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

Thursday, October 30, 2014

Clinical whole exome sequencing in child neurology practice.



Whole exome sequencing (WES) represents a significant breakthrough in clinical genetics as a powerful tool for etiological discovery in neurodevelopmental disorders. To better characterize the genetic landscape of neurodevelopmental disorders, we analyzed patients in our pediatric neurogenetics clinic who underwent WES.


We performed a retrospective cohort study on 78 patients with various neurodevelopmental disabilities and unrevealing workup prior to WES. We characterized their molecular diagnoses, clinical features, and whether their previous treatment plan changed due to WES results.


The overall presumptive diagnostic rate for our cohort was 41% (n = 32 of 78 patients). Nineteen patients had a single autosomal dominant (AD) disorder, 11 had a single autosomal recessive (AR) disorder, 1 had an X-linked dominant disorder, and 1 had both an AD and an AR disorder. The 32 patients with pathogenic or likely pathogenic variants exhibited various neurobehavioral and neuroimaging abnormalities, including intellectual disability/developmental delay (n = 28), cerebral palsy-like encephalopathy (n = 11), autism spectrum disorder (n = 5), delayed/hypomyelination (n = 7), and cerebellar abnormalities (n = 9). The results of WES affected management for all patients with a presumptive diagnosis, triggering reproductive planning (n = 27), disease monitoring initiation (n = 4), investigation of systemic involvement of the disorder(s) (n = 6), alteration of presumed disease inheritance pattern (n = 7), changing of prognosis (n = 10), medication discontinuation (n = 5) or initiation (n = 2), and clinical trial education (n = 3).


The high diagnostic yield of WES supports its use in pediatric neurology practices. It may also lead to earlier diagnosis, impacting medical management, prognostication, and family planning. WES therefore serves as a critical tool for the child neurologist. Ann Neurol 2014;76:473-483.

Monday, October 27, 2014

Tricare & Autism - New Access Rules and 46 percent reduction in ABA reimbursement!

Do you or your family member have Tricare for autism related services? 

Note MAJOR changes in the programs

"Those who are diagnosed with autism spectrum disorder after July 25 will receive current benefits under the Autism Care Demo by Dec. 31. Beneficiaries should contact their regional or plan contractor for information about how to get started."

Please let your legislator and the assistant sec-def named below know how important these services are. Many other insurances are playing this game. This cut is likely to affect access. - JR

TRICARE "Delays" Change in Autism Reimbursement to April

By Cheryl Pellerin
DoD News, Defense Media Activity
WASHINGTON, Oct. 10, 2014 – TRICARE has delayed until April a 46-percent reduction in the reimbursement level for some autism services while it awaits the results of an independent assessment of the prevailing rate for the services, defense officials said today.
The reduced reimbursement rate -- for one-on-one therapy with a board-certified behavior analyst for those with autism spectrum disorder -- was one of several program changes scheduled to go into effect Oct. 20 as TRICARE implements its new Comprehensive Autism Care Demonstration, or Autism Care Demo.
On Sept. 19, after the Defense Department published related changes to the TRICARE Operations Manual, providers and beneficiaries raised issues.
Rand Corp. independent analysis
On Oct. 8, Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson directed that the rate change be postponed until April 20, 2015, while RAND Corp. completes an independent analysis of prevailing rates for the service.
TRICARE will continue to pay the previous rate of $125 an hour for one-on-one therapy with a board-certified behavior analyst rather than the new $68-per-hour rate. Defense officials say the new Autism Care Demo does not cut applied behavior analysis benefits.
The new TRICARE Autism Care Demo began July 25 and replaces current applied behavior analysis benefits with one simple program, according to the TRICARE website.
TRICARE-covered services
TRICARE covers the following services under the basic applied behavior analysis benefit, and a TRICARE-authorized board-certified behavior analyst must provide the services:
-- An initial applied behavior analysis assessment and treatment plan;
-- Direct one-on-one applied behavior analysis services;
-- Supervision of subordinate applied behavior analysis providers;
-- An updated applied behavior analysis treatment plan and updates; and
-- Training of family members or caregivers.

Saturday, October 25, 2014

Study: Autistic children more sedentary than other children

A new study claims that autistic children are more sedentary than children without autism. JR

A new Oregon State University study of children with autism found that they are more sedentary than their typically-developing peers, averaging 50 minutes less a day of moderate physical activity and 70 minutes more each day sitting.
The small study of 29 children, some with autism and some without, showed that children with autism perform as well as their typical peers on fitness assessments such as body mass index, aerobic fitness levels and flexibility. The results warrant expanding the study to a larger group of children, said Megan MacDonald, an assistant professor in OSU's College of Public Health and Human Sciences.
"These kids, compared to their peers, are similarly fit," MacDonald said. "That's really exciting, because it means those underlying fitness abilities are there."
The findings were published this month in the journal Autism Research and Treatment. Co-authors are Kiley Tyler, a doctoral student at OSU, and Kristi Menear of the University of Alabama at Birmingham. The study was funded in part by the U.S. Department of Education with additional support from OSU.
For the study, researchers tested the fitness and physical activity levels of 17 children with autism and 12 children without autism. The fitness assessments, conducted in the Movement Studies in Disability Lab at OSU, included a 20-meter, multi-stage shuttle run to measure aerobic fitness; a sit-and-reach test to measure flexibility and a strength test to measure handgrip strength; as well as height, weight and body mass index measurements.
The fitness tests were selected in part because they are commonly used in schools, MacDonald said. Children in the study also wore accelerometers for a week to measure their movement, and parents filled out supplemental forms to report other important information.
Even though they were more sedentary, the children with autism lagged behind their peers on only one fitness measure, the strength test. The results were surprising but also encouraging because they show that children with autism are essentially on par with their peers when it comes to physical fitness activities, MacDonald said.
"That's really important for parents and teachers to understand, because it opens the door for them to participate in so many activities," she said.
More research is needed to determine why children with autism tend to be more sedentary, MacDonald said. It may be that children with autism have fewer opportunities to participate in organized sports or physical education activities, but if that is the case, it needs to change, she said.
"They can do it. Those abilities are there," she said. "We need to work with them to give them opportunities."
MacDonald encourages parents to make physical activity such as a daily walk or trip to the park part of the family's routine. She's also an advocate for adaptive physical education programs, which are school-based programs designed around a child's abilities and needs. Some communities also offer physical fitness programs such as soccer clubs that are inclusive for children with autism or other disabilities, she said.
"Physical fitness and physical activity are so important for living a healthy life, and we learn those behaviors as children," MacDonald said. "Anything we can do to help encourage children with autism to be more active is beneficial."
Read more here

Great Glossary of Neurology terms from the NINDS

Friends...Here is a useful glossary of terms relevant to pediatric neurology. I have abstracted some for educational purposes.

The full list is at the NIH's website at the NINDS.

Absence of the Septum Pellucidum
Acid Lipase Disease 
Acid Maltase Deficiency
Acquired Epileptiform Aphasia
Acute Disseminated Encephalomyelitis

Adie's Pupil
Adie's Syndrome
Agenesis of the Corpus Callosum

Aicardi Syndrome
Aicardi-Goutieres Syndrome Disorder

Alexander Disease

Alpers' Disease

Alternating Hemiplegia


Angelman Syndrome
Antiphospholipid Syndrome

Arachnoid Cysts
Arnold-Chiari Malformation

Arteriovenous Malformation
Asperger Syndrome
Ataxia Telangiectasia
Ataxias and Cerebellar or Spinocerebellar Degeneration

Attention Deficit-Hyperactivity Disorder
Autonomic Dysfunction

Back Pain
Barth Syndrome
Batten Disease
Becker's Myotonia
Behcet's Disease

Bell's Palsy
Benign Essential Blepharospasm
Benign Focal Amyotrophy
Benign Intracranial Hypertension
Bernhardt-Roth Syndrome

Bloch-Sulzberger Syndrome
Brachial Plexus Birth Injuries
Brachial Plexus Injuries

Bradbury-Eggleston Syndrome
Brain and Spinal Tumors
Brain Aneurysm
Brain Injury
Brown-Sequard Syndrome

Bulbospinal Muscular Atrophy

Canavan Disease
Carpal Tunnel Syndrome

Cavernous Angioma
Cavernous Malformation
Central Cervical Cord Syndrome
Central Cord Syndrome
Central Pain Syndrome

Central Pontine Myelinolysis
Cephalic Disorders
Ceramidase Deficiency
Cerebellar Degeneration
Cerebellar Hypoplasia

Cerebral Aneurysms
Cerebral Arteriosclerosis
Cerebral Atrophy
Cerebral Beriberi
Cerebral Cavernous Malformation

Cerebral Gigantism
Cerebral Hypoxia
Cerebral Palsy
Cerebro-Oculo-Facio-Skeletal Syndrome (COFS)
Charcot-Marie-Tooth Disease

Chiari Malformation
Cholesterol Ester Storage Disease
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

Chronic Orthostatic Intolerance
Chronic Pain
Cockayne Syndrome Type II
Coffin Lowry Syndrome

Complex Regional Pain Syndrome
Congenital Facial Diplegia
Congenital Myasthenia
Congenital Myopathy

Congenital Vascular Cavernous Malformations
Corticobasal Degeneration
Cranial Arteritis
Cree encephalitis

Creutzfeldt-Jakob Disease
Cumulative Trauma Disorders
Cushing's Syndrome
Cytomegalic Inclusion Body Disease
Cytomegalovirus Infection


Dancing Eyes-Dancing Feet Syndrome
Dandy-Walker Syndrome
Dawson Disease
De Morsier's Syndrome
Deep Brain Stimulation for Parkinson's Disease

Dejerine-Klumpke Palsy
Dementia - Multi-Infarct
Dementia - Semantic
Dementia - Subcortical

Dementia With Lewy Bodies
Dentate Cerebellar Ataxia
Dentatorubral Atrophy
Developmental Dyspraxia

Devic's Syndrome
Diabetic Neuropathy
Diffuse Sclerosis
Dravet Syndrome

Dyssynergia Cerebellaris Myoclonica

Dyssynergia Cerebellaris Progressiva

Early Infantile Epileptic Encephalopathy
Empty Sella Syndrome
Encephalitis Lethargica

Encephalopathy (familial infantile)
Encephalotrigeminal Angiomatosis
Epileptic Hemiplegia

Erb-Duchenne and Dejerine-Klumpke Palsies
Erb's Palsy
Essential Tremor
Extrapontine Myelinolysis


Fabry Disease
Fahr's Syndrome
Familial Dysautonomia
Familial Hemangioma

Familial Idiopathic Basal Ganglia Calcification
Familial Periodic Paralyses
Familial Spastic Paralysis
Farber's Disease
Febrile Seizures

Fibromuscular Dysplasia
Fisher Syndrome
Floppy Infant Syndrome
Foot Drop
Friedreich's Ataxia

Frontotemporal Dementia 

Gaucher Disease
Generalized Gangliosidoses
Gerstmann's Syndrome
Gerstmann-Straussler-Scheinker Disease
Giant Axonal Neuropathy

Giant Cell Arteritis
Giant Cell Inclusion Disease
Globoid Cell Leukodystrophy
Glossopharyngeal Neuralgia
Glycogen Storage Disease

Guillain-Barré Syndrome


Hallervorden-Spatz Disease
Head Injury
Hemicrania Continua
Hemifacial Spasm

Hemiplegia Alterans
Hereditary Neuropathies
Hereditary Spastic Paraplegia
Heredopathia Atactica Polyneuritiformis
Herpes Zoster

Herpes Zoster Oticus
Hirayama Syndrome
Holmes-Adie syndrome 
HTLV-1 Associated Myelopathy

Hughes Syndrome
Huntington's Disease
Hydrocephalus - Normal Pressure




Immune-Mediated Encephalomyelitis
Inclusion Body Myositis
Incontinentia Pigmenti
Infantile Hypotonia
Infantile Neuroaxonal Dystrophy 

Infantile Phytanic Acid Storage Disease
Infantile Refsum Disease
Infantile Spasms
Inflammatory Myopathies

Intestinal Lipodystrophy
Intracranial Cysts
Intracranial Hypertension
Isaacs' Syndrome

Joubert Syndrome


Kearns-Sayre Syndrome
Kennedy's Disease
Kinsbourne syndrome
Kleine-Levin Syndrome
Klippel-Feil Syndrome

Klippel-Trenaunay Syndrome (KTS)
Klüver-Bucy Syndrome
Korsakoff's Amnesic Syndrome
Krabbe Disease
Kugelberg-Welander Disease



Lambert-Eaton Myasthenic Syndrome
Landau-Kleffner Syndrome
Lateral Femoral Cutaneous Nerve Entrapment
Lateral Medullary Syndrome
Learning Disabilities

Leigh's Disease
Lennox-Gastaut Syndrome
Lesch-Nyhan Syndrome
Levine-Critchley Syndrome

Lewy Body Dementia
Lipid Storage Diseases
Lipoid Proteinosis
Locked-In Syndrome

Lou Gehrig's Disease
Lupus - Neurological Sequelae
Lyme Disease - Neurological Complications


Machado-Joseph Disease
Melkersson-Rosenthal Syndrome

Meningitis and Encephalitis
Menkes Disease
Meralgia Paresthetica
Metachromatic Leukodystrophy

Miller Fisher Syndrome
Mini Stroke
Mitochondrial Myopathies
Moebius Syndrome

Monomelic Amyotrophy
Motor Neuron Diseases
Moyamoya Disease

Multifocal Motor Neuropathy
Multi-Infarct Dementia
Multiple Sclerosis
Multiple System Atrophy
Multiple System Atrophy with Orthostatic Hypotension

Muscular Dystrophy
Myasthenia - Congenital
Myasthenia Gravis
Myelinoclastic Diffuse Sclerosis
Myoclonic Encephalopathy of Infants

Myopathy - Congenital
Myopathy - Thyrotoxic

Myotonia Congenita


Neurodegeneration with Brain Iron Accumulation
Neuroleptic Malignant Syndrome

Neurological Complications of AIDS
Neurological Complications of Lyme Disease
Neurological Consequences of Cytomegalovirus Infection
Neurological Manifestations of Pompe Disease
Neurological Sequelae Of Lupus

Neuromyelitis Optica 
Neuronal Ceroid Lipofuscinosis
Neuronal Migration Disorders
Neuropathy - Hereditary

Nevus Cavernosus
Niemann-Pick Disease

Normal Pressure Hydrocephalus


Occipital Neuralgia
Ohtahara Syndrome
Olivopontocerebellar Atrophy
Opsoclonus Myoclonus
Orthostatic Hypotension

O'Sullivan-McLeod Syndrome
Overuse Syndrome


Pain - Chronic
Pantothenate Kinase-Associated Neurodegeneration
Paraneoplastic Syndromes
Parkinson's Disease

Paroxysmal Choreoathetosis
Paroxysmal Hemicrania
Pelizaeus-Merzbacher Disease
Pena Shokeir II Syndrome

Perineural Cysts
Periodic Paralyses
Peripheral Neuropathy
Periventricular Leukomalacia
Persistent Vegetative State

Pervasive Developmental Disorders
Phytanic Acid Storage Disease
Pick's Disease
Pinched Nerve
Piriformis Syndrome

Pituitary Tumors
Pompe Disease
Postherpetic Neuralgia

Postinfectious Encephalomyelitis
Post-Polio Syndrome
Postural Hypotension
Postural Orthostatic Tachycardia Syndrome
Postural Tachycardia Syndrome

Primary Dentatum Atrophy
Primary Lateral Sclerosis
Primary Progressive Aphasia
Prion Diseases
Progressive Hemifacial Atrophy

Progressive Locomotor Ataxia
Progressive Multifocal Leukoencephalopathy
Progressive Sclerosing Poliodystrophy
Progressive Supranuclear Palsy

Pseudo-Torch syndrome
Pseudotoxoplasmosis syndrome
Pseudotumor Cerebri
Psychogenic Movement


Ramsay Hunt Syndrome I 
Ramsay Hunt Syndrome II
Rasmussen's Encephalitis
Reflex Sympathetic Dystrophy Syndrome
Refsum Disease

Refsum Disease - Infantile
Repetitive Motion Disorders
Repetitive Stress Injuries
Restless Legs Syndrome
Retrovirus-Associated Myelopathy

Rett Syndrome
Reye's Syndrome
Rheumatic Encephalitis
Riley-Day Syndrome


Sacral Nerve Root Cysts
Saint Vitus Dance
Salivary Gland Disease
Sandhoff Disease
Schilder's Disease

Seitelberger Disease
Seizure Disorder
Semantic Dementia
Septo-Optic Dysplasia

Severe Myoclonic Epilepsy of Infancy (SMEI)
Shaken Baby Syndrome
Shy-Drager Syndrome
Sjögren's Syndrome

Sleep Apnea
Sleeping Sickness
Sotos Syndrome
Spina Bifida

Spinal Cord Infarction
Spinal Cord Injury
Spinal Cord Tumors
Spinal Muscular Atrophy
Spinocerebellar Atrophy

Spinocerebellar Degeneration
Steele-Richardson-Olszewski Syndrome
Stiff-Person Syndrome
Striatonigral Degeneration

Sturge-Weber Syndrome
Subacute Sclerosing Panencephalitis
Subcortical Arteriosclerotic Encephalopathy
SUNCT Headache
Swallowing Disorders

Sydenham Chorea
Syphilitic Spinal Sclerosis

Systemic Lupus Erythematosus


Tabes Dorsalis
Tardive Dyskinesia
Tarlov Cysts
Tay-Sachs Disease
Temporal Arteritis

Tethered Spinal Cord Syndrome
Thomsen's Myotonia
Thoracic Outlet Syndrome
Thyrotoxic Myopathy
Tic Douloureux

Todd's Paralysis
Tourette Syndrome
Transient Ischemic Attack
Transmissible Spongiform Encephalopathies
Transverse Myelitis

Traumatic Brain Injury
Trigeminal Neuralgia
Tropical Spastic Paraparesis
Troyer Syndrome

Tuberous Sclerosis


Vascular Erectile Tumor
Vasculitis Syndromes of the Central and Peripheral Nervous Systems 
Von Economo’s Disease
Von Hippel-Lindau Disease (VHL)
Von Recklinghausen's Disease

WWallenberg's Syndrome
Werdnig-Hoffman Disease
Wernicke-Korsakoff Syndrome
West Syndrome

Williams Syndrome
Wilson Disease
Wolman’s Disease 


X-Linked Spinal and Bulbar Muscular Atrophy

Zellweger Syndrome