Pediatricians urge later school start time

This article explains why pediatricians are urging for later school start times for older kids in middle and high schools.

U.S. high schools and middle schools should start classes later in the morning to allow kids some much-needed sleep, a leading group of pediatricians is urging.

Ideally, the American Academy of Pediatrics says, the first bell should ring at 8:30 a.m. or later -- which is the case at only 15 percent of U.S. high schools right now.

At the very least, classes should start no earlier than 8 a.m., said Dr. Judith Owens, the lead author of a new academy policy statement on school start times.

The recommendations, published in the academy's journal Pediatrics, are based on research showing that U.S. kids are sleep-deprived, which has consequences for their health, school performance and safety.

"This is an important issue," said Dr. Marcel Deray, a Florida sleep specialist who wasn't involved in the recommendations.

"I see a lot of teenagers who are tired and have problems in school because they have to get up so early," said Deray, who directs the Sleep Disorders Center at Miami Children's Hospital. "Some kids are getting up at 5 a.m., 6 a.m."

Many people think the answer is for kids to just get to bed earlier, Owens noted. But it's not that easy, she said, because biology has other plans.

Around puberty, the body's natural sleep-wake cycle shifts, and it's actually hard for teenagers to fall asleep earlier than 11 p.m.

"Teenagers' bodies release melatonin later than (adults') do," Deray explained, referring to a hormone the brain secretes in the evening to induce drowsiness.

"The other issue," Owens said, "is that teenagers' sleep needs are greater than many people think. They need nine to nine-and-a-half hours."

Yet, 43 percent of U.S. public high schools start classes before 8 a.m., according to the U.S. Department of Education. Middle schools, meanwhile, typically start classes at 8 a.m. -- with about 20 percent starting earlier than that.

"And that's the first bell," Owens said. "That's not even counting the commute time."

So in areas where kids take the school bus, the actual school day could begin before sunrise.

According to Owens, U.S. high schools started bumping up start times back in the 1950s and '60s, mainly to space out bus runs. Many school districts start high schools and middle schools first, then circle buses back to pick up elementary school kids.

One option would be to flip elementary and high school start times, but parents often oppose that -- since young children could be standing at bus stops in the early-morning dark, or have no one at home after school. Another option -- running more buses -- would be expensive.

Transportation is not the only obstacle, according to the National Sleep Foundation, which supports pushing back school start times. Some other arguments are that sports and extracurricular activities would end too late; teenagers would have no time for after-school jobs; and a later start could conflict with working parents' schedules.

Owens acknowledged the logistical challenges, and said parents and school staff sometimes oppose later start times. As an example, she said the Fairfax County, Va., school district has been debating the issue for years. Four options, including one with a 9:15 a.m. high school start, will be put to a vote this fall.

Some districts have found "creative solutions" to certain obstacles -- like having high school students switch from school buses to public ones, according to the academy.

Deray thinks tackling the practical challenges is worthwhile. He said studies have linked kids' sleep deprivation not only to poorer school performance, but also to higher rates of car accidents, obesity and depression.

In a recent study of eight U.S. high schools that delayed their start times, researchers found improvements in kids' grades, attendance and car crash rates.

Later school starts are just one way to help sleepy kids, however. Deray offered parents some tips.

"All electronic devices should be turned off an hour or two before bed," he said. "The blue light from them suppresses melatonin production."

He also advised avoiding physical and mental stimulation close to bedtime -- which means exercise and homework should be done earlier in the evening. And while teenagers love to sleep till noon on weekends, that will only further disturb their sleep/wake cycle. Deray said kids should get up by 9 a.m. on weekends and get plenty of morning sunlight.

He acknowledged, though, that all of that is easier said than done.

Owens agreed. "One of the issues is that kids are overscheduled," she said. "Don't give them so many things to do that they can't get to bed before midnight."

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Epilepsy drugs used during pregnancy may be linked adverse outcomes!

This study looked at women who used certain epilepsy medications while pregnant and if there was an association with the drug and adverse outcomes.

Talk to your neurologist if you are planning pregnancy and have epilepsy. Certain medications may have less adverse effects than others. JR

Antiepileptic drugs may cause congenital malformations. Less is known about the effect on development in infancy and childhood. The aim of this study was to examine whether exposure to antiepileptic drugs during pregnancy has an effect on early child development. Exposure to antiepileptic drugs during pregnancy is associated with adverse development at 18 and 36 months of age, measured as low scores within key developmental domains rated by mothers.

 Exposures to valproate, lamotrigine, carbamazepine, or multiple antiepileptic drugs were associated with adverse outcome within different developmental domains.

Methods

• From mid-1999 through December 2008, children of mothers recruited at 13–17 weeks of pregnancy were studied in the ongoing prospective Norwegian Mother and Child Cohort Study.
• Information on birth outcomes were obtained from the Medical Birth Registry (108,264 children), and mothers reported on their child's motor development, language, social skills, and autistic traits using items from standardized screening tools at 18 months (61,351 children) and 36 months (44,147 children) of age.
• The relative risk of adverse outcomes in children according to maternal or paternal epilepsy with and without prenatal exposure to antiepileptic drugs was estimated as odds ratios (ORs), using logistic regression with adjustment for maternal age, parity, education, smoking, depression/anxiety, folate supplementation, and child congenital malformation or low birth weight.

Results

• A total of 333 children were exposed to antiepileptic drugs in utero.
• At 18 months, the exposed children had increased risk of abnormal scores for gross motor skills (7.1% vs. 2.9%; OR 2.0, 95% confidence interval [CI] 1.1–3.7) and autistic traits (3.5% vs. 0.9%; OR 2.7, CI 1.1–6.7) compared to children of parents without epilepsy. At 36 months, the exposed children had increased risk of abnormal score for gross motor skills (7.5% vs. 3.3%; OR 2.2, CI 1.1–4.2), sentence skills (11.2% vs. 4.8%; OR 2.1, CI 1.2–3.6), and autistic traits (6.0% vs. 1.5%; OR 3.4, CI 1.6–7.0).
• The drug-exposed children also had increased risk of congenital malformations (6.1% vs. 2.9%; OR 2.1, CI 1.4–3.4), but exclusion of congenital malformations did not affect the risk of adverse development.
• Children born to women with epilepsy who did not use antiepileptic drugs had no increased risks.
• Children of fathers with epilepsy generally scored within the normal range.

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Is it migraine or occipital epilepsy? Panayiotopoulos syndrome (PS) can cause vomiting and headache!

What are the key differences between occipital seizures and migraine? 

Sometimes its hard to tell...JR 
Panayiotopoulos syndrome (PS) 

Benign childhood focal epilepsies: assessment of established and newly recognized syndromes

1. Chrysostomos P. Panayiotopoulos, 
2. Michael Michael, 
3. Sue Sanders, 
4. Thalia Valeta and
5. Michael Koutroumanidis

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1. Department of Clinical Neurophysiology and Epilepsies, St Thomas’ Hospital, Guy's and St Thomas NHS Foundation Trust, London, UK

1. Correspondence to: Michael Koutroumanidis, MD, Department of Clinical Neurophysiology and Epilepsies, St Thomas’ Hospital, London SE1 7EH, UK E-mail:michael.koutroumanidis@gstt.nhs.uk

• Received April 14, 2008.
• Revision received June 30, 2008.
• Accepted July 1, 2008.

Next Section

Summary

A big advance in epileptology has been the recognition of syndromes with distinct etiology, clinical and EEG features, treatment and prognosis. A prime and common example of this is Rolandic epilepsy that is well known by the general pediatricians for over 50 years, thus allowing a precise diagnosis that predicts an excellent prognosis.

However, rolandic is not the only benign childhood epileptic syndrome.

Converging evidence from multiple and independent clinical, EEG and magnetoencephalographic studies has documented Panayiotopoulos syndrome (PS) as a model of childhood autonomic epilepsy, which is also common and benign. Despite high prevalence, lengthy and dramatic features, PS as well as autonomic status epilepticus had eluded recognition because emetic and other ictal autonomic manifestations were dismissed as non-epileptic events of other diseases.

Furthermore, PS because of frequent EEG occipital spikes has been erroneously considered as occipital epilepsy and thus confused with the idiopathic childhood occipital epilepsy of Gastaut (ICOE-G), which is another age-related but rarer and of unpredictable prognosis syndrome. Encephalitis is a common misdiagnosis for PS and migraine with visual aura for ICOE-G. Pathophysiologically, the symptomatogenic zone appears to correspond to the epileptogenic zone in rolandic epilepsy (sensory-motor symptomatology of the rolandic cortex) and the ICOE-G (occipital lobe symptomatology), while the autonomic clinical manifestations of PS are likely to be generated by variable and widely spread epileptogenic foci acting upon a temporarily hyperexcitable central autonomic network.

Rolandic epilepsy, PS, ICOE-G and other possible clinical phenotypes of benign childhood focal seizures are likely to be linked together by a genetically determined, functional derangement of the systemic brain maturation that is age related (benign childhood seizure susceptibility syndrome). This is usually mild but exceptionally it may diverge to serious epileptic disorders such as epileptic encephalopathy with continuous spike and wave during sleep.

Links with other benign and age-related seizures in early life such as febrile seizures, benign focal neonatal and infantile seizures is possible. Overlap with idiopathic generalized epilepsies is limited and of uncertain genetic significance.

Taking all these into account, benign childhood focal seizures and related epileptic syndromes would need proper multi-disciplinary re-assessment in an evidence-based manner.


Full article here....

Brain scans can determine which letter a person is reading

fMRI brain scans can be used to determine which letter a person regarding. This technology may be the first step to determining what a person is thinking.

By analysing MRI images of the brain with an elegant mathematical model, it is possible to reconstruct thoughts more accurately than ever before. In this way, researchers from Radboud University Nijmegen have succeeded in determining which letter a test subject was looking at.

The journal Neuroimage has accepted the article, which will be published soon.

Functional MRI scanners have been used in cognition research primarily to determine which brain areas are active while test subjects perform a specific task. The question is simple: is a particular brain region on or off? A research group at the Donders Institute for Brain, Cognition and Behaviour at Radboud University has gone a step further: they have used data from the scanner to determine what a test subject is looking at.

The researchers 'taught' a model how small volumes of 2x2x2 mm from the brain scans -- known as voxels -- respond to individual pixels. By combining all the information about the pixels from the voxels, it became possible to reconstruct the image viewed by the subject. The result was not a clear image, but a somewhat fuzzy speckle pattern. In this study, the researchers used hand-written letters.

Prior knowledge improves model performance

'After this we did something new', says lead researcher Marcel van Gerven. 'We gave the model prior knowledge: we taught it what letters look like. This improved the recognition of the letters enormously. The model compares the letters to determine which one corresponds most exactly with the speckle image, and then pushes the results of the image towards that letter. The result was the actual letter, a true reconstruction.'

'Our approach is similar to how we believe the brain itself combines prior knowledge with sensory information. For example, you can recognise the lines and curves in this article as letters only after you have learned to read. And this is exactly what we are looking for: models that show what is happening in the brain in a realistic fashion. We hope to improve the models to such an extent that we can also apply them to the working memory or to subjective experiences such as dreams or visualisations. Reconstructions indicate whether the model you have created approaches reality.'

Improved resolution; more possibilities

'In our further research we will be working with a more powerful MRI scanner,' explains Sanne Schoenmakers, who is working on a thesis about decoding thoughts. 'Due to the higher resolution of the scanner, we hope to be able to link the model to more detailed images. We are currently linking images of letters to 1200 voxels in the brain; with the more powerful scanner we will link images of faces to 15,000 voxels.'

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Biomarkers predict outcomes for children's brain injuries

Biomarkers found in cerebrospinal fluid can predict outcomes for pediatric traumatic brain injuries.

The study aims to systematically review the literature on brain injury biomarkers, defined as any injury biomarker detected in cerebrospinal fluid (CSF) or blood injury biomarkers primarily expressed in the brain parenchyma, to determine outcome prediction in pediatric severe traumatic brain injury (sTBI). Based on the status of current sTBI biomarker research, the authors recommend that future research should be directed at both novel biomarker discovery and validation of biomarker panels in large, well–designed longitudinal studies.

Methods

• A search of MEDLINE, EMBASE, PsycINFO, Pubmed, and the Cochrane Database, as well as grey literature sources, personal contacts, hand searches, and reference lists.
• The search terms used were traumatic brain injury, biomarkers, prognosis, and children.
• No language, publication type, or publication date restrictions were imposed.
• All articles were critically reviewed by two clinicians independently.

Results

• A total of 7,150 articles were identified initially with 16 studies identified for review.
• Eighteen different biomarkers were examined; 11 in CSF and 7 in blood.
• Outcomes assessed included either in–hospital mortality or functional state (hospital discharge, 3–months or 6–months; Glasgow Outcome Scale or Pediatric Cerebral Performance Category).
• Significant correlations were established between sTBI outcomes and various biomarkers in CSF (IL–6, IL–8, IL–1β, S100β, NGF, NSE, DCX, ET–1, HMGB–1, cytochrome C) and blood (GFAP, NF–H, UCH–L1, SBDP–145, leptin).
• Mixed results were obtained for blood S100β.
• Outcome did not correlate with several biomarkers in either CSF (BDNF, GDNF, α–Syn) or blood (NSE, MBP).
• The Class of Evidence was considered II in 1 study and III in the remaining 15 studies.

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Food purchasing is increased after sleep deprivation

A study links sleep deprivation to purchasing more food the following day which could influence weight gain and obesity over time.

People who were deprived of one night's sleep purchased more calories and grams of food in a mock supermarket on the following day in a new study published in the journal Obesity, the official journal of The Obesity Society. Sleep deprivation also led to increased blood levels of ghrelin, a hormone that increases hunger, on the following morning; however, there was no correlation between individual ghrelin levels and food purchasing, suggesting that other mechanisms -- such as impulsive decision making -- may be more responsible for increased purchasing.

Researchers in Sweden were curious as to whether sleep deprivation may impair or alter an individual's food purchasing choices based on its established tendency to impair higher-level thinking and to increase hunger.

"We hypothesized that sleep deprivation's impact on hunger and decision making would make for the 'perfect storm' with regard to shopping and food purchasing -- leaving individuals hungrier and less capable of employing self-control and higher-level decision-making processes to avoid making impulsive, calorie-driven purchases," said first author Colin Chapman, MSc, of Uppsala University.

On the morning after one night of total sleep deprivation, as well as after one night of sleep, Chapman, along with Christian Benedict, PhD, and their colleagues, gave 14 normal-weight men a fixed budget (approximately $50). The men were instructed to purchase as much as they could out of a possible 40 items, including 20 high-caloric foods and 20 low-calorie foods. The prices of the high-caloric foods were then varied to determine if total sleep deprivation affects the flexibility of food purchasing. Before the task, participants received a standardized breakfast to minimize the effect of hunger on their purchases.

Sleep-deprived men purchased significantly more calories (+9%) and grams (+18%) of food than they did after one night of sleep. The researchers also measured blood levels of ghrelin, finding that the hormone's concentrations were higher after total sleep deprivation; however, this increase did not correlate with food purchasing behavior.

"Our finding provides a strong rationale for suggesting that patients with concerns regarding caloric intake and weight gain maintain a healthy, normal sleep schedule," said Chapman.

Follow up studies are needed to address whether these sleep deprivation-induced changes in food purchasing behavior also exist under partial sleep deprivation, though. Additional research should also look into sleep deprivation's potential impact on purchasing behavior in general, as it may lead to impaired or impulsive purchasing in a variety of other contexts.

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Zebrafish help find model to treat childhood epilepsy

A study by the National Institute of Health (NIH) shows that zebrafish may help model a treatment for Dravet syndrome, a severe childhood epilepsy.

According to new research on epilepsy, zebrafish have certainly earned their stripes. Results of a study in Nature Communications suggest that zebrafish carrying a specific mutation may help researchers discover treatments for Dravet syndrome (DS), a severe form of pediatric epilepsy that results in drug-resistant seizures and developmental delays.

Scott C. Baraban, Ph.D., and his colleagues at the University of California, San Francisco (UCSF), carefully assessed whether the mutated zebrafish could serve as a model for DS, and then developed a new screening method to quickly identify potential treatments for DS using these fish. This study was supported by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health and builds on pioneering epilepsy zebrafish models first described by the Baraban laboratory in 2005.

Dravet syndrome is commonly caused by a mutation in the Scn1a gene, which encodes for Nav1.1, a specific sodium ion channel found in the brain. Sodium ion channels are critical for communication between brain cells and proper brain functioning.

The researchers found that the zebrafish that were engineered to have the Scn1a mutation that causes DS in humans exhibited some of the same characteristics, such as spontaneous seizures, commonly seen in children with DS. Unprovoked seizure activity in the mutant fish resulted in hyperactivity and whole-body convulsions associated with very fast swimming. These types of behaviors are not seen in normal healthy zebrafish.

“We were also surprised at how similar the mutant zebrafish drug profile was to that of Dravet patients,” said Dr. Baraban. “Antiepileptic drugs shown to have some benefits in patients (such as benzodiazepines or stiripentol) also exhibited some antiepileptic activity in these mutants. Conversely, many of the antiepileptic drugs that do not reduce seizures in these patients showed no effect in the mutant zebrafish.”

In this study, the researchers developed a fast and automated drug screen to quickly test the effectiveness of various compounds in mutant zebrafish. The researchers tracked behavior and measured brain activity in the mutant zebrafish to determine if the compounds had an impact on seizures.

“Scn1a mutants seize often, so it is relatively easy to monitor their seizure behavior at baseline and then again after a drug application,” said Dr. Baraban. “Using zebrafish placed individually in a 96-part petri dish we can accurately quantify this seizure behavior. In this way, we can test almost 100 fish at one time and quickly determine whether a drug candidate has any effect on these spontaneous seizures.”

In the first such application of this approach, UCSF researchers screened 320 compounds and found that clemizole was most effective in inhibiting seizure activity. Clemizole is approved by the U.S. Food and Drug Administration and has a safe toxicology profile. “This finding was completely unexpected. Based on what is currently known about clemizole, we did not predict that it would have antiepileptic effects,” said Dr. Baraban.

These findings suggest that Scn1a mutant zebrafish may serve as a good model of DS and that the drug screen may be effective in quickly identifying novel therapies for epilepsy.

Dr. Baraban also noted that someday these experiments can be “personalized,” by looking at mutated zebrafish that use genetic information from individual patients.

This research was funded by the Exceptional, Unconventional Research Enabling Knowledge Acceleration (EUREKA) program at NIH that supports innovative research with the potential for big impact in biomedical science.

“The goal of the EUREKA program is to provide a means to test high-risk ideas to see if they are worth pursuing further. These kinds of ideas often come from left field and are very creative. Since they are so unique, however, there may not be any existing preliminary data to support the hypothesis or demonstrate feasibility. EUREKA grants provide an opportunity to gather this information,” said Brandy Fureman, Ph.D., program director at NINDS.

This particular study was chosen in response to a request by NINDS to help spur novel research on epilepsy. “This research was selected for a EUREKA grant because it proposed a well-designed, inventive model of genetic epilepsy that could accelerate the pace of drug-screening for this devastating form of pediatric epilepsy” said Dr. Fureman.

Dr. Fureman noted that these findings not only describe a novel model of Dravet syndrome, but the positive results with an unexpected FDA-approved drug may lead to new therapeutic avenues. “There is more work to be done, but I am very pleased to see these initial results. These kinds of new directions are exactly what we hoped to stimulate with the EUREKA program,” she said.

For more information about Dravet syndrome and epilepsy, please visit:

• http://www.ninds.nih.gov/disorders/dravet_syndrome/dravet_syndrome.htm
• http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm

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Young adults with autism struggle with jobs and independent living

This article discusses how adults with autism may struggle in independent living situations and in their job search.

For young adults with autism spectrum disorders (ASDs), making the transition from school to the first rites of independent adult life, including a first job and a home away from home, can be particularly challenging.

Two newly published studies show precisely how stark the situation is for finding success in employment and independent living among young adults on the autism spectrum, compared to their peers with other types of disabilities. The researchers emphasize the need to strengthen services to help adolescents and young adults and their families with transition planning.

"Roughly 50,000 youth with autism will turn 18 years old this year," said Dr. Paul T. Shattuck, an associate professor in the A.J. Drexel Autism Institute and Drexel University School of Public Health, who co-authored both studies. "So many of these young people have the potential to work and participate in their communities. Supporting this potential will benefit everyone -- the person with autism, the family, employers and society."

Employment Outlook: Just Over Half with ASDs Had Ever Worked for Pay

In the Journal of the American Academy of Child & Adolescent Psychiatry, Shattuck's team reports that young adults with autism spectrum disorders have worse employment outcomes in the first few years after high school than do peers who have other types of disabilities.

"Not only was the employment rate low for young people with ASDs when compared with young adults with other disabilities, but pay for jobs -- if they got them -- was significantly lower compared to young adults with other types of disabilities," said Anne M. Roux, senior research coordinator at the A.J. Drexel Autism Institute, who led the employment study as a member of Shattuck's research team while both were at Washington University in St. Louis.

They report that just over half (53.4 percent) of the young adults on the autism spectrum they surveyed had ever worked for pay outside the home within the first eight years after leaving high school. Only about one in five (20.9 percent) young adults with ASDs worked full-time at a current or most-recent job. Average pay was $8.10 per hour.

Employment rates, full-time employment status and average pay were substantially higher for young adults with other disabilities, including learning disabilities, emotional disturbance and speech/language impairment, compared to young adults with ASDs. The employment gap widened even farther when adjusted for differences in functional skills and conversational ability.

"The news is mixed," Roux said. "This study highlights the particular difficulty that youth with autism are having during the transition into adulthood, especially youth from poorer households who are more likely to be disengaged from the services needed to secure and maintain a job.

"At the same time, half of young adults with an ASD did become employed, including youth with more challenging levels of impairment. This finding gives us hope for what might be possible with more effective preparation for employment, transition practices and workplace supports."

In an independent editorial in the same journal issue, Dr. Patricia Howlin of King's College London and the University of Sydney, wrote, "if young adults with autism miss out on this rite of passage, they risk transition into a world of social exclusion, financial hardship and significantly decreased quality of life. On the positive side, there is evidence that specialized, supported employment programs can be very helpful in assisting young people into work and in improving quality of life and even cognitive performance."

Residential Status: Young Adults with ASD Less Likely to Live Independently

In another study published this week in the journal Autism, members of Shattuck's research team report that young adults on the autism spectrum are less likely to have ever lived independently after high school, than adults with other disabilities.

"This paper suggests that the years following high school are markedly different for young adults with ASDs compared to other disability categories," said Kristy A. Anderson, a doctoral student at the University of Wisconsin-Madison, who led the residential status study. "Notably, young adults on the autism spectrum have higher rates of coresidency in the parental home."

Young adults on the autism spectrum were less likely to have ever lived independently since leaving high school, compared to their peers with other disabilities. More young adults with autism lived with their parents or guardians, and for longer periods of time, than did individuals with emotional disturbance, learning disability or intellectual disability. They also had the highest rates of living in a supervised living arrangement.

Young adults with an ASD also experienced the highest rates of postsecondary residential continuity (79.1 percent).

"They are residing in the parental home at higher rates and longer time periods relative to peers with other disabilities, warranting family-based services in the years following high school exit," Anderson said.

Despite the concurrent study on employment, the researchers found no association between having held a paying job and residential outcomes among young adults on the autism spectrum.

Long-Term Research Targets the Autism Services Cliff for Adolescents

The analyses of employment and residential status were both products of Shattuck's widely recognized research program examining outcomes and service use among adolescents and young adults on the autism spectrum. The needs of this age group are largely under-represented in research, even as many individuals diagnosed in childhood face a decline in available social services after they age out of the educational system.

The project involves long-term follow-up study on the outcomes of a large, nationally representative sample of young adults (National Longitudinal Transition Study). All of the participants were initially enrolled while receiving special education services in school; they or their parents completed regular follow-up surveys for up to 10 years after the student had completed high school.

"Many families tell us it's like driving off a cliff when their child with autism exits high school because there just aren't many options once they enter adulthood," Shattuck said. "Our work highlights the enormous challenges facing this vulnerable population and their families. Experimenting with innovative solutions that can help these youth is a top priority at the A.J. Drexel Autism Institute."

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Most common migraine trigger is stress

General practitioners in the UK claim that stress is the most common trigger for migraines.

Stress has been blamed as the most common trigger for Migraines, according to GPs.

Certain foods like cheese and chocolate, excess caffeine intake or withdrawal and drinks containing Alcohol are also common triggers for migraines too. 

What’s more, 37 per cent of GPs believe that prevalence of migraine is probably on the rise, according to the research from Imigran Recovery.

Classed as among the most disabling illnesses by the World Health Organization, migraine is likened to the pain of childbirth by 44 per cent of GPs.

Despite this, almost half of GPs report that people often struggle with migraine for too long before seeking advice or taking action. This also applies to diagnosis, with at least 50 per cent of patients estimated to be undiagnosed.

Media medic and practising GP, Dr Sarah Jarvis said: “The impact of stress on our Health can never be underestimated. Where there’s a migraine attack, then for a lot of my patients, there’s normally stress involved. Certainly, there are a number of reasons stress may have increased over the years, including the economic downturn to name but one. As a result, migraine prevalence may be increasing and I have seen this among my own patients."

More than half of GPs agree that sufferers are not doing enough to avoid migraine triggers and, as a result, some migraine sufferers can go their whole life without getting their condition under control. Without changes in lifestyle, avoiding triggers and taking medication, migraine cannot be fully controlled, according to 46 per cent of GPs.

Dr Sarah Jarvis continued: “Avoiding stress can be difficult, but it is only through sustained lifestyle changes, alongside medication, that migraine can be controlled. Treatments, such as sumatriptan-based products, can relieve symptoms of a migraine attack, but it’s also important that patients take preventative steps between Migraines.

"I often suggest starting with a migraine diary to help pinpoint the triggers. Almost always small lifestyle changes will help, for example taking regular exercise, regular sleeping habits, eating a healthy Diet and avoiding caffeine.”

GPs also report a lack of patient awareness about treatments, with 77 per cent believing that migraine sufferers are unaware of the range of treatments available. Often sufferers have misplaced faith in painkillers, unsuccessfully trying to control the condition. Analgesics, such as paracetamol, ibuprofen and aspirin, are overused by some migraine sufferers, according to 87 per cent of GPs. As a result, three quarters agree Medication Overuse Headache can be common amongst sufferers.

Despite their overuse, nearly three quarters of GPs believe analgesics provide insufficient relief for some migraine sufferers. As a result, treating and diagnosing migraine can be frustrating, according to 65 per cent of GPs, and 35 per cent believe it is still a poorly understood condition.

According to a separate study of 3,000 migraine sufferers by Imigran Recovery, 86 per cent of sufferers take no preventative action between migraine attacks. This could explain why nearly half of migraine sufferers feel helpless, believing that migraine is untreatable.

It’s no wonder then that more than a quarter of migraine sufferers believe their life would be happier if they could get control of migraine and more than a fifth believe their life would be significantly improved.

Experts believe that the widening of blood vessels in the brain causes the throbbing pain of migraine.  

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Study claims exercise reduces epilepsy risk in men

Consistent and vigorous exercise, such as during military training, is shown to reduce risk of later developing epilepsy for men.

New research suggests that men who exercise vigorously as young adults may reduce their risk of developing epilepsy later in life. The study is published in the September 4, 2013, online issue of Neurology, the medical journal of the American Academy of Neurology. Epilepsy is a brain disease that causes repeated seizures over time.

"There are a host of ways exercise has been shown to benefit the brain and reduce the risk of brain diseases," said study author Elinor Ben-Menachem, PhD, MD, with the University of Gothenburg in Sweden and an associate member of the American Academy of Neurology. "This is the first study in humans to show that exercise may also reduce the risk of epilepsy, which can be disabling and life-threatening."

For the study, 1.17 million Swedish men were given cycle tests that measured cardiovascular fitness when they enlisted for mandatory military service at age 18. The participants were then assessed for epilepsy for an average of 25 years. During follow-up, 6,796 men were diagnosed with epilepsy.

The study found that men who had a high level of fitness were 79 percent less likely to develop epilepsy than those with low fitness levels and 36 percent less likely to develop epilepsy than those with medium fitness levels.

The proportion of men with high fitness who developed epilepsy in the study was 0.48% (2,381 out of 496,973 with high fitness). The proportion of men with medium fitness who developed epilepsy was 0.62 percent (3,913 out of 629,876 with medium fitness). The proportion of men with low fitness who developed epilepsy was 1.09 percent (502 out of 46,230 with low fitness).

The results were lessened only slightly after considering genetic factors and a prior history of traumatic brain injury, stroke or diabetes.

"Exercise may affect epilepsy risk in two ways. It may protect the brain and create stronger brain reserve, or it may simply be that people who are fit early in life tend to also be fit later in life, which in turn affects disease risk," Ben-Menachem said.

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Preemies may face neurodevelopmental problems

A study shows that preemies born at or earlier than 25 weeks are likely to have extremely low IQ or other neurodevelopmental issues during childhood.

Babies who are born at 25 weeks' gestation or earlier and survive early life have a "substantial likelihood" of having a very low IQ or other neurodevelopmental problems in childhood, researchers said today.

In a review of nine past studies, they found between 24 and 43 percent of extremely premature infants went on to have moderate or severe impairment, depending on just how early the babies were born.

Dr. Henry Lee, from the Division of Neonatal & Developmental Medicine at Stanford University and Lucile Packard Children's Hospital in California, said it's a "very difficult circumstance for the family" when a baby is born between 22 and 25 weeks.

Normal gestation is 37 to 42 weeks. Twenty-two weeks is considered the earliest a baby can be born and still have a chance of surviving. But the odds can be so low, and the risks so high, that some hospitals might not even offer aggressive care to preemies delivered at 22 to 23 weeks, said Lee, who wasn't involved in the new research.

"First of all, they're at high risk of not even surviving, even when everything is done to help them," he told Reuters Health. "Even when they do survive, they have high rates of disability."

By 25 weeks in the womb, a baby's chances of surviving and going on to lead a normal life are thought to be significantly better.

Lee said the new data could be used to help counsel families of extremely premature infants.

"It's hopefully an informed decision that the family makes in terms of how they're going to proceed, whether to try to provide very aggressive, intensive care to these infants or potentially to provide palliative and comfort care," he said.

"The hard part too is there is still uncertainty. Even though there is this risk, there are some infants at each of these gestational ages that will survive and not have disability."

For their analysis, researchers led by Dr. Gregory Moore from The Ottawa Hospital in Ontario, Canada, pooled the results of nine studies that assessed kids born between 22 and 25 weeks' gestation when they were four to eight years old. Most of the studies were conducted in Europe and together they included close to 900 children.

Moderately or severely impaired children were those scoring in the lowest 2 to 3 percent on IQ tests, children with cerebral palsy and those who were fully or mostly deaf or blind.

Studies varied widely in the frequency of impairment they reported, likely based in part on different practices in different regions, the researchers said.

They found that across the board, children were at risk of neurodevelopmental problems - although those risks declined for every extra week in the womb.

Among babies born at 22 weeks, 43 percent were impaired. That compared to 40 percent of those born at 23 weeks, 28 percent born at 24 weeks and 24 percent born at 25 weeks' gestation, the study team reported Monday in JAMA Pediatrics.

About 4 to 5 percent of full-term babies go on to have some type of developmental problem, Moore said, but that includes children with milder impairment as well.

"Although substantial numbers of extremely preterm infants go on to develop moderate to severe (neurodevelopmental impairment), the results are not completely bleak in that over half of the children studied did not go on to develop moderate to severe impairment," Dr. Kimberly Noble, a pediatrician who studies child brain development at Columbia University in New York, said.

Noble, who wasn't involved in the new research, told Reuters Health in an email that it's unclear whether rates of impairment would be similar for U.S. babies born very early.

Moore, also from The Children's Hospital of Eastern Ontario, said the findings were limited by the small number of children born at the earliest gestations included in the studies.

"We don't want these (data) to make a physician automatically say, ‘There's no hope' or, ‘There's no chance,'" he told Reuters Health.

But, he added, "Many parents do think of long-term impairment as a major concern for them, and some parents think of it as a bigger concern than death, for example. For some parents knowing this data and knowing the limitations of it and speaking with a caring neonatologist about it, we would hope that that would help them in their decision making."

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Enzymes may be why autism develops

A study from the NIH shows that a group of enzymes may be the cause that autism develops.

A group of enzymes in the brain appears to be key to the activity of many genes linked to autism, a new study reveals.

Experts hope the findings will shed light on the causes of autism, and possibly lead to new treatments.

The study results, published online Aug. 28 in the journal Nature, hint that if disruptions in enzymes called topoisomerases occur during brain development, they might contribute to the development of autism spectrum disorders.

The enzymes are found throughout the body, and their main job is to "untangle the knots" in cells' DNA so the cells can function and reproduce themselves normally, explained senior researcher Mark Zylka, an associate professor of cell biology at the University of North Carolina at Chapel Hill.

Topoisomerases have been well studied for their role in helping tumor cells to spread, and drugs that inhibit the enzymes are already used to treat certain cancers.

There have also been hints, though, that topoisomerases might contribute to autism. Last year, researchers reported that some people with autism spectrum disorders have mutations in these enzymes.

"But we've known little about how they work in the brain," said Zylka.

In lab experiments with mouse and human brain cells, Zylka's team found that a topoisomerase-inhibiting drug reduced the activity of 49 genes that past studies have linked to autism. That points to the importance of topoisomerases in the normal expression of those genes.

"A single drug down-regulated all of those genes," Zylka said.

That does not mean, however, that topoisomerase inhibitors should be tested for treating autism. If anything, Zylka explained, you would want a drug that enhances the enzymes' actions.

But now researchers can look for compounds that do just that.

What's more, the findings point to a biological process that ties together dozens of different genes that are suspected of being involved in autism. "Well over 300 (autism-linked) genes have been identified now," Zylka said. "That list looks daunting, but the goal is to figure out how all these genes are connected," he said.

"It can be overwhelming when you look at the list of genes," agreed Andy Shih, senior vice president for scientific affairs for the advocacy group Autism Speaks.

But if you can zero in on the "biological pathways" linking those genes, "it all starts to make sense," said Shih, who was not involved in the study.

In the United States, it's estimated that at least one in every 88 children has an autism spectrum disorder, with the severity ranging widely from child to child. Some kids have little or no ability to speak, and focus obsessively on just a few interests; other kids speak and have normal to above-normal intelligence, but may have problems socializing and communicating more subtly -- for example, trouble using and "reading" gestures, body language and facial expressions.

No one knows what causes autism spectrum disorders, but experts believe that it's a complex mix of genetic vulnerability and environmental exposures -- possibly chemicals or microbes.

Shih pointed to an "interesting" fact about topoisomerases: Their activity is believed to be influenced by environment, including compounds in food and in the physical world. So, he said, studying the enzymes might help researchers pinpoint some of the environmental factors that contribute to autism spectrum disorders.

"We've been talking for a long time about the interaction between genes and environment in autism," Shih said. Topoisomerases could offer a way for scientists to begin to connect the dots.

Zylka agreed, and said his team is searching for environmental compounds that inhibit topoisomerases -- and may, therefore, be important for pregnant women or young children to avoid.

There is still, however, a long way to go in fully understanding the underpinnings of autism spectrum disorders. "We've just scratched the surface of what's going wrong in the brain" in autism, Zylka said.

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Dyslexia diagnosed by brain scans? Examine the arcuate fasciculus

Brain scans showing the brain's structure may soon be able to show a person is dyslexic. JR

About 10 percent of the U.S. population suffers from dyslexia, a condition that makes learning to read difficult. Dyslexia is usually diagnosed around second grade, but the results of a new study from MIT could help identify those children before they even begin reading, so they can be given extra help earlier.

The study, done with researchers at Boston Children's Hospital, found a correlation between poor pre-reading skills in kindergartners and the size of a brain structure that connects two language-processing areas.

Previous studies have shown that in adults with poor reading skills, this structure, known as the arcuate fasciculus, is smaller and less organized than in adults who read normally. However, it was unknown if these differences cause reading difficulties or result from lack of reading experience.

"We were very interested in looking at children prior to reading instruction and whether you would see these kinds of differences," says John Gabrieli, the Grover M. Hermann Professor of Health Sciences and Technology, professor of brain and cognitive sciences and a member of MIT's McGovern Institute for Brain Research.

Gabrieli and Nadine Gaab, an assistant professor of pediatrics at Boston Children's Hospital, are the senior authors of a paper describing the results in the Aug. 14 issue of theJournal of Neuroscience. Lead authors of the paper are MIT postdocs Zeynep Saygin and Elizabeth Norton.

The path to reading

The new study is part of a larger effort involving approximately 1,000 children at schools throughout Massachusetts and Rhode Island. At the beginning of kindergarten, children whose parents give permission to participate are assessed for pre-reading skills, such as being able to put words together from sounds.

"From that, we're able to provide -- at the beginning of kindergarten -- a snapshot of how that child's pre-reading abilities look relative to others in their classroom or other peers, which is a real benefit to the child's parents and teachers," Norton says.

The researchers then invite a subset of the children to come to MIT for brain imaging. The Journal of Neuroscience study included 40 children who had their brains scanned using a technique known as diffusion-weighted imaging, which is based on magnetic resonance imaging (MRI).

This type of imaging reveals the size and organization of the brain's white matter -- bundles of nerves that carry information between brain regions. The researchers focused on three white-matter tracts associated with reading skill, all located on the left side of the brain: the arcuate fasciculus, the inferior longitudinal fasciculus (ILF) and the superior longitudinal fasciculus (SLF).

When comparing the brain scans and the results of several different types of pre-reading tests, the researchers found a correlation between the size and organization of the arcuate fasciculus and performance on tests of phonological awareness -- the ability to identify and manipulate the sounds of language.

Phonological awareness can be measured by testing how well children can segment sounds, identify them in isolation, and rearrange them to make new words. Strong phonological skills have previously been linked with ease of learning to read. "The first step in reading is to match the printed letters with the sounds of letters that you know exist in the world," Norton says.

The researchers also tested the children on two other skills that have been shown to predict reading ability -- rapid naming, which is the ability to name a series of familiar objects as quickly as you can, and the ability to name letters. They did not find any correlation between these skills and the size or organization of the white-matter structures scanned in this study.

Brian Wandell, director of Stanford University's Center for Cognitive and Neurobiological Imaging, says the study is a valuable contribution to efforts to find biological markers that a child is likely to need extra help to learn to read.

"The work identifies a clear marker that predicts reading, and the marker is present at a very young age. Their results raise questions about the biological basis of the marker and provides scientists with excellent new targets for study," says Wandell, who was not part of the research team.

Early intervention

The left arcuate fasciculus connects Broca's area, which is involved in speech production, and Wernicke's area, which is involved in understanding written and spoken language. A larger and more organized arcuate fasciculus could aid in communication between those two regions, the researchers say.

Gabrieli points out that the structural differences found in the study don't necessarily reflect genetic differences; environmental influences could also be involved. "At the moment when the children arrive at kindergarten, which is approximately when we scan them, we don't know what factors lead to these brain differences," he says.

The researchers plan to follow three waves of children as they progress to second grade and evaluate whether the brain measures they have identified predict poor reading skills.

"We don't know yet how it plays out over time, and that's the big question: Can we, through a combination of behavioral and brain measures, get a lot more accurate at seeing who will become a dyslexic child, with the hope that that would motivate aggressive interventions that would help these children right from the start, instead of waiting for them to fail?" Gabrieli says.

For at least some dyslexic children, offering extra training in phonological skills can help them improve their reading skills later on, studies have shown.

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