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
Sunday, September 14, 2014
People who suffer migraines know that not even the best medicines may get rid of all the pain all the time. “Preventive medications help 50 percent of patients by about 50 percent,” Sheena Aurora, an associate professor of neurology at Stanford, tells writer Aviva Patz. In September’s edition of Health magazine, Patz suggests three of the “more promising, less traditional” alternative therapies that can be used along with drugs or by themselves as part of a migraine-relief strategy. And she includes comments from both clinical specialists and migraine sufferers. They are:
Cefaly: This is an FDA-approved band, worn across the forehead, that electrically stimulates the trigeminal nerve, said to be where migraine pain begins. Worn for 20 minutes a day (whether the user has a headache or not), Cefaly reduced monthly migraine days by 30 percent among participants in a study published in the journal Neurology last year. A tester for the magazine reported she used to get three to five migraines a week; in the four months after she started using Cefaly, she had only two.
Elimination diet: Some foods are known to activate an inflammation response that triggers migraines. The most common of these triggers are red wine, aged cheese, cured meats, MSG, dairy, artificial sweeteners, chocolate and gluten. Clinics typically recommend cutting out all these foods for six weeks, see if you feel better, then add them back into your diet one at a time to see which ones may cause pain. “Not all migraine sufferers have food sensitivities, but for those who do, eliminating a problem food can cut headaches by 50 to 60 percent,” says Merle Diamond of the Diamond Headache Clinic in Chicago. Consult a doctor before beginning this.
Botox: If it can relax facial muscles to smooth wrinkles, scientists wondered, could Botox also dull migraine pain? Studies published in early 2010 reported that migraine sufferers who received Botox injections experienced a major decrease in the number of headache days; later that year, the FDA approved the drug as a treatment for chronic migraine. A tester for the magazine reported that not only did Botox help her headaches, but the effect lasted longer after successive treatments. Insurance should cover the costs, Patz says. Warning: Potential side effects include bruising and neck pain.
Interesting effect of epilepsy on personality...
Dr. Rotenberg, Pediatric Epilepsy specialist, Houston TX
The case of a woman who began compulsively writing poems after being treated for epilepsy offers a rare glimpse into the ‘inner’ dimension of a neurological disorder. Here’s the paper in Neurocase from British neurologists Woollacott and colleagues.
The story in a nutshell: the patient, age 76, had been suffering from memory lapses and episodic disturbances of consciousness. An electroencephalography (EEG) test “revealed left anterior temporal sharp and slow waves”, and the patient was diagnosed with Transient Epileptic Amnesia (TEA).
She was prescribed the anti-epileptic drug lamotrigine (25 mg daily), which completely stopped the memory-loss and episodes of unconsciousness. However, this wasn’t the end of the matter:
Several months after starting lamotrigine, the patient suddenly began to write original verse. Whereas poetry had never previously been among her pastimes, she now produced copious short poems (around 10–15 each day).
These poems often had a wistful or pessimistic nature, but did not have a moral or religious focus. Her husband characterized them as “doggerel” because they were generally rhyming and often featured puns and other wordplay… she became irritated if attempts were made to disengage her. However, she appeared to derive pleasure from the activity and there was no evidence of distress.
Full article here...
Saturday, September 13, 2014
Teenagers who don't get enough sleep may wake up to worse consequences than nodding off during chemistry class. According to new research, risk of being obese by age 21 was 20 percent higher among 16-year-olds who got less than six hours of sleep a night, compared with their peers who slumbered more than eight hours. (The Centers for Disease Control and Prevention recommends nine to ten hours of sleep for teenagers.)
Researchers at the Mailman School of Public Health at Columbia University and the University of North Carolina Gillings School of Public Health are the first to examine the effect of sleeplessness on obesity in teenagers over time, providing the strongest evidence yet that lack of sleep raises risk for an elevated BMI. Results appear in Journal of Pediatrics.
Shakira F. Suglia, ScD, assistant professor of Epidemiology at the Mailman School, and colleagues analyzed health information from more than 10,000 American teens and young adults, ages 16 and 21, as part of the National Longitudinal Study of Adolescent Health. Information on height and weight and sleep was collected during home visits in 1995 and 2001.
Nearly one-fifth of the 16-year-olds reported getting less than six hours of sleep. This group was 20 percent more likely to be obese by age 21, compared to their peers who got more than eight hours of sleep. While lack of physical activity and time spent watching television contributed to obesity, they did not account for the relationship between sleeplessness and obesity.
"Lack of sleep in your teenage years can stack the deck against you for obesity later in life," says Suglia. "Once you're an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer."
"The message for parents is to make sure their teenagers get more than eight hours a night," adds Suglia. "A good night's sleep does more than help them stay alert in school. It helps them grow into healthy adults."
Daytime sleepiness and fatigue are known to affect what and how people eat, by altering appetite and stimulating cravings. Energy levels may also play a role. For the sleep-deprived, ordering calorie-dense fast food is easier than preparing a nutritious meal. Information on what the teens ate was not captured in the surveys, although it could play a role. Future research may look whether, for example, soda consumption is a factor in sleeplessness and, in turn, obesity. (A 2013 study by Suglia found young children who drink soda are more likely to have behavioral problems.)
Fish Oil Might Ease Tough-to-Treat Epilepsy: Study
People taking the low-dose omega-3 supplements had fewer monthly seizures, but more research is needed
By Robert Preidt
MONDAY, Sept. 8, 2014 (HealthDay News) -- Low doses of fish oil may help reduce the number of seizures experienced by people with a form of tough-to-treat epilepsy that no longer responds to drugs, a small new study suggests.
The research was led by Dr. Christopher DeGiorgio, of the University of California, Los Angeles, and included 24 people with epilepsy that could no longer be controlled using medications.
One expert not connected to the study said many people with epilepsy remain without adequate treatment.
"Although medications remain the primary treatment for newly diagnosed epilepsy, more than 35 percent of patients continue to haveseizures despite taking antiepileptic drugs," said Dr. David Friedman, director of the Comprehensive Epilepsy Center at Winthrop University Hospital in Mineola, N.Y.
Friedman said that in these cases, patients often resort to alternative treatments such as epilepsy surgeries, special diets or brain-stimulating devices. So the new study using a common nutrient is intriguing, he said.
In the study, the UCLA team gave the patients three separate treatments, each lasting 10 weeks and separated by a period of six weeks.
The treatments were: the "low-dose" intervention of three capsules offish oil (about 1,080 milligrams) a day plus three "dummy" capsules containing corn oil only; the "high-dose" involving six capsules of fish oil a day, and a placebo treatment of three capsules of corn oil taken twice a day.
The average number of seizures while taking the low dose of fish oil was about 12 a month, compared with just over 17 when taking a high dose of fish oil, and just over 18 when taking the corn oil only.
Two people were completely free of seizures while taking a low dose of fish oil. This did not occur while patients were taking a high dose of fish oil or corn oil....
Friday, September 12, 2014
Lack of sleep not only puts teens at risk for poor grades, it also puts them at increased risk for obesity, researchers warn.
The study authors analyzed data collected from more than 10,000 Americans when they were aged 16 and 21. Nearly one-fifth of them got less than six hours of sleep a night when they were age 16, and this group was 20 percent more likely to be obese at age 21 than those who got more than eight hours of sleep per night at age 16, the investigators found.
Although lack of exercise and too much time spent watching television were also risk factors for obesity, these behaviors did not account for the link between lack of sleep and obesity, according to the study published online recently in the Journal of Pediatrics.
"Lack of sleep in your teenage years can stack the deck against you for obesity later in life. Once you're an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer," study author Shakira Suglia, an assistant professor of epidemiology at the Mailman School of Public Health at Columbia University in New York City, said in a university news release.
"The message for parents is to make sure their teenagers get more than eight hours a night. A good night's sleep does more than help them stay alert in school. It helps them grow into healthy adults," Suglia added.
Teens should get nine to 10 hours of sleep a night, according to the U.S. Centers for Disease Control and Prevention.
It's known that daytime sleepiness and fatigue affect what and how people eat by triggering cravings and altering appetite. For example, sleep-deprived people find it easier to buy calorie-laden fast food rather than preparing a healthy meal.
This article describes a new screening questionnaire for chronic migraines.
Researchers have developed a new tool that can accurately identify patients with chronic migraine (CM).
The screening questionnaire — called the ID-CM — can potentially be used by physicians or by patients themselves.
"The way we imagine it in clinical practice is that someone completes this questionnaire in a physician's office and it provides a suggestion that the patient may have chronic migraine," said researcher Dawn Buse, PhD, director of Behavioral Medicine, Montefiore Headache Center, Bronx, New York. "The physician would still go through a careful history and physical and complete the diagnostic criteria."
"It may be helpful for people living with chronic migraine who don't realize there's a term for what they're living with," she said. "It might help connect them with specialist health care professionals who can treat them well, and it may help connect them with the right treatment."
The only treatment approved by the US Food and Drug Administration for chronic migraine, defined as having 15 or more migraine days a month, is onabotulinum toxin A (Botox, Allergan Inc), although patients do use other migraine therapies, including triptans.
Dr. Buse presented the research, funded by Allergan, here during PAINWeek.
Developing the tool took almost 3 years and involved a rigorous multi-step process. The research team reviewed existing instruments, sought input and consensus from headache physicians and research scientists from around the world, and had a group of people with CM assess the relevance of the questions being developed.
Another important step in the development process was psychometric validation. "This is where we look at someone with chronic migraine, someone with episodic migraine, and someone with no headache and see how well a particular item (for example, whether the pain is pulsating or how often the pain is severe) identifies or separates the different groups," explained Dr. Buse.
As well, headache experts used a semi-structured clinical interview to provide their own diagnosis, which was used as the gold standard. Compared to this gold standard, the screening tool had a sensitivity of 82%, a specificity of 87%, a negative predictive value of 77%, and a positive predictive value of 90%.
Among other things, the final 12-item screening tool asks respondents how often their pain is moderate or severe, how often they're unusually sensitive to light and sound, how often they feel nauseated or sick to their stomach, and how often they worry about missing work, school, or social events because of headaches.
Despite its substantial economic and quality-of-life burden, chronic migraine remains underdiagnosed and undertreated.
Dr. Buse and her colleagues hope to have the screening tool available in the next month or 2 and are working on a manuscript for possible publication.
Asked to comment, pain expert Lynn Webster, MD, vice president, scientific affairs, PRA Health Sciences, Salt Lake City, Utah, said he thought Dr. Buse's presentation was "very interesting" and relevant to the average physician who sees many patients with headaches in his or her daily practice.
"An accurate diagnosis is challenging for many physicians and a tool to help make that diagnosis would be welcomed," said Dr. Webster.
The tool appears to be reasonably accurate and sensitive, "which is always a challenge in developing such tools," added Dr. Webster.
Sleep, or lack thereof, and technology often go hand in hand when it comes to school-aged kids. Nearly three out of four children (72%) between the ages of 6 and 17 have at least one electronic device in their bedrooms while sleeping, according to a National Sleep Foundation survey. Children who leave those electronic devices on at night sleep less -- up to one hour less on average per night, according to a poll released by the foundation earlier this year.
Dr. Jill Creighton, Assistant Professor of Pediatrics, Stony Brook Children's Hospital says the key to a successful school year starts with Z's. So parents, how can you power down your kids at night and make bedtime easier? Dr. Creighton shares her tips. "First -- develop a nighttime routine," says Dr. Creighton. Whether it's a bath, reading a book or listening to soothing music, these actives will have a better impact on your child to help them relax before going to sleep.
Second -- Power off! "The hour before bed should be a no-electronics zone," says Dr. Creighton. Studies show that the light from backlit electronics (like tablets, smartphones and video games) can disrupt our ability to fall -- and stay -- asleep. Dr. Creighton says designate a spot in your home for electronics to be plugged in, then have your kids start their bedtime routine by plugging in one hour before lights out. Ban hand-held devices from the bedroom. "The burst of light from a phone (even if it's just to check the time) can break a sleep cycle," says Dr. Creighton. "A regular alarm clock is best."
If your child has a slight addiction to technology and is resistant about turning off their device, try dialing down the screen time. "Reduce screen time by 30 minutes or more each week until you reach your goal," says Dr. Creighton. "A good rule of thumb is try to limit recreational screen time to 60 minutes every day. And for every 30 minutes of screen time, make sure your kids get 30 minutes of physical activity."
Try to replace screen time with an activity. "It's sometimes hard to get kids off the couch and get them moving, especially if they think of physical activity as "exercise'' or "boring," says Dr. Creighton. "Parents, get creative and make moving fun for kids." Some of Dr. Creighton's ideas: a 20-minute family walk, 20 minutes of shooting hoops outside, walking the dog, going bike riding and doing chores (with the promise of an allowance) such as vacuuming, putting away laundry, raking leaves, shoveling snow and helping with the garbage/recycling, which are big favorites in her household.
Lastly, establish good habits. Being distracted by phones, hand-held devices and TV shows during mealtime cannot only lead to overeating, but additional unneeded screen time. And be a good role model. Parents, set a good example when it comes to screen time.
So how much sleep do your children need? General sleep guidelines from the National Heart, Lung and Blood Institute show that sleep time change as we age, but experts say there is no magic number for sleep, with individual needs varying.
• Newborns: 16-18 hours a day.
• Preschool-age children: 11-12 hours a day.
• School-age children: at least 10 hours a day.
• Teens: 9-10 hours a day.
• Adults (including the elderly): 7-8 hours a day.