next year or so at Johns Hopkins and four other institutions in North America as part of the ADvance Study led by Constantine G. Lyketsos, M.D., M.H.S., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, and Andres Lozano, M.D., Ph.D., chairman of the neurology department at the University of Toronto. Only patients whose cognitive impairment is mild enough that they can decide on their own to participate will be included in the trial.

Other sites performing the operation, supported by the National Institutes of Health's National Institute on Aging (R01AG042165), are the University of Toronto, the University of Pennsylvania, the University of Florida, and Banner Health System in Phoenix, Ariz. The medical device company, Functional Neuromodulation Ltd., is also supporting the trial.

"We are very excited about the possibilities of this potentially new way to treat Alzheimer's," says Lyketsos, director of the Johns Hopkins Memory and Alzheimer's Treatment Center in Baltimore.

While experimental for Alzheimer's patients, more than 80,000 people with the neurodegenerative disorder Parkinson's disease have undergone the procedure over the past 15 years, with many reporting fewer tremors and requiring lower doses of medication afterward, Lyketsos says. Other researchers are testing deep brain stimulation to control depression and obsessive-compulsive disorder resistant to other therapies.

The surgery involves drilling holes into the skull to implant wires into the fornix on either side of the brain. The fornix is a brain pathway instrumental in bringing information to the hippocampus, the portion of the brain where learning begins and memories are made, and where the earliest symptoms of Alzheimer's appear to arise. The wires are attached to a pacemaker-like device, the "stimulator," which generates tiny electrical impulses into the brain 130 times a second. The patients don't feel the current, Rosenberg says.

For the trial, all of the patients will be implanted with the devices. Half will have their stimulators turned on two weeks after surgery, while the other half will have their stimulators turned on after one year. Neither the patients nor the doctors treating them will know which group gets an early or later start.

"Deep brain stimulation might prove to be a useful mechanism for treating Alzheimer's disease, or it might help us develop less invasive treatments based on the same mechanism," Rosenberg says.

By 2050, the number of people age 65 and older with Alzheimer's disease may triple, experts say, from 5.2 million to a projected 11 million to 16 million, unless effective treatments are found.

Read more here

Children With Autism go to Emergency Room Nine Times More Than Peers

We work very hard to keep children with autism and neuropsychiatric / neurobehavioral problems out of emergency rooms.  Early recognition and treatment often avoids emergencies. JR


A study showed that children with autism are nine times more likely to show up at the emergency room with a psychiatric condition than other children.

In the first study to compare mental health-related emergency department (ED) visits between children with and without autism spectrum disorders (ASD), researchers found that ED visits are nine times more likely to be for psychiatric reasons if a child has an ASD diagnosis. Published in the journalPediatric Emergency Care (Epub ahead of print), the study found externalizing symptoms, such as severe behaviors tied to aggression, were the leading cause of ED visits among children with ASD. Importantly, the likelihood of a psychiatric ED visit was higher if a child carried private health insurance rather than medical assistance.

"This finding of higher rates of emergency room visits among children with autism demonstrates that many children with autism aren't receiving sufficient outpatient mental health care to prevent and manage the type of crises that are driving these families to seek urgent help," said Dr. Roma Vasa, senior study author and a child psychiatrist in Kennedy Krieger Institute's Center for Autism & Related Disorders. "These findings should highlight the urgent need for better comprehensive outpatient mental health care and insurance coverage for children with autism, along with greater education and training for emergency medical staff."

Using the 2008 National Emergency Department Sample, the largest all-payer ED database in the US, researchers examined data from a total of 3,974,332 ED visits for patients ages 3 to 17, of which 13,191 visits were from children with ASD. Mental health-related ED visits were based on International Classification of Disease (ICD) billing diagnoses that included mood, anxiety and psychotic disorders, suicide and self-injury, and externalizing behaviors such as aggression.

Researchers also studied the influence of different types of insurance coverage on the likelihood of an ED visit for psychiatric reasons. They found that children with ASD whose families had private medical insurance were 58 percent more likely to visit the ED for mental health-related reasons than those whose health insurance was provided through state medical assistance programs.

"We think this is because private insurance plans often exclude autism from behavioral health coverage, have few in-network providers or place restrictive limits on the amount of mental health expenses that they will reimburse," said Luther Kalb, MHS, first study author and a research scientist in Kennedy Krieger Institute's Center for Autism & Related Disorders.

With 1 in 88 children in the U.S. diagnosed with ASD, the use of the ED to treat psychiatric behaviors is likely to increase unless changes occur. Dr. Vasa suggests that this trend is especially troublesome because the ED is not an optimal setting for children with ASD since chaotic environments can exacerbate autism-related or comorbid psychiatric symptoms.

"Children with autism, especially those with co-occurring psychotic disorders or severe behaviors, need to have an emergency crisis plan in place," said Kalb. "Everyone involved in the life of a child with autism, from parents to medical professionals to school educators, needs to have routine discussions about what to do in the case of an escalating situation."

This study also suggests that emergency departments should consider adopting new measures to accommodate children with ASD. This includes greater education and training for ED professionals about how to properly assess and interact with children on the autism spectrum. Additionally, researchers suggest that the large numbers of children with autism accessing the ED may necessitate a separate area for children with ASD that is less chaotic and contains less stimulation than found in the otherwise busiest part of any hospital.

Further research on adults with ASD using the ED for psychiatric reasons and general trends associated with mental health care is needed. With more information, medical professionals and insurance providers can have a greater understanding of the gaps in care and work to improve services.

Read more here

Study: Changes in Anti-Epilepsy Treatment Options for Infants

New treatment options may be available for infants with epilepsy based on treatment for a similar condition.

A pilot study to determine the best hormonal treatment for infantile spasms (IS) that may lead to changes in prescribing practices for hormone therapy is being presented for the first time at the American Epilepsy Society's 66th Annual Meeting in San Diego California.

In a study of 30 infants, researchers from the division of Pediatric Neurology of Mattel Children's Hospital at UCLA in Los Angeles found very high dose prednisolone to be a reasonable alternative to adrenocorticotropic hormone treatment (ACTH) for children with infantile spasms . Using a standardized protocol in which ACTH is reserved for infants who do not respond to prednisolone, they yielded a favorable overall response rate of 77%, and were able to successfully forego ACTH therapy in 18 patients, thus avoiding more than 1000 intramuscular injections and achieving more than 2 million dollars in short-term cost savings. The results indicate that further research is warranted to determine whether high dose prednisolone is truly equivalent is ACTH, as 5 infants in this study responded to ACTH after failing prednisolone.

"In the absence of a definitive clinical trial, I encourage practitioners to use the treatment protocol set forth in our study to mitigate the risks and cost of traditional ACTH therapy. However, I do not advocate that ACTH therapy be completely abandoned. A head-to-head trial of high-dose prednisolone versus ACTH is required to resolve the uncertainly that remains." said Dr. Shaun Hussain of the Division of Neurology, Mattel Children's Hospital at UCLA, the lead author of the study.

The study was presented at a session of pediatric highlights at the AES Annual Meeting.

Read more here

Study of Non-Epileptic Seizures Produced Surprising Results

This study discusses the results of a study showing the differences between epileptic seizures and non-epileptic seizures.

A Loyola University Medical Center neurologist is reporting surprising results of a study of patients who experience both epileptic and non-epileptic seizures.

Non-epileptic seizures resemble epileptic seizures, but are not accompanied by abnormal electrical discharges. Rather, these seizures are believed to be brought on by psychological stresses.

Dr. Diane Thomas reported that 15.7 percent of hospital patients who experienced non-epileptic seizures also had epileptic seizures during the same hospital stay. Previous studies found the percentage of such patients experiencing both types of seizures was less than 10 percent.

Thomas reported the findings Dec. 2 at a meeting of the American Epilepsy Society. The finding is significant because epileptic and non-epileptic seizures are treated differently. Non-epileptic seizures do not respond to epilepsy medications, and typically are treated with psychotherapy, anti-depressants, or both, Thomas said.

Non-epileptic seizures used to be called pseudoseizures. But they are quite real, and the preferred term now is psychogenic non-epileptic seizure. A non-epileptic seizure can resemble the convulsions characteristic of a grand mal epileptic seizure, or the staring-into-space characteristic of a petit mal epileptic seizure. But unlike an epileptic seizure, the brain waves during a non-epileptic seizure are normal.

Non-epileptic seizures can be triggered by stresses such as physical or sexual abuse, incest, job loss, divorce or death of a loved one. In some cases, the traumatic event may be blocked from the patient's conscious memory.

Non-epileptic seizures often are mistaken for epileptic seizures. While some patients who have both types can distinguish between the two, others find it difficult to distinguish when they are having non-epileptic seizures.

The only way to make a definitive seizure diagnosis is to monitor a patient with an electroencephalogram (EEG) and a video camera. (The EEG can detect abnormal electrical discharges that indicate an epileptic seizure.) The patient is monitored with the camera until a seizure occurs, and the EEG recordings from the event are then analyzed.

Thomas conducted her study at the University of Maryland Medical Center, where she did a fellowship in epilepsy before recently joining Loyola. Thomas and colleagues reviewed 256 patients who had come to the hospital to have their seizures monitored. Seventy of the patients had documented non-epileptic seizures. Of these, 11 patients (15.7 percent) also experienced epileptic seizures during their hospital stays.

Read more here

Brain Damage Differences in Men and Women with Sleep Apnea

A study shows that of people with sleep apnea, women have a higher degree of brain damage than men do.

Women suffering from sleep apnea have, on the whole, a higher degree of brain damage than men with the disorder, according to a first-of-its-kind study conducted by researchers at the UCLA School of Nursing. The findings are reported in the December issue of the peer-reviewed journal Sleep.

Obstructive sleep apnea is a serious disorder that occurs when a person's breathing is repeatedly interrupted during sleep, sometimes hundreds of times. Each time, the oxygen level in the blood drops, eventually resulting in damage to many cells in the body. If left untreated, it can lead to high blood pressure, stroke, heart failure, diabetes, depression and other serious health problems.

Approximately 10 years ago, this UCLA research team was the first to show that men with obstructive sleep apnea have damage to their brain cells.

For this latest, multi-year study, "Sex Differences in White Matter Alterations Accompanying Obstructive Sleep Apnea," the researchers looked at patients who were diagnosed with obstructive sleep apnea at the UCLA Sleep Laboratory. They compared the nerve fibers in these patients' brains -- known as white matter -- to fibers of individuals without sleep problems and focused on unearthing the difference in brain damage between men and women with sleep apnea.

"While there are a great many brain studies done on sleep apnea and the impact on one's health, they have typically focused on men or combined groups of men and women, but we know that obstructive sleep apnea affects women very differently than men," said chief investigator Paul Macey, assistant professor and associate dean of information technology and innovations at the UCLA School of Nursing. "This study revealed that, in fact, women are more affected by sleep apnea than are men and that women with obstructive sleep apnea have more severe brain damage than men suffering from a similar condition."

In particular, the study found that women were impacted in the cingulum bundle and the anterior cingulate cortex, areas in the front of the brain involved in decision-making and mood regulation. The women with sleep apnea also showed higher levels of depression and anxiety symptoms, the researchers said.

"This tells us that doctors should consider that the sleep disorder may be more problematic and therefore need earlier treatment in women than men," Macey said.

With this finding as a foundation, Macey said that the next step is for researchers to "untangle the timing of the brain changes" and find out if treating sleep apnea can help the brain.

"What we don't yet know," he said, "is, did sleep apnea cause the brain damage, did the brain damage lead to the sleep disorders, or do the common comorbidities, such as depression, dementia or cardiovascular issues, cause the brain damage, which in turn leads to sleep apnea."

Co-investigators on the study included Rajesh Kumar, Ronald Harper and Dr. Frisca Yan-Go of UCLA's Brain Research Institute and the departments of neurobiology and neurology at the David Geffen School of Medicine at UCLA, and Mary Woo of the UCLA School of Nursing. All of the work for the study was performed at UCLA, with financial support provided by a grant from the National Institute of Nursing Research.

Read more here

Link Between Women and Migraines

This article discusses the basics of migraine headaches and why there is such a strong link between women and migraines.

THE fact that three out of every four persons struck with a migraine are women has resulted in this condition being considered the most common disabling problem faced by women globally that results in them having to see a doctor.

Here are some of the most common questions women ask about migraines.

What are migraines and who gets them?

It is a severe type of headache that is accompanied by other changes apart from just pain. For example, some persons might feel nauseous, some persons may actually vomit and, some persons may have visual changes like blurred vision or flashing lights. Some persons also have numbness on one side of their body.

While the causes of migraines are still not known, researchers say that those with a family history of migraine are more likely to have it. This is also the case for those who have a history of depression, anxiety, stroke or high blood pressure.

Why do more women than men suffer from migraines?

Researchers have noted that migraines mostly affect women who are between the ages of 15 and 55 years old. However, there are no definitive reasons as to why. "It could be hormonal, but I couldn't give you a good explanation for that," said Dr Campbell.

What are some of the things that trigger migraines?

Food allergies, bright lights, loud nights, strong odours, weather changes, hormonal changes during menstruation, lack of or too much sleep, stress and anxiety, caffeine, skipped meals, alcohol can be triggers.

Food additives like dyes are usually important triggers. For some people it's chocolate, for others, citrus. MSG is a culprit too.

What is the difference between a migraine headache and a bad tension headache?

There are several other types of headaches besides migraines. There is the tension headache, for example, which is less severe and debilitating.

"For a tension headache, the presentation is going to be different. That has to be a sort of a clinical diagnosis, but usually with a tension headache, the headaches come as a result of spasm of the muscles in the head," explained Dr Campbell. "But to determine which is which, one ought to be examined by a physician."

What can I do to ease my migraine pain?

While there is no cure, there are certain medications that can help to ease the pain. It is always important to be diagnosed by a doctor who can prescribe these treatments. However, magnesium, fish oil and guinea hen weed are generally helpful. The doctor said she personally uses guinea hen weed.

"I get the root of the guinea hen weed, wash it, chop it up, throw rum on it, and if I feel a headache coming on, I inhale it," she said.

Read more here

Study: Sleep Duration Affects Hunger in Men and Women Differently

A study shows that the more sleep a person gets could reduce their food intake. However, there is a difference in the affect between men and women.

A new study suggests that increasing the amount of sleep that adults get could lead to reduced food intake, but the hormonal process differs between men and women.

"Restricting sleep in healthy, normal weight participants has limited effects on metabolic risk factors and may affect food intake regulating hormones differently in men and women," said Marie-Pierre St-Onge, PhD, FAHA, the study's principal investigator. "We were surprised by the lack of a significant effect of sleep on glucose and insulin, leptin, and sex differences in the hunger-stimulating hormone ghrelin and the satiety hormone GLP-1."

The study, appearing in the November issue of the journal Sleep, tracked the sleep duration, glucose dysregulation, and hormonal regulation of appetite in 27 normal weight, 30- to 45-year-old men and women. Participants provided fasting blood draws, and they were studied under two sleep conditions: Short (4 hours) or habitual (9 hours). Short sleep increased total ghrelin levels in men but not women and reduced GLP-1 levels in women but not in men, a sex difference that has not been reported before. The results suggest that the common susceptibility to overeat during short sleep is related to increased appetite in men and reduced feelings of fullness in women.

"Our results point to the complexity of the relationship between sleep duration and energy balance regulation," St-Onge said. "The state of energy balance, whether someone is in a period of weight loss or weight gain, may be critical in the metabolic and hormonal responses to sleep restriction."

According to the authors, this is the largest controlled clinical investigation of the effects of sleep reduction on hormonal regulation of food intake. The results support a causal role of sleep duration on energy intake and weight control.

Read more here

Some Generic Epilepsy Tx More Equal than Others

I have posted the full abstract so that you can judge. My headline would be generic-brand doses varied excessively in 13 to 23%. 

I would offer other take home points: Do you want to take an antiseizure medicine with this variability? Do you want to offer meds with such variation to your child?

The article does not address generic-generic changes. Brand-generic equivalencies have to be within - 20% and +25% of the parent compound. Your pharmacist can switch you form one generic to another. You can go from a -10 to a +20 with an absolute change of 30% if you are switched. 

My recommendation....stick to one generic.

JR

Some Generic Epilepsy Treatment More Equal than Others

By John Gever, Senior Editor, MedPage Today

Published: December 02, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

Action Points

• This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Generic slow-release drugs for seizure disorders appear equivalent to branded versions.
• Note that the study determined the modified-release products are sufficiently equivalent to allow patients to "switch from brand to generic formulations with little or no changes in drug plasma concentrations and thus no apparent compromise in the safety and efficacy."

SAN DIEGO -- Generic slow-release drugs for seizure disorders appear equivalent to branded versions, researchers said here, unlike earlier findings with immediate-release formulations.

Bioequivalence data from 53 studies submitted to the FDA for 25 generic modified-release drugs for epilepsy -- including phenytoin, carbamazepine, levetiracetam, and divalproex -- were reviewed. Despite considerable variability in the upper and lower bounds of the 90% confidence intervals for maximal concentrations (C_max) and total drug exposure over time (area under the curve, AUC), the products could be interchanged without danger to patients, reported Ravi Juluru, MD, of Oak Ridge Institute for Science and Education in Nashville, and colleagues at the American Epilepsy Society's annual meeting.

In contrast, an earlier study involving immediate-release anti-epilepsy drugs -- led by Gregory Krauss, MD, of Johns Hopkins University in Baltimore, who was also senior investigator for the current work -- had found that patients switching among generic versions of the same drug ran significant risk of potentially dangerous increases or decreases in drug exposure.

The researchers determined the modified-release products are sufficiently equivalent to allow patients to "switch from brand to generic formulations with little or no changes in drug plasma concentrations and thus no apparent compromise in the safety and efficacy."

The FDA requires that makers of generic drugs show, through clinical pharmacokinetic studies, that blood levels of their products are close to those of the original branded forms.

Specifically, the upper bounds of the 90% CI for a generic drug's C_max and AUC cannot exceed 1.25 of the means for the branded version, and the lower bounds cannot be less than 0.8 of the branded form's means.

For most drug classes, such variation is not a concern. But anti-epilepsy drugs have an unusually narrow therapeutic index. Particularly for immediate-release formulations, doses are usually titrated carefully to achieve seizure control without excessive side effects. If product blood levels in a given patient increase by 15%, adverse effects may result, whereas a 15% decrease may trigger onset of seizures.

article here

Abstract Search

(Abst. 1.224 ), 2012

BIOEQUIVALENCE STUDIES AMONG GENERIC AND BRAND-NAME MODIFIED-RELEASE ANTIEPILEPTIC DRUGS SUPPORTS THERAPEUTIC EQUIVALENCE AND GENERIC SUBSTITUTION

Authors: R. K. Juluru, B. M. Davit, C. S. Chaurasia, Y. T. Chang, G. L. Krauss
Instit: Food and Drug Administration

Content:
RATIONALE:
Generic modified-release (MR) formulations of the antiepileptic drugs (AEDs) carbamazepine, phenytoin sodium, divalproex sodium, and levetiracetam are currently marketed in the US. MR formulations offer the advantages of less frequent dosing, improved maintenance of therapeutic drug plasma concentrations, and better patient compliance. In a previous study, we found that the smoother drug release provided by a MR AED formulation decreased serum fluctuations, leading to fewer breakthrough seizures. Thus, the objective of the present retrospective study is to evaluate the robustness of the bioequivalence (BE) measures determined in the pivotal clinical studies submitted to the FDA to support marketing approval of generic MR AEDs. BE studies, which determine whether a generic and corresponding brand drug provide the same rate and extent of absorption, are generally performed in healthy normal subjects given single doses of the drugs. The BE measures compared statistically are Cmax (peak drug plasma concentrations, to assess absorption rate), and AUC (total area under the drug plasma concentration versus sampling time profile, to assess absorption extent).
METHODS:
We collected Cmax and AUC data from the pivotal BE studies used to support the approvals of 25 generic AED MR formulations. Data were from BE studies under both fasting and fed conditions. We determined distributions of 90% confidence interval (CI) limits for generic/brand ratios of AUC and Cmax in the BE studies. We also obtained from the FDA-approved labeling information about the inactive ingredients in the generic and brand formulations.
RESULTS:
We evaluated 53 BE studies, including data from 1570 subjects. The 90% CIs of the generic/brand AUC and Cmax ratios differed by <15 125="125" 13.2="13.2" 15="15" 22.6="22.6" 25="25" 77.4="77.4" 80="80" 86.8="86.8" 90="90" acceptance="acceptance" aed="aed" aeds.="aeds." aeds="aeds" all="all" and="and" approved="approved" auc="auc" be="be" between="between" br="br" brand.="brand." brand="brand" by="by" cis="cis" cmax="cmax" compared="compared" demonstrated="demonstrated" did="did" differ="differ" differed="differed" drugs="drugs" for="for" formulation="formulation" formulations="formulations" general="general" generic="generic" higher="higher" however="however" immediate="immediate" in="in" intersubject="intersubject" irrespective="irrespective" limits="limits" measures="measures" moderate="moderate" more="more" mr="mr" nbsp="nbsp" not="not" observations="observations" of="of" or="or" our="our" poorly="poorly" previous="previous" products="products" rates="rates" ratios="ratios" release="release" respectively.="respectively." significantly="significantly" soluble="soluble" studies="studies" surveyed="surveyed" the="the" to="to" variability="variability" variable="variable" was="was" well="well" were="were" whether="whether" within="within">CONCLUSIONS:
Generic MR AED formulations provided total and peak drug delivery similar to that of brand products, ensuring therapeutic equivalence. Generic formulations were bioequivalent to the corresponding brand formulations despite differences in excipients and release mechanisms. This comparison of BE measures obtained in the pivotal studies supporting the approvals of generic MR AEDs suggests that patients can switch from brand to generic formulations with little or no changes in drug plasma concentrations and thus no apparent compromise in the safety and efficacy.

Clinical characteristics of language regression in children.

This is a landmark article in looking at children with autistic regression. Seizures noted in 15% with regression. 61% had some recovery after seeing neurology
BUT 51% had developmental abnormalities BEFORE regression.
JR

Clinical characteristics of language regression in children

Wilson S, Djukic A, Shinnar S, Dharmani C, Rapin I.

Source

Saul R Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.

Dev Med Child Neurol. 2004 Dec;46(12):852.

Abstract

The spectrum of language regression in childhood is incompletely understood. To describe the features of this disorder more fully, we reviewed the records of 196 consecutive children (143 males and 53 females) with language regression or perceived plateau evaluated between 1988 and 1994 by a child neurologist. 

Mean age at regression was 21.2 months and the mean interval to referral was 34.8 months. 

A trigger for the regression was identified in 74 of the children (38%) and was associated with a more rapid regression. 

Mean age at follow-up was 64 months (SD 55). Seventy per cent of the children became nonverbal, and 75% were cognitively impaired. 

Language regression was associated with a more global autistic regression in 93% of children. 

There was a history of seizures in 15% of the children.

Some recovery occurred in 61% but only one child recovered fully. Improvement was more likely in the 49% who were entirely developmentally normal before the regression. 

We conclude that language regression in childhood is a serious disorder with significant long-term morbidity.

Dev Med Child Neurol. 2003 Aug;45(8):508-14.