News: Pediatric Neurology Epilepsy Sleep Medicine Brain Injury - Houston Children & Families

Going to a Illness Specific Multispecialty Clinic - like Cacna1a or others? Here are pro-tips to make optimize the visit.

2025-07-18T08:50:00.004-05:00

Going to a Illness Specific Multispecialty Clinic - like Cacna1a or others?

Here are pro-tips to make the time valuable.

Feedback is always welcome in comments!

Step Zero: Prepare

Make a binder with different sections (specialist consultations for each problem, imaging, eeg, sleep studies, school and neuro-psychtesting)
Look for what other specialists are at that institution who might be helpful.
Plan to do a few fun things if you can.

What to prepare -

✅ General Neurology / Genetics

Full genetic testing reports (include any re‑interpretation letters).
Family history notes (migraines, ataxia, seizures, behavioral issues).
Prior neurology consults or clinic notes.

✅ Epilepsy Team

EEG reports (routine, prolonged, video EEG). Bring CDs/USB if possible.
Seizure history:
• Age of onset, type (describe what happens), frequency, duration, triggers.
• Current rescue plan (e.g., diazepam, midazolam).
• Medication history: all antiseizure drugs tried, doses, side effects, why stopped.
Seizure diaries (even handwritten or phone app screenshots).

✅ Movement Disorders Team

Notes from PT/OT or previous movement evaluations.
Videos of episodes: dystonia, tremor, ataxia, gait problems.
Details on triggers (illness, fatigue, certain activities).
Adaptive equipment or orthotics used.
Response to meds like acetazolamide or 4‑aminopyridine (if tried).

✅ Behavioral Neurology / Neurodevelopment

Neuropsychological evaluations (attention, memory, executive function).
School reports/IEP or therapist notes (speech, occupational therapy, behavioral plans).
Notes on mood, sleep, anxiety, irritability, sensory issues.
History of behavioral interventions tried and results.

✅ Ophthalmology, GYN issues, Physiatry (teens should have bone labs)

✅ Imaging and Other Studies

Brain MRI (with radiology report) on CD/USB.
Any other scans (CT, PET, etc.).
Relevant labs (metabolic panels, vitamin levels, etc.).
Taking acetazolamide - monitoring labs

🧭 2. The Summary Sheet

Bring a one‑page overview for quick reference:

Child’s name, age, primary diagnosis (CACNA1A mutation details).
Key symptoms (ataxia, seizures, behavior concerns).
Key events
Current medications and doses.
Current supplements
Most important questions/concerns for this visit.
Multiple copies!

🎥 3. Capture Episodes - Video the sweet and the sour.

Specialists appreciate short videos to see subtle or uncommon phenomena:
Record seizures, migraine auras, unusual movements, tremors, or gait difficulties. Note time of day and what was happening before the episode (trigger context).
Our kids do the unexpected. Bring videos of the great things they do. Neurologists often have this idea that a tired, scared child will offer the information they need for exam.

✨ 4. Questions to Ask Each Specialty

Movement Disorders

Are there medications or therapies that could improve ataxia/dystonia?
Should we consider 4‑aminopyridine, acetazolamide, or other channel therapies?
AQNeursa
Are there adaptive devices that could help (walkers, orthotics)?

Epilepsy

Do you recommend any medication adjustments or further monitoring?
Is epilepsy surgery, VNS, or ketogenic diet ever considered in CACNA1A cases?
What rescue plan do you recommend for prolonged events?

Behavioral Neurology

What strategies help with executive dysfunction, attention, or mood?
Are there specific behavioral therapies or medications that work best in CACNA1A?
Are there known links between CACNA1A and autism spectrum or ADHD‑like traits?
What is the Cerebellar Cognitive Affective syndrome.
What school recommendations / accommodations do you recommend.

Multidisciplinary / Big‑Picture

Are there clinical trials or registries we should join?
What screening or surveillance should we do annually?
How do we best coordinate care between home neurologist and the " team" ?

🧰 5. Practical Items to Bring

All current medications (or a photo of labels).
Fun or distracting items (headphones, favorite toy, snacks).
Mobility aids (stroller, wheelchair) if needed.
Charging cables / batteries for devices.
Insurance cards and referral/preauth paperwork.

💡 6. Pro Tips

Take notes use voice to text apps or bring someone to help document what each specialist says.
Ask for a written care plan or summary at the end of the visit.
If possible, send records to the clinic ahead of time (they often have a secure upload link) so specialists can review before you arrive.
Scan all your originals.
Have reasonable expectations. You are human beings and you likely have a lot of information for them to take in. Plan a zoom followup.
Here is a form that you can copy and customize

Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders

2025-03-03T16:36:00.001-06:00

Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders

Abstract

Background

Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects.

Objective

We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson’s disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction.

Methods

Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies.

Results

Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson’s disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy).

Conclusion

All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.

Full article here

What is Transcranial Direct Current Stimulation

2025-02-23T18:21:00.001-06:00

The basics of transcranial Direct Current Stimulation (tDCS):

Transcranial Direct-Current Stimulation (tDCS) is a portable, wearable brain stimulation technique that delivers a low electric current to the scalp. A fixed current between 1 and 2 mA is typically applied1. tDCS works by applying a positive (anodal) or negative (cathodal) current via electrodes to an area. tDCS is a neuromodulation technique that produces immediate and lasting changes in brain function. The position of the anode and cathode electrodes on the head is used to set how current flows to specific brain regions. The current delivered by tDCS is NOT strong enough to trigger an action potential in a neuron; instead its “sub-threshold” .....

MORE HERE

"tACDC" - Blended Transcranial Electrical Stimulation for Childhood Autism & ADHD : Evaluation of Procedural Feasibility

2025-02-20T16:55:00.007-06:00

"tACDC" - Blended Transcranial Electrical Stimulation

for Childhood Autism & ADHD : Evaluation of Procedural Feasibility"

Poster presentation at the International Brain Stimulation Conference 2025

Kobe, Japan

Alexandria Elkhadem - 1; Joshua Rotenberg, MD - 1

1-Houston Specialty Clinic

TDCS for Depression - Better than sham

2024-12-04T18:04:00.000-06:00

Article Abstract

More literature HERE

https://www.ncbi.nlm.nih.gov/sites/myncbi/103bGJGeIgzQv/collections/59242511/public/

Transcranial Electrical Stimulation (tES) using TDCS for ADHD and Autism

2024-05-17T12:09:00.005-05:00

We are excited to introduce a new complementary treatment option available at our clinic, Transcranial Electrical Stimulation (tES).

TES using direct current stimulation (TDCS) has shown promising results for individuals with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD).

Transcranial Electrical Stimulation is a non-invasive procedure that involves the application of a low-intensity electrical current to the scalp. This current is thought to influence brain activity and has been studied for its potential benefits in various neurological and psychiatric conditions.

For individuals with ASD, tES has been explored as a way to enhance cognitive abilities and address core pathologies of autism. Studies have suggested that tES could improve mini-columnar morphology and gamma oscillations in the brain, which are areas that can be atypical in individuals with ASD 1.

In the case of ADHD, tES, particularly transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex, has been investigated for its ability to improve cognitive control and impulse regulation. This could lead to significant improvements in cognition and impulse control for those with ADHD 2.

It’s important to note that while tES has very few potential side effects, it is an emerging therapeutic tool. It is still considered complementary for ASD and ADHD, meaning it is not meant to replace standard treatments.

Does tES hurt? In studies, subjects rated the discomfort as between watching TV and going to the dentist.

Our clinic is committed to providing the latest and most effective treatments, and the data indicates that tES offers a new avenue for improving the quality of life for our patients with ASD and ADHD.

If you or a loved one are interested in exploring this treatment option, we invite you to schedule a consultation.

Who is not a candidate?

Consider if they can sit still and tolerate mild discomfort for 30 minutes? If not, this treatment may not be the right fit.
Skull defects and transcranial metal surgical implants may preclude this treatment.

During this consultation, we will discuss the potential benefits, the procedure, and any questions you may have.

Your health and well-being are our top priority, and we are here to support you.

To learn more check our website link here. Please do not hesitate to reach out to us for more information or to arrange an appointment.

Ask about other uses:

Traumatic brain injury
Stroke
Multiple sclerosis
Movement disorders
Memory difficulties
Headaches
Major depressive disorder
Schizophrenia
Craving in substance use disorders
Obsessive-compulsive disorder
Mild cognitive impairment

New Home Sleep Apnea test for Children and Adults

2024-05-17T11:53:00.002-05:00

What is the SleepImage Ring (SIR) ?

The SIR is a simple, comfortable device that adult and pediatric patients can wear on their finger overnight. It has been cleared by the FDA for the diagnosis and management of sleep-disordered breathing, including obstructive sleep apnea (OSA) and central sleep apnea (CSA).

Here are some of the key benefits of this testing :

Ease of Use: The ring is designed to be worn on any finger, ensuring a snug fit without discomfort. This user-friendly approach allows for a more natural sleep study experience 1.

Comprehensive Data Collection: During sleep, the ring streams raw physiological data to a mobile app, which then uploads the data for analysis. This process provides extensive data that is interpreted by our specialists 1.

FDA-Cleared for Children and Adults: The SleepImage system is suitable for use in children over the age of 2 and adults 1.

In-Home Convenience: Patients to conduct sleep studies in their natural sleeping environment, reducing the likelihood of an overnight stay in a sleep clinic. By reducing the stress associated with traditional sleep studies, more patients can be screened 2.

Tracking Treatment Progress: The SIR helps in monitoring the effectiveness of treatments 3.

Cost-Effective: With the SIR, we offer patients a cost-effective alternative to traditional polysomnography4.

Why are the kids waiting for sleep studies and EEG? Why are they paying so much?

2024-05-17T10:09:00.001-05:00

Subject: Why are the kids waiting for sleep studies and EEG? Why are they paying so much?

Dear Referring Physicians and Health Care Professionals,

I hope this message finds you well. I am writing to (re)-introduce you to Academy Diagnostics’ sleep & EEG diagnostics services. Our commitment to excellence and to personal care sets us apart. We are proud to carry the gold-standard AASM (American Academy of Sleep Medicine) accreditation for over 10 years.

Our Services:

Pediatric Sleep Studies and Adult Sleep Studies: Our state-of-the-art facility is equipped to perform comprehensive sleep studies for children of all ages. From infants to adolescents, we tailor our assessments to meet the unique needs of pediatric patients.

EEG Testing: We offer advanced EEG monitoring services, aiding in the diagnosis and management of various neurological conditions.

Why Choose Academy Diagnostics?

Expertise: Our team of board-certified pediatric sleep specialists and neurologists has extensive experience.
Child-Friendly Environment: We understand the importance of creating a comfortable and reassuring atmosphere for young patients.
Timely Reporting: Prompt turnaround time for test results ensures timely intervention and treatment planning.
360 Sleep Medicine Care: A sleep center is more than a testing facility, it includes access to board certified sleep medicine specialists to support a comprehensive care plan.

Openings for Studies: We currently have openings for studies in the next 1-2 months. If you have patients who may benefit from a prompt study, you may refer them today.

To schedule a direct sleep study or EEG, please contact Academy at 832-210-2405 or visit the Academy website at https://www.academysleepcenter.com

Thank you for entrusting your patients’ care to Academy Diagnostics. We look forward to improving the health and well-being of our young patients.

Sincerely,

Josh Rotenberg MD, Pediatric Neurology & Epilepsy

Sarat Susarla MD, Pediatric Pulmonology

www.houstonspecialtyclinic.com

Transcranial direct current stimulation for post-COVID fatigue: a randomized, double-blind, controlled pilot study

2024-05-09T15:22:00.003-05:00

We are offering this treatment as a complementary treatment. JR

Transcranial direct current stimulation for post-COVID fatigue: a randomized, double-blind, controlled pilot study

Fatigue is one of the most frequent and disabling symptoms of the post-COVID syndrome. In this study, we aimed to assess the effects of transcranial direct current stimulation on fatigue severity in a group of patients with post-COVID syndrome and chronic fatigue. We conducted a double-blind, parallel-group, sham-controlled study to evaluate the short-term effects of transcranial direct current stimulation

. The modified fatigue impact scale score was used as the primary endpoint. Secondary endpoints included cognition (Stroop test), depressive symptoms (Beck depression inventory) and quality of life (EuroQol-5D). Patients received eight sessions of transcranial direct current stimulation and were evaluated at baseline, immediately after the last session, and one month later. Forty-seven patients were enrolled (23 in the active treatment group and 24 in the sham treatment group); the mean age was 45.66 ± 9.49 years, and 37 (78.72%) were women. The mean progression time since the acute infection was 20.68 ± 6.34 months. Active transcranial direct current stimulation was associated with a statistically significant improvement in physical fatigue at the end of treatment and 1 month as compared with sham stimulation.

No significant effect was detected for cognitive fatigue. In terms of secondary outcomes, active transcranial direct current stimulation was associated with an improvement in depressive symptoms at the end of treatment.

The treatment had no effects on the quality of life.

All the adverse events reported were mild and transient, with no differences between the active stimulation and sham stimulation groups.

In conclusion, our results suggest that transcranial direct current stimulation on the dorsolateral prefrontal cortex may improve physical fatigue.

Further studies are needed to confirm these findings and optimize stimulation protocols.

https://academic.oup.com/braincomms/article/5/2/fcad117/71117

Neuromodulation for appetite control in Prader Willi

2021-04-18T19:10:00.002-05:00

More literature how TDCS can modify food craving in Prader Willi.

Call our office for an appointment to see if your child is a candidate.

Abstract

Prader–Willi syndrome (PWS) is a neurodevelopmental genetic disorder characterized by multiple system involvement with hypotonia, poor suck with feeding difficulties, growth and other hormone deficiencies, intellectual disability, and behavioral problems with childhood onset of hyperphagia resulting in obesity, if not externally controlled. Transcranial direct current stimulation (tDCS) has been increasingly shown to modulate cognitive and behavioral processes in children and adults, including food-intake behaviors in patients with PWS. This study further reports the positive effects of brief tDCS sessions on Go/NoGo task performance involving food and non-food stimuli images, alterations in N2 brain amplitude, and genetic subgroup differences (maternal disomy 15, UPD; 15q11-q13 deletion, DEL) before and after tDCS as assessed by event-related potentials (ERPs) in 10 adults with PWS. The results indicate a group effect on baseline NoGo N2 amplitude in PWS patients with DEL vs UPD (p =0.046) and a decrease in NoGo N2 amplitude following tDCS (p = 0.031). Our tDCS approach also demonstrated a trend towards decreased response time. Collectively, these results replicate and expand prior work highlighting neurophysiological differences in patients with PWS according to genetic subtype and demonstrate the feasibility in examining neuromodulatory effects of tDCS on information processing in this patient population to stimulate additional research and treatment.

https://praderwillinews.com/2021/04/15/noninvasive-brain-stimulation-suggests-better-appetite-pilot-study/

Covid Vaccine Availability Teens and Adults in Texas

2021-02-12T16:03:00.000-06:00

Looking for a covid vaccine?

Here is a link

Covid Vaccine Sites Houston Dallas Austin San Antonio

Concussion Mild Brain Injury in Children Lasts Longer than a Few Weeks

2021-02-07T19:28:00.004-06:00

Hate to spoil the Super Bowl ...

But, so many kids suffer from brain injury that is unrecognized. It’s true in Houston Texas and elsewhere.

Post Here

Autism and Maternal Antibodies

2021-02-05T11:53:00.005-06:00

This is an interesting article about association without a clinical application at this time.

Risk assessment analysis for maternal autoantibody-related autism (MAR-ASD): a subtype of autism

Alexandra Ramirez-Celis,
Martin Becker,
Miriam Nuño,
Joseph Schauer,
Nima Aghaeepour &
Judy Van de Water

Molecular Psychiatry (2021)Cite this article

10k Accesses
177 Altmetric
Metricsdetails

Abstract

The incidence of autism spectrum disorder (ASD) has been rising, however ASD-risk biomarkers remain lacking. We previously identified the presence of maternal autoantibodies to fetal brain proteins specific to ASD, now termed maternal autoantibody-related (MAR) ASD.

The current study aimed to create and validate a serological assay to identify ASD-specific maternal autoantibody patterns of reactivity against eight previously identified proteins (CRMP1, CRMP2, GDA, NSE, LDHA, LDHB, STIP1, and YBOX) that are highly expressed in developing brain, and determine the relationship of these reactivity patterns with ASD outcome severity. We used plasma from mothers of children diagnosed with ASD (n = 450) and from typically developing children (TD, n = 342) to develop an ELISA test for each of the protein antigens.

We then determined patterns of reactivity a highly significant association with ASD, and discovered several patterns that were ASD-specific (18% in the training set and 10% in the validation set vs. 0% TD).

The three main patterns associated with MAR ASD are

CRMP1 + GDA (ASD% = 4.2 vs. TD% = 0, OR 31.04, p = <0.0001),
CRMP1 + CRMP2 (ASD% = 3.6 vs. TD% = 0, OR 26.08, p = 0.0005)
NSE + STIP1 (ASD% = 3.1 vs. TD% = 0, OR 22.82, p = 0.0001).

Additionally, we found that maternal autoantibody reactivity to CRMP1 significantly increases the odds of a child having a higher Autism Diagnostic Observation Schedule (ADOS) severity score (OR 2.3; 95% CI: 1.358–3.987, p = 0.0021).

This is the first report that uses machine learning subgroup discovery to identify with 100% accuracy MAR ASD-specific patterns as potential biomarkers of risk for a subset of up to 18% of ASD cases in this study population.

Cannabis Epilepsy Trivia

2020-11-23T15:23:00.002-06:00

Cannabis Trivia

CBD has been in the news as a treatment for many conditions epilepsy. It was widely used for millennia by Indian "Arabian" and Persian medical traditions.

Q: When was cannabis first described in WESTERN medical literature as a TETANUS treatment?

A: 1839

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592602/pdf/brforeignmedrev70073-0231.pdf

Medication Use ADD ADHD and Risk of Motor Vehicle Crashes

2020-09-19T23:47:00.009-05:00

Is there a relationship between medication use and a LOWER risk of accidents?

Yes.

Short term? Yes.

Long-term? Yes.

Men? Yes.

Women? Yes.

Please take your medicines.

Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes

Question

Is the use of attention-deficit/hyperactivity disorder medication associated with a reduced risk of motor vehicle crashes in patients with the disorder?

Findings

In a national cohort study of 2 319 450 patients with attention-deficit/hyperactivity disorder, the use of medication for the disorder was associated with a significant reduction in the risk of motor vehicle crashes in male and female patients.

Meaning

Attention-deficit/hyperactivity disorder medication use may lower the risk of motor vehicle crashes, a prevalent and preventable cause of mortality and morbidity among patients with the disorder.

ADHD & Accidents Crashes Violations Suspensions in Motor Vehicles - New Data

2020-09-19T23:41:00.000-05:00

Do teens with ADHD have more accidents? More Moving Violations?

Yes. For Years,

Traffic Crashes, Violations, and Suspensions Among Young Drivers With ADHD

Allison E. Curry, PhD, MPH,a,b Benjamin E. Yerys, PhD,c,d Kristina B. Metzger, PhD, MPH,a Meghan E. Carey, MS,a and Thomas J. Power, PhDb,d

Abstract

Methods: We identified patients of New Jersey primary care locations of the Children's Hospital of Philadelphia who were born in 1987-1997, were New Jersey residents, had their last primary care visit at age ≥12 years, and acquired a driver's license (N = 14 936). Electronic health records were linked to New Jersey's licensing, crash, and violation databases. ADHD diagnosis was based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. We calculated monthly per-driver rates of crashes (at fault, alcohol related, nighttime, and with peers), violations, and suspensions. Adjusted rate ratios were estimated by using repeated-measures Poisson regression.

Objectives: To compare monthly rates of specific types of crashes, violations, and license suspensions over the first years of licensure for drivers with and without attention-deficit/hyperactivity disorder (ADHD).

Results: Crash rates were higher for drivers with ADHD regardless of licensing age and, in particular, during the first month of licensure (adjusted rate ratio: 1.62 [95% confidence interval: 1.18-2.23]). They also experienced higher rates of specific crash types: their 4-year rate of alcohol-related crashes was 2.1 times that of drivers without ADHD. Finally, drivers with ADHD had higher rates of moving violations (for speeding, seat belt nonuse, and electronic equipment use) and suspensions. In the first year of driving, the rate of alcohol and/or drug violations was 3.6 times higher for adolescents with ADHD.

Conclusions: Adolescents with ADHD are at particularly high crash risk in their initial months of licensure, and engagement in preventable risky driving behaviors may contribute to this elevated risk. Comprehensive preventive approaches that extend beyond current recommendations are critically needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6564068/figure/fig2/?report=objectonly

Central Auditory Processing Disorder - CAPD Teaching Suggestions

2020-08-04T18:31:00.006-05:00

Parents can use these at home too.

"Suggestions for Successful Management of Students with Central Auditory Processing Disorder (CAPD): Tips for the Teacher"

The student with a central auditory processing disorder (CAPD) will respond in a variety of ways to changes within their environment and instructional program. Management suggestions identified for a student with a CAPD should be based on the student’s individual profile of auditory processing strengths and weaknesses. Suggestions in this listing are in the areas of attention, preferential seating, instructions, preview and review, time, classroom adaptations, self-advocacy, and organizational strategies. The audiologist will select those strategies most appropriate for the student’s CAP profile."

Full PDF here

http://www.iag-online.org/resources/New-Items-2e/CAPD-TipsForTeachers.pdf

CAPD - Central Auditory Processing Disorder - Strategies

Attention

• Gain bi-sensory attention. Auditory processing is maximized when the same information is received simultaneously through different modalities. Therefore, it is important to gain the student’s visual as well as auditory attention before speaking with him or her.

• Speak at eye level. Whenever possible, speak at the student’s eye level, get close to the student, and face the student to provide clear visual and auditory information.

• Use cueing. It may be beneficial to work out a cueing system to help students become aware of times when they are not paying attention. These “pretuning” techniques help to focus the student’s attention on the subject coming up. Use words such as “listen,” “ready,” and “remember this one.”

• Assign peer partners. Assign a peer partner to the student with a CAPD. The peer partner can assist the student with a CAPD in activities such as paying attention, getting assignments listed, participating in small group projects, and tuning in for key information. Peer tutoring may also be a part of the buddy system if appropriate.

• Mark transitions between activities. Students with auditory processing difficulties often need more time to make transitions. Therefore, it is helpful and important to mark transitions between activities by clearly identifying the new activity by naming and explaining the sequence of steps needed to accomplish the task.

• Review and transition. Clearly closing an activity may be accomplished by briefly summarizing what the student should have learned and/or completed before transitioning to the next activity.

• Provide notetaking assistance. Because it is difficult to watch the teacher and take notes simultaneously, it may be helpful for the student to be able to get a copy of another student’s notes, to get a copy of the teacher’s notes, to have a study guide, and/or be able to record the lesson for future reference and study.

Flexible Preferential Seating

• Provide preferential seating distance. Seat the student near the primary sound source (e.g., teacher, television, computer, center activity area). A distance of three-four feet is the best, but a distance up to six-eight feet should be adequate. This allows the student to derive maximum benefit from both auditory and visual information cues.

• Avoid seating near noise sources. Seat the student away from competing or distracting noise sources (e.g., external noise sources, bathroom area, telecommunications equipment, aquarium). Seating away from windows and doorways also will reduce possible sources of distraction.

• Provide better ear option. Seat the student so that the better ear, if indicated, is directed toward the primary sound source. (The audiologist will provide this recommendation if appropriate.)

• Allow flexible preferential seating options. Allow flexibility in seating to continuously achieve the preferential seating advantage. This enables the student to attend and actively participate as the classroom activities and the teacher or other primary sound source change location.

• Provide quiet study/work area. Provide the student with a “private” or isolated area, such as a study carrel, for individual seatwork, testing, or tutoring. This helps to minimize the student’s problems in foreground/ background discrimination.

• Use daily routines. Use daily routines or schedules to help keep the student focused and organized.

• Use earplugs. If their use is recommended, allow the student to use earplugs or earmuffs during individual seatwork time to help tune out distractions.

• FM amplification. Use a personal or sound field FM system to improve access to auditory information, if this is indicated by the student’s CAP profile. Students with difficulty hearing in noise, integrating information, or organizing information may benefit from FM amplification. An audiologist should make the recommendation for an FM system. The teacher(s) will receive an in-service on the use of the FM system. 66 Instructions

• Speak in a clear, well-modulated voice. Speak distinctly, at a comfortably loud level, and at a rate the student can follow easily. Vary loudness to increase the student’s attention. Remember not to overexaggerate your speech. Emphasize important information using intonation and stress. Repeat important words when necessary.

• Use natural gestures. Use natural gestures that enhance the message. Avoid extraneous gestures and excessive movement while delivering the message if this appears to distract the student.

• Reduce distractions. Avoid extraneous noises and visual distractions, especially when giving instructions and teaching new concepts.

• Alert the student. Before giving instructions, stand close to the student, call the student’s name, and gently tap the student’s shoulder, or use another cue to make sure you have the student’s attention. Using the student’s name during teaching time also will help to maintain attention.

• Reduce motor activities during instruction time. Reducing motor activities during verbal presentations is helpful for some students with a CAPD, especially if the student has an integration deficit.

• Define purpose. State the purpose of each activity clearly and directly before introducing the specific instructions for task completion.

• Give age and ability-appropriate directions. Give direct and uncomplicated directions. Use age-appropriate vocabulary that clarifies the logical, time-ordered sequence (e.g., first, second, last).

• Repeat direction and allow ample response time. It may be necessary to repeat each step of the instruction and allow time between each step for the student to process the information.

• Provide examples. Work on an example together and leave the example on display.

• Use modeling. Use modeling to provide a clear demonstration of student performance expectations.

• Identify key words. Emphasize key words when speaking or writing, especially when presenting new information.

• Give written and verbal instructions. Provide both written and verbal instructions to aid the student in following directions and completing tasks.

• List the steps. To help the student learn multi-step sequences, list the steps on a reference card. As the student becomes more familiar with the sequence, steps in the written directions may be omitted gradually and systematically until the student is able to complete the sequence automatically without referring to the written cues.

• Encourage the student to ask for clarification. Encourage the student to ask questions for clarification of information. It may be necessary to rephrase the information to ensure that the student with a CAPD is able to comprehend. Also, some students with a CAPD have a language deficit and may not be familiar with key words. By substituting words and simplifying the grammar, the intended meaning may be conveyed and understood more easily.

• Repeat or paraphrase. Have the student repeat the content of the instructions to provide the comprehension feedback. This technique allows the teacher to see which parts of the instruction need to be corrected or repeated. Ask for verbal accounts rather than a “yes” or “no” response. Reinforce listening for meaning rather than exact repetition.

• Give positive feedback. It is important that students receive positive feedback to ensure understanding of the message or instruction correctly. Feedback is important even if the student understood only a portion of the message.

• Boost self-confidence. Many students with a CAPD lack of self-confidence due to comparisons made by themselves or others about their performance. Reinforcing all work performed successfully will help to alleviate this problem.

• Check instruction comprehension. Check the student’s work after the first few items to ensure that the student understood and retained the instructions. The teacher should watch for signs of inattention, decreased concentration, or understanding. Periodic comprehension checks (e.g., paraphrasing instructions, main idea, key points) are helpful to keep the student on task.

• Allow subvocalization. To help with reading comprehension, the student could be allowed to subvocalize while reading until such time as this is unnecessary.

• Allow reauditorization. Some students have a need to reauditorize information as they formulate their response. This strategy also strengthens the memory trace. 67 Preview and Review

• Review, preview, and summarize class lessons. For all class lessons, review previous material, preview material to be presented, and help students summarize the material presented. Discuss new and previously introduced vocabulary words and concepts. Whenever possible, relate new information to the student’s previous experiences and environment.

• Provide pre-teaching materials and assignments. Provide preassigned readings and home assignments to help introduce new concepts and topics.

• Avoid divided attention. Avoid asking students with a CAPD to divide their attention between listening and taking notes at the same time. Allow students to tape record lessons or provide students with a detailed outline of the information presented in the class lesson.

• Review and orient. Provide a short review statement about the topic(s) to be discussed to orient the student. Write a brief outline and list key vocabulary on the board or an overhead projector. Provide the student with a copy of the outline and key vocabulary to use in following the discussion and for review.

• Frequently summarize key points. Repeat and summarize key points frequently. Emphasize key vocabulary words during the discussion.

• Give salient clues. Give salient clues to identify and emphasize important information (e.g., “This is important,” “The main points are…,” “This could be a test question.”).

• Use verbal review strategies. Use verbal review strategies to ask questions periodically about the material being presented. This is a helpful topic maintenance strategy. Verbal review questions should include language required for description, explanation, exemplification, comparison, and relating real events to abstract principles.

• Give individual attention. Students with a CAPD often need individual attention. Inform resource personnel and parents of planned vocabulary and curriculum topics to be covered in the classroom to allow opportunity for pre-teaching as a supplement to classroom activities.

• Reference important pages. Refer students to important textbook pages for less review and preview.

• Encourage class participation. Encourage participation in expressive language activities related to each lesson. Reading is especially important since information and knowledge gained through reading help compensate for what may be missed because of auditory difficulties. Time

• Avoid fatigue. Students with a CAPD often become fatigued more easily than their peers. It is often difficult for the student to attend because of the effort required to keep up and compete in classroom activities. To minimize fatigue, consider the following suggestions. - Give several short classroom activities instead of one long activity. - Provide short periods of instruction with breaks so the student can move around if needed. - Alternate activities requiring greater auditory processing requirements with those that are less demanding. - Avoid higher-level auditory tasks when the student is already fatigued. (Consider presenting high-auditory content information during the morning.)

• Allow extended time. Students with a CAPD should be given adequate time to comprehend and complete tasks. Avoid giving penalties for not completing assignments in the prescribed classroom time. Whenever possible, give students fewer items to complete in the amount of classroom time available or give them additional time in the resource room to complete the assignment.

• Give adequate response time. It may be necessary to allow students with a CAPD more time to formulate responses to verbal questions, especially questions that include comparisons, generalizations, and explanations requiring lengthier and more complex language organization. Classroom Adaptations

• Record instructions. Class lessons or instructions can be recorded so that the student can listen to and review the material later.

• Sound tune the classroom. Acoustical modifications may be implemented to create a positive acoustical listening and learning environment (e.g., carpeting, drapes, sound absorbing materials).

• Arrange classroom. Structure the classroom to reduce background noise, reverberation, and distractions. Noise interferes with the reception of auditory information and distracts the listener from the complex task of processing (e.g., organizing and interpreting) information. Special areas for small group instruction that are relatively quiet and distraction-free are helpful for many students.

• Avoid open classrooms. Avoid open classroom settings for students with a CAPD. In these settings, reduce distractions by using sound barriers (e.g., bookshelves, flannel boards) and other modifications to improve the listening environment.

• Close windows and doors. Keep doors and windows closed to reduce external noise entering the classroom.

Self Advocacy

• Encourage self-monitoring. Encourage the student to self-monitor the listening environment and identify any problems that may be interfering with the learning process.

• Encourage self-advocacy. Encourage the student to self-regulate by using strategies to modify conditions and situations that may compromise effective learning. This will assist the student in learning self-regulation strategies and becoming an effective manager of his listening and learning environment.

• Suggest counseling. If necessary, the student should be referred for counseling for social/emotional concerns as part of the management plan. The student (and parents) needs to understand the nature of the CAPD and why it is essential to develop compensatory strategies.

Organizational Strategies

• Encourage the use of agenda book or other organizers. Encourage the student to consistently use an agenda book (or other organizer or calendar) to ensure that assignments, upcoming events, and other important class information are recorded.

• Clearly present organizational expectations. Ensure that the student understands specific organizational expectations for the classroom (e.g., where to place homework, use of folders, required classroom tools). Use cue cards as reminders.

Vitamin D and Covid-19

2020-05-11T21:04:00.000-05:00

Covid-19 Prevention with Vitamin D

Vitamin D levels appear to play role in COVID-19 mortality rates

Patients with severe deficiency are twice as likely to experience major complications

Date:: May 7, 2020
Source:: Northwestern University
Summary:: Researchers analyzed patient data from 10 countries. The team found a correlation between low vitamin D levels and hyperactive immune systems. Vitamin D strengths innate immunity and prevents overactive immune responses. The finding could explain several mysteries, including why children are unlikely to die from COVID-19.

Covid-19 & Congenital Muscular Dystrophy - Preparation and Airway Clearance

2020-04-23T22:35:00.002-05:00

Check with your pulmonologist if this advice is best for you / your child. I am just a pediatric neurologist. Please call them. JR

Autism, CBD-Low THC Presentation

2020-04-21T17:01:00.003-05:00

Thank you to Compassionate Cultivation for coordinating the early AM Zoom meeting. FYI ...Im tired. JR

Autism and CBD

Overview

I am discussing a complementary treatment
The Low THC CBD program (TCUP) is NOT recreational cannabis.
I am treating a diverse population of neurologically complex individuals.
People with autism have significant problems that impact their lives AND the lives of others.
Cannabinoids have a biologic basis for efficacy
Clinical data for indication, risks is emerging but exists.
Link to a selection of PEER-REVIEWED articles (pro and con)

What is a Complementary Treatment? Added therapy BEYOND Standard treatment.

AUTISM and the ENDO Cannabinoid System - see below

Caveats - Complementary therapies will:

(1) provide a reasonable potential for therapeutic gain and (2) do not unreasonably place the patient's medical condition at risk.

(2) ... there is a professional obligation on physicians to:

(a) investigate, understand and assess whether the underlying therapeutic basis is designed to improve a patient's overall quality of life (even anecdotally and for limited a duration) and to

(b) ensure that the therapy is not medically contraindicated

BACKGROUND

Incidence of Autism in Children

In March 2014, the Center for Disease Control released a new estimate for children with an autism spectrum disorder. According to the CDC, one in 68 children have ASD, which is a 30 percent increase over the previous estimate of one in 88.

Assuming there are approximately 7 million children in Texas (2016):

102,941 have autism
14,700 have mild cognitive impairment
9,100 have moderate and severe cognitive impairment
In comparison, about 70,000 children have epilepsy in Texas and about 14,000 have refractory epilepsy.

Theoretically, about 77,000 Texas children have autism and insomnia.

Incidence of Insomnia in Children with autism, cognitive impairment

Insomnia in children with ASD occurs across all cognitive levels, and the prevalence may be as high as 60–86%, which is two to three times greater than typically developing (TD) children [3, 7, 22–27].
20% agitation.

Outcomes for insomnia in Children

Accidents
Elopement
Medicine side effects
Poor daytime functioning / adverse developmental outcome

What medicines are FDA-approved for insomnia in children? None.

Medications such as benzodiazepines (e.g.valium) and diphenhydramine (e.g Benadryl) were shown to have paradoxical, excitatory or even SEIZURE-provoking response.

What medicines are used? What are the side effects?

Melatonin followed by α-agonists (e.g clonidine)
Anti-Depressants (e.g.trazodone)
Anti-Psychotics
Anti-Convulsants
"In general pediatric insomnia, antihistamines are prescribed most commonly (n = 8367 [88.6%]), followed by antipsychotic agents (n = 465 [4.9%]), α-adrenergic receptor agonists (n = 399 [4.2%]), and selective serotonin reuptake inhibitors (n = 159 [0.1%]).”

What about Commercial CBD Products?

Safety
Reliability
Watch for pesticides, lead – other health problems

Texas MCD – estimate of expenditures

Costs: ASD costs a family $60,000/year on average

What number of physician visits for insomnia?

The prevalence of sleep problems among typically developing children is as high as 25%.
In one study of outpatient general pediatric visits “potentially sleep-related medications were prescribed for 6.1% of children (n = 9441)”.
The Endocannabanoid System in Autism Click For the article

Autism and Cannabis - The published Israeli Experience Click For the article

Autism and Cannabis and Sleep: Peer- Reviewed Literature Search

Autism and Cannabis CBD THC - Join US for a Morning Discussion

2020-04-16T18:50:00.003-05:00

Curious About Medical Cannabis And Autism?

When: Tuesday, April 21st, 2020 at 7:30 AM

Space is limited so register TODAY!

Join us for an interactive discussion with Dr. Joshua Rotenberg, Pediatric Neurologist. Dr. Rotenberg will be sharing his knowledge and experience as a physician in the Compassionate Use Program treating pediatric patients diagnosed with Autism.

Dr. Joshua Rotenberg practices at Houston Specialty Clinic.

We are accepting questions in advance! To submit a question to be answered during the discussion, please submit here.

We look forward to you joining us!

Compassionate Cultivation proudly supports the entire Autism Community.

Online Zoom / FB Live discussions Autism and the Texas Compassionate Use Program

Is your pediatric neurologist board-certified?

2020-04-12T08:09:00.003-05:00

It is important to ask if your physician, in my case, a child neurologist is board-certified.

Pediatric Neurology Telemedicine Tips

2020-03-25T22:25:00.000-05:00

A NICE GRAPHIC. EXCEPT, WE TRY TO GET PEOPLE USED TO THE PLATFORM WELL-BEFORE VISITS. - JR

Pediatric Neurology Telemedicine Tips

Child & Adolescent Neurology TELEMEDICINE

Pediatric Pulmonary TELEMEDICINE

Sleep Disorders Telemedicine

Pediatric Neurology Coronavirus Emergency Telemedicine link HERE!

Pediatric Neurology Services at Home During Corona / Covid -19

2020-03-19T11:54:00.002-05:00

Social Distancing Saves Lives in Child Neurology Too

19 March 2020

To: HSC Houston Specialty Clinic Child Adolescent Neurology Patients

Subject: Dr. Rotenberg, Kara Schmidt, Testing and EEG - Appointments during Coronavirus Emergency

The State of Texas is in the midst of a public health emergency due to coronavirus.
It is imperative to “flatten the curve” of this pandemic by practicing strict social distancing.
Our practice is committed to our patients' needs.
We need to make changes to safely deliver care under these unusual circumstances.
Telemedicine visits are an established part of our practice. It's business as usual.

Therefore, effective immediately:

All appointments will be moved to telemedicine status ONLY.
New patients will be completed by telemedicine ONLY.
Most testing, dietician consults will be completed by telemedicine.
There will be very few exceptions based on medical need.
EEG visits will be rescheduled to a different time or place.

Regarding pulmonary: Dr. Susarla to release updated guidelines later today.

This process will stay in place during the course of this emergency.

Please call your insurance and/or employer to check telemedicine benefits.

Thank you,

Dr. Rotenberg

Information on Covid19

https://www.facebook.com/groups/coronavirus.houston/

http://publichealth.harriscountytx.gov/Resources/2019-Novel-Coronavirus

Texas Telemedicine

Governor Abbott Waives Certain Regulations For Telemedicine Care In Texas

March 17, 2020 | Austin, Texas | Press Release

Governor Greg Abbott today waived certain regulations and directed that the Texas Department of Insurance (TDI) issue an emergency rule, all relating to telemedicine care for patients with state-regulated insurance plans to help doctors across Texas continue to treat their patients while mitigating the spread of COVID-19. The suspensions and emergency rule will work together to allow telemedicine visits for patients with state-regulated plans to be paid the same as in-office visits for insurance purposes. These actions build upon waivers the Governor issued last week of portions in the Occupations Code to expand provider flexibility in providing medical services over the phone.

“As the State of Texas responds to COVID-19, we continue to work to maintain regular health care services and operations throughout the state, and telemedicine is one of the most valuable tools we have to ensure Texans continue to receive the health services they need,” said Governor Abbott. “Expanding telemedicine options will help protect the health of patients and health care professionals, and help Texas mitigate the spread of COVID-19.”

Doctors will be eligible for payment from insurance plans regulated by TDI for medical visits they conduct over the phone instead of in-person at the same rate they would receive for in-person visits.

Medical providers seeking guidance on the impact of the new rule can expect guidance from the Texas Medical Board to be issued in the coming days, including administrative guidance for billing to ensure that claims are processed smoothly.

Insurers seeking guidance on implementation of the emergency rule should contact TDI or visit their webpage for more information.

This coordinated efforts between the Office of the Governor, the Texas Department of Insurance, the Texas Medical Board, and health insurance plans will increase access to health care for all Texans. Today’s action will expand telemedicine options by giving health care providers greater flexibility to perform audio-only telephone consultations with their patients.

As a reminder, Texans covered by CHIP or Medicaid will not be charged copays for test or telemedicine consults. Individuals covered by Medicare or large employer plans should check with their health plan administrator to determine their specific benefits.

Epilepsy & Covid-19 Coronavirus

2020-03-18T13:37:00.001-05:00

Epilepsy Coronavirus Covid-19 - A great site from the Epilepsy Foundation

FB meetup on 18 March

CONTENT HIGHLIGHTS

Are people with epilepsy at higher risk of developing COVID-19 (coronavirus)?
Can COVID-19 increase seizures if a person gets the virus?
How can I get more medicine if my health care provider prescribes it?
Are there shortages in seizure medicines in the United States?
If COVID-19 is in my community, what should I do?
How do I protect myself from getting sick?
We are Here for You!

COVID-19 Epilepsy Information More Here

News: Pediatric Neurology Epilepsy Sleep Medicine Brain Injury - Houston Children & Families

Going to a Illness Specific Multispecialty Clinic - like Cacna1a or others? Here are pro-tips to make optimize the visit.

🧭 2. The Summary Sheet

🎥 3. Capture Episodes - Video the sweet and the sour.

✨ 4. Questions to Ask Each Specialty

Movement Disorders

Epilepsy

Behavioral Neurology

Multidisciplinary / Big‑Picture

🧰 5. Practical Items to Bring

💡 6. Pro Tips

Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders

Abstract

What is Transcranial Direct Current Stimulation

"tACDC" - Blended Transcranial Electrical Stimulation for Childhood Autism & ADHD : Evaluation of Procedural Feasibility

TDCS for Depression - Better than sham

Efficacy and acceptability of transcranial direct current stimulation (tDCS) for major depressive disorder: An individual patient data meta-analysis

Transcranial Electrical Stimulation (tES) using TDCS for ADHD and Autism

New Home Sleep Apnea test for Children and Adults

Why are the kids waiting for sleep studies and EEG? Why are they paying so much?

Transcranial direct current stimulation for post-COVID fatigue: a randomized, double-blind, controlled pilot study

Neuromodulation for appetite control in Prader Willi

Abstract

Covid Vaccine Availability Teens and Adults in Texas

Concussion Mild Brain Injury in Children Lasts Longer than a Few Weeks

Autism and Maternal Antibodies

Abstract

Cannabis Epilepsy Trivia

Medication Use ADD ADHD and Risk of Motor Vehicle Crashes

Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes

Question

Findings

Meaning

ADHD & Accidents Crashes Violations Suspensions in Motor Vehicles - New Data

Traffic Crashes, Violations, and Suspensions Among Young Drivers With ADHD

Allison E. Curry, PhD, MPH,a,b Benjamin E. Yerys, PhD,c,d Kristina B. Metzger, PhD, MPH,a Meghan E. Carey, MS,a and Thomas J. Power, PhDb,d

Abstract

Central Auditory Processing Disorder - CAPD Teaching Suggestions

Vitamin D and Covid-19

Vitamin D levels appear to play role in COVID-19 mortality rates

Patients with severe deficiency are twice as likely to experience major complications

Covid-19 & Congenital Muscular Dystrophy - Preparation and Airway Clearance

Autism, CBD-Low THC Presentation

Autism and Cannabis CBD THC - Join US for a Morning Discussion

Curious About Medical Cannabis And Autism?

When: Tuesday, April 21st, 2020 at 7:30 AM

Space is limited so register TODAY!

Is your pediatric neurologist board-certified?

Pediatric Neurology Telemedicine Tips

Pediatric Neurology Services at Home During Corona / Covid -19

Governor Abbott Waives Certain Regulations For Telemedicine Care In Texas

Epilepsy & Covid-19 Coronavirus

Concerns About COVID-19 (Coronavirus) and Epilepsy