“In order to make the much needed environmental changes that the article, below, is concerned about, it might help to include additional statistics that show how citizens deprived at birth, of an equal chance to fulfill their potential, end up dragging society down, which over time affects all of us, including the corporate executives who avoid responsibility for their contribution to a toxic environment.
In an increasingly transparent planet, it’s becoming easier to see that in the great scheme of things, we are one,…….. if you hurt one, you hurt all.”
…………….Joyce Hays, Target Health Inc.
The New York Times, June 28, 2011, by Nancy Folbre — In an imaginary world of equal opportunity we would all be free to choose our own economic future. In reality, many children in the United States are born to lose, suffering health disadvantages at birth that reduce their likelihood of economic success.
Epidemiologists and economists have long agreed that low birth weight is an important, albeit approximate, predictor of future health problems. A wealth of new economic research tracing individuals over time shows that it is also an approximate predictor of future earnings problems, with statistical effects almost as strong as children’s test scores.
Among other things, low birth weight increases the probability of suffering from attention deficit hyperactivity disorder and lowers the probability of graduating from high school.
In the current American Economic Review, Janet Currie of Princeton, a pioneer in this new area of research, summarizes recent findings and points out that children of black mothers who dropped out of high school are three times as likely as children of white college-educated mothers to suffer low birth weight.
Many of the mechanisms that underlie this inequality are linked to characteristics of the physical environment, such as exposure to environmental toxins.
For instance, carbon monoxide related to automobile emissions harms fetal health. Detailed statistical analysis of families in New Jersey shows that moving from an area with high levels of carbon monoxide to one with lower levels has an effect on birth weight larger than persuading a woman who was smoking 10 cigarettes a day during pregnancy to quit.
Another memorable illustration of carbon monoxide effects comes from a study of the impact of E-ZPass electronic technologies, which improve infant health by reducing auto emissions in neighborhoods close to highway toll booths.
Professor Currie’s research shows that black and Latino children are significantly more likely than white children to be born to mothers living in proximity to such hazards, supporting arguments long made by environmental justice advocates.
Less-educated mothers are less aware of such health risks and less able to mobilize the economic resources necessary to move to better neighborhoods. This helps explain results showing that improved educational opportunities for mothers improve infant health.
Another important policy implication is that stricter environmental regulation would benefit low-income children in particular. Professor Currie has taken part in research showing that reductions in the release of three toxicants (cadmium, toluene, and epichlorohydrin) from 1988 to 1999 account for a 3.9 percent reduction in infant mortality over that time.
Previous research by Kenneth Y. Chay of the University of California, Berkeley, and Michael Greenstone of the Massachusetts Institute of Technology has shown that the 1970 Clean Air Act reduced infant mortality.
Yet many children in the United States live, play or go to school in areas with dangerously poor air quality – a particularly serious problem in summer months when smog heats up.
Greater publicity for economic research on the impact of regulation might quiet critics of the Environmental Protection Agency, who often focus on its short-term costs rather than its long-term benefits. Would changing its name — perhaps to the Environmental Child-Protection Agency — help win over the family-values crowd?
Professor Currie herself tends to emphasize the pricing problem. As she put it: “Factories dump toxic releases into the atmosphere but don’t pay the cost of pollution. There would be less harm to the children who ingest the toxins if the factories had to bear the cost.”
Changes would happen even more quickly if the chief executives of these companies — and their children — had to bear the cost. But these adults are free to choose where to live and what to breathe. And their children are, for the most part, born to win.
Dr. Brien Smith discusses next steps with Douglas Davis, a patient at Spectrum Health Butterworth Hospital in Grand Rapids, Mich. Photo: Johnny Quirin/Spectrum Health
The New York Times, June 28, 2011, by Pauline W. Chen MD — One day during medical school, my classmates and I learned that one of the most well-liked doctors-in-training in the hospital had had a seizure while leading morning work rounds.
The sight of him writhing had caused the other doctors and nurses on the ward to panic. Some stood mute, frozen with fear. An intern, believing that the seizure arose from low blood sugar levels, took his half-eaten jelly doughnut and held it against the mouth of his seizing colleague. Others yelled to the ward secretary to “call a code,” and continued to do so even after another dozen doctors and nurses had already arrived on the floor.
The young doctor eventually recovered. But for many of the medical students and doctors who heard about the episode or were on the wards that day, the dread of that morning would linger long beyond our years of training. Epilepsy was, and remains, a frightening and mysterious malady.
For the last 20 years, Dr. Brien J. Smith has tried to change how doctors and patients view epilepsy. Earlier this year, Dr. Smith, chief of neurology at Spectrum Health in Michigan, became chairman of the Epilepsy Foundation. Being elected head of a national organization does not seem unusual for a doctor who is a well-recognized authority and advocate in his or her field. What is extraordinary is that Dr. Smith knows firsthand about the disease and what his patients experience: He learned he had epilepsy when he was in high school.
“Every day I see how off-base health care workers are with seizures and epilepsy,” Dr. Smith said recently. “There’s a lot of stigma attached, a lot of stereotypes regarding cognitive abilities and how seizures should look.”
I spoke to Dr. Smith and asked him about his advocacy work, his diagnosis and how being a patient has affected his interactions with patients and colleagues.
When were you diagnosed with epilepsy?
My epilepsy probably started at a young age. I remember waking up as a young child with weird dreams — a kaleidoscope view of the world. In my midteens I had these feelings of kind of a brain warp that would pass. Finally as a junior in high school, I had a seizure getting out of the car in the high school parking lot.
How did you decide to become an epilepsy specialist in medical school?
I liked surgery and I liked emergency medicine. But I realized I needed to find something that didn’t require procedural work or spur-of-the-moment cataclysmic decisions where the pressure is on and even if you have a little short-circuit, that could mean life or death to someone.
I also was interested in neurology and figured it was my calling in life.
How did your epilepsy affect your interaction with colleagues?
I never hid the diagnosis. But a few years later after my training, I was asked to write a foreword for a book that was a collection of personal accounts of seizures. That was not an easy decision. I worried that by being so transparent, people might see me as handicapped, that they might view me differently.
The decision to write that foreword made me realize that I should be more of an advocate. I had noticed that among my colleagues, there were a lot of stereotypes of those with the disease, like “Oh, wow, look at that crazy person.” None of them were learning a lot about seizures in medical school and training, and they didn’t really understand how seizures could affect people.
What has happened with your epilepsy?
I was seizure-free for many years but had a major seizure on my way to my first major epilepsy meeting in 1992. On an M.R.I. afterward, the neuroradiologists found a slow-growing brain tumor that probably caused the seizures all along but was never seen, or missed on early CAT scans.
I ended up getting the left temporal lobe of my brain removed, which leaves people with difficulty naming things for the first six to 12 months until the brain figures out how to get around the problem.
So there I was for a while, a neurologist who couldn’t name things.
How have your own experiences affected your interactions with colleagues?
It’s really helped me see that doctors need to be taught to understand seizures. It’s a disorder with over 40 different types or syndromes that can affect anyone. There are Supreme Court justices who have had a couple of seizures and function normally. There are adults who have had significant head trauma, strokes or brain tumors. And there are individuals for whom epilepsy is catastrophic — children who all of a sudden find themselves going down a path where there is a strong likelihood they will never have a normal life.
Did the experience change how you interact with patients?
After my surgery, I was a very different person, with very little motivation and energy. We had just rearranged the furniture upstairs and I needed time to re-equilibrate. But one rarely hears doctors talking about the transition after surgery and how it can go in many different directions because most physicians have no clue of the implications of the diseases or their treatments.
One problem I face is whether I should share my own story with patients. I don’t want patients to assume that just because Dr. Smith is doing great, everyone who has epilepsy surgery will as well. My job is to be as realistic as possible about outcomes and risks. With brain surgery, the possibility of a major complication can’t be excluded. This is the brain we’re talking about. Once you take a part of it out, you can’t bring it back.
EPILEPTIC Seizures and Syndromes
Seizures happen when the electrical system of the brain malfunctions. Instead of discharging electrical energy in a controlled manner, the brain cells keep firing. The result may be a surge of energy through the brain, causing unconsciousness and contractions of the muscles.
If only part of the brain is affected, it may cloud awareness, block normal communication, and produce a variety of undirected, uncontrolled, unorganized movements.
Most seizures last only a minute or two, although confusion afterwards may last longer. An epilepsy syndrome is defined by a collection of similar factors, such as type of seizure, when they developed in life, and response to treatment.
The human brain is the source of human epilepsy. Although the symptoms of a seizure may affect any part of the body, the electrical events that produce the symptoms occur in the brain. The location of that event, the extent of its reach with the tissue of the brain, and how long it lasts all have profound effects.
There are many different types of seizures. People may experience just one type or more than one. The kind of seizure a person has depends on which part and how much of the brain is affected by the electrical disturbance that produces seizures. Experts divide seizures into generalized seizures (absence, atonic, tonic-clonic, myoclonic), partial (simple and complex) seizures, nonepileptic seizures and status epilepticus.
Classifying epilepsy by seizure type alone leaves out other important information about the patient and the episodes themselves. Classifying into syndromes takes a number of characteristics into account, including the type of seizure; typical EEG recordings; clinical features such as behavior during the seizure; the expected course of the disorder; precipitating features; expected response to treatment, and genetic factors. Find out more about epilepsy syndromes.
- Seizures are symptoms of abnormal brain function. With the exception of very young children and the elderly, the cause of the abnormal brain function is usually not identifiable. In about seven out of ten people with epilepsy, no cause can be found. Among the rest, the cause may be any one of a number of things that can make a difference in the way the brain works. Head injuries or lack of oxygen during birth may damage the delicate electrical system in the brain. Other causes include brain tumors, genetic conditions (such as tuberous sclerosis), lead poisoning, problems in development of the brain before birth, and infections like meningitis or encephalitis.
Some people who have epilepsy have no special seizure triggers, while others are able to recognize things in their lives that do affect their seizures. Keep in mind, however, that just because two events happen around the same time doesn’t mean that one is the cause of the other. Generally, the most frequent cause of an unexpected seizure is failure to take the medication as prescribed. That’s the most common trigger of all. Other factors include ingesting substances, hormone fluctuations, stress, sleep patterns and photosensitivity.
Photosensitivity and Seizures
Epilepsy affects more than three million Americans. For about 3 percent of them, exposure to flashing lights at certain intensities or to certain visual patterns can trigger seizures. This condition is known as photosensitive epilepsy.
While Watching Television:
» Watch television in a well-lit room.
» Reduce the brightness of the screen.
» Keep as far back from the TV as possible.
» Use the remote to change channels so you won’t have to get too close.
» Avoid watching for long periods.
» Try wearing polarized sunglasses.
Photosensitive epilepsy is more common in children and adolescents, especially those with generalized epilepsy, in particular juvenile myoclonic epilepsy. It becomes less frequent with age, with relatively few cases in the mid twenties.
Many people are unaware that they are sensitive to flickering lights or to certain kinds of patterns until they have a seizure. They may never go on to develop epilepsy, which is characterized by recurrent spontaneous seizures, though a seizure may be triggered by certain photic conditions. Many individuals who are disturbed by light exposure do not develop seizures but experience other symptoms such as headache, nausea, dizziness and more. They do not have epilepsy.
Examples of Triggers
Seizures in photosensitive people may be triggered by exposure to television screens due to the flicker or rolling images, to computer monitors, to certain video games or TV broadcasts containing rapid flashes or alternating patterns of different colors, and to intense strobe lights like visual fire alarms.
Also, seizures may be triggered by natural light, such as sunlight, especially when shimmering off water, flickering through trees or through the slats of Venetian blinds.
Certain visual patterns, especially stripes of contrasting colors, may also cause seizures. People have wondered whether flashing lights on the outside top of buses or emergency vehicles may trigger seizures in people with photosensitive epilepsy.
Not all televisions, video games, computer monitors, and strobe lights trigger seizures, however. Even in predisposed individuals, many factors must combine to trigger the photosensitive reaction.
- frequency of the flash (that is, how quickly the light is flashing)
- contrast with background lighting
- distance between the viewer and the light source
- wavelength of the light
- whether a person’s eyes are open or closed
The frequency or speed of flashing light that is most likely to cause seizures varies from person to person. Generally, flashing lights most likely to trigger seizures are between the frequency of 5 to 30 flashes per second (Hertz).
The likelihood of such conditions combining to trigger a seizure is small. However, to be safe, photosensitive individuals are advised to keep at a distance from TV screens and to place other lights in the surrounding area to lower the contrast between the brightness on the screen and the background. These conditions protect the viewer and are easy to obtain during TV viewing but not while playing video games or when randomly exposed to strong environmental lights. Therefore, other protective devices or strategies may be needed.
Check with your doctor if you are concerned about flashing lights triggering seizures. Chances are that your medical records will indicate how you responded to flashing lights during the electroencephalogram (EEG), a test done routinely in most people with epilepsy. During this test, sensors are attached to the patient’s scalp to monitor the electrical activity of the brain in various conditions, including light stimulation generated by a strobe positioned in front of the eyes. An abnormal response when the patient is exposed to various frequencies of flashing lights indicates the presence of photosensitivity. If you have not been diagnosed with epilepsy or have not had this type of test, ask your doctor about ordering one for you, or consult a local neurologist.
The same concerns may apply to relatives of individuals who are known to be photosensitive, such as siblings. Because the condition is genetic it may affect other members of the same family. Finding out if your are photosensitive or not is relevant, especially if the relatives are children or adolescents who intend to engage in activities presenting risks such as intense videogame playing.
If you are diagnosed with photosensitive epilepsy, your doctor may prescribe medication and suggest that you:
- avoid exposure to certain kinds of flashing lights; and
- cover one eye and turn away from the direct light source when in the presence of flashing lights.
You may also wish to discuss with your doctor whether the following tips suggested by photosensitivity and epilepsy experts would be helpful to you.
Visual Fire Alarm Strobe Lights
Under the Americans with Disabilities Act, most workplaces and places serving the public, including theaters, restaurants, and recreation areas, are required to have fire alarms, which flash as well as ring so that people who cannot hear or cannot hear well will know that there is an emergency.
To reduce the likelihood of the strobe light triggering a seizure, the Epilepsy Foundation’s professional advisory board recommends that
- the flash rate be kept to under 2 Hertz with breaks every so often between flashes; and
- flashing lights should be placed at a distance from each other and set to flash together at the same time to avoid an increase in the number of individual flashes.
- Watch television in a well-lit room to reduce the contrast between light from the set and light in the room.
- Reduce the brightness of the screen.
- Keep as far back from the screen as possible.
- Use the remote control to change channels on the TV so you won’t have to get too close to the set.
- Avoid watching for long periods of time.
- Wear polarized sunglasses while viewing television to reduce glare.
- Sit at least 2 feet from the screen in a well-lit room.
- Reduce the brightness of the screen.
- Do not let children play videogames if they are tired.
- Take frequent breaks from the games and look away from the screen every once in a while. Do not close and open eyes while looking at the screen – blinking may facilitate seizures in sensitive individuals.
- Cover one eye while playing, alternating which eye is covered at regular intervals.
- Turn the game off if strange or unusual feelings or body jerks develop.
- Use a flicker-free monitor (LCD display or flat screen).
- Use a monitor glare guard.
- Wear non-glare glasses to reduce glare from the screen.
- Take frequent breaks from tasks involving the computer.
Exposure to Strong Environmental Lights
- Cover one eye (either one) with one hand until the stimulus is over. Closing both eyes or turning your eyes in another direction will not help.
University of California Riverside Neuroscientists’ Discovery Could Bring Relief to People with Epilepsy
Maxim Bazhenov and Giri Krishnan used computational model to study epileptic seizures at the molecular level; research could lead to novel therapeutics for seizure disorder.
RIVERSIDE, Calif., 2011-06-28– Researchers at the University of California, Riverside have made a discovery in the lab that could help drug manufacturers develop new antiepileptic drugs and explore novel strategies for treating seizures associated with epilepsy – a disease affecting about 3 million Americans.
Neurons, the basic building blocks of the nervous system, are cells that transmit information by electrical and chemical signaling. During epileptic seizures, which generally last from a few seconds to minutes and terminate spontaneously, the concentrations of ions both inside the neuron and the space outside the neuron change due to abnormal ion flow to and from neurons through ion “channels” – tiny gateways that are embedded to the surface of the neuron.
Ordinarily, intracellular (inside the cell) sodium concentration is low compared to extracellular sodium (the reverse is true of potassium). During seizure, however, there is a buildup of intracellular sodium, with sodium ions moving into neurons from the extracellular space, and potassium ions doing the opposite.
To understand exactly how neurons function during epileptic seizures, Maxim Bazhenov, an associate professor of cell biology and neuroscience, and Giri P. Krishnan, a postdoctoral researcher in his lab, developed and used realistic computer simulations in their analyses and found that while there is a progressive and slow increase in intracellular sodium during seizure, it is this accumulation of intracellular sodium that leads to the termination of the seizure.
“According to our model, sodium concentration reaches a maximum just before the seizure terminates,” Bazhenov said. “After seizure initiation, this intracellular sodium buildup is required to terminate the seizure.”
The researchers’ computational model simulates the cortical network. (The cortex is the outer layer of the cerebrum of the mammalian brain. A sheet of neural tissue, it is often referred to as gray matter.) The model simulates neurons, connections between neurons, variable extracellular and intracellular concentrations for sodium and potassium ions and variable intracellular concentrations for chloride and calcium ions.
Bazhenov explained that conventional antiepileptic drugs are commonly designed to target various sodium channels in order to reduce their activity.
“These drugs essentially slow down the intracellular build-up of sodium, but this only prolongs seizure duration,” he said. “This is because seizure duration is affected by the rate of intracellular sodium accumulation – the slower this rate, the longer the seizure duration.”
According to Bazhenov, targeting the sodium channels is not the best approach for drugs to take. He explained that even for drugs to increase the activity of the sodium channels (in order to reduce seizure duration) there is an undesirable effect: seizures become more likely.
“The drugs ought to be targeting other ion channels, such as those responsible for the buildup of intracellular chloride,” he advises. “According to our model, restricting the chloride increase would lead to a faster termination of seizure and can even make seizures impossible.”
Bazhenov and Krishnan’s model also shows that the occurrence of seizures depends critically on the activity of ionic “pumps” – structures that are also embedded to the surface of neurons. These pumps help remove the sodium and chloride ions from inside the neurons and critically influence their concentrations in the brain.
Study results appear in the June 15 issue of The Journal of Neuroscience.
The research was supported by a grant to Bazhenov from the National Institutes of Health.
Reviewed by Joseph Sirven, M.D., Epilepsy Foundation Professional Advisory Board Chair-Elect
Epilepsy Awareness in the News!
Successful epilepsy surgery took place in New York City last week
Diagnosed at age 6, Daniel Jakubowitz has been under the care of a multidisciplinary team of leading neurologists and staff at the Comprehensive Epilepsy Center at Montefiore Hospital in New York, in partnership with Albert Einstein College of Medicine, for the past 20 years. Daniel also served as a volunteer for the Epilepsy Foundation of Long Island.
After a lifetime of seizures, Daniel underwent surgery 5 months ago to remove the part of the brain that was causing his seizures. The operation was a success and Daniel has been seizure-free ever since. Daniel’s care team includes: Solomon Moshe, M.D., Vice Chair, Department of Neurology, Director of Clinical Neurophysiology and Director of Child Neurology; Sheryl Haut, M.D., a neurologist specializing in adult care; Alexis Boro, M.D., Assistant Professor of Neurology; Alan Legatt, M.D., Ph.D., Director of the EEG Laboratory, Director of the Evoked Potential Laboratory, and Director of Intraoperative Neurophysiology at Montefiore Medical Center; and Patrick Lasala, M.D., who leads in the development of stereotactic neurosurgery.
Connecticut Governor Signs Legislation with Protections for People with Epilepsy
June 28, 2011–The Epilepsy Foundation of Connecticut announced, two weeks ago, that after a 4-year legislative effort, the Patient Prescription Protection Act has finally passed the legislature and was signed into law today by Connecticut Governor Dannell Malloy.
The bill is designed to protect people with epilepsy from having their medication switched without their consent. It requires pharmacists to notify and receive the consent of the patient and their physician before filling a prescription using a new drug manufacturer or distributor of the prescribed drug.
Epilepsy Foundation Executive Vice President Sandy Finucane said, “Informed consent is the critical issue here. People who are going from one epilepsy drug to another need to know in advance and be monitored by a physician during the change. Most do fine, but for some it’s a matter of life and death.”
The Connecticut affiliate expressed gratitude to the many advocates who have worked to support the bill over the past 4 years–writing letters, attending hearings and making phone calls. This session, Representatives Boukus, Ritter and Walker, as well as Senators Harp and Gerratana were strong supporters. In addition, former Senator Handley joined supporters of this legislation at the Public Health Committee hearing.
For the more than 60,000 people in Connecticut with epilepsy who rely on medication for controlling and/or reducing their seizures, this legislation is long overdue. Now people with epilepsy can be assured of a consistent supply of their medication and can live their lives without the fear of unexpected seizures due to a switch in their medication.