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, August 16, 2014

Home testing and monitoring for epilepsy - Available in the Houston Area ..and now in London.

A hospital in London is pioneering a home diagnosis test and monitoring for epilepsy. This is described as a first of its kind. 

But, as an epilepsy specialist, I noted the value and convenience of such a service. My pediatric neurology practice has been offering home EEG service for the Houston area a number of years. 

-JR


A London hospital is the first in Britain to pioneer home testing for epilepsy patients.

The brain-scanning service rolled out by King’s College Hospital NHS Foundation Trust will benefit hundreds of people who suffer devastating seizures, and improve treatment.

Home monitoring allows patients to carry on with daily life without the disruption of days in hospital — it is also thought to be a more accurate method.

The service is called Home Video Telemetry and the patient wears a special head device fitted with electrodes which records brain activity over several days.

A video camera also captures the physical seizures. A technician visits the patient’s home and collects the data on a daily basis which is analysed by a consultant.  Epilepsy affects about 600,000 people in the UK including more than 60,000 children. The condition affects the brain and causes multiple seizure attacks in severe cases. Brain scanning is crucial for doctors to diagnose patients with suspected epilepsy correctly and provide them with tailored treatment.

Hospital checks have been the gold standard until now for those who suffer multiple attacks. However, other NHS trusts are now expected to adopt home testing following the success of pilots by King’s. It comes as new research reveals that testing epilepsy patients in hospital may produce biased results. Dr Franz Brunnhuber at King’s has carried out work revealing that people are about half as likely to experience seizures in hospital than at home.

The consultant clinical neurophysiologist said this can make it difficult for doctors to determine the exact nature of a patient’s condition.

He added: “Misdiagnosis is a major problem with epilepsy because there are lots of conditions which mimic the disorder so it’s crucial to capture seizure attacks accurately. The home service is more convenient for patients. Hospital is a huge stress factor for them. Home testing means patients can lead a normal life.”

Read more here

Study: Weighted blankets do not help children with autism sleep...even though patients like them!

A study shows that weighted blankets do not help autistic children sleep.

But, it appears that parents and children like them and they are seem harmless.

This intervention goes into the category of "may be helpful" and "probably benign".

JR


Weighted blankets did not improve sleep duration, falling asleep faster or waking less often among children with autism spectrum disorder, according to recent study findings published in Pediatrics.


Paul Gringras, MBChB, MRCP, MsC, of Evelina London Children’s Hospital, and colleagues evaluated 67 children aged 5 to 16 years with a confirmed diagnosis and severe sleep problems for 10 months to determine the effect of weighted blankets on sleep duration, time to fall asleep and times waking throughout the night. Participants used a weighted blanket or usual weight blanket (control) for 2 weeks each.
At baseline, no differences were found between the groups for total sleep time, average sleep onset latency, average sleep efficiency, duration of wake after sleep onset and average number of night wakening.
The control blanket caused statistically significant better sleep (P=.01), although small, compared with the weighted blanket on the Composite Sleep Disturbance Index.
However, on the questionnaire, the weighted blanket yielded better results for the “really liked” category (48%) vs. the control (31%). Similarly, parents reported more improved sleep and their children being calmer with the weighted blanket compared with the control blanket.

“Weighted blankets are widely available commercially, and anecdotal reports promote their use in children with ASD,” the researchers wrote. “The blankets will cost families in excess of [$150] and cannot be returned to manufacturers if they are not effective. Our findings provide valuable evidence that although weighted blankets in children with ASD are safe and well perceived by child and parent alike, there is no measurable evidence they are beneficial for children’s sleep.”
Read more here

Tuesday, August 12, 2014

Drinking before pregnancy may indicate behavior problems in children

A study found that women who drink before pregnancy are more likely to have children with behavioral problems.

Risk drinking before pregnancy can increase the risk of the development behavioral problems in toddlers. This comes from a new study using data from the Norwegian Mother and Child Cohort Study (MoBa). Early intervention to help and support mothers and their children could help to prevent these problems from developing into long term behavioral problems.

In the study, several screening questions were used to measure maternal drinking behavior; how many drinks were needed to feel high, had others irritated or hurt them by criticizing their alcohol consumption, had they felt they ought to drink less alcohol, and had they ever drunk alcohol in the morning to relieve a hangover.
The study shows that risk drinking before pregnancy increases the risk of early behavior problems among children. According to the researchers, risk drinking may be due to other associated risk factors in maternal behavior such as anxiety, depression or attention deficit hyperactivity disorder (ADHD), which also are known to have an impact on child behavioral problems.
Prenatal exposure to alcohol is known to affect the developing fetus, with adverse cognitive and behavioral effects. Most risk drinking women therefore limit or stop drinking alcohol while pregnant. Paternal risk drinking is also known to have a negative impact on toddler behavior. This is the first study to study the impact of risk drinking before pregnancy. The results could not be explained by alcohol consumption during pregnancy and after birth.
"This increased risk for behavioral problems in the child is probably not due to the risk drinking per se, but rather to the general mental health and lifestyle of some of the mothers. Risk drinking behavior before pregnancy may indicate that these families could need closer follow-up and support during the early years of the child's life" says Ann Kristin Knudsen, primary author of the article published in the European Child and Adolescent Psychiatry journal.
The study considered both internalizing and externalizing behavioral problems among the toddlers. Internalizing behavioral problems include anxiety, inhibition, withdrawal or depression. Restlessness, defiance, fighting and lack of remorse are examples of externalizing behavior. These are known risk factors for behavior problems in childhood and adolescence, which sometimes continue into adulthood.
Read more here

Less flexibility in brain wiring of children with autism

A study shows that the brain wiring of children with autism is much less flexible than other children. This causes children with autism to have trouble in new situations.

When most children take on a task, various brain connections fire up. But scans showed less of this neuro-boosting activity in kids with autism, according to a small new study.


Moreover, children with more severe symptoms of autism displayed even less of this "brain flexibility," the researchers found.
"This reduced flexibility often causes difficulty when children with autism are faced with new situations," said study lead author Lucina Uddin, a neuroscientist and assistant professor of psychology at the University of Miami in Florida. "Knowing how the brain responds differently in these scenarios can help us to make transitions easier for these kids."
The finding -- published July 29 in Cerebral Cortex -- won't immediately lead to improvements in prevention, diagnosis or treatment of autism, which is estimated to affect one in 68 children in the United States. Still, it may provide more insight into the mysterious workings of the brain in autism.
People with autism have trouble interacting with others because they can't interpret many social signals that humans send to one another. They also engage in repetitive behaviors, such as obsessively focusing on one topic, or repeating the same action over and over.
"Based on our recent findings of overconnectivity in the brains of children with autism, I wanted to test the idea that a flexible brain is necessary for flexible behaviors," Uddin said.
In the new study, researchers performed brain scans on 34 children with autism and 34 typically developing children while at rest and while performing a task -- either solving math problems or distinguishing faces from one another. The idea was to include tasks that would -- and wouldn't -- significantly challenge kids with autism.
The kids with autism did as well as the others on the tasks. However, "across a set of brain connections known to be important for switching between different tasks, children with autism showed reduced 'brain flexibility' compared with typically developing peers," Uddin said.
The researchers also found a connection between the severity of restricted and repetitive behaviors and the degree of inflexibility.
In the big picture, "the findings may help researchers develop new therapies that target brain flexibility through strategies, tools and games that improve task-switching, for example," said study co-author Kaustubh Supekar, a science research associate with the department of psychiatry and behavioral sciences at Stanford University School of Medicine.
Jose Perez Velazquez, a senior scientist with Toronto's Hospital for Sick Children, cautioned that just because the brains of people with autism work differently doesn't mean that they work in a worse way. When it comes to behaviors, "which ones we want to label pathological or deviant is, many times, a matter of taste," said Velazquez, who wasn't involved in the study.
Read more here

No link between sleep apnea and cancer

A study shows there is no link between sleep apnea and cancer.

Canadian researchers have found no apparent connection between sleep apnea and cancer in a new study of more than 10,000 people with this common sleep disorder.
People with sleep apnea experience repeated periods of disrupted breathing during sleep. Studies suggesting a link between the condition and cancer risk theorized that low oxygen levels might trigger cell mutations connected with cancer.
"We were not able to confirm previous hypotheses that obstructive sleep apnea is a cause of overall cancer development through intermittent lack of oxygen," said lead author Dr. Tetyana Kendzerska, from the Institute for Clinical Evaluative Sciences and Women's College Hospital at the University of Toronto.
The report, published Aug. 5 in the Canadian Medical Association Journal, is unlikely to put the question to rest, however.
"Additional studies are needed to find out whether there is an independent effect of sleep apnea on specific types of cancer," Kendzerska said.
Dr. Leonard Lichtenfeld, deputy chief medical officer of the American Cancer Society, said the findings suggest that sleep apnea by itself is not related to an increased risk of cancer. "However, for some people the factors that cause sleep apnea are related to an increased risk of cancer," he said.
Risk factors for sleep apnea include smoking, chronic lung disease, obesity and diabetes, Lichtenfeld said. "It is these conditions that are more likely to cause the increased cancer risk seen in other studies, not the sleep apnea itself," he said.
This study isn't the "final answer," he said. "More research will have to be done."
For the study, Kendzerska and colleagues studied about 10,150 patients suffering from sleep apnea who took part in a sleep study between 1994 and 2010. They linked this data to health databases from 1991 to 2013.
At the start of the study, about 5 percent of the patients had cancer. Over an average of nearly eight years of follow-up, an additional 6.5 percent of the participants developed cancer. Most common were prostate, breast, colorectal and lung cancers, the researchers said.
Although no link was seen for cancer in general, the researchers did find that low oxygen levels related to sleep apnea were associated with smoking-related cancers, such as lung cancer.
Dr. Yosef Krespi, director of the Center for Sleep Disorders at Lenox Hill Hospital in New York City, cautioned that while sleep apnea may not cause cancer, it is a serious condition that needs to be treated.
"One should not ignore sleep apnea," Krespi said. "Sleep apnea is a chronic progressive disorder that if left untreated can result in serious heart problems."
More than 18 million American adults have sleep apnea, according to the National Sleep Foundation. Some experts say the condition is increasing because of the obesity epidemic.
Sleep apnea can make a cancer patient's life more difficult, Krespi said.
"The quality of life of sleep apnea patients with cancer and their ability to tolerate treatments such as chemotherapy and radiation can be very different than those without the condition," he said.
Read more here

Common treatments for migraines

This article provides information on migraine headaches and discusses treatments for migraine headaches.

Suffering from migraines can have a seriously negative impact on both your work and social life, but what exactly causes those splitting headaches?

Menwomen and children can suffer from migraines. Some people may have a migraine as often as a few times a week, whereas others might only experience them occasionally.
According to the NHS, there are several types of migraine. These include:
  • Migraine with aura – where there are warning signs before the migraine begins, such as seeing flashing lights.
  • Migraine without aura – where the migraine occurs without warning signs.
  • Migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop.
Although the exact cause of migraine is unknown, triggers are thought to include hormonal, emotional, physical, dietary, environmental and medical changes to your usual routine.
If you suffer from regular migraines it is important to visit your GP, as some experts have found migraines to indicate other underlying health issues such as abnormal blood vessel structure in the brain.
Migraine remains undiagnosed and under-treated in at least 50% of patients, and less than 50% of migraine patients consult a physician – but your GP could really help you to reduce your suffering.
GPs can help you to identify the triggers of your migraine and also prescribe medication to help you manage your condition like painkillers, triptans (medications that can help reverse the changes in the brain that may cause migraines), or anti-emetics (medications often used to reduce nausea and vomiting).
Read more here

Genetics may determine how much sleep a person needs

A study shows that genetics may play a role in how much sleep a person needs each night.

The news: Ever wondered why some people can get a whole lot less sleep than others and still function? Their secret isn't just coffee — it might also be their DNA.
Published in the journal Sleep, researchers largely from the University of Pennsylvania and the Philadelphia area claim that a genetic mutation may partly explain why a certain few can get by on six hours of sleep a night rather than the standard seven to nine.
The study: The team discovered the mutation while conducting a sleep study with 100 pairs of healthy, same-sex twins who were monitored while sleeping at home and were then subjected to a battery of cognitive tests during a 38-hour awake session.
The participants who performed relatively well despite the forced sleep deprivation — and who slept noticeably less — tended to have a mutation in the BHLHE41 gene, called p. Tyr362HIS. The researchers concluded that this and similar "mutations reduce total sleep while maintaining NREM sleep and provide resistance to the effects of sleep loss." What's more, the same group also recovered faster from the effects of the 38-hour sleep deprivation session.
"This work provides an important second gene variant associated with sleep deprivation and for the first time shows the role of BHLHE41 in resistance to sleep deprivation in humans," American Academy of Sleep Medicine President Dr. Timothy Morgenthaler told TechTimes.
Though the study doesn't prove that people who can sleep less have a genetic mutation, it does provide solid experimental evidence that the reason some people can sleep less is partly genetic.
What it means for you: Your optimal sleep schedule may be less a matter of personal preference and more a function of biological need. Sadly, you're also probably overestimating your ability to get by on insufficient sleep. Previous research has indicated that the number of people who are mostly unaffected by just five or six hours of sleep per night is as low as 5% of those making the claim — the rest are likely chronically sleep-deprived and don't realize it.
Experts have debated how much sleep is actually necessary for most people, but generally settle at around seven to eight hours a day. Leading sleep researcher Hans Van Dongen tells Vox that, "If you sleep much less than you need, we have good reason to believe that will impair your health."
Sleeping less is probably not in most peoples' genetic cards. But if it is, you've got mom and dad to thank. 
Read more here