Sunday, May 24, 2015

Memorial City – Pediatric Neurology Medical Assistant..Looking for a Great MA or LVN

Memorial City – Pediatric Neurology Medical Assistant or LVN

Make a difference every day!  Specialist in Memorial City is looking for a Full Time Medical Assistant or LVN to join our team.

Experience in pediatrics, neurology back office a plus!

This position requires computer skills as we are an EMR based practice.

This position requires a friendly, patient, reliable, and positive  team-player.

The ideal candidate will possess the following traits:

  • Multi-tasker
  • Exceptional customer service
  • Attention to detail
  • Vibrant personality & positive attitude
  • Ready for the challenge of a fast-paced work environment


We offer an excellent benefit package which includes:

  •  Medical
  • Dental
  •  Vision
  • Supplemental Insurances


Please respond with a resume and cover letter

to Miangela Kanaway at

clinicrotenberg@houstonspecialtyclinic.com

http://myspecialist.clinic/about-email.html

Saturday, May 23, 2015

Snoring and sleep apnea in pregnancy can cause problems with...

 2015 Jan 7. pii: S0002-9378(15)00002-2. doi: 10.1016/j.ajog.2015.01.001. [

The effect of maternal sleep-disordered breathing on the infant's neurodevelopment.


Abstract

OBJECTIVE: 

We sought to examine the effect of maternal sleep-disordered breathing (SDB) on infant general movements (GMs) and neurodevelopment.

STUDY DESIGN: 

Pregnant women with uncomplicated full-term pregnancies and their offspring were prospectively recruited from a community and hospital low-risk obstetric surveillance. All participants completed a sleep questionnaire on second trimester and underwent ambulatory sleep evaluation (WatchPAT; Itamar Medical, Caesarea, Israel). They were categorized as SDB (apnea hypopnea index >5) and controls. Infant GMs were assessed in the first 48 hours and at 8-11 and 14-16 weeks of age. At 12 months of age the Infant Developmental Inventory and the Brief Infant Sleep Questionnaire were administered.

RESULTS: 

In all, 74 women and their full-term infants were studied. Eighteen (24%) women had SDB. Mean birthweight was 3347.1 ± 423.9 g. Median Apgar score at 5 minutes was 10 (range, 8-10). In adjusted comparisons, no differences were found between infants born to mothers with SDB and controls in GM scores in all 3 evaluations. Low social developmental score was detected at 12 months in 64% of infants born to SDB mothers compared to 25% of infants born to controls (adjusted P = .036; odds ratio, 16.7). Infant snoring was reported by 41.7% of mothers with SDB compared to 7.5% of controls (P = .004).

CONCLUSION: 

Our preliminary results suggest that maternal SDB during pregnancy has no adverse effect on neonatal and infant neuromotor development but may affect social development at 1 year.
Copyright © 2015 Elsevier Inc. All rights reserved.

KEYWORDS: 

fetal outcome; neurodevelopment; pregnancysleep-disordered breathing

Why do children With Down Syndrome have seizures? Trisomy 21 and infantile spasms commonly occur...


Epileptic Disord. 2011 Mar;13(1):1-7. doi: 10.1684/epd.2011.0415.

Epilepsy in children with Down syndrome.

Abstract

This review discusses the various aspects of epilepsy in Down syndrome (DS) from the perspective of paediatric neurology.

DS is the most common genetic cause of mental retardation (MR) with a reported prevalence of epilepsy of 1-13%.

Infantile spasms (IS) or West syndrome (WS) is the most frequent epilepsy syndrome in children with DS. IS occur in 0.6-13% of children with DS, representing 4.5-47% of seizures in these children.

Curiously, these patients have electroencephalographic (EEG) characteristics of idiopathic rather than symptomatic WS. Despite a lack of consensus on therapeutic approach, no significant difference has been reported among the different regimens with regards to achieving clinical remission or EEG normalisation. 

It appears that DS patients have better seizure control compared to other patients with symptomatic IS, and early initiation of appropriate treatment may contribute to the prevention of late seizure development and better developmental outcome.

Lennox-Gastaut syndrome (LGS) also exhibits some distinctive features in children with DS including later onset and high incidence of reflex seizures. Other seizure types including partial and generalised tonic clonic seizures have also been described in children with DS.

There is a high rate of EEG abnormalities in children with DS, even among children without epilepsy, however, no patterns specific to DS have been identified and EEG does not correlate with outcome.

Various cellular and molecular mechanisms contribute to epileptogenesis in DS and offer an interesting field of study.

Sleep apnea is common AND commonly severe in DiGeorge Syndrome

Sleep apnea is common AND commonly severe in DiGeorge Syndrome. I cannot understand why so few children get a sleep study before airway surgery. - JR


22q11.2 Deletion syndrome and obstructive sleep apnea


Abstract
Otolaryngologic problems are common in the 22q11.2 deletion syndrome (DS) population. Structural anomalies and retrognathia may predispose these patients to obstructive sleep apnea (OSA). The current association of OSA in this population is not defined.

Objective

(1) Define the frequency of OSA in 22q11.2 DS patients referred for polysomnography (PSG). (2) Determine if OSA is present before and/or after surgery to correct velopharyngeal insufficiency (VPI). (3) Determine effect of prior adenotonsillectomy on OSA following VPI surgery.

Methods

Retrospective review of children treated from 2006 to 2013 in a tertiary care setting identified by ICD-9 758.32 (velocardiofacial syndrome) and 279.11 (DiGeorge syndrome). Surgical history and PSG data were abstracted from the identified records.

Results

We identified 323 patients with 22q11.2 DS; 57 (18%) were screened at any point in care using PSG and 15 patients had PSG at multiple time points in care. In most cases, indication for PSG was sleep disordered breathing or pre-operative planning. Overall, 33 patients met criteria for OSA on PSG, accounting for 10.2% of our study population; however, the percentage of patients with OSA was significantly higher within the group of 57 patients (58%) who were screened with PSG.
Twenty-one of the screened patients (54%) had PSG prior to any pharyngeal surgery and had mild to severe OSA (obstructive apnea/hypopnea index (AHI): median 5.1/h, range 1.9–25.6). Eighteen patients had PSG after adenotonsillectomy; 8 of these patients (44%) had mild to moderate OSA (median AHI 2.95/h, range 1.9–5.4). Seventeen patients had PSG after VPI surgery (palatopharyngeal flap (PPF) n = 16, sphincteroplasty n = 1). Nine of these patients (53%) had mild to severe OSA (median AHI 3/h, range 1.9–15). Patients who underwent adenotonsillectomy prior to VPI surgery had similar prevalence of OSA (50%, n = 12) than those who did not (OSA: 60%, n = 5, p = 0.70). Most children had mild OSA.

Conclusion

Prevalence of OSA in this population of 22q11.2 DS patients is higher than expected in the general population. OSA risk is highest after VPI surgery, and may be decreased by adenotonsillectomy. Providers should have awareness of increased prevalence of OSA in patients with 22q11.2 DS. Close monitoring for OSA is warranted given the likelihood of subsequent surgical intervention that can worsen OSA.

Friday, May 22, 2015

Relationship between epilepsy and autism may be...

A study looks into the relationship that may exist between epilepsy and autism.

Researchers at the University of Veracruz (UV), in the west coast of Mexico, study the neurobiological link between the Autism Spectrum Disorder (ASD) and epilepsy, in order to understand the reason why the brain of an autistic child is 20-30 percent more susceptible to seizures that an infant without this condition.


To know said relationship, Angel Alberto Puig Lagunes, a doctoral student in Brain Research of the UV works with two experimental models, one with autism and other of epilepsy because 30 percent of autistic people may have at some point in their lives some form of epilepsy, especially during childhood and adolescence.

The research seeks to understand the differences in the amount of neurotransmitters and receptors that may determine susceptibility to seizures. "If we know what happens in the brain structures of lab rats using these models, we can generate new insights into the characteristics that patients with ASD present that make them more susceptible to having seizures and may in the future provide new drugs or non-pharmacological interventions treatments for such illness, "says Angel Puig.

The World Health Organization estimates that worldwide one in 160 children under 12 years of age has autism. In Mexico, there are about 46,000 people with this disease.
The specialist refers that one to 1.5 percent of the global population have epilepsy, the equivalent to 50 million people. Various epidemiological data indicate that between 20 and 35 percent of children with autism have this condition; however, the neurobiological causes of such comorbidity are yet unknown.
In response, Puig Lagunes in collaboration with Maria Leonor López-Meraz, Jorge Manzo Denes and Rebeca Toledo Cárdenas assess neurochemical changes that occur in brain structures such as the hippocampus, amygdala, cerebellum and frontal cortex exposed to valproic acid, areas involved in autism and epilepsy.
The researcher analyzes seizures through drugs like pentylenetetrazol, used to induce crisis, and valproic acid, an anticonvulsant that is applied prenatally to rats, since research has shown that when it is administered to a pregnant woman there is greater likelihood that her child is born with ASD or congenital malformations.
With this method, says Angel Puig, we study whether fetuses exposed to the drug are more susceptible to presenting seizures and can identify, at a neurobiological level, what happens in the brain of an autistic person.
The results of this research show that like children with autism, laboratory rats that were prenatally exposed to valproic acid are more susceptible to presenting tonic-chronic seizures, common in people with generalized epilepsy.
With this research, Angel Puig won third place at the Annual Congress of the Mexican Chapter of the International League Against Epilepsy (Camelice) conducted in León, Guanajuato, center of Mexico.
Read more here

Thursday, May 21, 2015

What causes restless legs syndrome? Why do so many people have it?

Do kids get RLS? Why do children get RLS? Listen to this on NPR JR

When Brain Shuts Down, Legs Kick into Overdrive

 by David Kestenbaum


It's maddening to have a feeling that you can't explain. When I was a kid on long car rides, I would sometimes experience a strange sensation in my legs. I felt like I had to move my legs. When I did, the feeling would go away for a few seconds but then come back.
It struck at the worst times — my legs kept me awake when I was tired and needed to sleep. As an adult, the feeling periodically comes back to haunt me, during a slow movie, on airplane rides, or having a late drink at a bar...
I had no idea what this was until a few years ago when I found a Web site about something called Restless Legs Syndrome (RLS). I had that eureka moment people must have when they find out that what ails them has a name. "Yes!" I thought, "THIS IS WHAT I HAVE!"
My case is fairly tame. People with severe forms of Restless Legs Syndrome are sleep deprived and miserable.
Jumping Legs
The number of people affected by RLS is somewhat uncertain, but one large study found that almost 8 percent of people in the United States have experienced restless legs sometime in the past year. Three percent are bothered by it two or more times a week. And "bothered" probably isn't the right word — the study categorizes these people as experiencing "moderate or extreme distress."
People with RLS sometimes describe a "tugging" or "creepy crawly" sensation. Until recently, an average physician was unlikely to know what it was.
There are some early references to what appears to be RLS in the scientific literature. An English physician named Thomas Willis wrote a description in 1683:
"Wherefore to some, when being in bed they betake themselves to sleep, presently in the arms and legs. Leaping and contractions of the tendons and so great a restlessness and tossing of the members ensure, that the diseased are no more able to sleep, than if they were in the place of the greatest torture!"
.....Earley has a pet theory that RLS may be the body's way of reacting to reduced iron in the brain and saying, in essence, "Go get some iron!"
"5,000 or 10,000 years ago, the major source of iron was meat," he says. "So the guy out running around... was more likely to find meat and iron than the other guy sitting warmly in his cave keeping comfortable."
Studies indicate the RLS is more common in people from Scandinavia and northern Europe. Earley jokes that this could explain the trips taken by the Vikings.
"What could possibly possess a bunch of guys to get in a boat in the middle of winter and row across the Atlantic," he says, "other than a bad case of restless legs!".....

Tuesday, May 19, 2015

Study: Girls diagnosed with autism later than boys are

A study shows that girls are diagnosed with autism later than boys are.


Current statistics on autism spectrum disorder (ASD) show that boys are nearly five times more likely than girls to have autism. Now a new study proves that in addition to being diagnosed less, girls are also diagnosed at a later age than boys.
The study, conducted by the Kennedy Krieger Institute in in Baltimore, Maryland, analyzed data from the Institute’s Interactive Autism Network (IAN), an online information registry of nearly 50,000 people affected by autism and their families.  Researchers took into account the age that both boys and girls were diagnosed with autism for 9,932 children, and Social Responsiveness Scale data from 5,103 children, which identifies the presence and severity of social impairment.
Results showed that girls with a type of autism called pervasive developmental disorder (PDD)— which is characterized by delays in the development of socialization and communication skills— were diagnosed at an average age of 4 years old, compared to 3.8 years old in boys. In addition to PPD diagnosis, researchers found that Asperger’s syndrome diagnoses also happened later for girls – at 7.6 years old compared to 7.1 years of age for boys.
“The later diagnosis of girls appears to be tied to their areas of delay being less apparent, showing up more as shyness and quietness rather than the more unusual behaviors seen in boys, ” Dr. Paul Lipkin, study author and director of the Interactive Autism Network at Kennedy Krieger told FoxNews.com.
Lipkin said findings suggest that when it comes to social cognition, or the ability to interpret social cues, girls struggle more than boys, while boys have more difficulty with more obvious symptoms like severe mannerisms and repetitive behaviors.
“At the present time, autism screeners are not designed to look at boys and girls differently. This and other studies suggest that such may be needed, particularly around social skill development,” Lipkin said. “So parents, pediatric clinicians, therapists, educators now should give careful consideration to girls who are having difficulties in social situations and assist these girls early.”
Researchers noted an increase in the number of girls diagnosed with autism from 2010-2013 compared to the statistic measured four years earlier. Lipkin said he thinks the reason for the rise might be better public awareness and screening methods.
“We need to look at large groups of girls with autism and better understand their developmental pathways, in order to find the best means for their early identification and to find the best treatments for the challenges they experience,” he said. “One can no longer assume that boys and girls with autism are alike.”
Lipkin said he hopes the findings help change the way autism is diagnosed, and that further research will determine whether less recognizable symptoms in girls are not only leading to later diagnosis, but also under-identification of the condition.
“We need to find the best ways to identify those at both ends of the spectrum, those with severe problems and those with milder problems in social development,” he said. “The quiet girl with social difficulties may have an ASD and may benefit from special treatments aimed at these delays in social development.”
Read more here