How Botox can help with Cluster Headaches

This article discusses research that is currently being done to turn Botox into a treatment for cluster headaches.

Botox is best known as a facial wrinkle remover, but if all goes well with the research, someday soon it may be a treatment option for cluster headache. At least that is the hope of a team of scientists at the Norwegian University of Science and Technology (NTNU).

Why Botox?
Botox (onabotulinumtoxinA) is a neurotoxin and a drug that uses a potent poison called botulinum toxin, which is derived from the bacterium Clostridium botulinum. When it is injected into facial muscles, it paralyzes them temporarily and causes wrinkles to disappear for several months.

Similarly, injections of the toxin are used to block nerve signals that cause muscles contractions in cerebral palsy and bladder spasms, to block postsurgical pain and foot pain, and to temporarily relax eye muscles in people with strabismus (misaligned eyes). Botox also is sometimes used to treat migraine.

Cluster headache and Botox
Cluster headache pain is more severe than migraine pain and can drive patients to perform desperate acts, even suicide, to avoid it. Therefore finding effective treatments for this devastating condition, which affects an estimated 53 people per 100,000 per year, is essential.

That’s why Erling Tronvik, NTNU senior consultant and researcher, along with two colleagues, are about to undertake a study of the impact of Botox on cluster headache sufferers. This team has devised a treatment device that will allow them to shoot Botox through a hole in the nasal wall into a nerve bundle located behind the sinuses.

Clinicians will use magnetic resonance imaging (MRI) scans to accurately identify the location of the nerve bundle in each patient before treatment is initiated. According to Tronvik, this unique approach should (in theory) reduce or eliminate the flow of signals in this area for three to eight months, after which time patients would need to get another treatment.

“We designed the equipment ourselves, and Botox has never been used for this anywhere else,” noted Tronvik. Soon, 10 patients will enter the first pilot study of this treatment method.

If the results of the pilot study are positive, the team plans to enroll 30 to 40 patients who suffer with cluster headache and about 80 migraineurs as well.

Are there any side effects? Tronvik explained that use of MRI is a highly accurate way to locate the exact spot to inject the Botox. However, he also noted that if the toxin were to slightly miss the mark, patients could experience a weakened ability to chew or temporary double vision.

In the meantime, there’s some good news regarding chronic migraine. Botox has been shown to be helpful in relieving chronic migraine, as seen in the results of the PREEMPT (Research Evaluating Migraine Prophylaxis Therapy) clinical program.

In that study, nearly 70 percent of patients treated with Botox experienced at least a 50 percent reduction in the frequency of headache days. Other research has shown Botox to be effective as preventive treatment for chronic migraine and to provide a reduction in severity and intensity of pain as well as the number of days with disability.

If you suffer with cluster headache, a new effective treatment can’t come soon enough. Hopefully Botox or another option in the pipeline will prove beneficial in the near future.

Study References
Alvaro-Gonzalez LC et al. Botulinum toxin A in chronic refractory migraine: premarketing experience. Revista de Neurologia 2012 Oct 1; 55(7): 385-91
Aurora SK et al. OnabotulinumtoxinA for chronic migraine: efficacy, safety, and tolerability in patients who received all five treatment cycles in the PREEMPT clinical program. Acta Neurologica Scandinavica 2014 Jan; 129(1): 61-70

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Infant brain's blood flow is regulated differently than an adult brain

Researchers found the blood flow in a developing infant's brain is not the same as an adult's brain. This has many implications for treating developmental disorders.

A new study by Columbia Engineering researchers finds that the infant brain does not control its blood flow in the same way as the adult brain. The paper, which the scientists say could change the way researchers study brain development in infants and children, is published in the February 18 Early Online edition ofProceedings of the National Academy of Sciences (PNAS).

"The control of blood flow in the brain is very important" says Elizabeth Hillman, associate professor of Biomedical Engineering and of Radiology, who led the research study in her Laboratory for Functional Optical Imaging at Columbia. "Not only are regionally specific increases in blood flow necessary for normal brain function, but these blood-flow increases form the basis of signals measured in fMRI, a critical imaging tool used widely in adults and children to assess brain function. Many prior fMRI studies have overlooked the possibility that the infant brain controls blood flow differently."

"Our results are fascinating" says Mariel Kozberg, a neurobiology MD-PhD candidate who works under Hillman and is the lead author of the PNAS paper. "We found that the immature brain does not generate localized blood-flow increases in response to stimuli. By tracking changes in blood-flow control with increasing age, we observed the brain gradually developing its ability to increase local blood flow and, by adulthood, generate a large blood-flow response."

The study results suggest that fMRI experiments in infants and children should be carefully designed to ensure that maturation of blood-flow control can be delineated from changes in neuronal development. "On the other hand," says Hillman, "our findings also suggest that vascular development may be an important new factor to consider in normal and abnormal brain development, so our findings could represent new markers of normal and abnormal brain development that could potentially be related to a range of neurological or even psychological conditions."

Functional magnetic resonance imaging, or fMRI, is one of several brain-imaging methods that measure changes in blood flow to detect the presence and location of neuronal activity. In adults, blood-flow increases occur in specific regions of the brain during a particular task like moving your hand or reacting to a stimulus. FMRI relies upon measuring decreases in deoxygenated hemoglobin resulting from this blood-flow increase to understand which parts of the brain are responsible for different actions and emotions. FMRI and other brain-imaging methods are currently being widely used to explore brain development, and to understand disorders in infants and children including autism and ADHD.

"Until now, we had been studying blood flow in the adult brain," Hillman notes, "but we became interested in several studies that reported odd, sometimes negative, blood-flow responses in newborn and premature infants and decided to carefully explore what was different about the immature brain compared to the adult. Initially, I saw these studies as a way to watch how the adult system assembled itself during development. Then we realized how important our findings were to those using brain imaging to study child development and developmental disorders."

The team used a unique multispectral optical intrinsic signal imaging system (MS-OISI) built in Hillman's lab to perform the research. MS-OISI is a high-speed, high-resolution imaging approach that takes advantage of the different absorption spectra of deoxygenated and oxygenated hemoglobin in order to determine changes in the concentrations of each. The researchers found that, with increasing age, there was a gradual development of a localized increase in blood flow, while a strong, delayed decrease in flow was consistently present. Only by adulthood was the positive increase able to balance the decrease in flow.

"Our results suggest that the infant brain might not be able to generate localized blood- flow increases, even if there is neuronal activity occurring, and that the development of blood- flow control occurs in parallel with early neuronal development," says Kozberg. "This could suggest that fMRI studies of infants and children may be detecting changes in both vascular and neuronal development -- in fact, vascular development may be an important new factor to consider in normal and abnormal brain development."

The team also found that the younger age groups were highly sensitive to blood pressure increases in response to stimulation and that these increases can cause large increases in blood flow across the brain. "This finding indicates that the newborn brain is also unable to regulate its overall blood-flow levels," Kozberg explains. "This could explain earlier fMRI results in infants and children that were sometimes positive and sometimes negative, because it is difficult to tell whether blood pressure increases are occurring in infants and children. This result suggests that great care should be taken in setting stimulus thresholds in young subjects."

The researchers add that, since the newborn brain appears to be able to sustain itself without tightly controlled blood flow, their findings suggest that the infant brain may be intrinsically more resistant to damage due to a lack of oxygen than the adult brain. "This could be an important property to understand, both in terms of understanding how best to treat blood-flow problems in the newborn infant brain, which can cause lifelong problems such as cerebral palsy, and to potentially better understand how to treat the adult brain in conditions such as stroke," Hillman observes.

"Our lab operates at the intersection of neuroscience and engineering," continues Hillman." Not only do we develop the imaging systems that let us investigate the living brain in new ways, but like all engineers, we're fascinated with figuring out 'how things work,' and the brain is no exception."

Next steps for Hillman and her team include further defining the cellular mechanisms underlying the developing hemodynamic response at a cellular and microvascular level, using methods such as high-speed and multi-plane in-vivo two-photon microscopy, another technique developed in the lab. They're particularly interested in tracking changes in neuronal activity, microvascular architecture and connectivity, and the distribution and activity of other cellular populations thought to be associated with neurovascular coupling as a function of development.

"This will help us understand how the neonatal brain is different, and better understand how mature blood-flow control mechanisms in the adult brain work," says Kozberg. Adds Hillman, "We are also keen to take this research into the clinic and explore whether our findings could improve diagnosis and monitoring of newborn infants. Our findings so far feel like just the tip of the iceberg. There is so much more for us to do now to understand why the infant brain is so different, and how we can use our findings to improve understanding of a wealth of devastating childhood and developmental conditions."

This research was supported by grants and student fellowships from the National Institute of Neurological Disorders and Stroke, the National Eye Institute, the National Science Foundation, the National Defense Science and Engineering Graduate Fellowship, the Medical Scientist Training Program, and the Human Frontier Science Program. Hillman is also a member of the Columbia University graduate program in Neurobiology and Behavior and the Kavli Institute for Brain Sciences.

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Genetic Link Fount Between Migraine and Epilepsy

Research has found medical evidence of a genetic link between migraine headaches and epilepsy. The research indicates that a strong family history of epilepsy increases the likelihood that an individual will have migraines.

New research reveals a shared genetic susceptibility to epilepsy and migraine. Findings published in Epilepsia, a journal of the International League Against Epilepsy (ILAE), indicate that having a strong family history of seizure disorders increases the chance of having migraine with aura (MA).

Medical evidence has established that migraine and epilepsy often co-occur in patients; this co-occurrence is called "comorbidity." Previous studies have found that people with epilepsy are substantially more likely than the general population to have migraine headache. However, it is not clear whether that comorbidity results from a shared genetic cause.

"Epilepsy and migraine are each individually influenced by genetic factors," explains lead author Dr. Melodie Winawer from Columbia University Medical Center in New York. "Our study is the first to confirm a shared genetic susceptibility to epilepsy and migraine in a large population of patients with common forms of epilepsy."

For the present study, Dr. Winawer and colleagues analyzed data collected from participants in the Epilepsy Phenome/Genome Project (EPGP) -- a genetic study of epilepsy patients and families from 27 clinical centers in the U.S., Canada, Argentina, Australia, and New Zealand. The study examined one aspect of EPGP: sibling and parent-child pairs with focal epilepsy or generalized epilepsy of unknown cause. Most people with epilepsy have no family members affected with epilepsy. EPGP was designed to look at those rare families with more than one individual with epilepsy, in order to increase the chance of finding genetic causes of epilepsy.

Analysis of 730 participants with epilepsy from 501 families demonstrated that the prevalence of MA -- when additional symptoms, such as blind spots or flashing lights, occur prior to the headache pain -- was substantially increased when there were several individuals in the family with seizure disorders. EPGP study participants with epilepsy who had three or more additional close relatives with a seizure disorder were more than twice as likely to experience MA than patients from families with fewer individuals with seizures. In other words, the stronger the genetic effect on epilepsy in the family, the higher the rates of MA. This result provides evidence that a gene or genes exist that cause both epilepsy and migraine.

Identification of genetic contributions to the comorbidity of epilepsy with other disorders, like migraine, has implications for epilepsy patients. Prior research has shown that coexisting conditions impact the quality of life, treatment success, and mortality of epilepsy patients, with some experts suggesting that these comorbidities may have a greater impact on patients than the seizures themselves. In fact, comorbid conditions are emphasized in the National Institutes of Health Epilepsy Research Benchmarks and in a recent report on epilepsy from the Institute of Medicine.

"Our study demonstrates a strong genetic basis for migraine and epilepsy, because the rate of migraine is increased only in people who have close (rather than distant) relatives with epilepsy and only when three or more family members are affected," concludes Dr. Winawer. "Further investigation of the genetics of groups of comorbid disorders and epilepsy will help to improve the diagnosis and treatment of these comorbidities, and enhance the quality of life for those with epilepsy."

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Alcohol and Marijuana Use in Youth can Compromise White Matter in Brain

Research into how alcohol and marijuana use affects children's brains showed that the integrity of white matter can be compromised.

Chronic use of alcohol and marijuana during youth is associated with poorer neural structure, function, and metabolism, as well as worsened neurocognitive abilities into later adolescence and adulthood. This may be due to biological and psychosocial transitions occurring during adolescence that impart increased vulnerability to neurotoxic influences. A study of longitudinal changes in fiber tract integrity associated with adolescent alcohol and marijuana use during 1.5 years supports previous findings of reduced white-matter integrity in these youth.

Results will be published in a special online issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Research has shown differences in the brains of teens who use alcohol and marijuana as compared to teens who do not use these drugs or report only very infrequent, minimal use," said Joanna Jacobus, postdoctoral fellow at the University of California, San Diego as well as corresponding author for the study. "Alcohol and marijuana may have a negative impact by altering important cellular communication in the brain, preventing development of new healthy cells, and/or causing inflammation, which can adversely impact healthy brain development in many ways. For example, the results can lead to changes in brain structure such as volume, and function such as activity."

"The areas of the brain that are composed mostly of connecting axons have been termed 'white matter,' since these areas appear white in color," added Duncan Clark, associate professor of psychiatry at the University of Pittsburgh Medical Center. "However, prior research has not clearly demonstrated that this white matter disorganization is caused by alcohol or marijuana use. In some studies where adolescents are studied only once, white matter disorganization may have been present prior to alcohol or marijuana use."

"The teen brain is continuing to develop, so many neural systems are not yet fully matured, as compared to adults' brains," said Jacobus. "Brain connections important for inhibiting risky behaviors are still forming, and some youth are more likely to choose immediate effects, such as alcohol or marijuana use, over long-term benefits."

Clark agreed. "Maturation of the brain during adolescence is thought to be the foundation for self-control," he said. "The developing adolescent brain, compared to the fully developed adult brain, is also probably more vulnerable to alcohol neurotoxicity. Adolescents are vulnerable to loss of control and, when this loss of control involves substance use, excessive or risky substance use can have adverse consequences."

For 18 months, the researchers followed 92 adolescents (63 males, 29 females), ages 16 to 20 years, divided into two groups: 41 with extensive alcohol and marijuana use histories by mid-adolescence, and 51 with consistently minimal if any substance use. Participants were part of an ongoing longitudinal study of substance use in adolescence with teens recruited from local schools from 2005 to 2007. Both groups received diffusion tensor imaging and detailed substance use assessments, along with toxicology screening, at baseline and 18-month follow-ups -- 182 scans in all -- as well as interim substance-use interviews every six months.

"We found evidence for poorer white matter tissue health in teens who engage in heavy alcohol and marijuana use compared to those who abstain," said Jacobus. She noted that white matter, the "information highway of the brain," allows for quick and efficient communication between brain regions. Compromised white matter can mean slower cognitive processing and poorer cognitive performance such as memory, attention, and decision-making.

"As to whether there were differences in these teens before they began using alcohol and marijuana is difficult to determine, but we found that increasing alcohol use over 1.5 years in late adolescence was related to a decline in white matter health 18 months later, supporting a negative effect of alcohol use on the brain despite potential pre-existing differences," Jacobus said.

"White matter organization was particularly compromised in an area called the superior longitudinal fasciculus," added Clark. "This is one of the major connection roadways in the brain. When the connections between brain areas are severely damaged, those areas of the brain cannot properly function. While the more subtle deficit shown here may impair functioning, the degree of deficit involved is not likely to be obvious in day-to day functioning. However, we are concerned that even these subtle deficits in brain microstructure may lead to diminished self-control."

"Our findings underscore that early initiation of alcohol and marijuana use can have negative implications on the brain" said Jacobus. "We hope this information can be communicated to teens to help them understand why drinking during adolescence is discouraged. In the future, biomarkers such as tissue health may help identify teens that are particularly vulnerable for engaging in riskier behaviors such as drinking."

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Researchers show scientific proof of deficiencies in football helmets

Researchers have produced biomechanical tests to show how current football helmets do not protect football helmets from concussions.

Researchers at BRAINS, Inc. have conducted biomechanical tests revealing the deficiency of current football helmet designs in protecting players from brain injury, particularly concussion.

Historically, helmet effectiveness has been measured through drop-tests, using a device approved by the National Operating Committee on Standards for Athletic Equipment (NOCSAE). The result is helmets that are optimized against skull fractures, bruising, and other focal effects. 

“We modified the standard test device to consider rotationalacceleration in addition to conventional linear impact measures” explains John Lloyd, PhD.

Biomechanical researchers have long understood that angular forces can cause serious brain damage including concussion, axonal injury, and hemorrhages.

Using proprietary miniature sensors to measure concussion risk at the center of the brain, BRAINS researchers completed more than 330 tests across ten popular helmet brands. The team concluded that while these helmets provide excellent protection from linear impacts – those leading to bruising and skull fracture – they offer little or no protection against angular acceleration, a dangerous source of brain injury and encephalopathy.

The graph in the slideshow above shows percent reduction in linear impact acceleration, Head Injury Criterion (HIC), and angular acceleration provided by the different football helmets, compared to the same impact with no helmet. Note that all helmets provide considerable protection from skull fracture (blue) and focal brain impact (green), but are far less effective at reducing risk of diffuse brain injury and concussion and encephalopathy (red). In fact, some helmet designs offer no significant protection from concussion — and those that offer the least protection are among the most popular on the field.

The table, also in the slideshow above, presents a ranking of the more popular football helmets, from best to worst, based on their combined protection from skull fracture, focal brain impact and diffuse brain injury.

Protection against concussion and axonal injury is especially important for young players, including peewee, high school, and college participants, whose still-developing brains are more susceptible to the lasting effects of encephalopathy. Therefore, the need to develop headgear to protect susceptible individuals from life-changing brain damage is paramount.

Consistent with their innovative approach to meeting the challenges of brain trauma, combined with 20+ years of experience in biomechanics, and neurophysiology, BRAINS researchers have investigated several new technologies to measure and reduce the debilitating effects of concussion in football players. The team is poised to integrate their new technology into helmet design – a paradigm-shift in helmet construction – and bring to market a more comprehensive form of head gear to defend against catastrophic brain injuries while also mitigating linear forces associated with impact.

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Researchers find more Autism Genes

Its news like this that keeps me going. Every day, I meet parents who have given up on neurology.  Even in the last 5 years, our tools for diagnosis and treatment have changed. With advances in genetics more news will come. - JR 

Researchers at UCSD found a gene that indicated autism associated with epilepsy.

A genetic cause for a rare form of epilepsy-associated autism has been identified by UC San Diego and Yale scientists.

Moreover, symptoms of the newly discovered form have been reversed in mouse models by altering diet. This gives rise to the possibility that similar treatment might help people, the researchers said. The study was published online Thursday in the journal Science. 

Researchers led by Gaia Novarino and Joseph G. Gleeson of UCSD studied two families, one of Egyptian descent and another of Turkish origin. They examined the genome of patients and healthy relatives for exons, gene sequences that code for proteins. The researchers found that patients shared an exon mutation on a gene called BCKDK. The mutant gene is recessive, meaning that it must be inherited from both mother and father to manifest.

Moreover, the researchers found that the mutation caused patients to produce abnormally low levels of certain types of amino acids, the building blocks of proteins. They were able to boost levels of these amino acids to normal with a nutritional supplement from a health food store. Research is now ongoing as to whether this supplementation will reduce symptoms of epilepsy and autism in these patients.

Those who might be helped are only a small fraction of people with autism, Novarino said in an Tuesday interview. Those without the metabolic defect wouldn't benefit from the supplementation.

The study illustrates how scientists have become more sophisticated in using knowledge of the human genome to crack the puzzle of previously intractable diseases. The genome is the complete set of hereditary information encoded in DNA.

Narrowing the search

The vast majority of DNA does not code for proteins, the body's workhorse molecules. This "non-coding" DNA was ignored in the new method of DNA analysis, called "whole exome" sequencing, which looks only at the exons. An advantage of whole exome sequencing is that it focuses exclusively on proteins, which are altered or missing in genetic diseases.

Whole exome sequencing can find previously undiscovered genetic diseases, according to another study performed by some of the same UCSD researchers. They examined 118 patients diagnosed with neurological disorders who had no known genetic disease causes. In addition to the newly discovered genetic causes, in about 10 percent of cases the researchers even found a known disease-causing gene that had previously escaped detection.

That study was published in June in Science Translational Medicine, a journal devoted to getting research discoveries into the hands of doctors more quickly.

The new study is part of the same project of applying exome research to diseases, Novarino said.

Genetic knockout

In the study, the researchers produced genetically engineered "knockout mice" in which the BCKDK gene was inactivated. These mice experienced epileptic seizures, tremors, hind limb clasping and other symptoms of neurological disorders. Their brains were found to be deficient in certain chemicals called branched chain amino acids.

Seizures and hind limb clasping were "completely abolished" within a week when mice were given diets rich in these nutrients, the study said.

The researchers had previously examined neural cells of patients and unaffected family members. The neural cells were made from induced pluripotent stem cells, produced from skin cells and turned into neurons. However, the researchers couldn't find any differences in the cell cultures. That's when they turned to studying the effect of diet on whole knockout and healthy mice.

Novarino said it's too early to tell if BCAA supplementation is helping the human patients in the study.

The supplements have not caused any side effects in the patients, nor did they in the mouse, Novarino said.

The complete list of authors, including colleagues in Turkey, Egypt and Libya, can be found at the end of the press release. Funders of the study include the National Institutes of Health, the Center for Inherited Disease Research, and the Simons Foundation Research Initiative.

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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.

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Results of "Migraine in America 2012" Study

Below are the results of the "Migraine in America 2012" study which lists migraine causes, frequency, symptoms, and common triggers, as well as the impact migraines have on the people who get them.

Health Union, LLC, released the results of its landmark study "Migraine In America 2012" tonight via a live web conference. This patient survey was completed by over 2,600 migraine sufferers in May and June of this year and represents one of the largest studies of this type ever completed.

"The results of the Migraine In America Study are quite staggering," said Dr. Dawn Marcus, MD, Professor, Department of Anesthesiology at the University of Pittsburgh, "we've known for some time about the physical pain and suffering of migraine, but this study gives us an unprecedented glimpse into the real impact that migraine has on people's lives."

For example, the data showed that among participants in the survey:

• -Over 50% report that migraines have negatively impacted their professional development
• -Over 25% report that they have lost a job due to their migraines
• -Over 40% report that migraines have impacted their relationship with their children
• 
  

All study results are notably worse for those suffering from chronic migraine, defined as having over 15 days each month with headache symptoms lasting over four hours. For example over 38% of chronic migraine sufferers reported losing a job due to their condition.

The initial data presentation is available at http://migraine.com/mia2012/.

"This is an incredibly rich data set and we have just begun to scratch the surface," said Olivier Chateau, Co-Founder of Health Union, LLC the publisher of Migraine.com the largest and fastest growing online community dedicated solely to migraine, "over the coming months we will continue to analyze the data and will publish new findings on migraine.com."

Migraine impacts an estimated 37 million Americans[1]. Every 10 seconds someone in the United States goes to the emergency room with a headache or migraine, and American employers lose more than $13 billion each year as a result of 113 million lost workdays due to migraine.[2]

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7 Hours of Sleep a Night Needed for Brain Health

Of course, there are variations.  but, the bottom line is that adequate sleep is important for brain & body health.  It also affects longevity.

JR

How many z’s you get and the quality of them could be related to your brain’s health. Too much or too little sleep appears to have negative effects on concentration and memory.

New research reveals seven hours of sleep is what your brain needs for concentration and to hold those memories.

At the Alzheimer's Association International Conference® 2012 (AAIC® 2012) in Vancouver held yesterday, four studies suggest there is an association between sleep quality and quantity and the risk of cognitive decline, and that interventions to normalize sleep duration and correct sleep disorders may not only improve quality of life, but have potential to reduce or prevent cognitive decline, according to the AAIC press release.

An accumulation of evidence suggests that seven hours of sleep is recommended, but shorter than or longer than those seven hours may increase the risk for cardiovascular disease and type 2 diabetes. Now, four new studies take a look at sleep duration and influences on cognition among older adults.

In the first study which was one of the largest among the studies had evaluated data on 15,263 female participants of the Nurses’ Health Study. Research had indicate that those who had less sleep (5 hours or less) or more sleep (9 hours or more) had revealed lower mental functioning in comparison to participants that had seven hours of sleep.

Researchers had followed the women for fourteen years and had given three follow-up cognitive assessments biennially (occurring every two years).

Researchers had concluded that sleep durations that were shorter or longer than normal were associated to worse cognitive decline later on in life, consistent with findings for other chronic disease.

Elizabeth Devore, an associate epidemiologist at Brigham and Women's Hospital in Boston, author of study stated "I think this gives us data to think about sleep- and circadian-based interventions being a route to address cognitive function,” as reported by Health Day. Circadian rhythm is physical, mental and behavioral changes that follow a roughly 24-hour cycle, as noted by the National Institute of General Medical Sciences.

The second study conducted by the University of California, San Francisco. This study was led by Dr. Kristine Yaffe, MD, professor in the Departments of Psychiatry, Neurology and Epidemiology at UCSF. She is also Chief of Geriatric Psychiatry and Director of the Memory Disorders Clinic at the San Francisco VA Medical Center.

This study titled Sleep Disorders and Cognitive Function in Older Women, studied 1305 women, over the age of 75 with an average age of 83 years, who were enrolled in an ongoing prospective study and completed several days of wrist actigraphy and a subset with overnight polysomnography.

Researchers found sleep disturbances (sleep-disordered breathing or sleep apnea) had over twice the chance for developing mild cognitive impairment or dementia over a span of five years in comparison to those without sleep disturbances. Researchers note that their findings suggest that older adults be monitored for sleep disturbances and that interventions designed to improve sleep need to be investigated with particular attention to cognitive outcomes, according to the release.

The next study titled Sleep and Cognitive Decline in the Elderly: The French Three City Cohort, present by Dr. Claudine Berr, MD, PhD in epidemiology.

This study looked at almost 5,000 mentally healthy French people, aged 65 and over, and evaluated four times in a eight year period. Researchers had observed different aspects of insomnia and found that excessive daytime sleepiness (EDS) that had been reported by 17.9% of participants independently increase the risk for mental decline.

Researchers note their results show that EDS may be linked independently with the risk of cognitive decline in the elderly.

The last research noted comes from researchers at the Washington University School of Medicine, St. Louis, Missouri. The study titled Circadian Patterns of Beta-Amyloid in Human CSF and Plasma, presented by Dr. Yafei Huang MD, PhD.

Researchers had taken samples of blood and cerebrospinal fluid from three groups of volunteers; people with dementia, age-matched participants and younger participants, over 36 hours researchers found that daily sleep patterns were associated to levels of amyloid proteins (which are indicators of Alzheimer’s disease).

William Thies, PhD, Alzheimer's Association® chief medical and scientific officer stated in the release "We know that sleep patterns change as people age and that poor sleep affects overall health. What we don't know for certain is whether poor sleep has long-term consequences on cognitive function.”

In closing he adds "The studies presented today at AAIC suggest that cognitive health declines over the long term in some people with sleep problems. The good news is that tools already exist to monitor sleep duration and quality and to intervene to help return sleep patterns to normal. If we do this, there is the possibility that we may also help people preserve their cognitive health, but that needs to be tested.”

Numerous studies have been conducted on sleep patterns and cognitive function. These studies do not only apply to older adults but children as well.

In 2009, a study led by Dr. Naomi Friedman, PhD, senior research associate at the Institute for Behavioral Genetics at the University of Colorado at Boulder, had found that children who have sleep problems that remain through adolescences just may affect their cognitive ability later on in adolescences.

It appears that getting the right amount of sleep does matter when it comes to physical and mental health.

Can statins cause fatigue and exercise intolerance?

Researchers delving into the side effects of statins found evidence that the popular cholesterol-lowering drugs may sap energy levels in users.

The study indicates that statin drugs may contribute to a drop in energy and fatigue upon exertion.

The danger of the potential adverse effect was particularly enhanced in women.

Lead author of the study, Dr. Beatrice Golomb, associate professor of medicine at the University of California-San Diego stated, "We found that even at comparatively modest doses, statins were associated with a not-inconsequential drop in energy in some patients, a rise in fatigue with exertion in others and sometimes both.

She added, "This was true for both men and women. But it appears to be more of a problem for female patients."

Study Details
In a study designed to investigate whether statins can cause energy drain and exercise intolerance for users, the researchers tracked 1,016 healthy adults (700 men and more than 300 women) from the San Diego region.

The participants were all aged 21 years or older with elevated LDL or ‘bad’ cholesterol. However, none had a history of heart disease or diabetes.

As a part of the study, they were randomly assigned to receive either a placebo or 40 milligrams of Pravachol (pravastatin), the most water-soluble statin, 20 mg of Zocor (simvastatin), the most fat-soluble statin every evening before retiring for six months.

During the study, the volunteers were asked to rate their energy and fatigue levels on a five-point scale, from "much worse" to "much better." In addition they were questioned how they felt after exercising.

Outcome of the study
The study found those placed on statins were more likely to report lower energy levels and more fatigue with exertion compared to people assigned to the placebo.

The effect was more pronounced in women, with 40 percent experiencing weariness with exertion and a drop in energy while taking the daily dose.

Dr. Golomb says, “Energy is central to quality of life. Exertional fatigue not only predicts actual participation in exercise, but lower energy and greater exertional fatigue may signal triggering of mechanisms by which statins may adversely affect cell health.”

Based on the study findings, the researchers suggest that medical professionals should weigh the pros and cons before prescribing statins to people.

The findings were reported online June 11 in Archives of Internal Medicine.

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Higher maternal age increases risk of autism

Washington D.C., April 26, 2012 – In a study published in the May 2012 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, led by Mr. Sven Sandin, of the Karolinska Institutet, Sweden and King's College London, researchers analyzed past studies to investigate possible associations between maternal age and autism. While much research has been done to identify potential genetic causes of autism, this analysis suggests that non-heritable and environmental factors may also play a role in children's risk for autism.

The researchers compared the risk of autism in different groups of material age (under 20, 24-29, 30-34, and 35+). They found that children of mothers older than 35 years had 30% increased risk for autism. Children of mothers under 20 had the lowest risk of developing autism. The association between advancing maternal age and risk for autism was stronger for male offspring and children diagnosed in more recent years.

The analysis included 25,687 cases of autism spectrum disorder and over 8.6 million control subjects, drawn from the 16 epidemiological papers that fit inclusion criteria for the study as defined by the investigators. The researchers identified and discussed several potential underlying causes of the association between maternal age and risk for autism such as increased occurrence of gene alteration during the aging process and the effects of exposure to environmental toxins over time.

Sandin said of the study, "The study makes us confident there is an increased risk for autism associated with older maternal age, even though we do not know what the mechanism is. It has been observed in high quality studies from different countries, including the US. All studies controlled for paternal age which is an independent risk factor for autism. This finding adds to the understanding that older age of the parents could have consequences to the health of their children."

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New Laser Surgery can help Children with Epilepsy

Removing part of a patient's brain is the traditional way to cure certain kinds of epilepsy, but the complications can be worse than the seizures themselves.

Now, there is a new high-tech and low-risk way to erase epilepsy. It is a medical first.

Robin and Khris Dysart say their son Keagan had gelastic seizures that sounded like laughter three times every hour.

A craniotomy was the best chance for a cure. Surgeons may have to take out normal brain tissue to move the lesion causing the seizures. Complications can include paralysis, uncontrolled urination, and death.

Keagan’s mother Robin says, "There were lists of children who have died."

Dr. Angus Wilfong adds, "You can't put back brain that you wish you hadn't taken out."

To avoid taking out any brain, Dr. Angus Wilfong and Dr. Daniel Curry of Texas Children's Hospital developed a low-risk, minimally invasive, MRI-guided laser surgery to cure epilepsy.

Keagan was one of their first patients.

The instrument used is smaller than the size of a pencil lead piece, according to Dr. Wilfong.

The doctors navigated their way to Keagan's deep-seated lesion.

With the MRI, they were able to see in real time exactly where they were in Keagan's brain. The doctors watched the laser destroy the lesion and cure Keagan's epilepsy.

"That's exactly what's happening and it's really amazing to see."

Today, Keagan is seizure free.

Robin says, "Now, the world has opened up to him."

He loves basketball and says, "I've been practice dribbling."

His life has been forever changed by a laser.

Texas Children's Hospital is the first in the world to perform the MRI-guided laser surgery to cure epilepsy.

The procedure was adopted from a technique to treat brain tumors.

It's now being used for kids and adults. The doctors tell us some of their patients go home the day after their brain surgery.

RESEARCH SUMMARY

BACKGROUND: Gelastic seizures are epileptic events characterized by bouts of laughter. Laughter-like vocalization is usually combined with facial contraction in the form of a smile. Gelastic epilepsy is very rare and occurs slightly more commonly in boys than in girls. Of every 1000 children with epilepsy, only one or at the very most, two children will have gelastic epilepsy. (SOURCE: www.epilepsyfoundation.org, www.ncbi.nlm.nih.gov/pubmedhealth)

The gelastic and other types of seizures are often very difficult to control. It is rare for anyone to have their seizures controlled for more than a few weeks or months at a time. The best outcome is probably seen in those children (and adults) who have a benign tumor in the hypothalamus (the hamartoma or astrocytoma) causing their epilepsy. Successful surgery in these children and adults may improve not just their seizure control but also improve their behavioral and even learning problems. (SOURCE: epilepsy.org.uk)

TREATMENT: The type of treatment prescribed will depend on several factors including the frequency and severity of the seizures as well as the person's age, overall health, and medical history. The majority of epileptic seizures are controlled through drug therapy. Patients may take a drug called anticonvulsants, to reduce the number of seizures they experience. Patients may also make changes to their diet. In certain cases in which medications and diet are not working, surgery may be used. (SOURCE: www.ncbi.nlm.nih.gov/pubmedhealth, www.webmd.com)

LATEST BREAKTHROUGHS: Real-time MRI-guided thermal imaging and laser technology is now being used to destroy lesions in the brain that cause epilepsy and uncontrollable seizures. The surgery is performed by first mapping the area of the brain where the lesion is located using magnetic resonance imaging. The catheter is inserted through the skull in the operating room and then the patient is transferred to an MRI unit where the ablation of the lesion is performed. The MRI confirms probe placement in the target, and the magnetic resonance thermal imaging allows the surgeon to see the ablation of the lesion by the laser heat as it happens with an automatic feedback system that shuts the laser off when the heat approaches nearby critical brain structures.

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Study Claims People With Autism Possess Greater Ability to Process Information

People with autism have a greater than normal capacity for processing information even from rapid presentations and are better able to detect information defined as 'critical', according to a study published March 22 in theJournal of Abnormal Psychology. The research may help to explain the apparently higher than average prevalence of people with autism spectrum disorders in the IT industry.

Autism is a lifelong developmental disorder that affects social interaction, communication and, often, learning; however, people with autism show an increased ability to focus attention on certain tasks. Yet clinical reports backed up by some laboratory research show that these individuals can be more sensitive to the distracting effects of irrelevant stimuli, such as flashing lights or particular sounds, which can be easily ignored by people without the disorder.

Professor Nilli Lavie, from the Institute of Cognitive Neuroscience at UCL, hypothesises that this combination of the ability to focus and a susceptibility to distraction might be caused by a higher than normal information processing capacity.

Professor Lavie, together with Dr Anna Remington and Dr John Swettenham from the UCL Developmental Science department, tested this hypothesis on 16 adult volunteers with autism spectrum disorders and compared their results against those of 16 typical adults in a task to challenge their perceptual load capacity.

The task involved looking at a circle of letters flashed very briefly on the screen and searching for some 'target' letters. At the same time, the participants were also asked to detect a small grey shape that occasionally appeared outside the letter circle.

When only one or two letters were flashed on the screen, the researchers found that both groups could successfully find the letter and detect the shape. However, making the search task more challenging by increasing the number of letters significantly impaired the detection performance of the typical adults -- but not of the adults with autism spectrum disorders, who were able to detect the extra shape just as well in the more challenging conditions. When the task became harder, they significantly outperformed the typical adults.

Professor Lavie says: "Our study confirms our hypothesis that people with autism have higher perceptual capacity compared to the typical population. This can only be seen once the task becomes more demanding, with more information to process. In the more challenging task conditions, people with autism are able to perceive significantly more information than the typical adult."

Professor Lavie believes that the finding may help explain why people with autism spectrum disorders, such as Asperger's syndrome, may excel in some careers such as IT, which can require intense concentration and the ability to process a great deal of information from a computer screen. Autism diagnoses in California's Silicon Valley reportedly increased three-fold in the 1990s, a phenomenon termed 'geek syndrome' by 'Wired' magazine.

"Our study clearly shows that people with autism can do better than typical adults in tasks involving rapid presentations of a lot of information," says Professor Lavie. "There are clearly careers, such as in IT, that can benefit from employing people with high-functioning autism spectrum disorders."

"These findings could also enable clinicians and families to help individuals with autism spectrum disorder capitalise on their strengths by exploiting the increase in perceptual capacity," adds Dr Remington.

The research also sheds light on the relationship between autism and 'savants', such as artist Stephen Wiltshire (who is able to draw in incredible detail a scene seen for only a few seconds) and Kim Peek (on whom the eponymous character of the film 'Rain Man' was based). The researchers argue that these abilities are, in part, likely to be a consequence of their high perceptual capacity; however, their study suggests that most people with autism share this characteristic, regardless of whether they possess exceptional savant-like abilities.

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First Patient Enrolled Into European Registry for Deep Brain Stimulation in Patients With Refractory Epilepsy

Medtronic, Inc. (NYSE: MDT) today announced that a patient from Kempenhaeghe-Heeze (The Netherlands) is the first patient to be enrolled into the MORE (MedtrOnic Registry for Epilepsy) Registry which is designed to look at the long-term efficacy, quality of life impact and safety of deep brain stimulation (DBS) in patients with refractory epilepsy. DBS for epilepsy received CE mark for use in Europe in August 2010. Medtronic DBS Therapy is not currently approved by the U.S. Food and Drug Administration for use in the United States for the treatment of refractory epilepsy.

The MORE Registry will involve approximately 200 prospective patients over two years from more than 30 centres acrossEurope including the Tampere and Tubingen Hospitals which have the most experience to date with DBS of the Anterior Nucleus of the Thalamus. The primary objective of the registry is to examine the impact of DBS therapy on seizure frequency. The study will also look at seizure type and severity, safety and impact of the therapy on a patient's quality of life.

More than 30% of people with epilepsy fail to gain control of seizures with antiepileptic medications.^[1] These people are said to have refractory or drug resistant epilepsy, which is defined by the International League Against Epilepsy (ILAE) as: "the failure of adequate trials of two tolerated and appropriately chosen and used AED (anti-epileptic drugs) schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom".^[2] Currently, Medtronic DBS therapy is approved for use as adjunctive (add-on) therapy for reducing the frequency of seizures in adults diagnosed with epilepsy characterized by partial-onset seizures, with or without secondary generalization, that are refractory to antiepileptic medications.

The MORE registry is the latest in a long history of research using Medtronic DBS devices including three Level 1 studies of DBS for Parkinson's disease, ^[3,4,5] one Level 1 study of DBS for Epilepsy^[6] and a 10- year follow up study of DBS in Parkinson's disease led by the University of Toronto.^[7]

"The MORE registry is important in increasing our understanding of how electrical stimulation can help patients affected by refractory epilepsy. By studying the long-term impact of DBS on the anterior nucleus of the thalamus, we hope to understand even further how seizures can be controlled and reduced," said Professor Paul Boon, Professor of Neurology at the Department of Neurology, Ghent University Hospital in Belgium who is the chair of the steering group behind the MORE Registry.

The commencement of the MORE Registry comes as the neuromodulation community celebrates 25 years of DBS therapy. Professors Benabid and Pollak performed their first DBS implant for tremor at the University of Grenoble in January 1986.

"It is amazing to think how far we have come since the first experimental implant of deep brain stimulation for a movement disorder in the 1980s to today where the therapy is now approved for conditions such as epilepsy and treatment-resistant obsessive-compulsive disorder (OCD)," said Professor Pierre Pollak, Head of Neurology at the University Hospital Geneva.

In Europe, Medtronic DBS Therapy has been CE mark approved for the treatment of tremor since 1993, Parkinson's disease since 1998 and primary dystonia since 2003. The first approved implant of Medtronic DBS was carried out in 1993. More recently, Medtronic DBS therapy has received CE mark approval for obsessive compulsive disorder (OCD) in July 2009 and most recently for refractory epilepsy in August 2010.

"Working with leading physicians, Medtronic helped pioneer deep brain stimulation, and we continue to collaborate with leading researchers to advance DBS technology and research next-generation therapies to treat chronic neurological conditions," saidLothar Krinke, Ph.D., vice president and general manager for the Deep Brain Stimulation business in Medtronic's Neuromodulation division.

About Medtronic Deep Brain Stimulation Therapy

More than 85,000 patients worldwide have received Medtronic DBS Therapy, which uses a surgically implanted medical device, similar to a cardiac pacemaker, to deliver mild electrical pulses to precisely targeted areas of the brain. Electrical stimulation of these areas normalizes the brain circuits that control symptoms. The stimulation can be programmed and adjusted non-invasively by a trained clinician to maximize symptom control and minimize side effects. Only the ACTIVA family of neurostimulators provides clinicians with the ability to deliver stimulation in constant voltage or constant current mode, providing physicians with a choice based on their preference and clinical needs.

Medtronic's Leadership in Neuromodulation

Medtronic developed and leads the field of neuromodulation, the targeted and regulated delivery of electrical pulses and pharmaceuticals to specific sites in the nervous system. The company's Neuromodulation business includes neurostimulation and implantable, targeted drug delivery systems for the management of chronic pain, common movement disorders, spasticity and urologic and gastrointestinal disorders. To date more than 500,000 people worldwide have received Medtronic Neuromodulation therapies.

About Medtronic

Medtronic, Inc. (http://www.medtronic.com), headquartered in Minneapolis, is the global leader in medical technology - alleviating pain, restoring health, and extending life for millions of people around the world.

Any forward-looking statements are subject to risks and uncertainties such as those described in Medtronic's periodic reports on file with the Securities and Exchange Commission. Actual results may differ materially from anticipated results.

References:

1. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342:314-9
2. http://www.ilae-epilepsy.org/visitors/Documents/Epigraph_Definitionofdrugresistantepilepsy.pdf (accessed 12th September 2010)
3. Deuschl et al. A randomized trial of deep-brain stimulation for Parkinson's disease. N Engl J Med. 2006 Aug 31;355(9):896-908.
4. Williams et al. Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trial. Lancet Neurol. 2010 Jun;9(6):581-91. Epub 2010 Apr 29
5. Weaver et al. Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA. 2009 Jan 7;301(1):63-73.
6. Fisher R, Salanova V, Witt T, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia, 51(5):906-907, 2010
7. Ten-year outcome of subthalamic stimulation in Parkinson disease: a blinded evaluation. Castrioto A, et al . Arch Neurol. 2011 Dec;68(12):1550-6. Epub 2011 Aug

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