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Monday, January 26, 2015

BY REBECCA HISCOTT

 

If you have epilepsy and you sleep on your stomach, you may be at a higher risk for sudden unexpected death than those who sleep in other positions, according to a new study published in Neurology. This is particularly true for those who experience generalized tonic-clonic seizures.

 

For those whose seizures are not adequately controlled with medication, a phenomenon known as sudden unexpected death in epilepsy (SUDEP) is the leading cause of death. It usually happens unwitnessed during sleep, said study author James X. Tao, MD, PhD, an associate professor of neurology and director of the Electroencephalography (EEG) Laboratory at the University of Chicago, in a news release. It occurs in approximately 1 out of 1,000 people with epilepsy each year and its biological causes are largely unknown.

 

What the Researchers Found

After reviewing data from 25 studies that looked at 253 cases of SUDEP in which the patient’s body position had been recorded, Dr. Tao and colleagues found that 73 percent of the subjects died sleeping on their stomachs versus 27 percent who died in other sleep positions.

 

In a subgroup of 88 SUDEP cases, younger epilepsy patients were nearly four times as likely to be found on their stomach (also known as the “prone” position) compared with older subjects; 86 percent of people under 40 who died from SUDEP were sleeping on their stomach, compared with 60 percent of those over 40.

 

“We’re not sure why this was more common in younger people. It may be that they are more likely to be single and not have anyone with them during a seizure while sleeping,” Dr. Tao said.

 

In addition, 11 SUDEP cases occurred while patients were being monitored with video EEG. All 11 of them died while sleeping in the prone position and most had been on their stomachs before the seizure occurred. The patients also all had generalized tonic-clonic seizures and postictal generalized EEG suppression, a specific pattern of post-seizure electrical activity in the brain that can be detected by EEG. This pattern almost exclusively appears in the brains of people with generalized tonic-clonic seizures.

 

Who Is At Risk?

If you have generalized tonic-clonic seizures (which involve muscle stiffening and convulsions), postictal generalized EEG suppression, and you sleep on your stomach, you are at higher risk for SUDEP, the researchers said. Other known risk factors include early onset of epilepsy, chronic resistance to medication, and nocturnal seizures.

 

“Adults often have an impaired ability to wake up after a seizure,” which may hinder their ability to move their head when the airway becomes obstructed by soft bedding, thereby leading to SUDEP, Dr. Tao said.

 

Take These Precautions

To reduce your risk of SUDEP, practice these good habits:

  • Get Your Seizures Under Control. The most important way to reduce your risk for SUDEP? Take anti-epileptic drugs to control your seizures. If you’re already on medication and still have uncontrolled seizures, talk to your doctor about switching to a different drug or drug combination or upping your dose.
  • Stay Healthy. Avoid excess alcohol and illicit drugs, get enough sleep, follow a healthy diet, and stick to an exercise routine. These lifestyle changes can all help reduce seizures.
  • Sleep on Your Side or Back. The researchers can’t stress it enough: don’t sleep on your stomach if you have generalized tonic-clonic seizures or seizures at night.
  • Use Technology. Check out a seizure-tracking smart watch or similar device that can detect a seizure and wake you up. “Wrist watches and bed alarms designed to detect seizures during sleep may help prevent these deaths,” Dr. Tao said.
  • Inform Your Sleeping Partner. Ask your sleeping partner to push you onto your back if you have a generalized tonic-clonic seizure during the night, Dr. Tao suggested.

To learn more about SUDEP, visit sudepaware.org and browse our archives here.


Tuesday, January 20, 2015

BY REBECCA HISCOTT

 

A young child with autism. Behavior, not obvious physical features, distinguishes children with autism from other children. Here, as a familiar adult approaches this little boy to play, he prefers gazing at an object for an unusual length of time.

 

The sooner autism is diagnosed, the sooner parents can consult with experts to figure out which therapeutic options are appropriate for their child. Research has shown that early therapy can help correct or lessen some of the social and behavioral deficits of the disorder. But that diagnosis may not be happening in a typical visit to the pediatrician, according to a new study.

 

The decision to refer a child to a specialist for the more rigorous testing required for a diagnosis of autism is often made during a routine visit to the pediatrician. And if that decision is made based on brief observations alone, there’s a risk that even experts will miss a large percentage of children who need a referral, said lead study author Terisa Gabrielsen, PhD, NCSP, an assistant professor in the department of counseling, psychology and special education at Brigham Young University, in a recent interview.

 

That’s because even children with autism display mostly “typical” behaviors during these 10- to 20-minute visits, which may mask hallmark signs such as difficulty communicating, repetitive movements and behaviors, and a lack of certain social skills.

 

“We think our findings are an important clue as to why many children with autism are not identified until they are 4 to 5 years old or older,” she said. Typically, children with autism begin showing signs by age 1 or 2.

 

Study Design

The study, which was published in the journal Pediatrics, included 42 children between the ages of 15 and 33 months: 14 had been diagnosed with early signs of an autism spectrum disorder, 14 did not have autism but had suspected language delays, and 14 were developing normally. Researchers administered three tests that assessed the child’s risk for autism, including the Autism Diagnostic Observation Schedule (ADOS), which looks at whether a child displays abnormal behaviors in areas such as speech, making eye contact, showing or reading emotions, and movement.  

 

The researchers videotaped these evaluations in two 10-minute segments, so that there were two 10-minute videos for each child. They then showed the videos to two psychologists who specialized in autism spectrum disorders. The experts rated the children’s behaviors as either “typical” or “atypical” and indicated whether they would refer each child for a full autism evaluation, based on the behaviors observed in that video.

 

What the Experts Missed

Surprisingly, even though the children with autism displayed more “atypical” behaviors such as repetitive movements, avoiding eye contact, and not responding to their name, most of their behavior still looked like that of a typically developing child. The psychologists classified only 11 percent of the autistic children’s behaviors as “atypical,” compared with 2 percent among normally developing children.

 

When asked which of the children should be sent for an autism assessment, the psychologists were incorrect 39 percent of the time. The two experts agreed on what constituted an “atypical” behavior only 35 percent of the time—showing just how difficult it is to pick out atypical behavior in a short observation period, the study authors said.

 

Making a Diagnosis

A proper diagnosis of autism requires more than just a behavioral observation. It requires “autism screening tools, parent observations, developmental testing, and a detailed [medical and behavioral] history,” the authors wrote.

 

It also takes a full team both to diagnose and treat a child with autism, Dr. Gabrielsen added, involving input from “psychologists, speech and language pathologists, occupational therapists, developmental pediatricians, other health care professionals, and sometimes physical therapists”  in cases of physical disability or impairment.

 

The American Academy of Pediatrics now recommends that all children be evaluated for autism using tests such as the ADOS at 18 and 24 months. If you suspect your child may have autism or another developmental disorder, talk to your doctor about a referral for screening. You can also consult the Modified Checklist for Autism in Toddlers online.

 

To learn more about the signs of autism, visit the CDC’s resources on autism spectrum disorders and browse our archives here.


Thursday, January 15, 2015

BY REBECCA HISCOTT

 

Newly diagnosed cancer patients have an increased risk for stroke compared with people without cancer, especially in the three months following diagnosis, according to a new study published in the journal Annals of Neurology. That risk is highest among those with more aggressive forms of cancer, such as lung, pancreatic, and colorectal cancer.

 

The study suggests that cancer may increase stroke risk independently of other known risk factors such as high blood pressure, smoking, or diabetes, the researchers said. It is unclear why cancer may increase this risk, but scientists believe that cancer and cancer treatments such as chemotherapy and radiation affect the body’s clotting mechanism, which can lead to the formation of blood clots that cause stroke.

 

“Stroke is particularly relevant to cancer patients because strokes often preclude or delay cancer treatments, resulting in reduced survival,” study author Babak Navi, MD, an assistant professor of neurology and neuroscience at Weill Cornell Medical College in New York, said in a news release.

 

Based on these findings, future research should investigate whether blood thinners are a viable option for lowering stroke risk in cancer patients, Dr. Navi said.

 

stroke-brain

The Database

For the study, researchers looked at database of people enrolled in Medicare who were diagnosed with cancer between 2001 and 2007. They specifically examined five cancer types: breast, colorectal, lung, and prostate cancer, which are the four most common malignant types of cancer, as well as pancreatic cancer, which has been linked to a higher rate of clotting problems, including stroke, in past studies.

 

Each cancer patient—327,289 in all—was matched with a Medicare recipient of the same age, sex, race, and history of hypertension (high blood pressure) or atrial fibrillation (irregular heartbeat) who did not have cancer, so that the researchers could compare the two groups in terms of stroke incidence.

 

The Risks

They found that cancer patients were significantly more likely to experience a stroke than non-cancer patients, with the highest risk occurring within the first three months following diagnosis. After one year, there was no longer any difference between the groups in terms of stroke risk.

 

Overall, 5.1 percent of lung cancer patients, 3.4 percent of pancreatic cancer patients, 3.3 percent of colorectal cancer patients, 1.5 percent of breast cancer patients, and 1.2 percent of prostate cancer patients experienced a stroke, compared with 1.1 to 1.5 percent of matched controls.

 

Based on the data, the risk of stroke also appeared to be linked to the aggressiveness of the cancer. Patients with lung, pancreas, and colorectal cancers, which are often diagnosed at later stages, had a higher rate of stroke than patients with breast and prostate cancer, which tend to be less aggressive forms of cancer.

 

Other Ways to Control Stroke Risk

Cancer may be an uncontrollable stroke risk factor, but others are within your power to control. Here are four of the most important ways to reduce your risk for stroke:

 

·         Eat right. Obesity, diabetes, high blood sugar, and high cholesterol are all linked to an increased risk for stroke. Cutting back on processed foods, ditching foods with lots of sodium and added sugar, and eating more fruits, vegetables, whole grains, and fish will keep your heart, your brain, and your waistline happy.

 

·         Exercise. Inactivity is another well-documented stroke risk factor. Getting a little aerobic exercise such as walking or cycling for 30 minutes five times a week will lower your blood pressure and blood sugar levels and boost levels of high-density lipoprotein, the “good” kind of cholesterol, making it a simple way to dramatically reduce your risk for stroke.

 

·         Quit smoking. Smokers are much more likely than non-smokers to experience a stroke—to say nothing of the myriad other health problems smoking can cause. Smoking causes plaque to collect in the arteries and reduces your levels of “good” cholesterol, which can increase your risk of stroke-causing blood clots. Research suggests that quitting smoking can cut your stroke risk by as much as 40 percent.

 

·         Treat underlying medical conditions. High blood pressure—and possibly even mildly high blood pressure—is strongly linked to an increased stroke risk, as are atrial fibrillation and sickle cell anemia. If you have one or more of these conditions, talk to your doctor about medications and lifestyle modifications that can help you treat them.

 

If you are a newly diagnosed cancer patient concerned about your risk of stroke, be sure to talk to your doctor about specific ways to mitigate that risk.

 

To learn more about stroke, see Stroke: The Basics and browse our archives here.


Tuesday, January 13, 2015

BY REBECCA HISCOTT

 

Image via Brad Flickinger on Flickr.

 

If you want your child to get a good night’s rest, keep the television out of the bedroom. Parents have known this for years—and research has confirmed it.

 

Now, a new study published in the journal Pediatrics reveals that gadgets like smartphones and tablets have an even worse effect on sleep, for many of the same reasons. The bright light the screens emit delays the production of melatonin, a brain chemical that aids in sleep, and kids often delay their bedtime to check out one more thing on their gadget.

 

Why Gadgets Are Worse

Not only do smartphones and tablets affect how long your child sleeps, they also affect the quality of that sleep. Researchers cite three reasons for this. Firstly, kids hold these devices close to the face, which may delay melatonin production more than a screen that is farther away. Secondly, watching TV is passive, whereas playing a game or responding to a text message is more active, which may keep the brain and body in a greater state of wakefulness. Lastly, smartphones and tablets often emit noises when receiving text messages, even when the device is not in use, which can wake your child and make it difficult for him or her to fall back asleep.

 

The Study

Researchers looked at data from 2,048 fourth- and seventh-grade students who were enrolled in a study of childhood obesity in Massachusetts. The children had been asked whether they had a TV in their bedroom or slept near a smartphone or other portable device with a screen. They were also asked to record their bedtimes and wake times, and to report whether they felt they’d gotten enough sleep on a given night.

 

The Results

Overall, 54 percent of the students surveyed reported sleeping near a small screen, and 75 percent reported sleeping in a room with a TV. Kids who had a TV in the bedroom slept an average of 18 minutes less each night than kids without a TV set in the bedroom, while those who slept near a cell phone, smartphone, or iPod touch slept an average of 20.6 minutes less each night than kids who didn’t sleep near these gadgets.

 

In addition, kids who slept near a small screen were more likely to report feeling like they hadn’t gotten enough sleep. Kids who had a TV in the bedroom, in contrast, were no more likely to complain of insufficient sleep than kids without a TV.

 

Make the Bedroom a Screen-free Zone

The study results provide further evidence that “recreational screen time should be limited” at night, study author Jennifer Falbe, ScD, MPH, a researcher in the School of Public Health at the University of California, Berkeley, said in a recent interview. “Parents can set a screen or device curfew one hour before bedtime,” she said.

 

The American Academy of Pediatrics, which publishes the journal Pediatrics, likewise recommends that parents limit kids’ screen time and establish “screen-free” areas in the home—including bedrooms—where smartphones and other gadgets aren’t allowed.

 

Why Sleep Matters

Sleep doesn’t just keep kids from being cranky. Past studies show that lack of sleep is linked to a higher risk of obesity and lower academic performance.

 

In addition, neuroscientists believe that sleep provides a crucial rest period for the brain, allowing it to clear out harmful toxins—including amyloid-beta, which may play a role in Alzheimer’s disease. That’s why some researchers believe that over time, lack of sleep increases the risk for thinking and memory problems, and perhaps even Alzheimer’s and dementia, later in life.

 

That’s enough to keep you awake at night—but don’t let it!

 

Look for more information about how to get a good night’s sleep in the February/March 2015 issue of Neurology Now. To learn more about how sleep and sleep disorders affect the brain, browse our archives here.


Friday, January 09, 2015

BY REBECCA HISCOTT

 

Having your child or teen rest too much after a mild concussion may impede recovery, according to a new study published in the journal Pediatrics. The study tested current recommendations for concussion (one or two days of bed rest at home, with a gradual return to school, work, and physical activity as symptoms fade) against a more strict protocol of five days of rest and no school, work, or physical activity.

 

“Contrary to our expectations, strict rest for five days immediately after concussion did not help teenagers get better compared to our current advice,” study author Danny G. Thomas, MD, MPH, a researcher at the Children’s Hospital of Wisconsin, said in a recent interview. “We found that teenagers instructed to rest five days actually reported more symptoms over the course of the study.”

 

A student participates in a concussion study. Image via University of the Fraser Valley on Flickr.

 

Study Design

The researchers assigned 88 patients between the ages of 11 and 22 who presented to the emergency room with a mild concussion to either usual care (24 to 48 hours of rest, as decided by a physician) or to the five-day protocol.

 

All patients were asked to record and rate the severity of their symptoms for the first 10 days post-concussion, including physical, cognitive, and emotional symptoms (such as difficulty thinking clearly and concentrating, headache, dizziness, or nausea, mood swings, feelings of anxiety and depression, and irritability), and sleep quality. They also took computerized tests of brain function and balance at three and 10 days post-injury.

 

The Results

More than 60 percent of patients in both groups saw their symptoms clear up within the 10-day follow-up period. However, the researchers reported, it took three days longer for half of patients in the five-day rest group to report symptom resolution.

 

The 45 patients assigned to the five-day protocol also reported experiencing more concussion symptoms, particularly irritability and depression, than patients in the usual care group. There were no significant differences between the groups in terms of brain function or balance over the 10-day period.

 

Extra Rest May Cause Stress

The emotional stress caused by missing out on school and other activities for a prolonged period of time may explain the difference in emotional symptoms between the groups, the researchers suggested. “Missing social interactions and falling behind academically may contribute to situational depression increasing physical and emotional symptoms,” they wrote. They added that restricting movement and exercise might also “contribute to sleep abnormalities and adversely affect mood.”

 

Best Rest

The optimal rest period for each patient may vary depending on factors such as age, gender, and the initial severity and type of symptoms, concussion experts William P. Meehan III, MD, and Richard G. Bachur, MD, wrote in an accompanying Pediatrics editorial.

 

“The entire plan for managing a concussion should not be determined in the emergency department,” they added. “A few days of rest followed by prompt follow-up with the pediatrician, sports medicine physician, or other capable provider should be recommended, and each management plan should be tailored to each individual patient.”

 

The Exceptions

Dr. Thomas and colleagues stressed that the study results do not apply to hospitalized patients with more severe concussion or traumatic brain injury, who would likely benefit from a longer rest period. But for children and teens with mild concussion, a 24- to 48-hour period of rest appears to be the best treatment.

 

Consult a Doctor

If you suspect your child has sustained a concussion, take him or her to see a doctor immediately. Although most people who experience a concussion recover within 10 days, occasionally the effects can linger, especially in young children and teens who have sustained multiple blows to the head. A concussion can occur even if the initial injury doesn’t cause a loss of consciousness. That’s why it’s important to promptly see a doctor or call 911 in cases of severe injury requiring immediate treatment.

 

For more coverage of concussion and traumatic brain injury, see Traumatic Brain Injury: The Basics and browse our archives here.