Epilepsy - Family Scholarship

UCB, The Epilepsy Company™, is committed to recognizing the achievements in the lives of people living with epilepsy, their family members and caregivers. We congratulate the 2009 scholarship winners and remind the 2010 hopefuls that now is the time to apply.

http://www.epilepsyadvocate.com/resources/epilepsy-scholarship.aspx

Sleep Med Clin. 2008 Mar;3(1):37-46.

Polycystic Ovary Syndrome and Obstructive Sleep Apnea.

Tasali E, Van Cauter E, Ehrmann DA.

Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL.

Polycystic ovary syndrome (PCOS), the most common endocrine disorder of pre-menopausal women, is characterized by chronic hyperandrogenism, oligoanovulation, obesity and insulin resistance. Importantly, PCOS women are at increased risk for glucose intolerance, type 2 diabetes and cardiovascular disorders. Recent reports indicate an unexpectedly high prevalence of obstructive sleep apnea (OSA) in PCOS. Alterations in sex steroids (i.e. high androgen and low estrogen levels) and increased visceral adiposity in PCOS could potentially contribute to the increased prevalence of OSA in this disorder. There is some evidence to suggest that there may be strong associations between the presence and severity of OSA and the metabolic disturbances that characterize PCOS. Causal mechanisms in the link between PCOS and OSA remain to be elucidated. Clinicians who manage PCOS patients should be aware of the high prevalence of OSA in these patients and systematically evaluate these women for sleep disturbances.

http://www.ncbi.nlm.nih.gov/pubmed/19255602

http://www.psychologytoday.com/blog/overcoming-pain/201001/getting-the-crux-bruxism

Getting To The Crux Of Bruxism

Chomping at the bit.

Published on January 21, 2010

Your face hurts and you wonder why. Well, maybe the days of wondering and wandering from doctor to doctor are over. You might be, quite literally, chomping at the bit.

A survey published in "Acta Odontologica" sought to determine whether orofacial pain was associated with bruxism and insomnia symptoms. The researchers found that moderate to severe pain was significantly associated with insomnia and frequent bruxism, in addition to female gender, but negatively associated with age over 45 years....

Of course, it is reasonable to try oral splints. However, caregivers should also focus on the brain, and not just the teeth: depression and anxiety should be ruled in or out, and aggressively treated. Sleep apnea should be ruled out with a sleep study, and treated if found, as sleep apnea is known to be a cause of secondary bruxism.

Girls With ADHD at High Risk for Psychiatric Complications in Young Adulthood

Pam Harrison

January 22, 2010 — Girls with attention-deficit/hyperactivity disorder (ADHD) are at high risk for psychiatric complications in young adulthood, particularly antisocial, addictive, mood, anxiety, and eating disorders, according to a longitudinal case-control study with follow-up of 11 years.

Published online in the January 15 issue of the American Journal of Psychiatry, investigators found that the risk for 6 composite lifetime diagnostic categories was significantly higher in girls with ADHD compared with controls, with hazard ratios of 6.8 for mood disorders, 2.1 for anxiety disorders, 7.2 for antisocial disorders, 3.2 for developmental disorders, 2.7 for substance dependence disorders, and 3.5 for eating disorders.

Girls with ADHD also had significantly higher 1-year prevalence of composite mood, anxiety, antisocial, and substance dependence disorders relative to the comparison group, investigators add.

"We were not surprised for these findings at all, but the overwhelming amount of research in ADHD is in boys, and we needed to extend our research to females as there are very few studies assessing what happens to girls with ADHD," Joseph Biederman, MD, Harvard Medical School, Boston, Massachusetts, told Medscape Psychiatry.

"So even though the findings are not different from boys with ADHD, it is very important to establish that girls are at very high risk of developing the same complications as boys," he added.

Original Sample

For the study, investigators analyzed data on 96 girls with ADHD and 91 comparison girls from the original longitudinal sample. All girls had completed a full follow-up assessment at a mean of 11 years after enrollment.

At the 11-year follow-up reassessment, 93% of girls with ADHD had received some form of treatment for the disorder — 1% counseling alone, 21% medication alone, and 71% counseling and medication.

During the year preceding the 11-year follow-up assessment, 42% of ADHD girls were also receiving some form of treatment, whereas the rate of full or subthreshold ADHD during the interval between year 5 and year 11 was 69%. The rate of current full or subthreshold ADHD was 62%.

Girls with ADHD had a significantly higher lifetime prevalence of major depression, bipolar disorder, separation anxiety disorder, agoraphobia, social phobia, specific phobia, panic disorder, generalized anxiety disorder, oppositional defiant disorder, conduct disorder, antisocial personality disorder, Tourette or tic disorders, language disorder, enuresis, and bulimia than comparison girls.

The 1-year prevalence of eating disorders did not differ significantly between the 2 groups, but mood, anxiety, and antisocial disorders all remained significantly higher in girls with ADHD after controlling for baseline psychopathology.

Table. Adjusted 1-Year Prevalence Estimates for Psychiatric Disorders in ADHD and Comparison Subjects at 11 Years of Follow-up

Disorder	Comparison Group (95% CI) (n = 91)	ADHD Group (95% CI) (n = 96)
Mood disorders	0.07 (0.03 – 0.14)	0.23 (0.15 – 0.32)
Anxiety disorders	0.21 (0.14 – 0.31)	0.47 (0.37 – 0.57)
Antisocial disorders	0.04 (0.02 – 0.11)	0.21 (0.14 – 0.31)
Substance dependence disorders	0.07 (0.04 – 0.15)	0.31 (0.22 – 0.41)
Eating disorders	0.03 (0.01 – 0.10)	0.07 (0.03 – 0.14)

ADHD = attention-deficit/hyperactivity disorder; CI = confidence interval

Multiple Factors at Play

There may be multiple reasons girls with ADHD are so highly predisposed to developing psychiatric complications in young adulthood, said Dr. Biederman. The risk factors that produce ADHD may also lead to a wide range of complications as girls mature, he said.

"Patients with ADHD are more impulsive and reactive and more prone to experiment with drugs and then transition from experimentation to abuse and then dependence," said Dr. Biederman.

Moreover, children with ADHD typically do not do well in school, at play or even within the family, all of which may serve to demoralize and upset them, setting the stage for depression and other psychiatric disorders in later life.

Whatever the various reasons or combinations of causes, "the comorbid conditions that girls with ADHD develop in themselves are very morbid and risky, and knowing that ADHD is associated with bad outcomes may allow clinicians to very aggressively diagnose and treat it and which may have important implications for diminishing the risk of comorbidity," said Dr. Biederman.

Strength of the Study

Scott Kollins, PhD, MS, Duke University School of Medicine, Durham, North Carolina, told Medscape Psychiatry that the strength of the longitudinal study is in showing that ADHD outcomes are just as poor for girls as they are for boys and that it is "really valuable" to demonstrate this kind of impairment into adulthood.

He also agrees with investigators that girls with ADHD are less likely to be referred for diagnosis and treatment in childhood and therefore are not receiving treatment for ADHD, the result of which is a possible future "pernicious course" as shown in this study. Dr. Kollins feels that the protective effect of early treatment of ADHD against poor outcomes later in life continues to be debated.

Nevertheless, "what is clear is that if you treat the impairment in ADHD, it’s a good thing and even if you do not have a huge impact down the road, if you intervene early, there is a possibility of reducing the risk for some of these other complications later on."

Dr. Biederman has received research support, consultation fees, or speaker’s fees from Abbott, Aiza, AstraZeneca, Bristol Myers Squibb, Celltech, Cephalon, Eli Lilly, Esai, Forest, GlaxoSmithKline, Gliatech, Janssen Pharmaceuticals, McNeil, Merck, NARSAD, National Institute on Drug Abuse, National Institute of Child Health and Human Development, National Institute of Mental Health, New River, Novartis, Noven, Neurosearch, Organon, Otsuka, Pfizer, Pharmacia, Prechter Foundation, shire, Stanley Foundations, UCB Pharma, and Wyeth. Dr Kollins has disclosed no relevant financial relationships.

Am J Psychiatry. Published online January 15, 2010.

Transitioning to Texas Medical & Sleep Specialists is going well.

I now have privileges at Texas Children's Hospital.

Houston direct line is 713-464-4107.

New Houston Office to Open August 3 2009

Pediatric Obesity Symposium 2009 - New Braunfels

4 April 2009

http://www.christussantarosa.org/pdfs/4_2009.pdf

New Braunfels Pediatrics Associates presents:
2nd Annual Pediatric Obesity Symposium
Saturday, April 4, 2009

LOCATION:
McKenna Event Center
801 W. San Antonio Street
New Braunfels, Texas 78130

The goal of this symposium is to implement a multidisciplinary approach within our community for the identification and management of childhood obesity.

TARGET AUDIENCE
This seminar is targeted to pediatricians, family medicine physicians, physician assistants, pediatric and family nurse practitioners, office and school nurses, healthcare policy makers, and any other medical specialists with an interest in pediatric obesity.

OBJECTIVES:
Discuss the magnitude of the pediatric obesity problem at the medical and community levels.
Outline the financial impact of pediatric obesity statewide and nationwide.
Identify nutritional needs and deficiencies in obese children.
Discuss the diagnosis and management of liver disease in obese children.
Illustrate the relationship between ADHD and weight status.
Identify neurological conditions and treatment options.
Discuss ways to promote a successful physical activity program for weight loss.
Explain the relationship between obesity and sleep apnea and determine appropriate management.
Identify barriers for reimbursement and coding for obesity management.
Appraise a successful evidence-based school program for pediatric obesity and the lasting impact made in the community.
Encourage the development of interpersonal relationships with medical and community professionals who are interested in promoting the overall health of children.

AGENDA:

7:00 A.M. Registration and continental breakfast
7:45 A.M. Welcome and Introductory Remarks (Ramos)
8:00 A.M. The Price We Pay for Pediatric Obesity: Addressing Health Literacy & Community Involvement (Campos)
8:30 A.M. Vitamin D Deficiency and Renal Complications in Obese Children (Lynch)
9:00 A.M. Diagnosis and Management of Liver Disease in Children (Torres)
9:30 A.M. Learning, Behavior and Obesity (Statler)
10:00 A.M. Break
10:30 A.M. Neurology Update and Treatment Options (Rotenberg)
11:00 A.M. Implementing a Successful Physical Activity Program (Gomez)
11:30 A.M. Diagnosis And Treatment of Sleep Apnea in Children (Patel)
12:00 P.M. Reimbursement And Coding of Outpatient Services for Obese Patients (Owens)
12:30 P.M. Lunch Presentation
Bienestar- A Successful Evidence-Based School Program for Obese Children (Treviño)
1:30 P.M. Wrap up and Evaluation (Ramos)


COURSE DIRECTOR:
Awilda I. Ramos, MD, FAAP
Private Practice Pediatrics
New Braunfels Pediatrics Associates, PA
New Braunfels, Texas
FACULTY:
Carlos Campos, MD, MPH
Family Medicine, Private Practice
New Braunfels, Texas
Jorge E. Gomez, MD
Pediatrics, Sports Medicine
Clinical Professor, UTHSCSA
Stephen A. Harrison, MD, LTC, MC
Chief of Hepatology, Brooke Army Medical Center
Fort Sam Houston, Texas
Jane L. Lynch, MD
Pediatric Endocrinology
Associate Professor of Pediatrics, UTHSCSA
Mary E. Owens, RN, BSN, CPC-PEDS
Certified Pediatric Coder, Clinic Administrator
New Braunfels Pediatric Associates, PA
New Braunfels, Texas
Tarak Patel, MD
Pediatric Pulmonology, Pediatrics, and Sleep Medicine
San Antonio, Texas
Joshua S. Rotenberg, MD
President & Medical Director
Neurology & Sleep Specialists PA
San Antonio, Texas
Mark D. Statler, MD
Private Practice, Pediatrics
New Braunfels Pediatrics Associates, PA
New Braunfels, Texas
Roberto P. Treviño, MD
Private Practice, Internal Medicine
Executive Director, The Bienestar Diabetes Prevention Program
San Antonio, Texas

CME CREDIT:
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Texas Medical Association (TMA) through the Joint Sponsorship of CHRISTUS Santa Rosa Health Care and New Braunfels Pediatrics Associates. CHRISTUS Santa Rosa Health Care is accredited by TMA to provide continuing medical education for physicians.

CHRISTUS Santa Rosa Health Care designates this educational activity for a maximum of 5.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

REGISTRATION FEES:
Physicians $50
PAs/NPs $35
Others $25

Fee includes seminar, course materials, CME credits, continental breakfast, break and luncheon. Refund of registration fee will be issued if cancellation is received no less than 72 hours prior to the program. No refunds will be made after the program begins. Deadline for registration is March 28, 2009.

REGISTRATION:
Advance registration is required! Registrations must be accompanied by a payment.

To register online and pay via credit card, go to http://www.christussantarosa.org/physicians_main.html. Click on ‘Register for CME activities’ and select the 2nd Annual Pediatric Obesity Symposium. Simply click Register now, and create a login and password.



Make Checks Payable to New Braunfels Pediatrics Associates
Mail with registration form to:
Jann Harrison, CME Program Manager
CHRISTUS Santa Rosa Health Care
333 N. Santa Rosa St.
San Antonio, TX 78207

For questions or for further information please contact Jann Harrison, CME Program Manager, CHRISTUS Santa Rosa Health Care 210.704.3785 or email jann.harrison@christushealth.org.