Study links anesthesia exposure in kids to ADHD

This is an uncontrolled observational study. As an illustration of a potential  problem with bias in such a study, consider this chain of facts.... Many times, children undergo adenoidectomy and tonsillectomy for sleep apnea. Sleep apnea is associated and may be causative with ADHD. So is it the surgery of the sleep apnea that is connected to the ADHD?

Still, it make sense to be cautious. Its important to make sure a chid needs surgery. In my field, a sleep study is recommended before getting tonsils out.  - JR

Study links anesthesia exposure in kids to ADHD

Children exposed to anesthesia before age 3 may have a higher risk of developing ADHD, suggests a new investigation. Researchers found two exposures to anesthesia might double the risk of attention-deficit - hyperactivity disorder (ADHD) in kids.

Mayo Clinic researchers observed the link after becoming intrigued by animal studies that showed anesthesia changes the brain of young animals.

In the study, led by David Warner, M.D., a Mayo Clinic pediatric anesthesiologist and lead investigator looked at ADHD rates and learning disabilities in children born between 1976 and 1982 in Rochester, Minnesota, U.S.

The research team found 341 cases of ADHD in youth under age 19 in medical records included in the Rochester Epidemiology Project, which is a complete database of patient care in Olmsted County, Minnesota.

A study published May, 2011, led by Dr. Vesna Jevtovic-Todorovic, M.D., Ph.D., M.B.A., Professor of Anesthesiology and Neuroscience at the University of Virginia Health System also found a link between anesthesia and learning disabilities.

The study, presented at the "SmartTots: Pediatric Anesthesia Neurotoxicity panel" at the International Anesthesia Research Society annual meeting in Vancouver, B.C" linked Ketamine, an anesthetic drug used to sedate children for minor procedures to learning dysfunction, based on primate studies.

The current study found higher rates of ADHD in children exposed to anesthesia before age 3. Two or more exposures to anesthesia before age 3 was associated with 17.9 percent higher rate of attention deficit hyperactivity disorder, even after adjusting for other factors including existing health conditions.

The researchers are planning more studies to clarify the finding. The current investigation found two or more exposures to anesthesia before age 3 more than doubled the incidence of attention deficit hyperactivity disorder, compared to children who had no exposure to anesthetic drugs.

ADHD causes symptoms that include inability to focus. The Mayo Clinic states symptoms in children can occur as early as age 2 or 3. Children with attention deficit disorder (ADD) have difficulty playing quietly, might talk excessively, have difficulty sitting still and are easily distracted. A medical exam is necessary for proper diagnosis.

The observational study, published February 2 in the Mayo Clinic Proceedings, doesn’t mean anesthesia exposure before age 3 definitely causes ADHD, but does suggest further studies are warranted, according to Dr. Warner.

Read more: http://www.digitaljournal.com/article/318910#ixzz1lR4ZvNaE

Target Is ‘Down’ With Down Syndrome: 5 Things Target Said By Saying Nothing At All

Target Is ‘Down’ With Down Syndrome: 5 Things 

Target Said By Saying Nothing At All

January 2, 2012

If you were browsing through this week’s Target ad you may have passed right over the adorable little boy in the bright orange shirt smiling at you on page 9!  And if so, I’m glad!

The reason I’m glad?  Well, that stylish young man in the orange shirt is Ryan. Ryan just so happened to have been born with Down syndrome, and I’m glad that Target included a model with down syndrome in their typical ad! 

This wasn’t a “Special Clothing For Special People” catalog.  There wasn’t a call out somewhere on the page proudly proclaiming that “Target’s proud to feature a model with Down syndrome in this week’s ad!”  And they didn’t even ask him to model a shirt with the phrase, “We Aren’t All Angels” printed on the front.

In other words, they didn’t make a big deal out of it.  I like that....

 read more HERE

Diabetes during pregnancy may raise ADHD risk

Young children are far more likely to experience attention and hyperactivity problems if their mother develops diabetes during pregnancy and they are born into a poor or lower-middle-class household, a new study suggests.

The study, published this week in the Archives of Pediatrics and Adolescent Medicine, found that children whose mothers received a diabetes diagnosis during pregnancy (known as gestational diabetes) were twice as likely as their peers to meet the criteria for attention deficit hyperactivity disorder (ADHD) at age six.

Living in a family with below-average socioeconomic status likewise doubled the risk of ADHD in six-year-olds. But children with both risk factors -- those who were exposed to gestational diabetes and grew up in a less-than-affluent household -- had a 14-fold increased risk of ADHD compared to children with neither risk factor.

The findings don't prove that gestational diabetes directly causes ADHD, but the researchers say they send a message to mothers and doctors that gestational diabetes may pose hidden dangers to a child well after birth, especially if the child grows up in a challenging environment.

"Mothers should be aware that gestational diabetes can affect her fetus," says Yoko Nomura, Ph.D., the lead author of the study and an assistant clinical professor of psychiatry at the Mount Sinai School of Medicine, in New York City.

Gestational diabetes, which affects roughly 5% of expectant mothers in the United States, generally develops during the second or third trimester of pregnancy -- the same window of time in which a fetus undergoes a critical burst of brain development.

Women with gestational diabetes have abnormally high blood sugar (glucose). If the fetus is bombarded with excess blood sugar, energy normally used for nervous-system development could potentially be diverted to absorb that excess, Nomura says. As a result, the central nervous system may not develop properly.

Growing up in poverty would likely aggravate any underlying nervous-system deficits, Nomura says.

"When babies are born into higher socioeconomic status households, they have better access to medical care [and] remedial activities, intellectual stimulus is higher, they have better foods," she says.

In addition, low-income women may not control their gestational diabetes as well as more prosperous mothers-to-be, says Luigi Garibaldi, M.D., clinical director of pediatric endocrinology at the Children's Hospital of Pittsburgh.

"Having diabetes during pregnancy by itself may not be so bad, but if you don't take care of it, there may be consequences on the brain development of the child," says Garibaldi, who was not involved in the study.

Read more: http://edition.cnn.com/2012/01/02/health/diabetes-pregnancy-adhd-risk/index.html

Schizophrenia Diagnosis Associated With Progressive Brain Changes Among Adolescents

Adolescents diagnosed with schizophrenia and other psychoses appear to show greater decreases in gray matter volume and increases in cerebrospinal fluid in the frontal lobe compared to healthy adolescents without a diagnosis of psychosis, according to a report in the January issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

"Progressive loss of brain gray matter (GM) has been reported in childhood-onset schizophrenia; however, it is uncertain whether these changes are shared by pediatric patients with different psychoses," the authors write as background information in the study.

Celso Arango, M.D., Ph.D., of the Hospital General Universitario Gregorio Marañón, Madrid, Spain, and colleagues, examined the progression of brain changes in first-episode early-onset psychosis and the relationship to diagnosis and prognosis at two-year follow-up among patients at six child and adolescent psychiatric units in Spain. The authors performed magnetic resonance imaging (MRI) of the brain for 61 patients (25 diagnosed with schizophrenia, 16 with bipolar disorder and 20 with other psychoses) and 70 healthy control participants. MRI scans were conducted at study baseline and after two years of follow-up.

Compared with control patients, those diagnosed with schizophrenia showed greater gray matter volume loss in the frontal lobe during the two-year follow-up. Patients with schizophrenia also showed cerebrospinal fluid increase in the left frontal lobe. Additionally, changes for total brain gray matter and left parietal gray matter were significantly different in patients with schizophrenia compared with patients in the control group.

Among patients with schizophrenia, progressive brain volume changes in certain areas were related to markers of poorer prognosis, such as more weeks of hospitalization during follow-up and less improvement in negative symptoms. Greater left frontal gray matter volume loss was related to more weeks of hospitalization whereas severity of negative symptoms correlated with cerebrospinal fluid increase in patients with schizophrenia.

The authors did not find any significant changes in patients with bipolar disorder compared to control patients, and longitudinal brain changes in the control group were consistent with the expected pattern described for healthy adolescents.

"In conclusion, we found progression of gray matter volume loss after a two-year follow-up in patients who ended up with a diagnosis of schizophrenia but not bipolar disease compared with healthy controls," the authors write. "Some of these pathophysiologic processes seem to be markers of poorer prognosis. To develop therapeutic strategies to counteract these pathologic progressive brain changes, future studies should focus on their neurobiological underpinnings."

Read more: http://www.sciencedaily.com/releases/2012/01/120102180842

School-age children need more sleep at night

Many parents don’t realize their child might not be getting enough sleep every night.

Most people feel eight hours a night is plenty of sleep for a school-aged child.

However, children between 5 and 12 years old need about 9 to 12 hours of sleep every night.

Sleep is important for children because it has an effect on their mental and physical well-being, and the hormone that stimulates growth is released while a child sleeps.

Symptoms of sleep deprivation in children include:

• Moodiness and irritability;

• Tendency to explode or have tantrums;

• Over-activity or hyperactive behavior; and

• Reluctance to get out of bed or overly groggy in the morning.

Some suggestions for making sure your child sleeps enough are:

• Don’t let your child’s activities interfere with sleep. Many children participate in activities such as sports or other hobbies.

Though these activities are beneficial for them, if they have too much going on in their lives, they might miss out on valuable sleep.

• Try to keep your child calm before bedtime. Regular exercise is good for children, but exercise too close to bedtime can keep children awake.

• Give your child a warm bath. If your children are too wound up to go to sleep, try having them take a warm bath before bedtime. Soaking for even 15 minutes can relax them.

• Don’t let your child have caffeine for at least six hours before bedtime. Caffeine, a stimulant in sodas and chocolate, can keep your child awake at night. If they want a drink before bedtime, give them milk or water.

• Don’t allow your child to watch television or play on the computer before bed. Instead, read to your child before bedtime. Reading is a great way to help children get to sleep.

• No texting 30 minutes before bedtime or during the night.

• Make sure their room is comfortable and sleep-friendly. It should be quiet, not too hot or too cold, and dark. If necessary, use a small night light.

• Set a consistent sleep schedule and be firm about bedtime. The body functions best when it’s on a regular timetable so it’s best for a child to wake up and go to bed at the same time every day — weekends included.

• Make sure your child knows it’s important to get a good night’s sleep.

Children who have sleep problems, such as daytime drowsiness, loud snoring or breathing pauses during sleep, might have a sleep disorder. If your child has these symptoms, talk to your pediatrician.

Here’s another thing to keep in mind: The earlier your children go to bed, the more time you have to relax and catch up on your own sleep.

Read more: http://galvestondailynews.com/story/283366

Nap-Deprived Tots May Be Missing out On More Than Sleep

A new study led by the University of Colorado Boulder could be a wake-up call for parents of toddlers: Daytime naps for your kids may be more important than you think.

The study shows toddlers between 2 and a half and 3 years old who miss only a single daily nap show more anxiety, less joy and interest and a poorer understanding of how to solve problems, said CU-Boulder Assistant Professor Monique LeBourgeois, who led the study. The results indicate insufficient sleep alters the facial expressions of toddlers -- exciting events are responded to less positively and frustrating events are responded to more negatively, she said.

"Many young children today are not getting enough sleep, and for toddlers, daytime naps are one way of making sure their 'sleep tanks' are set to full each day," she said. "This study shows insufficient sleep in the form of missing a nap taxes the way toddlers express different feelings, and, over time, may shape their developing emotional brains and put them at risk for lifelong, mood-related problems."

LeBourgeois and her colleagues assessed the emotional expressions of healthy, nap-deprived toddlers one hour after their normal nap time, and tested them again on another day following their normal nap. The study, believed to be the first to look at the experimental effects of missing sleep on the emotional responses of young children, indicates the loss of a nap -- in this case in just 90 minutes -- may make toddlers unable to take full advantage of exciting and interesting experiences and to adapt to new frustrations, she said.

"Just like good nutrition, adequate sleep is a basic need that gives children the best chance of getting what is most important from the people and things they experience each day," said LeBourgeois of the integrative physiology department.

In the study, the toddlers' faces were videotaped while they performed "kid-friendly" picture puzzles, including those of farm animals, sea creatures and insects. One puzzle each child worked had all of the correct pieces, which gave him or her the opportunity to experience and express positive emotion, she said. A second puzzle had a "wrong" piece and therefore was frustrating to the toddlers in the study because it was unsolvable.

Facial expressions of the toddlers were coded on a second-by-second basis for emotions like joy, interest, excitement, sadness, anger, anxiety, disgust, shame and confusion.

The study showed nap-deprived toddlers completing the solvable puzzles had a 34 percent decrease in positive emotional responses compared to the same children completing similar puzzles after their usual midday naps. The study also showed a 31 percent increase in negative emotional responses of nap-deprived toddlers when they attempted to complete unsolvable puzzles when compared with puzzle-solving attempts after they had napped.

In addition, the study found a 39 percent decrease in the expression of "confusion" when nap-deprived toddlers attempted to put together unsolvable puzzles. "Confusion is not bad -- it's a complex emotion showing a child knows something does not add up," said LeBourgeois. "When well-slept toddlers experience confusion, they are more likely to elicit help from others, which is a positive, adaptive response indicating they are cognitively engaged with their world."

A paper on the subject recently appeared online and will be published in an upcoming issue of the Journal of Sleep Research. Co-authors included Rebecca Berger and Ronald Seifer of Bradley Hospital in East Providence, R.I., Alison Miller of the University of Michigan School of Public Health and Stephanie Cares of Boston College. The study was funded by the National Institute of Mental Health. The study participants were from Providence, R.I.

"The non-adaptive emotional effects we saw in toddlers who missed a single nap make us wonder how young kids who consistently don't get enough sleep deal with their complicated social worlds," said LeBourgeois, who undertook the study with colleagues while at Brown University.

The toddlers were kept on a strict sleep schedule of at least 12 and a half hours of nighttime and daytime sleep for at least five days before the emotion-testing sessions. Having children follow a set sleep schedule before testing is important because it synchronizes their circadian cycles and makes sure the participants are well-slept prior to the nap and no-nap emotional assessments.

"A sleepy child in a classroom or daycare environment may not be able to engage with others and benefit from positive interactions," she said. "Their coping skills decrease and they may be more prone to tantrums or frustration, which would affect how other children and adults interact with them. This study shows that missing even a single nap causes them to be less positive, more negative and have decreased cognitive engagement."

Similar interactions in the home setting could affect parent-child relationships and a child's quality of life, LeBourgeois said.

The toddlers in the study all wore devices on their wrists that measured their sleep patterns. The parents also kept daily diaries documenting their toddlers' sleep.

"The goal of our study was to understand how losing sleep affects the way young kids respond emotionally to their world," said LeBourgeois. "This is important because toddlerhood is a sensitive period for developing strategies to cope with emotions and a time children naturally lose some sleep as they begin giving up their daytime naps."

Le Bourgeois and her colleagues are now recruiting 40 families with 2-year-olds from the Boulder area for a toddler-sleep study that involves how sleep restriction may affect not only emotion, but also higher levels of cognition known as executive function, which includes working memory and inhibitory control. "These are the building blocks for lifelong learning," she said.

Read more: http://www.sciencedaily.com/releases/2012/01/120103165012

Sleepy At 3? Don’t Reach Out For Sugar-Based Foods!

It’s three o’clock in the afternoon and you have a few more hours of work to wind up at the office before you head for home. Yet you think you can barely go on any longer.

You are drowsy and desperate for a nap. You reach for the donut you bought while you were out walking after lunch.

Sound familiar? Studies now suggest that is exactly the thing you should not be doing. Apparently it is protein, and not sugar, that keeps us up and alert.

Scientists at the University of Cambridge have found that protein activates the cells that are responsible for keeping us awake and help us burn more calories. These cells called orexin cells or hypocretins are basically a type of excitatory neuropeptide hormones.

Orexin cells or hypocretins are responsible for stimulating food intake, wakefulness and energy expenditure. Reduced activity of these special orexin cells causes narcolepsy as well as conditions of weight gain. (1)

The findings of the study were published in the scientific journal Neuron (November issue) has deeper implications in terms of understanding sleep disorders and obesity. It was found that orexin is affected by different nutrients to different degrees. Nutrients found in proteins such as egg whites stimulated orexin neurons more than other nutrients found in any other food.

We have always known that sleep patterns and health are intertwined with body weight, but now orexin cells which are affected by the type of food we eat also plug into the wakefulness and body weight issues.

Scientists were able to highlight the orexin cells which are usually hard to find and then introduced different nutrients to them and waited to see the resultant excitability of these cells. They found that amino acids stimulate orexin cells considerably.

It was particularly interesting because the same group of scientists had earlier observed that glucose blocks the orexin cells and thus the level of wakefulness reduces drastically. This had helped them explain post-meal drowsiness.

The researchers then studied the interactions between sugars and protein and discovered that proteins were stopping the glucose from blocking orexin cells, or in other words, nullifying the glucose effect. (2) This goes to show why it is smarter to eat an egg or other protein-based snack mid-afternoon rather than going for that donut to combat sleepiness.

According to the lead researcher, Dr Denis Burdakov of the Department of Pharmacology and Institute of Metabolic Science, “To combatobesity and insomnia in today's society, we need more information on how diet affects sleep and appetite cells. For now, research suggests that if you have a choice between jam on toast, or egg whites on toast, go for the latter! Even though the two may contain the same number of calories, having a bit of protein will tell the body to burn more calories out of those consumed.” (2)

Read more: http://www.empowher.com/wellness/content/sleepy-3-don-t-reach-out-sugar-based-foods

Autism May Be Linked to Abnormal Immune System Characteristics and Novel Protein Fragment

Immune system abnormalities that mimic those seen with autism spectrum disorders have been linked to the amyloid precursor protein (APP), reports a research team from the University of South Florida's Department of Psychiatry and the Silver Child Development Center.

The study, conducted with mouse models of autism, suggests that elevated levels of an APP fragment circulating in the blood could explain the aberrations in immune cell populations and function -- both observed in some autism patients. The findings were recently published online in the Journal of the Federation of American Societies for Experimental Biology.

The USF researchers concluded that the protein fragment might be both a biomarker for autism and a new research target for understanding the physiology of the disorder.

"Autism affects one in 110 children in the United States today," said research team leader Jun Tan, MD, PhD, professor of psychiatry and the Robert A. Silver Chair, Rashid Laboratory for Developmental Neurobiology at USF's Silver Child Development Center. "While there are reports of abnormal T-cell numbers and function in some persons affected with autism, no specific cause has been identified. The disorder is diagnosed by behavioral observation and to date no associated biomarkers have been identified."

"Not only are there no associated biomarkers, but the prognosis for autism is poor and the costs associated with care are climbing," said Francisco Fernandez, MD, department chair and head of the Silver Center. "The work of Dr. Tan and his team is a start that may lead to earlier diagnosis and more effective treatments."

Read more: http://www.sciencedaily.com/releases/2012/01/120103150755

Infants' Sleep Woes May Persist into Toddlerhood

Infants who have trouble falling and staying asleep might be at risk for persistent sleep problems throughout their early childhood, a new study suggests.

Researchers asked 359 mothers to fill out a questionnaire to learn whether their infants and toddlers had trouble sleeping.

They found that 10 percent of children were reported to have a sleep problem at some point during early childhood, and that the problems that developed in young infants tended to persist through toddlerhood.

"Research shows that if you deprive a child of sleep, it could have an impact on their daily functioning," said Dr. Hari Bandla, a pediatric sleep specialist at the University of Chicago Medical Center, who was not involved with the study.

"If they don't get enough sleep based on their age, it can change how they function day-to-day," Bandla said. "Lack of sleep or poor sleep can negatively affect their learning, a crucial part of their development."

The study is published online today (Jan. 4) in the journal Pediatrics.

Sleep is crucial for a child's development

The new study is the first to investigate the prevalence of sleep problems in infants and toddlers under age 3. About 70 percent of children 10 years or younger experience some type of sleep problem, according to the National Sleep Foundation's 2004 Sleep in America poll, which was based on about 1,500 children.

Sleep problems can include having nightmares, insomnia, restless legs syndrome, night terrors and sleep apnea, which is a sleep disorder that may cause someone to briefly stop breathing while sleeping. These problems could result in poor sleep that makes you tired during the day.

Studies have shown that if left untreated, sleep apnea is associated with an increased risk of high blood pressure, heart disease, obesity and diabetes.

In the new study, mothers filled out questionnaires when children were 6 months, 1 year, 2 years and 3 years old.

The moms reported that 20 to 35 percent of children who had sleep problems at the start of the study continued to have problems two and half years later, whereas only 6 to 8 percent of kids without sleep problems at the start were having them later.

Night wakings and less sleep time were problems that moms commonly reported in children ages 6 months to 2 years, while nightmares and restless sleep were reported in children who were 1 to 3 years old.

Researchers also found that moms who reported that their child snored didn't perceive it to be a problem. The survey showed that 12 to 20 percent of children snored many nights during week.

"Snoring is something parents should pay more attention to," Bandla said. "It's considered a normal part of sleep, but parents should be aware that snoring is an important symptom for sleep apnea. If their child is snoring, they should talk with their doctor about it."

What parents can do

Study co-author Kelly Byars, a sleep specialist at Cincinnati Children's Hospital Medical Center, recommended that parents monitor their children's sleeping habits, especially at bedtime.

"If it takes longer than 15 to 20 minutes for a child to go to sleep, there might be a problem," Byars said.

He noted that while it's completely normal for children to wake up two to four times during the night, a child who can't go back to sleep may have a problem.

"You end up having a child and parent not getting enough sleep, which disrupts their mood, and has an impact on their daytime functioning," Byars said.

One way for parents to address a child’s difficulty falling asleep is to develop a consistent bedtime schedule, Byars suggested.

He recommended putting the child to bed when they are drowsy, but awake. If the child can’t fall asleep, he suggests checking on them periodically, reassuring them briefly, but avoid taking them out of their crib or bedroom.

Read more: http://www.myhealthnewsdaily.com/2069-infants-sleep-problems-persist-toddlerhood.html

More Sleep Can Be Good for Health

Here's a New Year’s resolution you can start today: Try to get an extra 30 minutes of sleep tonight. Dr. Phyllis Zee, a sleep disorder expert from Northwestern Medicine, joined us to explain.

Dr. Zee said an extra 30 minutes a night can make a big difference to how you feel. Lack of sleep can increase risk factors for many health conditions such as heart attack and diabetes. Lack of sleep is also linked to diminished immune responses, lack of concentration, irritability, and depression. Sleep can also improve your appearance and work performance.

Dr. Zee said a recent study her team conducted found that staying up late every night and sleeping in is a habit that could put you at risk for gaining weight. People who go to bed late and sleep late eat more calories in the evening, more fast food, fewer fruits and vegetables and weigh more than people who go to sleep earlier and wake up earlier, according to the research.

In order to get a good night’s sleep, Dr. Zee recommends you:

• Take it seriously and plan ahead
• Create a relaxing routine before bed
• Create a comfortable sleeping environment, with loose pajamas
• Keep it cool, maybe run a fan, lower the thermostat to below 70 degrees
• Keep it dark, draw the shades
• The TV, computer, iPad and cell phones need to take a break at nighttime too
• Caffeine, nicotine and alcohol can have an impact: limit use at nighttime
  

Read More: http://www.myfoxchicago.com/dpp/health/get-more-sleep-good-health-weight-gain-phyllis-zee-20120104

Two-Drug Combo Appears Best for Refractory Epilepsy

Two-Drug Combo Appears Best for Refractory Epilepsy

By Todd Neale, Senior Staff Writer, MedPage Today

December 30, 201; MedPage Today Action Points


•About one-third of patients with epilepsy are refractory to monotherapy with antiepileptic drugs and they are typically treated with combinations of two or more drugs.
•This retrospective study of treatment records of developmentally disabled adults with refractory epilepsy suggests that there is little benefit of three-drug combinations compared to two and that one particular antiepileptic drug combination of two agents appears to be superior to others.



Review

For patients with refractory epilepsy, a combination of lamotrigine and valproate may be the best option for preventing seizures, a retrospective analysis showed.



When used together, those drugs were associated with a relative 48% reduction in seizure frequency compared with an aggregate measure of all other treatment regimens (P=3x10-6), according to Nicholas Poolos, MD, PhD, of the University of Washington in Seattle, and colleagues.



In head-to-head comparisons, combinations of two or three drugs that included lamotrigine and valproate were associated with a relative 45% to 61% reduction in seizure frequency compared with six other regimens, including each drug as monotherapy (P<0.05 for all), the researchers reported in the Jan. 3 issue of Neurology.



Although the results suggest that combining lamotrigine and valproate provides efficacy superior to that of other regimens for refractory epilepsy, Poolos and colleagues noted that "this conclusion should ideally be confirmed in a prospective study of refractory patients, preferably from the general population."



They added that the study does not rule out the possibility of other regimens with improved efficacy because of low numbers of patients taking certain combinations.



About one-third of patients with epilepsy are refractory to treatment and they are usually treated with two or more antiepileptics. But it remains unclear whether any one combination is better than the rest.



To explore the issue, Poolos and colleagues retrospectively examined treatment records of 148 institutionalized, developmentally disabled adults with highly refractory epilepsy who received care at two state-run facilities in Washington. There was an average of nearly 12 years of treatment data for each patient.



On average, the patients had 3.2 seizures per month.



The eight most common drugs used at the two institutions alone or in combination were lamotrigine, valproate, carbamazepine, phenytoin, topiramate, levetiracetam, gabapentin, and zonisamide.



Of the 32 most frequently used combinations of up to three drugs, only the combination of lamotrigine and valproate stood out from the aggregate measure of other treatment regimens.



In the head-to-head comparisons, six of the 10 that revealed significant differences in treatment efficacy favored combinations that included those two drugs.



"It has been suggested that lamotrigine/valproate may be more effective based on pharmacodynamic synergism between the two drugs' mechanisms of action," the authors wrote. "Valproate exerts a well-known pharmacokinetic effect on lamotrigine metabolism, reducing its hepatic clearance."



But data from the current study suggested that that could not explain the greater efficacy of that particular combination.



"In the absence of serum drug level data, however, this question remains unresolved," the authors wrote.



An additional analysis revealed that using two drugs together was associated with a 19% decrease in seizure frequency compared with monotherapy (P=0.03), but that adding a third drug did not add any benefit.



"Use of antiepileptic drug combinations in clinical practice might best involve no more than two drugs at a time," Poolos and colleagues concluded. "This approach may lessen the increased toxicity that accompanies increasing the number of [drugs], while not sacrificing efficacy."



They acknowledged some limitations of the study, including the retrospective design, the lack of randomization, the inclusion of the eight most commonly used drugs only, the lack of a correlation of effects with drug dosage or serum levels, and the small sample sizes for some drug combinations.



The study was supported by the University of Washington Royalty Research Fund.



Poolos serves on the editorial board of Epilepsy Currents and receives research support from the National Institutes of Health.



Primary source: Neurology

Source reference:

Poolos N, et al "Comparative efficacy of combination drug therapy in refractory epilepsy" Neurology 2012; 78: 62-68.



Disclaimer

The information presented in this activity is that of the authors and does not necessarily represent the views of the University of Pennsylvania School of Medicine, MedPage Today, and the commercial supporter. Specific medicines discussed in this activity may not yet be approved by the FDA for the use as indicated by the writer or reviewer. Before prescribing any medication, we advise you to review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse effects. Specific patient care decisions are the responsibility of the healthcare professional caring for the patient. Please review our Terms of Use.












Link here

Sea Snails Help Scientists Explore a Possible Way to Enhance Memory

Efforts to help people with learning impairments are being aided by a species of sea snail known as Aplysia californica. The mollusk, which is used by researchers to study the brain, has much in common with other species including humans. Research involving the snail has contributed to the understanding of learning and memory.

At The University of Texas Health Science Center at Houston (UTHealth), neuroscientists used this animal model to test an innovative learning strategy designed to help improve the brain's memory and the results were encouraging. It could ultimately benefit people who have impairments resulting from aging, stroke, traumatic brain injury or congenital cognitive impairments.

The proof-of-principle study was published on the Nature Neuroscience website on Dec. 25. The next steps in the research may involve tests in other animal models and eventually humans.

The strategy was used to identify times when the brain was primed for learning, which in turn facilitated the scheduling of learning sessions during these peak periods. The result was a significant increase in memory.

"We found that memory could be enhanced appreciably," said John H. "Jack" Byrne, Ph.D., senior author and chair of the Department of Neurobiology and Anatomy at the UTHealth Medical School.

Building on earlier research that identified proteins linked to memory, the UTHealth investigators created a mathematical model that tells researchers when the timing of the activity of these proteins is aligned for the best learning experience.

Right now, the scheduling of learning sessions is based on trial and error and is somewhat arbitrary. If the model proves effective in follow-up studies, it could be used to identify those periods when learning potential is highest.

"When you give a training session, you are starting several different chemical reactions. If you give another session, you get additional effects. The idea is to get the sessions in sync," Byrne said. "We have developed a way to adjust the training sessions so they are tuned to the dynamics of the biochemical processes."

Two groups of snails received five learning sessions. One group received learning sessions at irregular intervals as predicted by a mathematical model. Another group received training sessions in regular 20-minute intervals.

Five days after the learning sessions were completed, a significant increase in memory was detected in the group that was trained with a schedule predicted by a computer. But, no increase was detected in the group with the regular 20-minute intervals.

The computer sorted through 10,000 different permutations in order to determine a schedule that would enhance memory.

To confirm their findings, researchers analyzed nerve cells in the brain of snails and found greater activity in the ones receiving the enhanced training schedule, said Byrne, the June and Virgil Waggoner Chair of Neurobiology and Anatomy at UTHealth.

"This study shows the feasibility of using computational methods to assist in the design of training schedules that enhance memory," Byrne said.

Read more: http://www.sciencedaily.com/releases/2011/12/111227093103