Neuro Night Presents "The Adolescent Brain"

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1 Neuro Night Presents "The Adolescent Brain" OPEN TO THE PUBLIC 6 p.m. Tuesday Sept. 18, 2011 Fountains at Canterbury 1404 N.W. 122nd St. Oklahoma City Oklahoma Center for Neuroscience Biomedical Research Center, Room N.E. 10th St. Oklahoma City, OK Phone: (405) Fax: (405) brandt-wiskur@ouhsc.edu The University of Oklahoma is an equal opportunity institution. For accommodations on the basis of disability, please call (405) Panelists Sheila Algan, assistant professor, Department of Orthopedic Surgery and Rehabilitation, OU College of Medicine Peter Johnson, assistant professor, Department of Pediatrics, OU College of Medicine Lee Tran, post-doctoral fellow, Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center Refreshments served at 5:30 p.m. and meeting commences promptly at 6 p.m. Donations are appreciated! Driving Direction From I-235 (Broadway Extension) take the N.E. 122nd St. exit and head west on N.E. 122nd St. The Fountains at Canterbury is between Western and Penn Avenues. Turn left (south) on Reynolds Road into the community. As the road veers to the right, look for the five-story building (Town Center Apartments). Please follow the Special Event signs posted. Neuro Night is held in the Commons Room.

SPORTS TIPS CONCUSSION A concussion is a traumatic injury to the brain that alters mental status or causes other symptoms.

Football players often say I just got my bell rung when a blow to the head causes ringing in the ears, but those symptoms are often consistent with concussion. HOW IS A CONCUSSION DIAGNOSED?

neurological exam Focused orientation exam that tests short-term memory recall such as the event, play, opponent, score or last meal Focused orientation exam that tests long term recall such as name,

2 SPORTS TIPS CONCUSSION A concussion is a traumatic injury to the brain that alters mental status or causes other symptoms. Many people assume they do not have a concussion if they have not lost consciousness. However, significant injury can occur without losing consciousness at all. Football players often say I just got my bell rung when a blow to the head causes ringing in the ears, but those symptoms are often consistent with concussion. HOW IS A CONCUSSION DIAGNOSED? When concussion is suspected, a trained coach, certified athletic trainer, or the team physician should immediately perform an initial sideline evaluation, including: Symptoms list review Focused neurological exam Focused orientation exam that tests short-term memory recall such as the event, play, opponent, score or last meal Focused orientation exam that tests long term recall such as name, birth date, place of birth Assessment of athlete s ability to stay attentive to a complex task such as reciting months backwards If left undiagnosed, a concussion may place an athlete at risk of developing second impact syndrome a potentially fatal injury that occurs when an athlete sustains a second head injury before a previous head injury has completely healed. CONCUSSION STOP S por ts Injurie s Keeping Kids in the Game for Life

3 WHAT ARE THE SIGNS/SYMPTOMS OF A CONCUSSION? Concussion symptoms include the following: Balance problems Difficulty communicating, concentrating Dizziness Drowsiness Fatigue Feeling emotional Feeling mentally foggy Headache Irritability Memory difficulties Nausea Nervousness Numbness or tingling Sadness Sensitivity to light or noise Sleeping more than usual or difficulty falling asleep Visual problems blurry or double vision Vomiting Baseline testing collects data on an athlete s cognitive and physical abilities prior to suffering the concussion. Baseline testing can include a neurocognitive evaluation (usually by computer) that tests multiple areas of brain function, including memory, problem solving, reaction times, and brain processing speeds. Symptom checklists, sideline assessment tools such as the Sideline Concussion Assessment Tool (SCAT), and balance testing are other examples of baseline evaluations that may be helpful. WHEN IS IT SAFE TO RETURN TO PLAY? All athletes who sustain a concussion no matter how minor should undergo an evaluation by a qualified healthcare provider before returning to play. Athletes can return to play after they are completely free of all symptoms of a concussion and remain symptom free during and after physical testing. Unfortunately, it is difficult to determine if the brain has healed from a concussion; even after all symptoms have resolved, healing may not be complete. Neurocognitive testing can be a very helpful tool in determining brain function. With a comparison to a baseline test, this evaluation can be used in conjunction with a physician s examination to reduce future risks. EXPERT CONSULTANTS Jeffrey S. Kutcher, MD Wayne Sebastianelli, MD REFERENCES Centers for Disease Control (CDC), Concussion Management Guidelines, Physician Tool Kit International Conference on Concussion in Sport, Vienna, 2001; Prague, 2004; Zurich, 2008 Sports Tips provide general information only and are not a substitute for your own good judgement or consultation with a physician. To order multiple copies of this fact sheet or learn more about sports injury prevention, please visit Copyright American Orthopaedic Society for Sports Medicine. All rights reserved. SSTO TOP P SSp po or rt ts s I ni nj uj ur ri ei es s Keeping Kids in in the the Game for for Life

4 University of Oklahoma College of Medicine Oklahoma Center for Neuroscience Neuro Night: The Adolescent Brain I. Overview: a. Introduction b. Dextromethorphan c. Bath Salts Peter (Pete) N. Johnson, Pharm.D., BCPS Adjunct Assistant Professor of Pediatrics University of Oklahoma College of Medicine Assistant Professor of Pharmacy Practice University of Oklahoma College of Pharmacy CNS Effects of Toxic Ingestions in Adolescents II. Introduction: a. In 2009 the American Association of Poison Centers, using the Toxic Exposure Surveillance System reported that out of 2,479,355 human exposures that 1,613,272 (65.1%) occurred in patients < 20 years of age. i. Exposures in children < 6 years of age: 1. 99% of exposures are unintentional 2. Usually associated with single ingestions 3. Associated with a low death rate ii. Adolescents: 1. 46% of exposures are intentional 2. Usually associated with mixed ingestions 3. Associated with higher death rate than younger children b. Gender: i. Males: exposures more common in < 13 years of age ii. Females: exposures more common in adolescence and adulthood c. Top ten exposures in adolescents: 1. Pain medications 6. Alcohols 2. Sedative & anti-psychotic medications 7. Bites and envenomations 3. Anti-depressants 8. Pesticides 4. Household cleaning substances 9. Anti-seizure medications 5. Cardiovascular medications 10. Cosmetics/personal care products III. Dextromethorphan: a. General: Cough suppressant b. Street names : dex, DXM, Robo, Skittles, Triple-C, Vitamin D, Tussin, Red Devils c. Available over-the-counter: i. Single ingredient product (e.g., Delsym cough suspension) ii. Combination ingredient product (e.g., NyQuil, Vicks Formula 44, Robitussin DM, Coricidin HBP Cough & Cold) d. Epidemiology: i. Adolescents consider dextromethorphan safe and socially acceptable ii. 300% increase in dextromethorphan abuse in adolescents between iii. Associated with a number of adolescent deaths e. Toxicity: i. Symptoms can be worse in individuals with altered break down of drug (fast/slow) ii. Drug interactions can worsen symptoms iii. CNS symptoms listed in Table 1

5 Table 1: CNS Effects of Dextromethorphan Stage Stage 1 Stage 2 Stage 3 Stage 4 Symptoms Restlessness, generalized euphoria, visual & auditory sensitization Exaggerated auditory & visual sensations, imbalance, hallucinations, increased energy & excitability Impaired cognitive ability, mania, delayed reaction & response time, visual & auditory disturbances Complete disassociation, hallucinations/delusions, ataxia iv. Additional symptoms includes: elevated heart rate, seizures, high blood pressure, & extremely slow breathing rate, death v. Additional ingredients in combination OTC products and long-acting dextromethorphan products increase the risk of toxicity f. Treatment: i. No antidote exists ii. Activated charcoal can decrease adsorption following consumption iii. Treatment is supportive care g. Take-away message: i. Dextromethorphan is readily available ii. A number of CNS and other symptoms are common with large overdoses IV. Bath Salts : a. General: i. Recreational designer drugs with NO legitimate use for bathing and marketed for not for human consumption ii. Contain stimulants such as 3,4-methylenedioxpyrovalerone (MDPV) or mephedrone iii. Product names: Ivory Wave, Vanilla Sky, Snow, Tranquility, Blue Silk, and Hurricane Charlie iv. Available at head shops, convenience stores, gas stations, and the Internet v. Being purchased with intent to be snorted, injected, or smoked vi. Not regulated by the U.S. Drug Enforcement Administration vii. Bill introduced in Oklahoma State Legislature this past term banning bath salts b. Toxicity: i. CNS symptoms listed in Table 2 Table 2: CNS Effects of Bath Salts Panic attacks Anxiety Agitation Hallucinations Thoughts of suicide Sleep problems Depression Aggressive & violent behavior ii. Additional symptoms include: elevated heart rate, seizures, high blood pressure, heart rhythm problems, extremely slow breathing rate, chest pain, and death c. Treatment: i. No antidote exists ii. Treatment is supportive care iii. Anti-seizure and anti-psychotic medications may be needed to stop symptoms d. Take-away message: i. Bath salts are fake designer drug products ii. Symptoms are severe and deadly Poison Control Number ( )

What s different about the teen brain? Adolescent behavior can be partially explained by the development of the brain.

6 Epigenetic Programming of the Brain During Adolescence: A Period of Critical Brain Development Lee Tran, Ph.D. What is adolescence? Adolescence is a transitional time period characterized by impulsive, emotional, risktaking behaviors. Hallmarks of adolescence also include physical changes in addition to mental changes. What s different about the teen brain? Adolescent behavior can be partially explained by the development of the brain. Whereas the prefrontal cortex grows at a linear rate, the limbic regions grow exponentially, dominating behaviors. Why is this period important? Numerous affective disorders including anxiety, depression, schitzophrenia, bipolar disorder, etc. develop during adolescence, warranting studies of this developmental period. How does the brain process affect? Emotions are processed in the limbic region, which is also responsible for coordinating primitive behaviors associated with adaptation. Because of this, regions including the amygdala are very plastic. Why is adolescence a critical time in development? Factors that affect development can program sustained anomalies. For example stress during this time period in an animal model has been shown to program dysfunctional emotional stress responses in adulthood. How do you program the adolescent brain? Our lab studies mechanisms that alter persistent changes in gene expression called epigenetics. Epigenetic mechanisms include histone modifications and DNA methylations. It also includes microrna s, which will not be discussed.

How does epigenetics work? The chromosome contains our genetic information - a blueprint. It consists of DNA wrapped around proteins called histones.

The accessibility of the DNA for this process can be chemically modified. Methylation of DNA tightens to chromosome, preventing access to the DNA.

7 How does epigenetics work? The chromosome contains our genetic information - a blueprint. It consists of DNA wrapped around proteins called histones. A set of proteins including transcription factors and RNA polymerase access the DNA to produce mrna, which can then be used to produce proteins and enzymes. The accessibility of the DNA for this process can be chemically modified. Methylation of DNA tightens to chromosome, preventing access to the DNA. Acetylation of the histones loosens the DNA to make it more accessible. These chemical changes are long-lasting and can even be passed on from generation to generation. What is the current research? Our lab has shown that stress can produce changes in methylation and acetylation in the amygdala that leads to chronic anxiety-like behavior and irritable bowel syndrome (IBS)-like symptomology in animal models. What are the implications? It is important to be cautious of what adolescents are exposed to. Factors that have been shown to affect epigenetics include: smoking, alcohol, drugs, stress, nurturing, pollution, and diet. The environment that an adolescent is exposed to can program permanent changes in behavior, which can lead to disorders. For more information: Adolescent brain development Mental disorders Epigenetics Oklahoma Center for Neuroscience

8 Neuro Night Presents "The Injured Brain" OPEN TO THE PUBLIC Nov. 15, p.m. Tuesday Fountains at Canterbury 1404 N.W. 122nd St. Oklahoma City Oklahoma Center for Neuroscience Refreshments served at 5:30 p.m. and meeting commences promptly at 6 p.m. Donations are appreciated! Biomedical Research Center, Room NE 10th St. Oklahoma City, OK Phone: (405) Fax: (405) brandt-wiskur@ouhsc.edu The University of Oklahoma is an equal opportunity institution. For accommodations on the basis of disability, please call (405) Driving Directions From I-235 (Broadway Extension) take the N.E. 122nd St. exit and head west on N.E. 122nd St. The Fountains at Canterbury is between Western and Penn Avenues. Turn left (south) on Reynolds Road into the community. As the road veers to the right, look for the five-story building (Town Center Apartments). Please follow the Special Event signs posted. Neuro Night is held in the Commons Room.

10/18/2011 Fountains at Canterbury Event Evaluation Sheet "The Adolescent Brain" Directions: On a Scale of 1-5, please rate the questions listed below (1 = poor, 2 = needs improvement, 3 = undecided,

9 10/18/2011 Fountains at Canterbury Event Evaluation Sheet "The Adolescent Brain" Directions: On a Scale of 1-5, please rate the questions listed below (1 = poor, 2 = needs improvement, 3 = undecided, 4=good, 5 = excellent). 1 The event met my expectations The content was relevant to the topic The material presented was well organized There was enough time for questions and answers The handouts and/or power point presentations were helpful This event has expanded my knowledge regarding the topic I learned more about OUHSC scientific & clinical research The event facility was satisfactory Please Rate the Speakers 9 Sheila Algan, M.D Pete Johnson, M.D Lee Tran, Ph.D Open-Ended Statements: Please use the following space and the back of the evaluation form to provide event feedback. The Oklahoma Center for Neuroscience appreciates your feedback, and we look forward to your attendance at future events. If you have not done so already, please provide your name and address in the space provided so that we can send you future event information. For additional copies of event material, please visit our website at To sponsor an OCNS event or OCNS graduate student, please contact Dr. Brandt Wiskur at Brandt- Wiskur@ouhsc.edu or call Name:

CONCUSSION IN SPORTS. Corona del Sol High School Athletics

CONCUSSION IN SPORTS. Corona del Sol High School Athletics CONCUSSION IN SPORTS Corona del Sol High School Athletics WHAT IS A CONCUSSION? A concussion is a brain injury All concussions are serious Can occur in any sport Can occur without loss of consciousness