About The Practice

Serving Texas Children's Concerns about Neurology, Epilepsy Developmental & Sleep Disorders. Advanced spasticity management.

The Houston Area ( Bellaire Katy Sugar Land Richmond Missouri City Cypress The Woodlands Lake Jackson)

The Greater San Antonio Area ( New Braunfels Seguin Central Texas)

Dr Joshua Rotenberg. Board Certified in Neurology with Special Qualifications in Child Neurology.

Dr. Rotenberg has added subspecialty board certification in epilepsy AND sleep disorders (American Board of Psychiatry & Neurology-Child Neurology).

Member - American Epilepsy Society

Member - American Academy of Cerebral Palsy & Developmental Medicine

Texas Medical & Sleep Specialists - Children & Adults Welcome. WWW.TXMSS.COM 713-464-4107

Saturday, November 22, 2014

TED Talk:One more reason to get a good night’s sleep - Loss of sleep is a waste!

Loss of sleep is a waste! Get rid of the day's garbage....seriously...

This is a great talk!


Jeff Iliff: One more reason to get a good night’s sleep

. It's something we spend about a third of our lives doing, but do any of us really understand what it's all about?
0:19Two thousand years ago, Galen, one of the most prominent medical researchers of the ancient world,proposed that while we're awake, our brain's motive force, its juice, would flow out to all the other parts of the body, animating them but leaving the brain all dried up, and he thought that when we sleep, all this moisture that filled the rest of the body would come rushing back, rehydrating the brain and refreshing the mind. Now, that sounds completely ridiculous to us now, but Galen was simply trying to explainsomething about sleep that we all deal with every day. See, we all know based on our own experiencethat when you sleep, it clears your mind, and when you don't sleep, it leaves your mind murky. But while we know a great deal more about sleep now than when Galen was around, we still haven't understood why it is that sleep, of all of our activities, has this incredible restorative function for the mind.
1:17So today I want to tell you about some recent research that may shed new light on this question. We've found that sleep may actually be a kind of elegant design solution to some of the brain's most basic needs, a unique way that the brain meets the high demands and the narrow margins that set it apart from all the other organs of the body...
Link here

Friday, November 21, 2014

Medication to help children with life threatening seizures

Research has shown that an investigational medication can help treat children with potentially life threatening seizures.

In its first clinical application in pediatric patients, an investigational medication developed and manufactured at UC Davis has been found to effectively treat children with life-threatening and difficult-to-control epileptic seizures without side effects, according to a research report by scientists at UC Davis and Northwestern University.
The investigational formulation of allopregnanolone was manufactured by UC Davis Health System's Good Manufacturing Practice Laboratory. Two children were treated with the allopregnanolone formulation, one at UC Davis Children's Hospital, the other at the Ann & Robert Lurie Children's Hospital in Chicago. Both children were weaned from general anesthetics and other seizure treatments and their seizures resolved. In both instances the children are recovering.
The research is published online in Annals of Neurology, an official journal of the American Neurological Association and the Child Neurology Society.
Super-refractory status epilepticus is a condition diagnosed in patients with refractory status epilepticus being treated with infusions of general anesthetics when seizures continue for longer than 24 hours, despite anesthesia, or when seizures recur on reduction or withdrawal of the anesthesia. Super-refractory status epilepticus has high morbidity and mortality. There are no Food and Drug Administration (FDA)-approved treatments for the condition.
Allopregnanolone is a positive allosteric modulator of GABAA receptors in the brain. Research in animals has shown that allopregnanolone protects against seizures and can stop status epilepticus. Although the allopregnanolone used to manufacture the investigational treatment was produced by chemical synthesis according to procedures regulated by the FDA, it is synthesized normally in small quantities in the body from progesterone.
"Our laboratory studies have shown that allopregnanolone is effective in stopping status epilepticus that is refractory to treatment," said Michael Rogawski, professor in the UC Davis Department of Neurology and a co-author of the report.
In both of the clinical cases, the patients continued to have seizures despite weeks of intensive treatment with medications, including infusion of anesthetics. Emergency treatment with the investigational medication was approved by the FDA; the two patients received the medication over a five-day period, during which time both were weaned from anesthetics and other seizure medications. Status epilepticus did not recur after treatment. There were no adverse drug effects, the researchers said.
Mortality rates in super-refractory status epilepticus can be as high as 50 percent, and those who survive experience high rates of subsequent neurological impairment. The authors note that progesterone and ganaxolone, a chemical analog of allopregnanolone, have been studied in clinical trials for epilepsy and have shown benefit. Researchers at UC Davis, led by Rogawski, currently are investigating the use of allopregnanolone as a treatment for traumatic brain injury.
"Neurosteroids, including allopregnanolone, are a promising treatment for epilepsy and refractory status epilepticus that may overcome resistance to benzodiazepines and barbiturates and facilitate the withdrawal of these agents by preventing rebound seizures, a key problem in treatment of super-refractory status epilepticus," Rogawski said.
Read more here

Researching darting mice could help study ADHD, autism, and bipolar disorder

A study of mice with darting behavior could help research ADHD, autism, and bipolar disorder in humans.

A darting mouse may hold an important clue in the development of Attention Deficit Hyperactivity Disorder (ADHD), autism and bipolar disorder, according to a study by a Vanderbilt University-led research team recently published in the Proceedings of the National Academy of Sciences.
The transgenic mouse, into which was inserted a rare human genetic variation in the dopamine transporter (DAT), could lead to improvements in the diagnosis and treatment of these all-too-common brain disorders, said Randy Blakely, Ph.D., the report's senior author.
The mutation, which has been found in people with ADHD, autism and bipolar disorder, affects the function of DAT, a protein that regulates the brain's supply of the neurotransmitter by removing excess dopamine from the synapse, or the space between nerve cells.
The DAT mutation causes the transporter to become "leaky" and spew out dopamine like "a vacuum cleaner in reverse," said Blakely, Allan D. Bass Professor of Pharmacology.
While mice with leaky DAT proteins have too much dopamine hanging around their synapses, surprisingly they aren't particularly hyperactive, possibly because DAT can still remove some of the dopamine.
But the mice exhibit an unusual "darting behavior." While their wild-type littermates are docile and quite unresponsive when researchers pick them up, those with the mutation "take off."
"Early on," Blakely said, "we could tell which ones carried the mutation by observing this response." Heightened anxiety does not appear to be the cause.
Blakely and his colleagues wonder whether this behavior is a form of "impulsivity." Rather than acting on their memories of being picked up a lot, the mice are opting for an inappropriate escape strategy.
Normal mice also stand up a lot to explore their cage. This "rearing" behavior is exacerbated by stimulant drugs. But not in these mice.
"We wonder whether this may be a sign that their behavior is driven less by searching for clues to appropriate behavior versus acting on innate impulses," Blakely said.
Other, better tests of impulsivity that evaluate premature decision-making can be applied in rodents and humans. "These tests are next on our docket," he said.
The actions of amphetamine and methylphenidate (Ritalin) are also affected by the mutation. In normal animals and people without ADHD, the stimulants flood the synapse with dopamine, eliciting hyperactivity.
But when given to the mutant animals, the drug demonstrates a "blunted" effect on both dopamine release and on locomotor activation compared to normal animals.
Blakely wonders whether stimulants like Adderall and Ritalin quell hyperactive and impulsive behaviors in some children with ADHD by reducing inappropriate dopamine leak. "These mice may give us much better clues as to how these drugs are acting," he said.
To that end, Blakely recently received a five-year, $2-million grant from the National Institutes of Health (NIH grant number MH109054) to pursue explorations of these mice.
"Dopamine has classically been implicated in reward and the ability to detect novelty and to respond to pleasure and to engage in effective social interactions," he continued. The darting mice thus might shed light on a much broader spectrum of behaviors.
"We've got a lot to do," he said, "a lot of needy people (to help)."
Read more here

Tips on how to use a sleep tracker

Sleep experts provide tips on how to use a sleep tracking device.

Sleeping in the 21st century has changed — these days, there are loads of gadgets to help you track every snore, shift and 2 a.m. bathroom break.

Sleep trackers come in all shapes and sizes. There are the wristbands, like the ones from Jawbone and FitBit. Smart watches could become all the rage once the Apple Watch goes on sale. And other sleep trackers do everything from sense movement from under the mattress and track breathing from the nightstand. 

Ultimately, they are trying to do the same thing: collect data on how much sleep people are getting and whether that sleep is any good. But once people get all of those numbers, what are they supposed to do with them? 

We asked three sleep experts how to get the most out of their sleep trackers. 

1. Take the long view

Don't freak out if you only got five hours of sleep last night. It's better to "examine the trends (e.g., several nights in a row), instead of just focusing on one night's data," Dr. Clete Kushida, medical director of the Stanford Sleep Medicine Center, told TODAY via email. 
It's about looking for troubling long-term trends, not fretting over whether last night's Frappuccino was a bad idea

2. Don't make things worse

Most likely, you don't sleep on your remote control or wear your favorite watch to bed. There is a reason for that.

"The problem can be in some cases that the wearable disrupts sleep itself," Michael Breus, a clinical psychologist known as the "Sleep Doctor," told NBC News. 

If wearing something like a FitBit or the Microsoft Band to bed is comfortable for you, go for it. Breus is currently trying two gadgets that hopes can make sleep trackers less intrusive: the ResMed S+ and the Beddit, both of which don't need to be connected to the body. 

3. Go to the pros

Every professional contacted for this story warned that if you think you have a sleep disorder, you should tell a doctor or sleep specialist. 

"If you are interested in learning more, then I am fine with [using sleep trackers]," Breus said. "If you are trying to diagnose a sleep disorder, then you are much better off seeing a sleep specialist and getting a sleep study."

Most sleep trackers overestimate how long people sleep and underestimate how many times they wake up at night, Hawley Montgomery-Downs, a sleep researcher at West Virginia University, told NBC News.

Essentially, people may think they are getting more sleep than they really are. 
"It's very detailed information, but the details are wrong," she said. 

That could be dangerous for people who really need professional help, she said. 

The technology Montgomery-Downs uses tracks everything from eye movement to brain waves. While she doesn't think any gadget she has tested comes close to what the pros use, she hopes that the boom in sleep trackers could result in something that delivers the whole package. 

"I'm very optimistic," she said. "I think it's entirely possible that within the next decade we could have technology that will be able to replace 40 external sensors on someone."

Read more here

Nasal spray to treat migraines

This article explains a nasal spray being developed to treat migraines.

Scientists from Nevada's Roseman University of Health Sciences presented their work on a nasal spray formulation of the antipsychotic prochlorperazine for the treatment of migraines at the American Association of Pharmaceutical Scientists annual meeting in San Diego.

"Prochlorperazine is a dopamine receptor antagonist that is widely used as an anti-nausea medication," said Venkata Yellepeddi, assistant professor of pharmaceutical sciences at Roseman University, in a statement. "Comparative clinical studies have shown that prochlorperazine provides better pain relief than other anti-migraine drugs such as sumatriptan, metoclopramide and ketorolac. Currently, there are no marketed nasal spray formulations of prochlorperazine available for the treatment of migraine. Prochlorperazine is only available in tablet form, which has delayed onset of action."

According to the FDA and the National Institutes of Health's medicine library, the generic drug prochlorperazine maleate is available in tablet form from Sandoz, the generics unit of Novartis, and Teva for the treatment of severe nausea and vomiting, schizophrenia and the short-term treatment of generalized nonpsychotic anxiety.

The Roseman University team hypothesizes that the reformulation will be effective, fast-acting and improve patient adherence, according to the release. It also avoids side effects associated with the use of preservatives.

Using high-performance liquid chromatography and microbiological assays, Yellepeddi showed that the nasal spray remained stable for up to 120 days, according to the release. Next, he will test the safety, efficacy and pharmacokinetics of the spray in rats. His research is being funded by a grant from the International Academy of Compounding Pharmacists Foundation.

While Yellepeddi's research is still in the early stages, in June, Avanir Pharmaceuticals touted positive results from a Phase III trial of its AVP-825 sumatriptan intranasal powder for migraines as compared with an oral formulation of the same treatment.
- read the release

Read more here

Study: Pregnant women with PTSD more likely to give birth early

A study found that pregnant women with PTSD are more likely to give birth early.

Pregnant women with post-traumatic stress disorder are at increased risk of giving birth prematurely, a new study from the Stanford University School of Medicine and the U.S. Department of Veterans' Affairs has found.
The study, which examined more than 16,000 births to female veterans, is the largest ever to evaluate connections between PTSD and preterm birth.
Having PTSD in the year before delivery increased a woman's risk of spontaneous premature delivery by 35 percent, the research showed. The results will be published online Nov. 6 in Obstetrics & Gynecology.
"This study gives us a convincing epidemiological basis to say that, yes, PTSD is a risk factor for preterm delivery," said the study's senior author, Ciaran Phibbs, PhD, associate professor of pediatrics and an investigator at the March of Dimes Prematurity Research Center at Stanford University. "Mothers with PTSD should be treated as having high-risk pregnancies."
Spontaneous preterm births, in which the mother goes into labor and delivers more than three weeks early, account for about six deliveries per 100 in the general population. This means that the risk imposed by PTSD translates into a total of about two additional premature babies for every 100 births. In total, about 12 babies per 100 arrive prematurely; some are born early because of medical problems for the mother or baby, rather than because of spontaneous labor.
A piece of the prematurity puzzle
"Spontaneous preterm labor has been an intractable problem," said Phibbs, noting that rates of spontaneous early labor have barely budged in the last 50 years. "Before we can come up with ways to prevent it, we need to have a better understanding of what the causes are. This is one piece of the puzzle."
Doctors want to prevent prematurity because of its serious consequences. Premature babies often need long hospitalizations after birth. They are more likely than full-term babies to die in infancy. Many of those who survive face lasting developmental delays or long-term impairments to their eyesight, hearing, breathing or digestive function.
Phibbs' team analyzed all deliveries covered by the Veterans Health Administration from 2000 to 2012, a total of 16,344 births. They found that 3,049 infants were born to women with PTSD diagnoses. Of these, 1,921 births were to women with "active" PTSD, meaning the condition was diagnosed in the year prior to giving birth, a time frame that the researchers thought could plausibly affect pregnancy.
The researchers examined the effects of several possible confounding factors. Being older, being African-American or carrying twins all increased the risk of prematurity, as extensive prior research has shown.
The researchers also looked at the effects of maternal health problems (high blood pressure, diabetes and asthma); possible sources of trauma (deployment and military sexual trauma); mental health disorders other than PTSD; drug or alcohol abuse; and tobacco dependence. However, these factors had little influence on risk for premature birth.
The effect of stress
In other words, although pregnant women with PTSD may have other health problems or behave in risky ways, it's the PTSD that counts for triggering labor early.
"The mechanism is biologic," Phibbs said. "Stress is setting off biologic pathways that are inducing preterm labor. It's not the other psychiatric conditions or risky behaviors that are driving it."
However, if a woman had been diagnosed with PTSD in the past but had not experienced the disorder in the year before giving birth, her risk of delivering early was no higher than it was for women without PTSD. "This makes us hopeful that if you treat a mom who has active PTSD early in her pregnancy, her stress level could be reduced, and the risk of giving birth prematurely might go down," said Phibbs, adding that the idea needs to be tested.
Although PTSD is more common in military veterans than the general population, a fairly substantial number of civilian women also experience PTSD, Phibbs noted. "It's not unique to the VA or to combat," he said, noting that half of the women in the study who had PTSD had never been deployed to a combat zone. "This is relevant to all of obstetrics."
The VA has already incorporated the study's findings into care for pregnant women by instructing each VA medical center to treat pregnancies among women with recent PTSD as high-risk. And Phibbs' team is now investigating whether PTSD may also contribute to the risk of the mother or baby being diagnosed with a condition that causes doctors to recommend early delivery for health reasons.
Read more here

Mouse models help find new genetic links to autism

New genetic links to autism have been found using mouse models.

With the help of mouse models, induced pluripotent stem cells (iPSCs) and the "tooth fairy," researchers at the University of California, San Diego School of Medicine have implicated a new gene in idiopathic or non-syndromic autism. The gene is associated with Rett syndrome, a syndromic form of autism, suggesting that different types of autism spectrum disorder (ASD) may share similar molecular pathways.

"I see this research as an example of what can be done for cases of non-syndromic autism, which lack a definitive group of identifying symptoms or characteristics," said principal investigator Alysson Muotri, PhD, associate professor in the UC San Diego departments of Pediatrics and Cellular and Molecular Medicine. "One can take advantage of genomics to map all mutant genes in the patient and then use their own iPSCs to measure the impact of these mutations in relevant cell types. Moreover, the study of brain cells derived from these iPSCs can reveal potential therapeutic drugs tailored to the individual. It is the rise of personalized medicine for mental/neurological disorders."
But to effectively exploit iPSCs as a diagnostic tool, Muotri said researchers "need to compare neurons derived from hundreds or thousands of other autistic individuals." Enter the "Tooth Fairy Project," in which parents are encouraged TO register for a "Fairy Tooth Kit," which involves sending researchers like Muotri a discarded baby tooth from their autistic child. Scientists extract dental pulp cells from the tooth and differentiate them into iPSC-derived neurons for study.
"There is an interesting story behind every single tooth that arrives in the lab," said Muotri.
The latest findings, in fact, are the result of Muotri's first tooth fairy donor. He and colleagues identified a de novo or new disruption in one of the two copies of the TRPC6 gene in iPSC-derived neurons of a non-syndromic autistic child. They confirmed with mouse models that mutations in TRPC6 resulted in altered neuronal development, morphology and function. They also noted that the damaging effects of reduced TRPC6 could be rectified with a treatment of hyperforin, a TRPC6-specific agonist that acts by stimulating the functional TRPC6 in neurons, suggesting a potential drug therapy for some ASD patients.
The researchers also found that MeCP2 levels affect TRPC6 expression. Mutations in the gene MeCP2, which encodes for a protein vital to the normal function of nerve cells, cause Rett syndrome, revealing common pathways among ASD.
"Taken together, these findings suggest that TRPC6 is a novel predisposing gene for ASD that may act in a multiple-hit model," Muotri said. "This is the first study to use iPSC-derived human neurons to model non-syndromic ASD and illustrate the potential of modeling genetically complex sporadic diseases using such cells."
Read more here