Childhood Epilepsy, Memory, and Health Quality - No Connection to Seizure Frequency

Children with epilepsy and poor memory, in this study,  appear to have lower health-related quality of life.

Interestingly, this finding is not connected to seizure frequency.

As an illness, there is an experience that is broader than just the "seizures". 

Ask your neurologist about cognitive, attention, and emotional problems. Assess your child's sleep. Assess the effects of medications. Bone health, nutrition, weight gain and loss are all common problems. - JR

Poor memory in children with epilepsy linked to lower health related quality of life

(dailyRx News) Memory is often an area of concern for people with epilepsy. For children who are just learningabout the world around them, memory can be of particular importance to their physical, mental, emotional and social development.

A recent study investigated the link between memory and health-related quality of life - or how overall well-being is affected over time by disease, disability or other health issues - in children with epilepsy.

The study found that verbal, emotional difficulty and behavioral problems were associated with a lower health-related quality of life more than other factors, including frequent and intense seizures.

Marianne Hrabok, PhD, of the Alberta Children’s Hospital Research Insititute in Calgary, Alberta, Canada, and colleagues studied 90 children with epilepsy at a children’s hospital.

The number and frequency of seizures in the children varied. Thirty-seven percent of children had fewer than one seizure a month while 15 percent had more than one seizure a day.

Verbal skills and health-related quality of life assessments were examined. The researchers also looked at intellectual function, executive function, behavior and ability to adapt.

Details on socio-demographic factors and neurological status were included in the study.

Gender, age and socioeconomic status are examples of socio-demographic factors. Number of antiepileptic drugs and seizure severity are examples of neurological status.

The researchers found that health-related quality of life was not associated with socio-demographic and neurologic factors.

However, neuropsychological factors - including verbal memory, IQ, executive function, emotional and behavioral function and adaptability - were associated with health-related quality of life. Memory, emotional function and behavioral function had a particular relationship to health-related quality of life.

Those with low verbal memory had a two times greater risk of low health-related quality of life than those who did not have low verbal memory. Those with emotional and behavioral difficulty had a 10 times greater risk of low health-related quality life than those without the difficulty.

Having both low verbal memory and emotional and behavioral difficulty resulted in a risk 17 times greater than not having those difficulties.

The study authors believe these results showed the importance in neuropsychological assessment. Identifying those with poor memory and emotional function could help doctors identify those more likely to have a low health-related quality of life.

The authors suggested that psychosocial interventions for children with epilepsy include a team of health professionals with varying disciplines, an emphasis on involvement of the parents, psychological education, cognitive and behavioral strategies and the development of coping skills. Past studies have shown that a six-week program that includes these factors can improve health-related quality of life.

The study was published in Pediatrics. The research received no external funding. The authors did not report any conflicts of interest.

Read more here

Greater Costs, Morbidity Among Uncontrolled Epilepsy Patients

An intersting article about the costs of poorly controlled epilepsy - JR

Greater Costs, Morbidity Among Uncontrolled Epilepsy Patients

By: TARA HAELLE, Clinical Neurology News Digital Network

10/23/12 

VITALS

Major Finding: Compared with patients with well-controlled epilepsy, patients with uncontrolled epilepsy have 1.9-2.2 times more fractures and head injuries, receive 1.3-1.9 times more prescriptions, are hospitalized 5.4-6.7 times more often, are admitted to emergency departments 3.7-5 times more often, and incur $12,258-$14,582 greater annual health care costs.

Patients whose epilepsy was uncontrolled had more injuries, spent more time in the hospital, received more prescriptions, and incurred greater health care resource usage and costs than did patients whose epilepsy was under control in a retrospective, longitudinal matched-cohort study.

Additionally, uncontrolled epilepsy in private insurance patients incurred nearly $2,900 more in work time lost for disability and sick leave, comprising about one-fifth of these patients’ total direct health care costs.

Lead author Ranjani Manjunath of GlaxoSmithKline and her associates analyzed public and private insurance claims to determine how health care resource utilization and costs and epilepsy-related injuries differed between patients with uncontrolled epilepsy and those with well-controlled epilepsy. The findings were reported online Oct. 17 (Neurology 2012;79:1908-16).

The researchers defined patients with uncontrolled epilepsy as those who had at least two consecutive changes in their antiepileptic drug (AED) regimen (at least a month apart) and at least one subsequent hospitalization or emergency department visit within the next year. Patients taking AEDs but who had no changes in their therapy as well as no hospitalizations or ED visits were defined as having well-controlled epilepsy.

A total of 3,454 Medicaid patients and 602 private insurance patients with uncontrolled epilepsy were matched 1:1 with well-controlled epileptic patients for the study. Propensity score matching was used to reduce sample selection bias, and adjusted risk ratios for outcomes took into account age, sex, state or region, baseline AED use, use of other drugs known to increase seizure risk, baseline costs, and psychiatric conditions or epilepsy-related comorbidities (Alzheimer’s disease, brain tumor, meningitis, migraine, and stroke). A lower percentage of uncontrolled epilepsy patients were using AEDs at baseline: 48.1% of uncontrolled Medicaid patients, compared with 52.6% of well-controlled Medicaid patients (P less than .001), and 40% of uncontrolled private patients, compared with 45.5% of well-controlled private patients (Pless than .05).

...

The researchers selected only adult patients who had a prescription for an AED and who had been diagnosed with epilepsy or diagnosed with two nonfebrile seizures more than a month apart. All patients had been enrolled in their insurance plan for at least a year, and baseline included the 180 days before the patient’s first AED prescription. Patients were tracked until death, the end of continuous enrollment, or the end of the period for which data were available.

The study found that Medicaid and private patients with uncontrolled epilepsy had similarly higher incidence rate ratios (incidence rate defined as events divided by patient-years) of injury with 1.9-2.2 times more fractures and head injuries. 

Medicaid patients had 2.45 times more car accident injuries and 10 times more status epilepticus episodes.

Compared with patients who had well-controlled epilepsy, Medicaid patients had 1.94 times more AED prescriptions, 1.47 times more non-AED prescriptions, 6.65 times more hospitalizations, 7.72 times more days in the hospital, 3.67 times more ED visits, 1.66 times more outpatient services, and 3.09 times more neurologist visits. 

Likewise, private patients received 1.75 times more AED prescriptions, 1.34 times more non-AED prescriptions, 5.37 times more hospitalizations, 7.27 times more days in the hospital, 5.05 times more ED visits, 1.41 times more outpatient services, and 2.28 times more neurologist visits. (All P values were less than .05.)

Overall, Medicaid patients with uncontrolled epilepsy incurred an average $12,258 more in costs than Medicaid patients with well-controlled epilepsy, and uncontrolled epileptic private patients’ total extra cost was $14,582. 

Most of these costs came from hospitalization; outpatient services and prescription drugs comprised the next largest share. Private patients also missed 2.5 times more workdays, including 61% more sick days.

Article here

Effect of Treatment of Obstructive Sleep Apnea on Seizure Outcomes in Children With Epilepsy

Besides medicine, what else can you do to reduce seizures in children? Check their sleep! JR

Effect of Treatment of Obstructive Sleep Apnea on Seizure Outcomes in Children With Epilepsy

• Eric Segal, MD
, 
• Martina Vendrame, MD, PhD
, 
• Matthew Gregas, PhD
, 
• Tobias Loddenkemper, MD
, 
• Sanjeev V. Kothare, MD

Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

Received 22 October 2011; accepted 8 March 2012.

• Abstract
• Full Text
• PDF
• References

Abstract 

A retrospective review of children with epilepsy and obstructive sleep apnea, treated surgically for their obstructive sleepapnea from January 2008-October 2010, was performed for age, sex, type of epilepsy, antiseizure medications, sleep-study data, and changes in seizure frequency. Twenty-seven subjects (median age, 5 years) with no adjustment to their medications around their time of surgery were identified. Three months after surgery, 10 (37%) patients became seizure-free, three (11%) demonstrated >50% seizure-reduction, and six (22%) exhibited an amelioration of seizure frequency. Two (7%) demonstrated unchanged seizure-frequency, and six (22%) manifested a worsening of seizure frequency. Median seizure frequency before surgery was 8.5 (interquartile range, 2-90), and after surgery, three (interquartile range, 0-75), with a 53% median seizure reduction. Multivariate analysis demonstrated a trend toward seizure freedom with each percentile increase in body mass index and early age of surgery. We conclude that obstructive sleep apnea surgery may decrease seizure frequency, especially in children with elevated body mass index scores and younger age at time of surgery.

article here

Detecting Epilepsy in Newborns

This article discusses signs that may detect epilepsy in newborns other than seizures.

Newborns twitching or rolling up their eyes or making frequent jerky body movements could mean they are having epileptic attacks and need immediate medical attention. Epilepsy may be the most common neurological disorder in the country. According to an ICMR-supported study published in the June issue of the Indian Journal of Neurology, one in 100 suffers from it, though not many are aware of its early warning signs.

While convulsions are an obvious sign of epilepsy, doctors specially warn parents to not to ignore subtle signs such as unexplained blank episodes or those of confusion and fainting and constant shaking of hands and legs as they could indicate the onset of epilepsy. One needs to be especially careful if there is a history of seizures or epilepsy in the family, which can be picked up as early as within 28 days of a child being born.

"In newborns, it is not really a disease as the symptoms are usually minor and result in not-so-serious issues, such as low sugar or calcium levels. However, in teenagers and adults, the cause of attacks could be serious, such as a brain infection, bleeding, legion or cyst that would need proper treatment in the form of medicines," said Dr Nitin Verma, senior consultant, department of paediatrics, Max Super Specialty Hospital, Saket.

Anvesha Mittal (name changed on request), 42, thought her 15-year-old son was having nightmares when he would shiver in his sleep.

"I thought he was having a bad dream. Gradually, the episodes increased and he started shivering during his afternoon naps as well. That's when we took him to a doctor," she said.

Her son was diagnosed with epilepsy after an MRI scan showed a small legion on the left side of the brain. "I have kept his teachers in the loop. They are careful with him now," she added.

The serious form of epilepsy mostly affects people when they are most productive, that is when they are aged between 14 and 45 years. Depending on the condition, treatment can last up to three years to a lifetime.

"A person with epilepsy needs to take medicines for long. Though the medicines are not very expensive, they still can burn holes in the pockets of many. A large number never receive treatment, and 75% of those who do, leave it mid-way," said Dr Manjari Tripathi, additional professor, department of neurology, All India Institute of Medical Sciences (AIIMS), who was part of the ICMR-supported study.

Almost four-fifth of those affected do not receive treatment despite it being fairly inexpensive and effective in 95% of the cases.

Surgery can also treat epilepsy. But not every patient can be operated because of high chances of irreversible brain damage.

Looking at the large numbers, the Government of India is considering an epilepsy control programme to spread awareness about the disease and distribute free medicines.

"The national programme will help by reaching out to people at the periphery, like it happened with the national mental health programme," said Dr P Sathish Chandra, director and vice-chancellor, National Institute of Mental Health and Neuro Sciences, Bangalore.

It is estimated that there are more than 10 million people with epilepsy in our country. "One million new cases get added to the figure every year," said Dr Satish Jain, who runs the Indian Epilepsy Centre in Delhi.

"It is an eminently treatable disorder and it is high-time the government takes it up on a priority basis to benefit the poor," said Dr Chandra.

Read more here

Kleefstra Syndrome - Meetup In October in 2012

What is Kleefstra Syndrome

Last Updated on Thursday, 31 May 2012 12:44

Kleefstra syndrome is a rare genetic condition in which a tiny piece is missing from near the end of one of the body’s 46 chromosomes. The missing piece includes a gene called EHMT1. Its absence is believed to cause the major symptoms of the syndrome. The syndrome was officially recognised as Kleefstra syndrome in April 2010 but you may still see it referred to as any of the following:

• 9q34.3 deletion

This was the most common name before Kleefstra Syndrome was recognised, and in fact our original website address was www.9q34.org In April 2010 OMIMrecognised the term "Kleefstra syndrome" and in May 2010 our website adopted the new name.  

• 9qSTDS

Short for 9q Subtelomere Deletion Syndrome - It was suggested by a specialist in the field that this become the uniformed name. Some parents disliked this however, due to other meanings of the term STD.

• CHOMS

Short for Craniofacial characteristics, Hypotonia, Obesity, Microcephaly, Speech problems.  It was suggested to be the uniformed name by one of the specialists looking at the condition.

Other variations are:    

• 9q34.3 microdeletion

• 9q34.3 terminal deletion syndrome
• 
  

Diagnosis

What are the first signs that a baby or child has the disorder?

The first signs can be incredibly diverse. Out of a group of 14 babies, five seemed fine at birth but concern grew later about their development: they failed to track visually, to watch their mother while feeding or their rate of development was slow. One baby seemed to progress as expected until developing a type of seizure at three months; another repeatedly failed hearing tests.

In nine babies there were signs immediately after birth of something wrong, varying from a weak cry, feeding difficulties and unusual facial features (twice thought to suggest Down’s syndrome) to a small head, hernias in the groin and at the navel, a floppy larynx, heart problems, cataracts and seizures. Although a low muscle tone (floppiness) is usually characteristic of newborn babies with Kleefstra syndrome, this may not be obvious: in four babies, no floppiness was observed.

Diagnosis

Last Updated on Tuesday, 01 May 2012 12:56

What are the first signs that a baby or child has the disorder?

The first signs can be incredibly diverse. Out of a group of 14 babies, five seemed fine at birth but concern grew later about their development: they failed to track visually, to watch their mother while feeding or their rate of development was slow. One baby seemed to progress as expected until developing a type of seizure at three months; another repeatedly failed hearing tests.

In nine babies there were signs immediately after birth of something wrong, varying from a weak cry, feeding difficulties and unusual facial features (twice thought to suggest Down’s syndrome) to a small head, hernias in the groin and at the navel, a floppy larynx, heart problems, cataracts and seizures. Although a low muscle tone (floppiness) is usually characteristic of newborn babies with Kleefstra syndrome, this may not be obvious: in four babies, no floppiness was observed.

New Scan May Cause A ‘Paradigm Shift’ in Epilepsy Research

A new non-invasive scan taken directly after a seizure may change the way epilepsy is researched.

An innovative new study merges engineering and clinical expertise to develop a revolutionary method to diagnose and treat epilepsy patients.

Researchers from the University of Minnesota and the Mayo Clinic believe a new type of non-invasive brain scan — taken immediately after a seizure — will provide advanced insight into possible causes and treatments for epilepsy patients.

The new findings could benefit millions of people who are unable to control their epilepsy with medication.

The research is published online in the journal Brain.

Researchers say the study resulted in several significant findings:

• Important data about brain function can be gathered through non-invasive methods, not only during a seizure, but immediately after a seizure;
• The frontal lobe of the brain is most involved in severe seizures;
• Seizures in the temporal lobe are most common among adults. The new technique used in the study will help determine the side of the brain where the seizures originate.

“This is the first-ever study where new non-invasive methods were used to study patients after a seizure instead of during a seizure,” said Dr. Bin He, a biomedical engineering professor in the University of Minnesota’s College of Science and Engineering and senior author of the study. “It’s really a paradigm shift for research in epilepsy.”

Epilepsy affects nearly 3 million Americans and 50 million people worldwide. Although medications and other treatments help many people of all ages who live with epilepsy, about 1 million people in the U.S. and 17 million people worldwide continue to have seizures that can severely limit their lives.

Medical researchers have always faced the challenge of determining the part of the brain responsible for the seizures. Learning the specific site of the seizure helps physicians determine the best possible treatment.

In the past, most research has focused on studying patients while they were having a seizure, or what is technically known as the “ictal” phase of a seizure. Some of these studies involved invasive methods such as surgery to collect data.

In the new study, researchers used a novel approach by studying the brains of 28 patients immediately after seizures, or what is technically know as the “postictal” phase of a seizure.

They used a specialized type of non-invasive EEG with 76 electrodes attached to the scalp for gathering data in contrast to most previous research that used 32 electrodes. The researchers used specialized imaging technology to gather data about the patient.

The findings may lead to innovative means of locating the brain regions responsible for seizures in individual patients using non-invasive strategies.

Read more here

The Best Ways To Integrate Special Needs Students

I found this report on NPR. I hear parents talk about special education issues every day. Accommodations and modifications are a difficult process for all. Children with seizures, autism, cerebral palsy, ADHD and other neurodevelopmental problems are entitled to education. Parents expect a full range of services. In general, schools have motivated and highly professional personnel and accurate services. At the same time, schools have limited budgets for personnel, occupational, physical and speech therapy.  Its a difficult situation.  A physician can help. JR

The Best Ways To Integrate Special Needs Students

May 2, 2012

Budget cuts in many school districts have some parents and teachers questioning whether they have the resources to support their students. NPR education correspondent Claudio Sanchez and Thomas Hehir of Harvard University talk about how to integrate special needs students into mainstream classrooms.

JENNIFER LUDDEN, HOST:

This is TALK OF THE NATION. I'm Jennifer Ludden, in Washington. A troubling new video has reinvigorated the debate over special needs education. A father was told his special needs child was unruly, so he sent him to school wearing a wire. On the recording, his son is harassed and mocked by a teacher and aide in a special needs classroom.

The video is only the latest example of a widespread sense of frustration about special education. What to do? Advocates often want special needs students to get their own classes, but school districts say that's expensive, and certainly in a time of budget cuts, mainstreaming is on the rise.

If you're the parent or teacher of a special needs student, what works? Our number is 800-989-8255. Our email address is talk@npr.org. And you can join the conversation at our website. Go to npr.org and click on TALK OF THE NATION. Later in the program, why some schools are forcing kids off their bikes and into cars.

But first, best practices for mainstreaming special needs students. Joining me now is NPR's education correspondent Claudio Sanchez here in Studio 3A. Hi, Claudio. Welcome.

CLAUDIO SANCHEZ, BYLINE: Good to be here.

LUDDEN: So this is a trend that's been growing in public schools, but mainstreaming may not be a term that everyone's familiar with. Can you just tell us what it means?

SANCHEZ: Mainstreaming means that a child's instruction takes place in a classroom with non-disabled kids, regular kids, a decision based often on the special needs of that child. So, yes, there's an attempt to have this kid feel inclusive, be inclusive, but often it has to be tailor-made. That's where something very crucial here has to happen, and that is that an individual education plan be designed for this child, which calls for special accommodations, certainly special attention if necessary.

And this is all, of course, in the law, the 1975 law that actually was originally called the Education for All Handicapped Children's Act. It later became the Individual Disability Education Act, and that was, for the most part, kind of reauthorized in 1990.

LUDDEN: So, for decades, there's been this effort - so there was a sense beforehand that special needs kids were kind of shunted away and kept out of sight. Parents wanted them in the mainstream. And yet, as I understand it, there have been a lot of bad experiences in these mainstream classes.

SANCHEZ: And remember, they weren't just shunted away. They were literally kept out of school. I mean, for many, many years, these kids were warehoused somewhere else. Schools didn't deal with them. You know, it took several legal cases and challenges to that, most - especially in 1972 in Pennsylvania, which literally led to the creation of the law.

But you're right. The problem has been money, in many ways. You know, there's been an acceptance that these kids can learn, should be mainstreamed, but the money issue is huge. The federal government, when it authorized this law, more recently said we're going to contribute 40 percent - this is Congress talking - 40 percent of the funding for special education.

To this day, it's never been more than 18 percent. So that means that local and state education folks have to come up with the money somewhere, and we're talking about tens of thousands of dollars for every child, every year. So it's a very - it's a very difficult problem for schools because they don't have the money.

LUDDEN: And I guess more so now with - we've seen so many cuts at local school districts.

SANCHEZ: Exactly. And certainly in this time of austere and very limited budgets, I mean, where do you go? The federal government is not coming up with more money, believe me. States are obviously cutting left and right. So, I mean, often, it comes down to litigation on the part of parents. And if you have a good attorney, sometimes they get money out of the district to pay for these services or to put the child in a private program.

LUDDEN: So this terrible, painful video has surfaced of this child's experience. But I take it that's not a surprise to people who look at this field, that there's been a series of studies recently that show this these kinds of instances.

SANCHEZ: Yes, although I would say that the - you know, it's difficult to really document, certainly, every instance of abuse, but they are pretty common. You know, there are cases - there was on in Georgia, a 13-year-old boy committed suicide after being sent to an eight-by-eight, concrete-block time-out room in Gainesville, Georgia, at the public school there.

For students, this was a place that they put students in for behavioral problems. Then there was - you know, there are these famous screaming rooms that some schools have where teachers put kids when they're acting out, when they're out of control. And, you know, there was that famous case, I forget where, it may have been Kentucky, where a child was - who was misbehaving, a special ed kid, had been found stuffed in a duffel bag.

I mean, you know, you hear about these things, and you say this can't be. This has to be the exception to the rule. But you'd be surprised how often - I mean, some of these things aren't even reported, but it happens.

Transcript and link to story here

Benefits of hypothermia for infants continue through early childhood

NIH study shows increased survival from treatment for oxygen deficiency at birth.  I have set up these protocols.   The data is clear that  The treatment  works  and  and I have seen remarkable outcomes.   The protocols need to involve neurology because of the high risk of  subtle seizures and the need for cervical examinations by expert.  One needs to ask if this is a standard of care in 2012.  JR

Benefits of hypothermia for infants continue through early childhood

A treatment to reduce the body temperatures of infants who experience oxygen deficiency at birth has benefits into early childhood, according to a follow-up study by a National Institutes of Health research network.

Children who received the hypothermia treatment as infants were more likely to have survived to ages 6 and 7, when they were evaluated again, than were children who received routine care, the study found. They were no more likely than the routine care group to experience a physical or cognitive impairment, it said. The report appears in the New England Journal of Medicine.

“The findings show that the use of this cooling technique after birth increases the chances of survival, without increasing the risk of long-term disability,” said senior author Rosemary D. Higgins, M.D., of the Pregnancy and Perinatology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The study was conducted by Seetha Shankaran, M.D., of Wayne State University in Detroit, Dr. Higgins, and 25 other researchers in the NICHD Neonatal Research Network. In addition to NICHD, funding was also provided by the NIH's National Center for Research Resources and the National Center for Advancing Translational Sciences.

Infants born at term may fail to get enough oxygen, from blood loss or other birth complications. Oxygen deprivation during the birth process is called hypoxic-ischemic encephalopathy, or HIE. In severe cases of HIE, death rates can reach 50 percent. Survivors often sustain brain damage, which can result in cerebral palsy, cognitive impairment, or hearing and vision loss. Even if they do not experience detectable brain damage, children who experience HIE at birth are at higher risk for learning disabilities, language delays, and memory deficits. Severe oxygen deficiency at birth is also known as birth asphyxia.

The current study was in follow up to an earlier study, conducted when the children were newborns and had received the body cooling treatment shortly after birth. That earlier study found that infants who received the cooling treatment were less likely to die or to develop moderate or severe disability than were the infants who received routine care. The original study assessed children's movement and cognitive abilities, hearing, and vision when they were 18 to 22 months old.

The study authors noted that neonatal intensive care units around the world have adopted this cooling technique to reduce the risk of death and disability among full-term infants who show signs of the brain dysfunction indicating oxygen deficiency.

“Testing at 18 months can identify major delays in a toddler's growth or brain development, but can't identify some of the more subtle cognitive or physical impairments that might become apparent in an older child,” Dr. Higgins said. “This follow-up study confirms the original finding, showing that children who received the cooling treatment were more likely to survive, and that the survivors were no more likely to have a disability than the children in the untreated group.”

The 208 children in the study were diagnosed with HIE within 6 hours of birth and treated in newborn intensive care units in the network. They were given the usual intensive care or treated with the body cooling technique. With this technique, cool water circulates inside a waterproof blanket beneath the infant. The cool water reduces the infant's temperature as low as 91.4 degrees Fahrenheit, and maintains it there 72 hours, after which caregivers allow the infant's body temperature to return to a normal.

To conduct the current study, the researchers analyzed data from follow-up visits conducted when these infants had turned 6 or 7 years old. The researchers compared rates of death and disability among those who got the cooling therapy and those who had received the usual intensive care. Mortality rates reflected the number of children who died between birth and age 7. The study found a 28 percent mortality rate in the hypothermia group, compared with 44 percent rate in the usual care group.

The researchers calculated the number of deaths and cases of severe disability as a single combined outcome. In the cooling group, the combined rate was 41 percent, compared with 60 percent in the usual care group. Severe disability involved motor function, cognitive ability, and vision. Rates of cerebral palsy, blindness, and epilepsy were similar between the two groups.

“Before the advent of this cooling treatment in 2005, doctors couldn't treat HIE

How to get kids' sleep schedules back on track for school

I recommended that families start this to 3 weeks ago.  But, here we are.  see my advice at the end of this post...JR



How to get kids' sleep schedules back on track for school

This article offers great tips for getting kids back on a regular sleep schedule for school. There is also a great slideshow on the site itself.

After a summer filled with camp, amusement park trips and swim lessons, switching back to that 6 a.m. morning routine is a rude awakening -- literally.

"A lot of kids get out of a regular schedule in the summertime,” Dr. Dennis Rosen, M.D., associate medical director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital, tells The Huffington Post, “shifting their internal clocks later, to the point that they’re out of sync with the external clock.”

Those later summertime bedtimes lead to later wake up times for school-aged children, too, he explains, especially teens. But sleeping until noon only causesproblems when September rolls around.

“Waking up earlier becomes quite difficult, almost akin to jet lag,” says Rosen. Not only does it feel crummy, he says, but because sleep plays an important roll in processing and consolidating memories, this seasonal version of jet lag can have an effect inside the classroom as well.

Unlike adults, who need around seven to nine hours of sleep a night, children of different ages require a wide range of sleep amounts to be at their best. Preschoolers typically need about 11 to 13 hours of sleep a night, kids up to 12 years old need 10 to 11 hours of sleep a night and teens need about 8.5 to 9.25 hours, according to the National Sleep Foundation.

But the bell rings at most schools in the U.S. at 8 a.m., HuffPost Education reported in May, and 20 percent of kids and teens must report to first period by 7:45 or before, making it difficult to hit the hay early enough to log the recommended winks.

That’s part of the reason a number of sleep advocates have been pushing for later school start times, a move that would not only allow children and teens to get more -- and better -- sleep, but may also aid learning, boost memory and improve grades and overall performance.

So how can you help your children get their sleep on track in time for headingback to school? Many of our favorite sleep rules still apply: Make your child’s bedroom a peaceful environment for sleep only. Take any electronic gadgets out of the bedroom, and keep it cool, dark and quiet. But there are some summer-specific methods the experts suggest, as well.

Read more here

Children  and teenagers get a circadian rhythm disorder at this time of year called to lead sleep phase  syndrome.  In essence, this is jetlag without the fun of travel.  

Their brain clock is set to go to sleep at a certain time.   This time will not change just because a parent so so.  

 Here is what will happen this week. If your child is set to go to sleep at midnight, they will continue to go to sleep at a late hour. Then because of school, they will be  awakened at 6 or 7. The 1st day they will drag. They may be emotional. They may be inattentive. If they are a set up for ADHD, headaches, tics, seizures,  you may see these increase.

If you  tell your child to go to bed at 9 PM but they have been going to sleep at midnight all week, don't expect a miracle. They are jetlagged by 3 hours.

Have some realistic and gradual expectations.  You need to set up your child to be physiologically ready to accept behavioral change.

 Also,  many people are not aware that the tendency to stay up late is the natural state of the young person's brain.  They live in a 25 hour world.  Unfortunately,  schools still function in a 24-hour world.

Like jetlag the principles of treating are the same.   You need to be awake during the day and sleep when the sun goes down.

So,

• Get your child or teen up at his regular school time this weekend.  Keep them up all day and do not allow napping until the regular bedtime.  
• Get them outside early in the day to expose them to natural bright light. 
• Do not allow  any gizmos that make light after sundown.
• Do not allow caffeine.
• Consistency is key.  Don't change schedules on the weekend.
• Please understand that sometimes this is a difficult problem to treat and medical intervention may be required. A  pediatric sleep specialist  can help. 

New Brain Pacemaker that can Detect Epilepsy and Treat Seizures in Rats

A brain pacemaker has been invented that can detect epilepsy in rats and even help treat their seizures.

Scientists have created a "brain pacemaker" that controls epilepsy in rats by responding only to abnormal electrical patterns in the brain associated with seizures.

The skull implant is similar to an implantable defibrillator and is inserted in the brain and reacts only when a seizure starts to occur by terminating the seizure's electrical activity.

Results from the study, published in the journal Science, showed that the self-adjusting device delivered therapeutic electrical impulses to the brain at the beginning of a short but frequent type of seizure in rats, reducing the length of epileptic seizure by 60 percent in rats with a ‘petit mal’ form of epilepsy, and then automatically shuts itself off.

Most electrical stimulation devices, like ones that deliver deep-brain stimulation to treat Parkinson’s disease and depression, continuously deliver electrical impulses regardless of the patient's brain activity and can cause a range of side effects like headaches.

While other newer seizure-responsive types of deep brain stimulation devices don't continuously operate, these devices also use electrodes that are implanted in the brain and can pose certain risks like worsening epilepsy symptoms.

Lead researcher György Buzsáki, a neuroscientist at the New York University School of Medicine, and his colleagues, used a less invasive treatment method that involved transcranial electrical stimulation (TES) of neurons using electrodes implanted in the skull rather than in brain tissue.

The device is described as a simple, closed-loop system. Additionally, because the device is only activated in response to seizures, researchers said that the risk of causing brain changing side effects is significantly smaller compared to the effects of continuously stimulating devices.

Epilepsy, a brain disorder that triggers repeated seizures over time, affects nearly 3 million people in the U.S., according to the Epilepsy Foundation, making it third most prevalent neurological disorder in the country after Alzheimer's disease and stroke.

Seizures are episodes of disturbed brain activity that leads to changes in attention or behavior. In a seizure, brain cells keep firing instead of acting in an organized way. The brain's faulty electrical system and sudden chaotic neuronal activity triggers an overflow of energy that can cause unconsciousness and involuntary muscle contractions.

Epilepsy patients can suffer from two different kinds of seizures like petit mal seizures and grand mal seizures. Petit mal seizures occur frequently and often last for just a few seconds whereas grand mal seizures are rarer but involve more violent muscle contractions and a loss of consciousness.

Buzsáki and his team tested the new device against petit mal seizures in laboratory rats because this type of seizure can happen hundreds of times a day, allowing the scientists to effectively test the system they designed.

Researchers noted that patients with petit mal seizures are effectively treated with drugs, so the device would not be used to treat that type of seizure and instead by used to treat seizure in drug-resistant patients.

While the device does not prevent seizure, it treats them right away and reduces the length of the seizure by about 60 percent.

Researchers explained that in people, two plates about the size of a pocket watch could be inserted into the skill in a position that targets the affected area of the brain. The electrodes will sit right on top of the brain and be powered by ultra-light electrical circuits implanted in the skull.

Buzsáki and his team hope to replicate their findings on people with complex partial seizures or epileptic seizures that affect both sides of the brain and cause patients to lose consciousness and can occur simultaneously with head injuries, brain infection and stroke.

There is no cure for complex partial seizures, and the cause of the condition is unknown. An estimated 20 percent to 40 percent of people who have complex partial seizures do not respond to medication.

Dr. Orrin Devinsky, director of the epilepsy program at New York University and who was not associated with the study, told HealthDay that the recent findings have great potential for treating epilepsy and other neurological problems like tremors, Parkinson's disease and even serious depression.

"What's unique about this technique is that it's a sophisticated way to identify the rhythmicity of the seizure itself and interrupt the cycle with precision," he said, according to HealthDay. "Existing [deep brain stimulation] devices don't finesse the timing this way."

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