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.

Thursday, January 30, 2014

Effects of sleep deprivation on the pediatric eeg.

Effects of sleep deprivation on the pediatric electroencephalogram.

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  1. Donald L. Gilbert, MDc
  1. aDivisions of Pediatric Neurology
  2. bPediatric Hospitalists, Helen DeVos Children's Hospital, Grand Rapids, Michigan
  3. cDivision of Pediatric Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio


BACKGROUND. The routine electroencephalogram aids in epilepsy syndrome diagnosis. Unfortunately, routine outpatient electroencephalogram results are normal in roughly half of children with epilepsy. To increase the yield, practice guidelines recommend electroencephalograms with sleep and sleep deprivation. The purpose of this study was to rigorously evaluate this recommendation in children.
METHODS. We conducted a randomized, blinded comparison of routine electroencephalograms versus sleep-deprived electroencephalograms in 206 children aged 0 to 18 years. Electroencephalograms were ordered for standard indications after a neurologist's clinical assessment indicated ≥1 seizure (83%) or unclear spell (17%). The primary outcome was the proportion of normal routine electroencephalogram results versus sleep-deprived electroencephalogram results. Logistic regression modeling was used to assess the influence of sleep, as well as other clinical factors.
RESULTS. Although children with sleep-deprived electroencephalograms had less sleep the night before (4.9 vs 7.9 hours) and more sleep during electroencephalograms (73% vs 55%), the increase in electroencephalogram yield was borderline significant (56% normal sleep-deprived electroencephalogram versus 68% normal routine electroencephalogram). Moreover, sleep during the electroencephalogram did not increase its diagnostic yield. Sleep-deprived electroencephalogram yield tended to be higher in children with preelectroencephalogram clinical diagnosis of seizure(s) and at older ages (>3 years).
CONCLUSIONS. Sleep deprivation, but not sleep during the electroencephalogram, modestly increases the yield of the electroencephalogram in children diagnosed with seizures by neurologists. Compared with a routine electroencephalogram, the number needed to test with sleep-deprived electroencephalogram to identify 1 additional child with epileptiform discharges is ∼11.
Key Words:
  • Accepted June 6, 2008.
EEG in Houston Sugar Land Katy Cypress Missouri City

Sunday, January 26, 2014

Sleep-disordered-breathing in Ehlers-Danlos Syndrome (a genetic model of obstructive sleep apnea).

ChestChestAugust 10, 2013

Sleep-disordered-breathing in Ehlers-Danlos Syndrome (a genetic model of obstructive sleep apnea).

Christian Guilleminault, Michelle Primeau, Yean Hsiao, Kin Min Yuen, Damien Leger, Arnaut Metlaine
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Aims:  Investigation of the presence of sleep-disordered-breathing (SDB) in patients with Ehlers-Danlos(ED) Syndrome. ED is a genetic disorder characterized by cartilaginous defects, including nasal-maxillary cartilages.
Method:  A retrospective series of 34 ED patients presenting to clinic with complaints of fatigue and poor sleep were evaluated via clinical history, physical examination, polysomnography (PSG) and in some cases with anterior rhinomanometry. Additionally, a prospective clinical investigation of 9 ED patients was performed in a specialized medical ED clinic.
Results:  All ED patients evaluated had SDB on PSG. In addition to apneas and hypopneas, SDB included flow limitation. With increasing age, flow limitation decreased in favor of apnea and hypopnea events, but clinical complaints were similar independent of the type of PSG finding. In the subgroup of patients who underwent nasal rhinometry, increased nasal resistance was increased relative to normative values. Nasal CPAP improved patient symptoms. ED patients in medical clinic presented with symptoms and clinical signs of SDB, but they never were referred for evaluation of SDB.
Conclusion:  In ED patients, abnormal breathing during sleep is commonly unrecognized and is responsible for daytime fatigue and poor sleep. ED patients are at particular risk for SDB due to genetically related cartilage defects that lead to the development of facial structures known to cause SDB. ED may be a genetic model for obstructive sleep apnea because of abnormalities of oral-facial growth. Early recognition of SDB may allow treatment with orthodontics and myofacial reeducation.

Relationship between Sleep and Pain in Adolescents with Juvenile Primary Fibromyalgia Syndrome

Sleep disturbance is very common in teens with fibromyalgia and chronic pain. JR

Relationship between Sleep and Pain in Adolescents with Juvenile Primary Fibromyalgia Syndrome 

To investigate sleep quality in adolescents with juvenile primary fibromyalgia syndrome (JPFS) and determine whether sleep abnormalities, including alpha-delta sleep (ADS), correlate with pain intensity. We hypothesized that successful treatment for pain with exercise therapy would reduce ADS and improve sleep quality.


Single-center preintervention and postintervention (mean = 5.7 ± 1.0 weeks; range = 4.0-7.3 weeks) observational study.


Ten female adolescents (mean age = 16.2 ± 0.65 SD yr) who met criteria for JPFS and completed treatment.


Multidisciplinary pain treatment, including intensive exercise therapy.

Measurements and Results:

Pain and disability were measured by a pain visual analog scale (VAS) and the Functional Disability Inventory. Subjective sleep measures included a sleep VAS, an energy VAS, and the School Sleep Habits Survey. Objective sleep measures included actigraphy, polysomnography (PSG), and the Multiple Sleep Latency Test. Baseline PSG was compared with that of healthy age- and sex-matched control patients. At baseline, patients had poorer sleep efficiency, more arousals/awakenings, and more ADS (70.3% of total slow wave sleep [SWS] versus 21.9% SWS, P = 0.002) than controls. ADS was unrelated to pain, disability, or subjective sleep difficulty. After treatment, pain decreased (P = 0.000) and subjective sleep quality improved (P = 0.008). Objective sleep quality, including the amount of ADS, did not change.


Although perceived sleep quality improved in adolescents with JPFS after treatment, objective measures did not. Our findings do not suggest exercise therapy for pain improves sleep by reducing ADS, nor do they support causal relationships between ADS and chronic pain or subjective sleep quality.


Olsen MN; Sherry DD; Boyne K; McCue R; Gallagher PR; Brooks LJ. Relationship between sleep and pain in adolescents with juvenile primary fibromyalgia syndrome. SLEEP 2013;36(4):509-516.

Thursday, January 23, 2014

Houston ADD Conference - Strategies for Life with ADHD 26th Annual Conference

Strategies for Life with ADHD
26th Annual Conference
Double Tree by Hilton Hotel Houston Intercontinental Airport
15747 John F Kennedy Blvd, Houston, TX 77032
Saturday, February 22, 2014

2014 Registration Brochure (PDF — 245 KB)
This event is designed for parents, educators, adults with ADD and mental health professionals. The general session speaker will be Dwight Wolfe, M.D. with UTMB in Galveston covering updated trends in ADHD. Author Chris Zeigler Dendy and her husband, Tommy Dendy will present sessions addressing teen issues. They will introduce their new video for dads. Twenty breakout sessions will cover a wide variety of topics including behavior management, life skills, medication, educational laws, related conditions and classroom strategies. TEA approved CPE credits for educators will be available and continuing education credits, including ethics credits, will be available for social workers, psychologists, Type 1 for OTs, LPCs, and LMFTs. Discounts are available for groups of educators. A limited number of scholarships covering registration and hotel are available for individuals or families coping with ADHD. Mark your calendars and join us.

Featured Speaker
Dwight Wolfe, M.D. is a Professor in the Department of Psychiatry, Division of Child and Adolescent Psychiatry at the University of Texas Medical Branch at Galveston.  He earned a Bachelor of Science in Biology from Lamar University in Beaumont, TX and completed medical school and residency training at UTMB.   He is board certified in both Adult and Child and Adolescent Psychiatry.  Dr. Wolf’s responsibilities at UTMB include the medical directorship of the Psychiatry Department’s outpatient clinics, supervision of residents and medical student education.  He is responsible for the clinical supervision of the Child and Adolescent Psychiatry residents in their final year of training.  Dr. Wolf serves as the chairman of one of two Institutional Review Boards which oversees all human subject research at UTMB.   His clinical practice includes a broad based patient population with an emphasis on the treatment of ADHD as well as mood disorders.   His research interests include the study of bipolar disorder, and medical student education with an emphasis on team based learning and the use of film and cinema in psychiatric education.   

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Cost of Attendence
Members- $100 (Early Bird $75), Non-Members- $135 (Early Bird $110), Special! (Join now & Attend Conference)- $130 (Early Bird $105)

Early Bird prices end 1/31/2014

Hotel Accommodations DoubleTree by Hilton Hotel Houston Intercontinental Airport 15747 JFK Boulevard, Houston, TX 77032

Go to http://doubletree.hilton.com/en/dt/groups/personalized/H/HOUAPDT-ADD-20140221/index.jhtml to make your reservations. ADDA-SR Conference rate is $89/night. Book by February 8, 2014.

CE Credits
Continuing Education Credits available:

  • LPCs                  5.25 Credits
  • LMFTs                5.25 Credits
  • Social Worker     5.25 Credits
  • Educators           5.25 CPE Credits
  • OTs                    5.25 Type 1 Credits
Dress Code  Casual Attire.
8:00 - 8:45 Special Pre-Conference Session (no credits— please register)
1 ABCs of ADHD
  David Brown, M.D. 
Educational Laws Overview, 504 and IDEA
  Rachel Beard, Advocate
Developing Self Control in Young Children
  Sue MacHugh, Trainer 

9:00 - 10:30 Conference Welcome General Session—New Developments in ADHD Treatment  
                  Dwight V. Wolf, M.D.                         AEMP       

10:30—10:45 Break 

10:45— 11:45 
School Success from Elementary to High School
   Kimberly Harrison, MA, LPC, LPA                      EMP
Managing Anxiety in Adult ADHD:  Behavioral Interventions and Self-Management 
   Joel Farb, M.A.                                                 AM         
The Nurtured Heart Approach
   Nancy Kling, M.A., LPC                                     EMP
Mastering Manipulation
  George Burnetz, M.Ed., NCC-LPC                       EMP
5Co Morbids and Medication Management
   Debra Stokan, M.D.                                          AMP 

11:45 - 1:15 Lunch (on your own) 

12:30 - 1:10 Special Sessions—No CEs—Registration not required 
The Doctor Is In, Meds Q & A
  Bernard Rosenberg, M.D.
The Advocate Is In, IDEA and 504 Q & A
  Laura Peddicord, Advocate & Robin Rettie, M.Ed.
3 Clips from Video, Father to Father: Expert Advice on ADHD Dad’s Video
  Chris ZeiglerDendy, M.S. & Tommy Dendy, B.S.
4 Organizing and Leading Support Groups for ADHD
  Aaron Fink, M.D. 

1:15 - 2:15 
Utilization of New Technology in the Evaluation and Treatment of ADHD (Part 1)          
  Jay D. Tarnow, M.D. & Ron J. Swatzyna, Ph.D., LCSW                                             AEMP  
Managing Motivation and Procrastination
  Eddie Rodriguez, B.S., ACT                                 AM
Off the Wall Approaches
  George Burnetz, M.Ed., NCC-LPC                       EMP
Teaching Strategies to Enhance Executive Functions
  Chris Dendy, M.A.                                               EP 

2:15 - 2:45 Beverage Break 

2:45– 3:45 
Utilization of New Technology in the Evaluation and Treatment of ADHD (Part 2)           AEMP   
  Jay D. Tarnow, M.D. & Ron J. Swatzyna, Ph.D., LCSW
2 Sunrise, Sunset – Circadian Rhythms and Learning
  Joshua Rotenberg, M.D                                       AEMP
3 Structured Discipline Communication: Helping Children with Attention Problems 
   Listen,Cooperate and Do!      
   Earl S. Saltzman, Ph.D.                                     EMP
Organization and Task Management
  Evan Weinberger, PH.D.                                      AEMP
Father to Father: Expert Advice on ADHD
  Chris Zeigler Dendy, M.S                                      AMP

3:45 - 4:00 Break 

4:00 - 5:00
Surviving the Ride: Parenting Challenging Teens with ADHD
  Chris Zeigler Dendy, M.S.  & Tommy Dendy, B.S.                                                       EMP
Story as a Mode of Social Skill Instruction for Students
 Thomas Merriman, Ed.D.                                      EMP
Paper, Paper Everywhere
  Ellen Delap, CPO                                                AEMP
Interpersonal Relationships                                 AM
Ethical Decision Making
  Robbie Sharp, Ph. D.***

*** qualifies for ethics credits              
A - Adults with ADD, Spouses, Parents of adult children, E - Educators M - Mental Health Professionals P - Parents of Children with ADD/ADHD