Non-Motor Symptoms Different Among Men and Women, Study Shows

MAY 25, 2018  BY JOSE MARQUES LOPES, PHD 

Non-motor symptoms (NMS) in Parkinson’s disease are significantly more frequent and differ between men and women, a new study shows.

The study, “Frequency of non-motor symptoms in Parkinson’s disease presenting to tertiary care centre in Pakistan: an observational, cross-sectional study,” was published in the journal BMJ Open.

Parkinson’s NMS include anxiety, depression, dementia, psychosis, sleep impairment, pain, fatigue, constipation, and sexual dysfunction.

Although NMS are common and most of them treatable, some, such as bowel incontinence or sexual dysfunction, may be under-reported due to embarrassment or lack of awareness that they may be associated with Parkinson’s. Prior research in the U.S. has indicated that phsysicians failed to recognize anxiety, depression and fatigue in more than half of encounters with patients.

To determine the frequency of non-motor symptoms in Parkinson’s patients, researchers used the 30-item NMS questionnaire, which is intended to empower patients and caregivers to report relevant NMS not otherwise discussed in routine clinical visits.

This questionnaire has been independently validated and is recommended by the U.K.’s Department of Health for use in clinical practice.

The study included 85 adult Parkinson’s patients who came to a movement disorder clinic at a tertiary care center in Lahore, Pakistan. The team evaluated NMS’ pattern and analyzed potential differences between men and women.

Results revealed a mean of nearly seven different NMS per patient. Constipation (56%) and nocturia (frequent urination at night, 49%) were the most common NMS, while 35% of patients reported urinary urgency.

As for neuropsychiatric complications, 47% of patients reported low mood and sadness, while 36% reported anxiety/panic, and 45% short-term memory impairment.

Light-headedness and dizziness were reported by 40%, sexual dysfuntion by 30%, difficulty falling asleep by 29%, pain unrelated to the musculoskeletal system by 30%, and loss or change in the ability to taste or smell by 29%. All other NMS, including daytime sleepiness, were under 25% in frequency.

Regarding sex differences, feeling sad or blue, light-headededness and dizziness, unexplained pain, unpleasant sensations in the legs while at rest, difficulty in swallowing, and faecal incontinence were the most frequently reported NMS in women; men reported constipation, nocturia, and problems with memory more often.

Male patients reported sexual dysfunction more frequently than women, which the authors attribute to women in Pakistan being uncomfortable with discussing intimate issues.

Among the study’s limitations, the scientists mentioned the low number of women (15), which they hypothesize may be due to men seeking medical care more often.

“In this study we have shown the high frequency of NMS in patients with [Parkinson’s] in Pakistan … Certain NMS are more common in women as compared with men,” researchers wrote, adding that the findings warrant large-scale study to assess the sex-specific incidence of NMS in Parkinson’s patients.

https://parkinsonsnewstoday.com/2018/05/25/parkinsons-non-motor-symptoms-differ-men-women-study-shows/

Obesity, Sedentary Behavior Not Linked to Parkinson’s Disease Risk, Study Shows

MAY 25, 2018   BY ALICE MELÃO 

Increased body mass and sedentary behavior do not increase the risk of having Parkinson’s disease, a study shows.

To date it is still not fully understood what causes Parkinson’s disease, but several environmental and lifestyle factors have been suggested as contributors to this disease.

In the study, “Body mass index, sitting time, and risk of Parkinson disease,” which was published in the journal Neurology, researchers from the Karolinska Institutet in Sweden focused on the potential of body mass index (BMI) — a measure indicative of obesity — and sitting time to contribute for Parkinson’s disease development and progression.

The team already had reported that more physical activity around the house and commuting lowered Parkinson’s risk. “Regardless of time spent on physical activity, sedentary behavior characterized by sitting extended periods of time has been associated with increased general morbidity and mortality,” the researchers wrote. “Thus, sedentary behavior may affect PD pathogenesis through mechanisms other than physical activity.”

Clinical records of 41,638 individuals who completed a comprehensive questionnaire with extensive assessment of lifestyle factors at a national fund-raising event in September 1997 (The Swedish National March Cohort) were analyzed.

During the study period (13 years) 286 participants were diagnosed with Parkinson’s disease.

Participants who spent six or more hours seated per day had a 6 percent higher risk. Also, those with body max index of 30 or higher had a 13 percent increased risk compared to leaner patients. These results were not found to be influenced by age, sex, or smoking status.

Although some differences were found, these data do not show a significant correlation between baseline body mass and sitting time with the risk of developing Parkinson’s, which is in accordance with previous studies.

However, researchers highlighted that all the analysis was based in data collected at the beginning of the study, and some measures could have changed during follow-up. “If such changes are related to the outcome, this could lead to misclassification and an over- or underestimation of any true association,” they wrote.

Still, it is widely accepted that the underlying mechanisms of Parkinson’s start many years before symptom onset. So, any factor that might contribute to development of this disease may occur in an “exposure window of interest closer to the baseline exposure assessment,” they said.

“Future studies should focus on environmental factors other than obesity and sedentary time in efforts to disentangle the complex causation of Parkinson’s disease,” the authors suggested.

https://parkinsonsnewstoday.com/2018/05/25/obesity-sedentary-behavior-not-linked-parkinsons-disease-risk/

Stem cell therapy in Parkinson’s disease: Promising treatment or Hoax? By Dr. De León

May 25, 2018

Dr. DeLeon

Given the fact that living with a chronic neurological disease like Parkinson’s for which there is no cure can make any of us in a moment of desperation turn to any form of treatments and therapies which promise a cure. I have recently noted an increase of talk about this subject on social media in our PD community. Unfortunately, many good people have been bamboozled into believing the hype on social media about stem cell therapy as a cure all! The people offering stem cell therapy as a cure have prayed upon the fears, and suffering of many in our community. However, it is important for me to outline the facts and discard the myths surrounding these so called new therapies that promise so much.

Let’s first look at what are stem cells and why are we so interested in stem cells as a possible treatment for Parkinson’s disease. 

• They can continue to divide for a long time

• Unspecialized

• Can give rise to specialized cells

Back in the 1980’s, there were trials in which fetal dopaminergic neurons were transplanted into the brain of some patients some of who had long lasting effects. It was then proposed that in vitro dopamine cells derived from cells derived from embryonic cells and bone marrow could be harvested to produce same effect. However, as of today, there has been no evidence that in vitro cells injected/transplanted in to animals with experimental PD can then re-innervate the striatum with dopamine neurons in vivo and give rise to a considerable improvement and recovery from deficits resembling human Parkinson’s symptoms.

Furthermore, in order for the recovery to be effective one must have a large quantities of dopamine neurons which has not been feasible due to extremely short survival after transplantation.

Since, there is still so much we don’t know about this extremely complex disease, finding ways to modify it has proven to be a daunting task. Nevertheless, back at the beginning of this decade there was a small study with stem cells which showed some modicum of promise. This study used adult stem cells (these can be obtain from same person -autologous or another individual-allogenic). Both have their advantages and disadvantages.

Types of cells

• Embryonic- An embryonic stem cell is one that can differentiate into any cell type of the body this is known as pluripotent these then give rise to multipotent stem cells which can the. Differentiate into specialized terminal cells e.g. nervous system giving rise to different type of neurons

• Adult …they do not regenerate as well and if place in different environment these may or may not develop that areas specialized cells which means these cells have to be placed in basal ganglia to even have a chance …

• Umbilical

• Hematopoietic

Studies involving stem cells have included embryonic cells and placed into brain via olfactory nerve tract

The main problem is that most of the people claiming to have the “cure” using stem cells are using adult stem cells from the skin which remain as skin cells especially since they are given back as an intramuscular injection. Many times these develop into scar tissue or lipomas (fat tumors)causing other problems. It is also important to note that when receiving cells from another individual these must be matched for ABO blood type, Rho factors as well as gender. If implanted outside of the nervous system having a mismatch can result in antibody production as well as decrease in longevity of cells. However, if implanted in the nervous system because of blood brain barrier this is not an issue necessarily. However, the effects of this is not known as of yet because the nervous system also possess cells like macrophages and glia which are the brains immune system which can potentially attack these new cells.

In the study, I mention previously autologous totipotent stem cells were used.

These cells are capable of differentiating into any cell and give rise to an entire human organism. The cells were uncommitted to a particular cell type when used therefore potentially much more likely to develop neurons if placed in nervous system. The reason autologous cells are preferred as I mentioned before we would eliminate the need for autoimmune suppressants necessary in all transplantations when foreign cells used.

Remember not all stem cells are alike…although stem cell research is actively evolving and is currently a very dynamic field. Scientists have discovered that hematopoietic cells can be harnessed to develop into nerve cells. These types of cells have already been used to treat other medical problems. However, cells have to be extracted from bone marrow (-autologous). Plus it need the right location …into the striatum of the brain. Placing outside of basal ganglia will NOt produce the appropriate dopamine producing neurons even if placed in the brain much less if placed outside of the central nervous system. Things like temporal lobe epilepsy could potentially result if cells are placed at random in the brain causing migration to other parts of the brain.

In conclusion, what we want is autologous adult totipotent stem cells not embryonic or fetal to be placed inside the brain cavity meeting all these requirements makes for a higher likelihood of success although yet to be proven. Unless, you are participating in a trial meeting these parameters then you are allowing yourself to be part of sham therapies which on top of being extremely expensive could be deleterious to your own health. Fortunately, because of so many scammers, the FDA recently announced back in march of this year that the “wild west of stem cell therapies” is coming to an end with the introduction of a new frame work and guidelines due to the national and international pandemic of providing treatment which are not only ineffective and costly but also proven harmful. I for one could not be happier about this! People need to be held accountable for their careless actions.

As an aside: An autologous bone marrow adult totipotent stem cell study is currently taking place at UT Houston under Dr. Mya Schiess- The coordinator number to get more information can be reached at 18326329 to see if you qualify.

Copyright@2018

All rights reserved by Maria De Leon

Sources:

Lindvall O., Kokaia Z. Stem cells for the treatment of neurological disorder. Nature June 29, 2006 Vol. 441

https://www.omicsonline.org/open-access/treating-parkinson-disease-with-adult-stem-cells-2329-6895.1000121.pdf

Is the wild west of stem cell therapies coming to an end? American council on science and health http://acsh.org/news/2017/11/17/

https://defeatparkinsons.com/2018/05/26/stem-cell-therapy-in-parkinsons-disease-promising-treatment-or-hoax-by-dr-de-leon/

Doctors fail to flag concussion patients for critical follow-up

May 25, 2018, University of California, San Francisco

As evidence builds of more long-term effects linked to concussion, a nationwide study led by scientists at UCSF and the University of Southern California has found that more than half of the patients seen at top-level trauma centers may fall off the radar shortly after diagnosis, placing in jeopardy treatments for these long-term effects.

Among 831 patients treated in hospital emergency departments for concussion, or mild traumatic brain injury (TBI), only 44 percent saw a physician or other medical provider within three months, the scientists report. The study appears in JAMA Network Open on May 25, 2018.

Concussion and other more serious forms of traumatic brain injury affect between 3.2 million and 5.3 million Americans, according to the Centers for Disease Control and Prevention. An expanding volume of research has found that traumatic brain injuries are associated with an elevated risk for neurodegenerative and psychiatric disorders. Research includes two UCSF studies published earlier this month that found a link between concussion and Parkinson's disease, and concussion and dementia.

"The focus of concussion has been directed at a very narrow segment of the population—football players and professional athletes," said the study's co-author Geoffrey Manley, MD, Ph.D., a professor of neurosurgery in the UCSF Department of Neurological Surgery and member of the UCSF Weill Institute for Neurosciences. "Everyone who falls off their bike or slips off their skateboard or down the steps needs to be aware of the potential risks of concussion."

Concussion Treated as Minor Injury for 'Too Many Patients' 

"This is a public health crisis that is being overlooked," said Manley, who is the principal investigator of TRACK-TBI, which has collected and analyzed clinical data on close to 3,000 traumatic brain injury patients from 18 top-level trauma centers nationwide, and was used in this study. "If physicians did not follow up on patients in the emergency department with diabetes and heart disease, there would be accusations of malpractice. For too many patients, concussion is being treated as a minor injury."

The researchers found that of those patients who saw a provider within three months, 15 percent visited a clinic that specialized in concussion or traumatic brain injuries, while approximately half saw a general practitioner, who may or may not have training in managing this condition. More worrisome was the finding that even among those concussion patients with more serious signs and symptoms, many had no further care after hospital discharge. Of the 236 patients whose CT scans indicated a lesion, and 279 patients with three or more moderate-to-severe post-concussive symptoms, 40 and 41 percent, respectively, did not see a physician or health provider within three months after discharge.

Additionally, approximately half of the patients were discharged without a handout explaining symptoms and red flags requiring follow-up.

"The lack of follow-up is concerning because these patients can receive adverse and debilitating symptoms for a very long time," said lead author Seth Seabury, Ph.D., director of the Keck-Schaeffer Initiative for Population Health Policy at the University of Southern California. "Even patients who reported experiencing significant post-concussive symptoms often failed to see a provider. This reflects a lack of awareness among patients and providers that their symptoms may be connected to brain injury."

TBIs Endemic Among Homeless, Prison Populations

Undiagnosed and untreated traumatic brain injuries are endemic in the homeless and incarcerated populations, said Manley, who is also chief of neurosurgery at the Zuckerberg San Francisco General Hospital and Trauma Center.

"We have all these people untreated and no real system of care," he said. "Even in the best trauma centers in the country, patients with concussion are not getting the follow-up care they desperately need."

Among the patients in the study, who had been recruited from 11 trauma centers throughout the country, 58 percent were white, 65 percent were male and their average age was 40. Approximately one-third suffered moderate-to-severe post-concussive symptoms. In total, 59 percent of the concussions resulted from a road traffic incident; versus 24 percent from falls and 6 percent from assaults.

More information: Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion: Results from the TRACK-TBI study, JAMA Network Open, jamanetwork.com/journals/jaman … etworkopen.2018.0201 

Provided by: University of California, San Francisco

https://medicalxpress.com/news/2018-05-doctors-flag-concussion-patients-critical.html

Identifying Crohn's disease risk factors in the Ashkenazi Jewish population

May 25, 2018 by Namrata Sengupta, Broad Institute of MIT and Harvard

It is estimated that one in three individuals of Ashkenazi Jewish (AJ) descent carry mutations that increase their risk for certain genetic diseases. For instance, Crohn's, a highly heritable inflammatory bowel disease, is two to four times more prevalent among people of AJ ancestry, compared to those of non-Jewish European ancestry.

n a study published today in PLoS Genetics, an international team of researchers describes Crohn's disease-related genetic risk factors that appear up to four-fold times more frequently in the AJ population, compared to other populations.

Analysing 5,685 exomes (protein-coding regions of the genome) from individuals of AJ descent, the researchers provide a detailed list of genetic variants that increase the risks of Crohn's, as well as certain rare diseases like Gaucher, Canavan, and Tay Sachs. While Crohn's is an inflammatory disease of the digestive tract, Gaucher is a metabolic disease, and Canavan and Tay Sachs are both neurodegenerative diseases.

"We wanted to make this information immediately available to the community. This will benefit other researchers who are studying these diseases and can help clinical practitioners with screening efforts," said lead author Manuel Rivas, assistant professor in the Department of Biomedical Data Science at Stanford University and visiting scientist at the Broad Institute of MIT and Harvard.

The researchers found ten Crohn's-associated mutations in the genes NOD2 and LRRK2, all of which occurred more frequently in the AJ population. NOD2 is an immune-system function gene, while LRRK2, which is active in the brain, is associated with Parkinson's disease.

They also noted eight-, 12-, and 27-fold increases, respectively, in the frequency of risk-related variants in the genes associated with Gaucher (GBA), Canavan (ASPA), and Tay Sachs (HEXA) among members of the AJ population. All three genes are associated with the brain and with other neurodegenerative diseases.

"This study was a global collaborative effort that will help us understand and hopefully improve how we treat Crohn's—but also quantifies the underlying increased risk for diseases such as Gaucher, Canavan, and Tay Sachs," said co-senior author Mark Daly, institute member and co-director of the Program in Medical and Population Genetics at the Broad, chief of Analytical and Translational Genetics Unit at Massachusetts General Hospital, and associate professor of medicine at Harvard Medical School. "It particularly highlights the value of using exome sequencing data across large population samples to determine risk factors."

More information: Manuel A. Rivas et al. Insights into the genetic epidemiology of Crohn's and rare diseases in the Ashkenazi Jewish population, PLOS Genetics (2018). DOI: 10.1371/journal.pgen.1007329 

Journal reference: PLoS Genetic

Provided by: Broad Institute of MIT and Harvard

https://medicalxpress.com/news/2018-05-crohn-disease-factors-ashkenazi-jewish.html

New computational tool could help optimize treatment of Alzheimer's disease

May 24, 2018

Reversion of pathological electroencephalographic activity in Alzheimer's disease with minimal energy deposition over the tissue can be achieved through delivering a computationally tuned brain stimulation that considers individual neuroimaging data. Credit: Lazaro Sanchez-Rodriguez, partially using BrainNet Viewer

Scientists have developed a novel computational approach that incorporates individual patients' brain activity to calculate optimal, personalized brain stimulation treatment for Alzheimer's disease. Lazaro Sanchez-Rodriguez of the University of Calgary, Canada, and colleagues present their new framework in PLOS Computational Biology.

Electrical stimulation of certain parts of the brain could help promote healthy activity in neural circuits impaired by Alzheimer's disease, a neurodegenerative condition. This experimental treatment has shown some promise in clinical trials. However, all patients currently receive identical treatment protocols, potentially leading to different outcomes according to individual variations in brain signaling.

To investigate the possibility of personalized brain stimulation, Sanchez-Rodriguez and colleagues took a theoretical approach. They built a computational tool that incorporates patients' MRI scans and physiological brain signaling measurements to calculate optimal brain stimulation signals, with the goal of delivering efficient, effective personalized treatment.

The new approach is based on a computational strategy known as the state-dependent Riccati equation control (SDRE), which has been applied in other fields—such as aerospace engineering—to optimize input signals that control dynamic, nonlinear systems like the human brain. This strategy enabled the new tool to identify specific brain regions that would not benefit from brain stimulation.

The researchers also used their new framework to show that certain parts of the brain, the limbic system and basal ganglia structures, could serve as particularly powerful targets for brain stimulation in Alzheimer's disease. Moreover, they found that patients whose neural structures are highly integrated in the brain network may be the most suitable candidates for stimulation.

"With our new framework, we are getting closer to erasing the knowledge gap between theory and application in brain stimulation," Sanchez-Rodriguez says. "I think we will soon see a boom in the application of our framework and similar tools to study other diseases involving impaired brain activity, such as epilepsy and Parkinson's."

Next, the researchers plan to refine their tool so that it accounts for additional variation in brain activity between patients. The approach will need to be tested in animals before it enters clinical trials.

More information: Sanchez-Rodriguez LM, Iturria-Medina Y, Baines EA, Mallo SC, Dousty M, Sotero RC, et al. (2018) Design of optimal nonlinear network controllers for Alzheimer's disease. PLoS Comput Biol 14(5): e1006136. doi.org/10.1371/journal.pcbi.1006136 

Journal reference: PLoS Computational Biology

Provided by: Public Library of Science

https://medicalxpress.com/news/2018-05-tool-optimize-treatment-alzheimer-disease.html

Early hearing loss could pave the way for dementia,' study says

May 24, 2018 

The majority of us will think nothing of listening to loud music via headphones, or standing in the front row, next to the speakers, at a rock concert. But these habits may lead to subtle hearing loss, which, research now shows, may affect the brain in undesirable ways.

Beware of minor hearing problems early in life; they may lead to cognitive impairment as you grow older.

Every day of our lives, we face being exposed to loud noises — particularly those of us who live in busy cities.

These are not normally loud enough to harm our hearing. But if we are consistently exposed to sounds that break a certain noise threshold, it may, in time, cause some amount of hearing loss.

The unit used to measured sound intensity is decibels, and the Centers for Disease Control and Prevention (CDC) offer examples of which types of sounds are harmless and which may endanger hearing, based on decibel level.

Normal conversation or soft background noises — such as the humming of an air conditioning unit — amount to about 60 decibels. Louder noises that you may find annoying — such as the sound of the washing machine running — amount to 70 decibels. The noise of city traffic could rise to about 80–85 decibels.

Exposure to noises above 85 decibels (but under 120 decibels) over a long period of time can harm the hearing. Such noises could be music listened to at maximum volume using headphones, sitting close to the speakers at a music concert or at the movies, and working with power tools.

The unit used to measured sound intensity is decibels, and the Centers for Disease Control and Prevention (CDC) offer examples of which types of sounds are harmless and which may endanger hearing, based on decibel level.

Normal conversation or soft background noises — such as the humming of an air conditioning unit — amount to about 60 decibels. Louder noises that you may find annoying — such as the sound of the washing machine running — amount to 70 decibels. The noise of city traffic could rise to about 80–85 decibels.

Exposure to noises above 85 decibels (but under 120 decibels) over a long period of time can harm the hearing. Such noises could be music listened to at maximum volume using headphones, sitting close to the speakers at a music concert or at the movies, and working with power tools.

Extremely loud noises over 120 decibels can cause immediate hearing loss.

Recently, researchers from Ohio State University in Columbus have found that young adults with minor hearing loss display changes in brain activity that are normally only seen in old age.

"Hearing loss, even minor deficits, can take a toll in young people — they're using cognitive resources that could be preserved until much later in life," notes lead researcher Yune Lee.

“Most concerning, this early hearing loss could pave the way for dementia."

Yune Lee  

The team's findings were recently published in the journal eNeuro.

Brain activity characteristic of aging

Initially, Lee and his colleagues had set out to complete different kind of project. They recruited 35 participants aged between 18 and 41 who agreed to undergo functional MRI scans while listening to sentences of varying complexities.

The researchers were interested in monitoring and comparing brain activity when a listener had to process messages with a simple structure versus more complicated sentences that likely involved a different kind of cognitive effort.

Yet their study took a different turn as they noted something surprising about some of their young adult participants.

Yet after conducting the fMRI scans, they noticed that the participants with subtle hearing problems actually processed the messages they heard differently from their peers. And not just that, but their brain activity in this context was similar to that of aging listeners.

Specifically, healthy young adults with no hearing problems only use the left hemisphere of the brain to process heard information. But the participants with minor hearing impairments actually showed activity in both the left and the right hemispheres of their brains.

In the case of the latter, the right frontal cortex became active — something normally seen only in older people.

"This isn't about the ear — it's about the brain, the cognitive process, and it shouldn't be happening until people are at least older than 50," Lee explains.

Twice as likely to have dementia'

The study authors explain that, normally, healthy young adults only use the left brain hemisphere when engaged in language comprehension tasks. As people age, however, they start to engage the right frontal part of the brain too, as they put more effort into processing spoken language.

"But in our study," says Lee, "young people with mild hearing decline were already experiencing this phenomenon."

"Their brains already know that the perception of sound is not what it used to be and the right side starts compensating for the left," he adds.

It is hard to say how this might impact these individuals later in life, but Lee and team worry that the hearing issues may only worsen, affecting comprehension. And, this can hasten the development of neurodegenerative conditions such as dementia.

"Previous research," says Lee, "shows that people with mild hearing loss are twice as likely to have dementia. And those with moderate to severe hearing loss have three to five times the risk."

"We can't be sure," he continues, "but we suspect that what happens is you put so much effort into listening you drain your cognitive resources, and that has a negative effect on your thinking and memory and that can eventually lead to dementia."

For these reasons, Lee advises young adults to look after their hearing more carefully and avoid exposing themselves to situations that are likely to have undesired consequences.

"Letting [hearing loss] happen early in your life," Lee cautions, "could be like spending your retirement money when you're in your 30s. You're going to need that down the road."

https://www.medicalnewstoday.com/articles/321905.php?utm_source=newsletter&utm_medium=email&utm_country=US&utm_hcp=no&utm_campaign=MNT%20Daily%20Full%20%28non-HCP%20US%29%20-%20OLD%20STYLE%202018-05-24&utm_term=MNT%20Daily%20News%20%28non-HCP%20US%29

Feds Eye New Rules On Flying With Service Animals

 by Shaun Heasley | May 22, 2018

The U.S. Department of Transportation is soliciting public comment as it considers changes to regulations governing service animals on airplanes. (Josie Lepe/Bay Area News Group/TNS)

Citing “significant concerns” from people with disabilities and others, federal airline regulators are weighing big changes to rules for service animals in flight.

The U.S. Department of Transportation said this month that it wants feedback from the public on possible alterations to service animal regulations under the Air Carrier Access Act.

Specifically, transportation officials want to know if emotional support animals, psychiatric service animals and other types of service animals should be treated differently from each other and if there should be limits on the species, size or number of service animals that can fly with a person. In addition, the Transportation Department notice asks if owners should be required to confirm that their service animal is trained and questions if leashes or harnesses should be mandated.

The request for public comment comes after several major air carriers moved in recent months to issue new policies on service and emotional support animals following a significant uptick in passengers bringing such animals aboard. Delta Air Lines, United Airlines and American Airlines have all announced policies since the start of the year that they say are designed to curtail problems with biting, urination and other misbehavior.

“The department recognizes the integral role that service animals play in the lives of many individuals with disabilities and wants to ensure seamless access to air transportation for individuals with disabilities while also helping to deter the fraudulent use of animals not qualified as service animals,” the Transportation Department said in announcing its effort to seek public feedback.

Previously, a Transportation Department advisory committee tasked with addressing accessibility was unable to reach a consensus on how to tackle the issues surrounding service animals on airliners.

In addition to soliciting comment, transportation officials also issued an “interim statement of enforcement priorities” this month related to service animals outlining the agency’s current procedures.

The Advance Notice of Proposed Rulemaking on Traveling By Air with Service Animals is up for public comment for 45 days.

To Comment:  https://www.regulations.gov/docket?D=DOT-OST-2018-0068

https://www.disabilityscoop.com/2018/05/22/feds-eye-flying-service-animals/25113/

What is formication?

 23 May 2018   By Jamie Crawford

Formication is the sensation of having insects crawling on or under the skin. The name comes from the Latin word "formica," which means ant.

Formication is a tactile hallucination, which means a person feels a physical sensation, but there is no physical cause. The sensation can lead to itching, which may be worse at night and can be severe enough to impact on a person's quality of life.

Feeling sensations on the skin with no physical stimulation is a type of paresthesia, which may also include burning, tingling, numbness, and cold.

Formication is linked to several other medical conditions, as well as withdrawal from some drugs and substances.

Causes of formication

Several conditions can cause formication. They include:

• Parkinson's disease
• shingles
• fibromyalgia
• anxiety
• perimenopause
• Lyme disease
• diabetic neuropathy
• skin cancer
• schizophrenia

It is possible that lower estrogen levels during perimenopause and menopause may also cause formication.

Formication can sometimes occur when a person is going through withdrawal from drugs, especially from opiates. The list below includes some of the drugs that can cause formication during withdrawal.

• Ritalin
• Wellbutrin
• Lunesta
• opioid pain medications, such as codeine or morphine
• some antidepressants, such as SSRIs
• Tramadol
• cocaine
• heroin
• methamphetamine
• MDMA

Formication linked to drug withdrawal is usually temporary and should resolve when a person recovers from withdrawal.

If the sensation continues or is very intense, it could be due to drug psychosis. This may cause a person to believe that they have an actual infestation of bugs in their skin.

Alcohol withdrawal can also cause formication. People may experience visual hallucinations too, as well as other symptoms. It is, therefore, best to have a doctor or other professional oversee alcohol withdrawal, as symptoms may be severe.

Diagnosis

It is essential to give the doctor full and honest answers at the appointment so that they can provide an accurate diagnosis. They may want to know:

• any other symptoms that are present in addition to formication
• at what time of day the crawling sensations occur
• what was happening when the sensations first started
• any medication being taken
• whether a person has used any recreational drugs
• if a person drinks alcohol

A doctor might also want to rule out scabies. Scabies is an infection of tiny mites that burrow in the skin. They cause extreme itching and leave a rash.

Treatment

Treatment for formication will depend on the underlying cause. A topical cream, such as hydrocortisone, might lessen the itching for some people. Moisturizers or barrier creams may also help by keeping the skin healthy and hydrated.

It could also be worth placing an ice pack on the affected areas, which can provide a soothing effect for immediate relief.

If the cause of the formication is Parkinson's disease, shingles, or fibromyalgia, a doctor will prescribe appropriate medication and may create a long-term treatment plan.

If medication is the cause, a doctor can usually recommend alternatives. Sometimes, an antihistamine, such as Zyrtec or Benadryl, can help reduce the sensations of formication.

Some antihistamines can make people drowsy, so it is important to read the labels and ask a pharmacist questions about the side effects before using them.

If formication is linked to recreational drug use, quitting and finding professional support for withdrawal can resolve symptoms.

Possible complications

If a person is experiencing formication, they may be prone to constant scratching. This can break the skin, which can allow bacteria to enter and possibly cause infections to develop.

Formication can cause poor quality sleep and tiredness.

Potential complications of scratching include:

• gangrene
• discharge
• lockjaw (tetanus)
• fever
• blood loss
• in severe cases, sepsis

Other complications of formication include:

• tiredness
• frustration
• poor sleep quality
• depression
• anxiety
• problems concentrating
• aching or feeling stiff

It is important to seek medical advice for any and all complications. Feeling tired or depressed can make formication worse.

Outlook

Formication is a symptom of an underlying condition, so fully treating this condition should typically get rid of the symptoms. The condition may be physical, psychological, or related to substance misuse.

If the cause is not apparent, screening out possible conditions could detect something previously undiagnosed.

Speaking openly and honestly with a doctor will allow them to develop a personalized treatment plan to improve the condition as soon as possible.

https://www.medicalnewstoday.com/articles/321896.php