Houston Area Pediatric Specialists

Independent pediatric specialists aim to serve our community. We want to share news and analysis regarding our specialties and our practices.

Tuesday, November 2, 2010

Alphabet soup of the medical world

Board Certified

Medical Doctor

Doctor of Osteopathy



November is Epilepsy Awareness Month - Get the Seizure Facts

Get the facts about seizures and epilepsy!!

Here is a great one page resource on the facts about seizures. JR

Seizure First Aid Do you know what to do?

From Dr. Rotenberg, Child & Adolescent Neurologist
Board Certified Epileptologist
Member American Epilepsy Society 
www.txmss.com - 714-464-4107

Do you know what to do?
Find out How Seizure Smart You Are and Take the Quiz!
This November, for National Epilepsy Awareness Month, the Epilepsy Foundation is asking everyone to Get Seizure Smart about seizure first aid, recognition and types. Epilepsy affects people of all ages and races, and represents one percent of the population in this country—nearly 3 million people.
Review Seizure First Aid (convulsive, generalized tonic-clonic)

Thursday, October 14, 2010

Great Site for the Autism Industry Skeptic

I am reposting this one since it contains a link for labs performing tests with "NON- STANDARD" techniques

What does this mean? Diagnostic tests are performed using validated and standardized techniques. As a result, you get similar results in different labs.

Would you build a bridge with non-standard techniques? Would you fly in plane fixed with non-standard techinique?

Why would you treat a child based on such methods?

Great Site for the Autism Skeptic - This is a great one stop shop for rational inquiry.



---“A Wake-Up Call” for Parents and Pediatricians--

In what is believed to be the first study showing neural changes in the brains of children with serious, untreated sleep apnea, Johns Hopkins researchers conclude that children with the disorder appear to suffer damage in two brain structures tied to learning ability.

Writing in the Aug. 22 issue of the global online journal Public Library of Science Medicine, the Hopkins investigators say they compared 19 children with severe obstructive sleep apnea (OSA) to 12 children without the disorder. Using a special type of MRI, researchers identified changes to the hippocampus and the right frontal cortex. Next, using IQ tests and other standardized performance tests that measure verbal performance, memory and executive function, researchers were able to link the changes in the two brain structures to deficits in neuropsychological performance.

The hippocampus, a structure in the temporal lobe, is vital to learning and memory storage, while the right frontal cortex governs higher-level thinking, such as accessing old memories and using them in new situations.

“This should be a wake-up call to both parents and doctors that undiagnosed or untreated sleep apnea might hurt children’s brains,” says lead author Ann Halbower, M.D., a lung specialist at the Johns Hopkins Children’s Center. “This is truly concerning because we saw changes that suggest brain injury in areas of the brain that house critical cognitive functions, such as attention, learning and working memory.”

Link to article http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030301

Site - http://www.hopkinsmedicine.org/press_releases/2006/08_21_06.html

Wednesday, October 13, 2010

Snoring and Sleep apnea, is it so inflammatory?

From Dr. Susarla....

Snoring and Sleep apnea, is it so inflammatory?

A recent article in the journal Chest summarizes the association of breathing problems during sleep with multiple other medical conditions in children, raising concerns about how dangerous snoring may be.

Excerpted below: Among the many articles on childhood sleep-disordered breathing (SDB) in the last several years, there is a recurring theme: an array of comorbidities. Whether the disorder is defined as habitual snoring, upper airway resistance syndrome, or obstructive sleep apnea (OSA), studies have consistently linked SDB in children with seemingly unrelated symptoms of neuropsychologic deficits, obesity, cardiovascular abnormalities, parasomnias, and inflammation.

In addition, there appears to be a genetic association for childhood SDB. In the current issue of CHEST (see page 519), Li and colleagues1 have performed a large-scale population survey of symptom clusters and have demonstrated that all of these comorbid symptoms of SDB are increased in a population of children with habitual snoring. Their study in > 6,000 children aged 5 to 14 years with habitual snoring suggests an association of SDB with genetic influences, BMI, neuropsychologic problems, and inflammation, including recent upper-respiratory infection, allergic rhinitis, tonsillitis, and sinusitis. Do these clinical features relate to a single mechanism?

Chest September 2010 138:469-471

Saturday, September 25, 2010

Children with Autism Dont Yawn Contagiously

Children Under Four and Children With Autism Don't Yawn Contagiously

From Dr. Rotenberg - Fascinating news on a subconscious social behavior.

ScienceDaily (Sep. 16, 2010) — If someone near you yawns, do you yawn, too? About half of adults yawn after someone else does in a phenomenon called contagious yawning. Now a new study has found that most children aren't susceptible to contagious yawning until they're about 4 years old -- and that children with autism are less likely to yawn contagiously than others.


Wednesday, September 22, 2010

Neuropsychological and behavioural aspects in children and adolescents with idiopathic epilepsy

Neurology note - A comprehensive approach to epilepsy includes attention to neuropsychological function. Dr Rotenberg

Seizure. 2010 Aug 21. [Epub ahead of print]

Neuropsychological and behavioural aspects in children and adolescents with idiopathic epilepsy at diagnosis and after 12 months of treatment.

Piccinelli P, Beghi E, Borgatti R, Ferri M, Giordano L, Romeo A, Termine C, Viri M, Zucca C, Balottin U.

Child Neuropsychiatry Unit, University of Insubria, Macchi Foundation Hospital, Varese, Italy; Department of Child Neurorehabilitation, "Eugenio Medea" Scientific Institute, Bosisio Parini, Italy.


PURPOSE: To study neuropsychological functions in children with idiopathic epilepsy at onset of treatment and after 1 year of therapy and to identify factors associated with cognitive impairment.

METHODS: 43 Subjects aged 5.2-16.9 years with newly diagnosed idiopathic epilepsy were enrolled and started treatment with valproate or carbamazepine. At admission and after 12 months, all patients underwent clinical examinations, the Child Behavioural Checklist, EEG and a neuropsychological test battery. The results of each test were correlated to demographic, clinical, electrophysiological and therapeutic variables.

RESULTS: Except for attention, all neuropsychological functions were normal at admission and after 12 months. An improvement with time was noted for memory (p<0.05)>

DISCUSSION: Idiopathic epilepsy can affect attention, even before starting treatment. Emotional and behavioural difficulties and a low socio-economical status are associated with cognitive impairment.


PMID: 20732824 [PubMed - as supplied by publisher]

Rare condition sometimes mistaken for cerebral palsy

Rare condition sometimes mistaken for cerebral palsy

An Ontario mother refused to accept her infant had cerebral palsy and fought to get a second opinion. It turns out she was right: he had another, easily treatable disease called dopamine-responsive dystonia.
The condition is part of a group of illnesses that cause repetitive and painful muscle contractions. It can be mistaken for cerebral palsy, but unlike CP, this condition can be treated, if patients get the right diagnosis.
At three months of age, Corinne Fewster-Gagne's son Beckham started showing symptoms of clenched fists, painful stiffness, and uncontrollable crying.
"I was shocked," she told CTV News. "The only question I could think to ask at the time was, 'Is my son ever going to be able to walk?'"
She refused to accept the diagnosis and searched for a second opinion.....

Educational Note - Children can have movement disorders that mimic CP. JR


Another video...


Monday, September 20, 2010

Sudden Unexplained Death in Epilepsy - Unmasking Silent Killer in Epilepsy

Unmasking Silent Killer in Epilepsy

On July 9, 2009, Steve Wulchin went to wake his 19-year-old son, Eric, in their home in Boulder, Colo. Eric had been given a diagnosis of epilepsy three years earlier, but other than that, his father said, “there was nothing out of the ordinary.” His seizures had been well controlled; he had not had one in six months.

Yet that morning, Mr. Wulchin found Eric lying on the floor. CPR and paramedics were too late; Eric had died at about 2:30 a.m.

The cause of Eric’s death was ultimately listed as Sudep, for sudden unexplained death in epilepsy. The syndrome accounts for up to 18 percent of all deaths in people with epilepsy, by most estimates; those with poorly controlled seizures have an almost 1 in 10 chance of dying over the course of a decade.

Yet many patients and their families never hear about Sudep until someone dies. Mr. Wulchin said none of Eric’s four neurologists ever mentioned it to the family.

“The message we got back was, ‘There’s no reason why he can’t live a long and normal life,’ ” he said. “It never occurred to me that this was a possibility.”

Now, physicians, researchers, advocates and relatives like Mr. Wulchin, a technology executive, are trying to raise awareness about Sudep. One of their goals is to establish registries of deaths and autopsy results, building databases to support future research.

Sudep most often affects young adults, typically ages 20 to 40, with a history of the convulsive seizures once known as “grand mal.” Others at risk include those with difficult-to-control seizures, or seizures at night; people who take a large number of anti-epileptic medications or take them irregularly; African-Americans with epilepsy; and people with epilepsy whose I.Q. is under 70......more....


Saturday, September 18, 2010

Obesity and Disturbed Sleep - Eat less, Move more, SLEEP more

Obesity and Disturbed Sleep - Eat less, Move more, SLEEP More - Dr. Josh Rotenberg comments on new research on WABC News


Insufficient sleep increases the risk of obesity.

  • Both body and brain need quality sleep.

Sleep must be of adequate quantity and quality.
Watch for the the vicious circle
  • reduced sleep can increase body weight
  • increased weight can cause sleep apnea
  • sleep apnea fragments and reduces sleep
    Breaking the vicious cycle can help with weight loss. (tie in Denzel?)
If your child has a weight problem
  • Maintain a healthy and firm sleep schedule
  • Turn off video games, computer TV after dark
  • Make behavioral change a family project
  • Keep a sleep diary
  • Watch for a sleep problem
  • Call your physician for further testing

Monday, September 13, 2010

World Class Pediatric Specialists - Right Here in Your Own Back Yard

John M. Robertson, M.D. and Sarat C. Susarla, M.D.,
are pleased to announce the opening of their new pediatric specialty office in Katy for children with breathing and sleep disorders. They take care of children with asthma, sleep apnea, recurrent pneumonia, chronic cough, exercise induced breathing problems or symptoms, and shortness of breath, as well as respiratory problems related to prematurity like chronic lung disease and apnea. Experts in their field, these physicians bring experience and trusted care for your child right to your neighborhood. Houston Pediatric Pulmonary and Sleep Associates offer state of the art treatment options and equipment for your child’s health inside and outside of the hospital. They see patients at Christus St. Catherine, Kingwood Medical Center, The Women’s Hospital of Texas, Clearlake Regional Hospital, Texas Children’s Hospital, and Children’s Memorial Hermann in the Texas Medical Center. They currently have additional offices in the Medical Center, Clearlake, Kingwood and Sugar Land.

Dr. Robertson is board certified in pediatric and pediatric pulmonology. He received a B.S. in Microbiology from Texas A&M University in College Station TX and is a graduate of the University of Texas Southwestern Medical School in Dallas, Texas. He completed his pediatric residency at Children's Medical Center of Dallas and his fellowship in Pediatric Pulmonology at Texas Children's Hospital.

In his spare time, Dr. Robertson is a poet with 24 works published, as well as a mixed-media artist. His wife Julie, also an Aggie, works for the American Heart Association.

Dr. Susarla is a board certified pediatrician specializing in pediatric pulmonology. He grew up in the Houston area and received his B.S. in Molecular Biology from The University of Texas at Austin and his medical degree from The University of Texas Medical Branch in Galveston.

He completed his pediatric residency at Arnold Palmer Hospital for Children in Orlando, Florida and his Pediatric Pulmonary Fellowship at Texas Children's Hospital in Houston. His professional interests include pediatric asthma and sleep-disordered breathing.

In his spare time, Dr. Susarla enjoys tennis with his wife, and plays guitar and classical violin. He and his wife recently celebrated the birth of their first child, Gopal.
705 S. Fry Road / Katy, TX 77450
Phone: 713.794.0200 / Fax: 713.794.0203 / Website: http://www.hppsa.com/

Saturday, September 11, 2010

Adolescents With Chronic Fatigue May Suffer Long-Term Effects

Adolescents With Chronic Fatigue May Suffer Long-Term Effects
Keeping up with healthy peers results in increased fatigue, sleep need

WEDNESDAY, Sept. 8 (HealthDay News) -- Adolescents who do not recover from chronic fatigue syndrome (CFS) continue to experience extreme fatigue, to use medical services at a high rate, and to miss school and work; and, those who attempt to keep up with their healthy peers experience greater fatigue and need for sleep, according to two articles published in the September issue of the Archives of Pediatrics & Adolescent Medicine.

Stefan M. van Geelen, of the University Medical Center Utrecht in the Netherlands, and colleagues followed 54 adolescents with CFS for a mean of 2.2 years to describe the long-term outcomes, use of health care, and risk factors associated with non-recovery in this patient population. They found 28 (51.9 percent) had a near-complete improvement in symptoms, while 26 (48.1 percent) did not improve. Those in school had missed 33 percent of classes on average in the last month, while the other subjects had worked 38.7 percent of a full-time job on average. Of all the subjects, 66.7 percent were treated by a physical therapist, 38.9 percent received clinical treatment in rehabilitation, 48.1 percent had received psychological support, and 53.7 percent had used alternative treatment.


Friday, September 10, 2010

Baby Emergencies iphone App - When your mind goes blank

From Dr. Robertson

RN Tara Summers was inspired to make an iPhone app after a frightening episode where she saw her infant child choking. Because she was a nurse, she sprang into action and gave the Heimlich maneuver, but worried about parents (or babysitters) without the same training.

So, along with her emergency medicine physician husband, she created MedBasics -- a readily accessible information packet for the home about things to do in an emergency. Now, they're announcing an iPhone app called BabyMedBasics, for emergencies when you're not at home.


Playing Sports with Asthma

Playing Sports with Asthma

By John M. Robertson, M.D.

One of the most frequent questions asked by parents after their child is diagnosed with asthma is "Can he or she play sports?” Asthma is a chronic disease caused by inflammation of the airways that makes it hard to breathe. Typical asthma symptoms are one or more of the following: wheezing, coughing, chest tightness, or poor exercise tolerance. Some children only have asthma symptoms when they exercise, but most children with asthma develop asthma symptoms with exercise. So, if exercise can trigger asthma, shouldn't someone with asthma avoid sports? By no means! Long gone are the days when the asthmatic was forbidden from participating in sports. In fact, there are a number of professional and Olympic athletes with asthma such as Jerome “The Bus” Bettis, Amy Van Dyken, Kristi Yamaguchi, and Jackie Joyner-Kersee.

"Initially I thought that with asthma, I couldn't be involved in any sports or other activities. Thankfully, my mother encouraged me, instead of discouraged me, to play. She said, 'As long as you take your medicine, the doctor told me that you will be fine.‘” - Jerome “The Bus” Bettis, Super Bowl XL Champion Pittsburgh Steelers Running Back (1996-2005)

Modern medications combined with simple warm-up and breathing techniques make full athletic participation the norm for asthmatics. One common method to prevent exercise limiting asthma symptoms is to use a “rescue” medication, such as albuterol or levalbuterol, about 15 minutes before exercising. This helps to prevent or minimize the changes in the asthmatic lung that cause symptoms and limit exercise. This may be sufficient for the athlete who only has asthma symptoms during or after exercise. However, the athlete with asthma symptoms on and off the court may benefit from a daily “maintenance” (also called “controller”) medication on top of their “rescue” medication.

Today, asthma medicines are so effective that, if a child with asthma is unable to participate in sports because of breathing problems, then the top three most likely culprits are...

1. The child is not on the right medicine.

2. The child is on the right medicine, but not the right dose.

3. The child is on the right medicine, at the right dose but is not using it correctly.

The secret to controlling asthma is the right medication at the right dose and used the right way. In addition, there are simple warm-up and breathing techniques an athlete can use to further reduce asthma flare ups during or after exercise. Aerobic warm-up exercise of mild intensity, like jogging, for 20 minutes activates the body’s own anti-asthma defense mechanisms. This warm-up can be done before beginning strenuous exercise to prevent exercise induced asthma symptoms. Proper breathing during exercise can further minimize the triggering effect exercise has on asthma. Cold, dry air tends to promote asthma symptoms. The nose warms and humidifies air as it travels through toward the lungs. Therefore, athletes with asthma are taught to breathe in through their nose and out through their mouth to eliminate the exposure of their lungs to cold, dry air. Combined with proper medicine, these techniques can eliminate asthma as a barrier to athletic participation.

All of these interventions are not right for all child athletes with asthma. This is a situation in which a specialist such as a pediatric pulmonologist can help. Pediatric pulmonologists are trained to care for children (from birth to 18 years of age) whose asthma is still limiting their quality of life despite proper treatment by their primary care physician. A pediatric pulmonologist will evaluate the child’s current asthma symptoms, medications, and how those medications are being used. They will prescribe a plan tailored to the specific needs of the individual patient. This individualized plan will include teaching on the proper use of asthma medications and instruction on warm-up and breathing techniques to eliminate the impact of asthma on athletes.

Modern asthma management is extremely effective. In almost all cases, it is only when asthma is ignored or improperly treated that it limits a child’s ability to participate and enjoy athletics. A specialist like a pediatric pulmonologist can design a treatment plan to meet the individual needs of the child athlete, and can eliminate asthma as a barrier to athletic participation.

“It [asthma] interferes with almost everything I want to do from sleeping to laughing. But I've been able to work with my doctor on a good medication regimen so that it doesn't affect me as much.” - Amy Van Dyken, 6-time Olympic Gold Medalist in swimming (1996, 2000).

Monday, September 6, 2010

Does your child have a weight problem? Make sure they have sufficient sleep.

Does your child have a weight problem? Make sure they have sufficient sleep.
Children who sleep less than 8 hours, snack more and take in more fat and carbohydrates. JR


The Association of Sleep Duration with Adolescents’ Fat and Carbohydrate Consumption

Allison Weiss1; Fang Xu, MS1; Amy Storfer-Isser, MS1; Alicia Thomas, MS, RD, LD1; Carolyn E. Ievers-Landis, PhD2; Susan Redline, MD, MPH1

Study Objectives: To investigate the relation between sleep duration and energy consumption in an adolescent cohort.
Design: Cross-sectional.
Setting: Free-living environment.
Participants: Two hundred forty adolescents (mean age 17.7 ± 0.4 years).
Measurements and Results:Daily 24-hour food-recall questionnaires and wrist-actigraphymeasurements of sleep duration were employed to test the hypothesis that shorter weekday sleep duration (< p =" 0.004)" p =" 0.001).">Conclusion: Quantitative measures of macronutrient intake in adolescents were associated with objectively measured sleep duration. Short sleep duration may increase obesity risk by causing small changes in eating patterns that cumulatively alter energy balance.
Keywords: Sleep duration, diet, obesity, adolescents, 24-hour food recall

Citation: Weiss A; Xu F; Storfer-Isser A; Thomas A; Ievers-Landis CE; Redline S. The association of sleep duration with adolescents’ fat and carbohydrate consumption.
SLEEP 2010;33(9):1201-1209.

Saturday, September 4, 2010

Long waits and long distances for specialists at Childrens Hospital - Texas No Different

Some thoughts....

Wait times for children's hospitals can reach 13 weeks (developmental pediatrics) 9.5 weeks (neurology) and 8.1 weeks (pulmonology / pulmonary)

1) This article does not specify if these appointments are in a) resident clinics supervised by attending physicians OR b) with nurse practitioners as opposed to c) a full board-certified specialist.

2) Many parents are pleasantly surprised to find shorter waits (often only days) with private practice specialists of equivalent training & expertise.

Long waits and long distances for specialists at Childrens Hospital - Texas No Different

"...Conclusion: Children’s hospitals have experienced subspecialty shortages that affect timely appropriate care for children. While hospitals have adopted strategies to fill the gap, long wait times to see a subspecialist still remain. Policy changes are needed to attract and retain new pediatric subspecialists. "


Friday, August 27, 2010

Absence Epilepsy - Which medication is best?

Big news from the New England Journal on absence epilepsy - ethosuximide is more effective than valproate or lamotrigine in Childhood Absence Epilepsy. Dr. Josh Rotenberg


2010 Mar 4;362(9):790-9.

Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy.

Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Capparelli EV, Adamson PC; Childhood Absence Epilepsy Study Group.

Collaborators (157)

Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital, 3333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA. tracy.glauser@cchmc.org

Comment in:


BACKGROUND: Childhood absence epilepsy, the most common pediatric epilepsy syndrome, is usually treated with ethosuximide, valproic acid, or lamotrigine. The most efficacious and tolerable initial empirical treatment has not been defined.

METHODS: In a double-blind, randomized, controlled clinical trial, we compared the efficacy, tolerability, and neuropsychological effects of ethosuximide, valproic acid, and lamotrigine in children with newly diagnosed childhood absence epilepsy. Drug doses were incrementally increased until the child was free of seizures, the maximal allowable or highest tolerable dose was reached, or a criterion indicating treatment failure was met. The primary outcome was freedom from treatment failure after 16 weeks of therapy; the secondary outcome was attentional dysfunction. Differential drug effects were determined by means of pairwise comparisons.

RESULTS: The 453 children who were randomly assigned to treatment with ethosuximide (156), lamotrigine (149), or valproic acid (148) were similar with respect to their demographic characteristics. After 16 weeks of therapy, the freedom-from-failure rates for ethosuximide and valproic acid were similar (53% and 58%, respectively; odds ratio with valproic acid vs. ethosuximide, 1.26; 95% confidence interval [CI], 0.80 to 1.98; P=0.35) and were higher than the rate for lamotrigine (29%; odds ratio with ethosuximide vs. lamotrigine, 2.66; 95% CI, 1.65 to 4.28; odds ratio with valproic acid vs. lamotrigine, 3.34; 95% CI, 2.06 to 5.42; P<0.001 p="">

CONCLUSIONS: Ethosuximide and valproic acid are more effective than lamotrigine in the treatment of childhood absence epilepsy. Ethosuximide is associated with fewer adverse attentional effects.

How can families prepare for a sleep study for a child?

How can families prepare for a pediatric sleep study? Here is a nice site.
Make sure that you are going to a center specializing in children. It makes a difference in the data collection, analysis, diagnosis and treatment. My protocol (learned from doing EEG's all the time) adds some developmentally sensitive elements and gets 92% success with kids.
Josh Rotenberg MD

Getting A Sleep Study
Ask the Sleep Expert
Dr. Rafael Pelayo, MDStanford Sleep Disorders Clinic, Stanford, CA


I recommend that kids and parents make it a fun night, since typically the parent will be sleeping in the room with the child. They can wear matching pajamas, order take out food, and stay up as late as they like. This helps take the pressure off the child falling asleep since the sleep study is to find out what happens during sleep. The children typically sleep better than the parents do.
I also tell children the same rules apply in the sleep clinic as in their home; if they’re able to jump on the bed at home they can do it here. I encourage them to bring anything from home— except their pets—to make them feel comfortable, such as pillows, blankets, and sheets. We also make sure the clinic is very child-appropriate with video games, magazines, and telephones for the child to call home if they want to.

Symptoms of a seizure can be subtle...

Symptoms of a seizure can be subtle...

Symptoms of a Seizure

A seizure is usually defined as a sudden alteration of behavior due to a temporary change in the electrical functioning of the brain, in particular the outside rim of the brain called the cortex. Below you will find some of the symptoms people with epilepsy may experience before, during and after a seizure. Seizures can take on many different forms and seizures affect different people in different ways. It is not implied that every person with seizures will experience every symptom described below.

Seizures have a beginning, middle, and end

When an individual is aware of the beginning, it may be thought of as a warning or aura. On the other hand, an individual may not be aware of the beginning and therefore have no warning.
Sometimes, the warning or aura is not followed by any other symptoms. It may be considered a simple partial seizure by the doctor.

The middle of the seizure may take several different forms. For people who have warnings, the aura may simply continue or it may turn into a complex partial seizure or a convulsion. For those who do not have a warning, the seizure may continue as a complex partial seizure or it may evolve into a convulsion.

The end to a seizure represents a transition from the seizure back to the individual’s normal state. This period is referred to as the “post-ictal period” (an ictus is a seizure) and signifies the recovery period for the brain. It may last from seconds to minutes to hours, depending on several factors including which part(s) of the brain were affected by the seizure and whether the individual was on anti-seizure medication. If a person has a complex partial seizure or a convulsion, their level of awareness gradually improves during the post-ictal period, much like a person waking up from anesthesia after an operation. There are other symptoms that occur during the post-ictal period and are detailed below.

Please note: Below is only a partial list, some people may experience other symptoms not listed below. These lists are meant to help patients communicate with their physicians.

Early seizure symptoms (warnings)

Deja vu
Jamais vu
Visual loss or blurring
Racing thoughts
Stomach feelings
Strange feelings
Tingling feeling

Pleasant feeling


No warning: Sometimes seizures come with no warning

Seizure symptoms

Black out
Electric Shock Feeling
Loss of consciousness
Spacing out
Out of body experience
Visual loss or blurring


Chewing movements
Difficulty talking
Eyelid fluttering
Eyes rolling up
Falling down
Foot stomping
Hand waving
Inability to move
Lip smacking
Making sounds
Teeth clenching/grinding
Tongue biting
Twitching movements
Breathing difficulty
Heart racing

After-seizure symptoms (post-ictal)

Memory loss
Writing difficulty

Depression and sadness

Difficulty talking
Urge to urinate/defecate

If you or someone you know has the symptoms listed above -- you are not alone.

Adapated from: Schachter SC, editor. Brainstorms: epilepsy in our words. New York: Raven Press; 1993; and Schachter SC, editor.The brainstorms companion: epilepsy in our view. New York: Raven Press; 1995..

Night-time wakings in your baby? Thinking about "crying it out"? Trying the Ferber method? Think again! ...Dr. Rotenberg

Coddle or let the kid cry? New research awakens the sleep-training debate !

There is perhaps no parenting decision that tugs on the heartstrings as strongly as whether to let a baby cry him- or herself to sleep.

At one end of the spectrum are parents who use some form of “cry-it-out” method to teach their baby to sleep through the night. The method is characterized by periods of letting a baby cry – from a few minutes to more than an hour – without picking him or her up. At the other end are the “no-cry” types who consider letting a baby cry for any length of time to be cruel and unusual punishment.

“ "I don’t want to diss sleep-training programs per se, but the way we construed emotional availability is that an emotionally available parent is not a parent who is going to abandon a child at night and let the child cry it out.””

Stuck in the middle are a lot of exhausted parents hoping to make the right choice – especially since sleep deprivation in infants has been linked to behavioural and cognitive problems, not to mention its effects on mom and dad.

New research on infant sleep appears to deal a blow to those in the cry-it-out camp. Penn State researcher Douglas Teti examined the role of emotional availability on infant sleep and found that regardless of a family’s night-time routine, infants with parents who were responsive and warm had fewer night wakings and an easier time drifting off. In his study, which involved infrared cameras placed in families’ bedrooms and nurseries, a lapse of more than a minute resulted in a lower emotional availability score.


Link to the abstract ...


J Fam Psychol. 2010 Jun;24(3):307-15.
Maternal emotional availability at bedtime predicts infant sleep quality.
Teti DM, Kim BR, Mayer G, Countermine M.
Human Development and Family Studies, The Pennsylvania State University, S-211 Henderson Building, University Park, PA 16802, USA. dmt16@psu.edu
In the present study, linkages were examined between parental behaviors (maternal practices) at bedtime, emotional availability of mothering at bedtime, and infant sleep quality in a cross-sectional sample of families with infants between 1 and 24 months of age. Observations of maternal behaviors and maternal emotional availability were conducted independently by 2 sets of trained observers who were blind to data being coded by the other. With infant age statistically controlled, specific maternal behaviors at bedtime were unrelated to infant sleep disruptions at bedtime and during the night. By contrast, emotional availability of mothering at bedtime was significantly and inversely related to infant sleep disruption, and, although these links were stronger for younger infants, they were significant for older infants as well. Maternal emotional availability was also inversely linked with mothers' ratings of whether their infants had sleep difficulties. These findings demonstrate that parents' emotional availability at bedtimes may be as important, if not more important, than bedtime practices in predicting infant sleep quality. Results support the theoretical premise that parents' emotional availability to children in sleep contexts promotes feelings of safety and security and, as a result, better-regulated child sleep.
PMID: 20545404 [PubMed - in process]

Wednesday, August 25, 2010

Pesticide Exposure in the Womb Increases ADHD Risk

Exposure to pesticides while in the womb may increase the odds that a child will have attention deficit hyperactivity disorder, according to researchers at the University of California-Berkeley School of Public Health. Combine that with research published in May in Pediatrics finding that children exposed to pesticides were more likely to have ADHD, and it's enough to make parents wonder how to reduce their family's exposure to pesticides.


Sunday, August 22, 2010

Pediatric Insomnia in ADHD Clinical Study - Enrolling Patients

Pediatric Insomnia in ADHD Study - Mulitcenter Study
Study summary:A randomized, placebo-controlled, double-blind, fixed-dose study of the efficacy and safety of Eszopicolone (Lunesta) in children 6-11, adolescents 12-17 with attention deficit/hyperactivity disorder- associated insomnia.
Qualified participants must:• Have documented ADHD-associated insomnia, defined as the subject or subject's parental guardian reports difficulty with sleep latency greater than 30 min
• Have daytime functional impairment as a result of sleep problems
• Have tried behavioral intervention for sleep problems
• Be able to stay over night in a sleep lab for testing


Insomnia before school? Think delayed sleep phase...

From Dr. Rotenberg...

Delayed Sleep Phase Syndrome

What is delayed sleep phase disorder?

Delayed sleep phase disorder is a sleep disorder in which the person’s sleep-wake cycle (internal clock) is delayed by 2 or more hours. Basically, because of the shift in the internal clock by two or more hours, the ability to fall asleep is also postponed. For example, rather than falling asleep at 10 PM and waking at 7 AM, an adolescent with delayed sleep phase disorder will not fall asleep until 12 or 1 AM and then has great difficulty awakening at 7 AM for school or work. If the child or adolescent is allowed to sleep until late in the morning, he will feel rested and can function well. Most children and adolescents with delayed sleep phase disorder describe themselves as “night owls” and usually feel and function their best in the evening and nighttime hours. They usually get much less sleep on weekdays compared to weekends or holidays....


Thursday, July 29, 2010

The Case for $320,000 Kindergarten Teachers

The Case for $320,000 Kindergarten Teachers
How much do your kindergarten teacher and classmates affect the rest of your life?
Economists have generally thought that the answer was not much. Great teachers and early childhood programs can have a big short-term effect. But the impact tends to fade. By junior high and high school, children who had excellent early schooling do little better on tests than similar children who did not — which raises the demoralizing question of how much of a difference schools and teachers can make.
There has always been one major caveat, however, to the research on the fade-out effect. It was based mainly on test scores, not on a broader set of measures, like a child’s health or eventual earnings. As Raj Chetty, a Harvard economist, says: “We don’t really care about test scores. We care about adult outcomes.”
Early this year, Mr. Chetty and five other researchers set out to fill this void. They examined the life paths of almost 12,000 children who had been part of a well-known education experiment in Tennessee in the 1980s. The children are now about 30, well started on their adult lives.
On Tuesday, Mr. Chetty presented the findings — not yet peer-reviewed — at an academic conference in Cambridge, Mass. They’re fairly explosive. ....


Tuesday, July 6, 2010

Insomnia in Children Can be Dangerous

Missing autistic teen returns homeMissing autistic teen returns home

Police have confirmed to Fox59 News that a missing teenager with autism who had wandered away from his home Tuesday night, has been found. Police said 13-year-old Josh Arnett came back home late Wednesday morning.


Friday, July 2, 2010

Sleeping With Your Pet?

Sleeping With Your Pet?

Afraid to admit that you sleep with your pet? We have some good news. It may be therapeutic! Here's how to find out more...... Dr. Mary Rose, Clinical Psychologist, Sleep Specialist, and Director of Psycho-Oncology at Baylor College of Medicine Breast Center is offering two seminars on "Pets and Sleep" at Rover Oaks Pet Resort. The seminars will focus on: the pros and cons of sleeping with pets; how companion animals may facilitate human sleep and overall well-being; the role that dogs can play in treating human sleep disorders including sleep walking and pediatric nightmares; and how humans might negotiate the sleep environment with their pets. Dr. Rose has been involved in the sleep field for over 20 years. In addition to Baylor College of Medicine, she holds academic appointments with the Sleep Center at MD Anderson Cancer Center and the VAMC Sleep Disorders Clinic. The "Pets and Sleep" seminar will be offered at Rover Oaks Katy on Saturday, July 17 from noon to 1:00 p.m., and at Rover Oaks Houston on Thursday, July 22 from 7:00 to 8:00 p.m. The fee for each seminar is a $25 donation to Schnauzer Rescue of Houston or to Poodle Rescue of Houston. Space is limited, so reservations are required! To register, send an email to steve@roveroaks.com and make sure you identify which seminar you would like to attend (July 17 at Rover Oaks Katy or July 22 at Rover Oaks Houston). Also include the names of any other individuals who would like to come with you. Please note that we will not have space at these seminars for your pet compansions.

Tuesday, June 1, 2010

Einstein's Brain and Neuroscience

Astrocytes are important to you know...see the really interesting picture of Einstein getting an EEG

Einstein's Brain Unlocks Some Mysteries Of The Mind

In the 55 years since Albert Einstein's death, many scientists have tried to figure out what made him so smart.

But no one tried harder than a pathologist named Thomas Harvey, who lost his job and his reputation in a quest to unlock the secrets of Einstein's genius. Harvey never found the answer. But through an unlikely sequence of events, his search helped transform our understanding of how the brain works.

Job advertisment for Pediatric OT Specialist

posting this for a related referring group....JR

Job Title: Pediatric Occupational Therapist - Pediatric Group

Job Type:Part-Time

Location: Houston, TX

Hours: Some flexibility

Salary: Commensurate with experience

Pediatric Occupational Therapy Post Date: 6/2/2010

Job Description: Provide Occupational Therapy evaluations and counselling in a pediatric group practice to patients who have impairments, developmental disabilities, functional limitations, disabilities, or changes in physical function and health status resulting from injury, disease or other causes.

Actively collaborates with the health care team to perform evaluations including evaluations of infant development, assisting with evaluation of spasticity management. Facilitates referrals to local agencies and therapists for ongoing treatment.
Basic Qualifications: This position requires a Bachelor's degree and at least 2-3 years related experience. NICU experience preferred.

License Required: Current TX license.

Liability Insurance - negotiable

This is a part-time position in a new position; days and shift based on needs of department.

Background screens will be performed and must be approved prior to employment. Please be prepared to provide required information.

Please send resumes and cover letters to academytherapeutics@gmail.com

Sunday, May 16, 2010

Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea

From Dr. Rotenberg - The success in this study is similar to my experience with CPAP/BiPAP in children.

Pediatrics. 2006 Mar;117(3):e442-51.

Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea.

Marcus CL, Rosen G, Ward SL, Halbower AC, Sterni L, Lutz J, Stading PJ, Bolduc D, Gordon N.

Division of Pulmonary Medicine, Sleep Center, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. marcus@email.chop.edu

Comment in:


OBJECTIVES: Positive airway pressure therapy (PAP) is frequently used to treat children who have obstructive sleep apnea syndrome and do not respond to adenotonsillectomy. However, no studies have evaluated objectively adherence to PAP in children, and few studies have evaluated objectively the effectiveness of PAP. The objective of this study was to determine adherence and effectiveness of PAP (both continuous [CPAP] and bilevel [BPAP] pressure) in children with obstructive apnea. METHODS: A prospective, multicenter study was performed of children who were randomly assigned in a double-blind manner to 6 months of CPAP versus BPAP. Adherence was measured objectively using the equipment's computerized output. Effectiveness was evaluated using polysomnography. RESULTS: Twenty-nine children were studied. Approximately one third of children dropped out before 6 months. Of the 21 children for whom 6-month adherence data could be downloaded, the mean nightly use was 5.3 +/- 2.5 (SD) hours. Parental assessment of PAP use considerably overestimated actual use. PAP was highly effective, with a reduction in the apnea hypopnea index from 27 +/- 32 to 3 +/- 5/hour, and an improvement in arterial oxygen saturation nadir from 77 +/- 17% to 89 +/- 6%. Results were similar for children who received CPAP versus BPAP. Children also had a subjective improvement in daytime sleepiness. CONCLUSIONS: Both CPAP and BPAP are highly efficacious in pediatric obstructive apnea. However, treatment with PAP is associated with a high dropout rate, and even in the adherent children, nightly use is suboptimal considering the long sleep hours in children.