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The concussion literature has increasingly shown that preinjury factors influence the course of concussion recovery. In a recent Annals of the Child Neurology Society article, neuropsychology fellow Laura Winstone-Weide, PhD, with colleagues Kelly Gettig, DNP, APRN, and Cynthia Austin, PhD, ABPP, used structural equation modeling (SEM) to examine the contribution of preinjury factors, baseline symptoms, and first-visit symptoms to the time required to return to baseline following injury.

SEM is an advanced statistical technique that allows simultaneous consideration of multiple variables as well as mediation analysis to test direct and indirect effects. The study analyzed prospectively collected data from 642 adolescents who were assessed in the Dell Children’s concussion clinic. Preinjury variables included a history of headache, anxiety, depression, attention-deficit/hyperactivity disorder, learning disability, previous concussions, and female gender. A particular strength of the study was the diversity in patient ethnicity (54% Hispanic), insurance status (41% Medicaid), and mechanism of injury (54% sports-related concussion), facilitating broader generalization across adolescent concussion populations.

Preinjury headaches, depression, and anxiety had the strongest direct effects on baseline symptoms. Adolescents with preinjury depression and/or anxiety took an average of four to six additional days to clearance for high-risk activities. Notably, a history of prior concussions or learning disability did not influence symptom reporting or recovery when considered simultaneously with other risk factors. The study emphasizes the unique, additive effects of preinjury factors on symptom reporting and concussion recovery. The authors concluded that preinjury risk factors should be viewed as a constellation, with particular attention to mental health factors in concussion management.

The Traumatic Brain Injury and Concussion Program at Dell Children’s Medical Center was established in 2018 and has evaluated over 2,000 patients. Its complex concussion clinic focuses on children and adolescents with risk factors for prolonged recovery time. In addition to collecting data to support evidence-based guidance on concussion management and recovery expectations, clinic staff members provide annual concussion management education to hundreds of school nurses, athletic trainers, and coaches. Their work recently led to modification of the Texas High School Coaches Association’s required return-to-play education to include active rehabilitation.

Winstone-Weide LK, Gettig K, Austin CA. Postconcussive symptom severity, risk factors for prolonged recovery, and mental health history: pathways of influence in a diverse pediatric sample. Ann Child Neurol Soc. 2024;2:281-289, doi.org/10.1002/cns3.20094.

The third annual Timothy M. George, MD, Memorial Lecture, held at Dell Children’s on November 8, was presented by Susan Durham, MD, MS, professor of clinical neurological surgery at Keck School of Medicine of USC, holder of the J. Gordon McComb Family Chair in Neurosurgery, and chief of neurosurgery at Children’s Hospital Los Angeles. Durham spoke on building a multidisciplinary pediatric brachial plexus program and described the contributions of each specialty to the brachial plexus team.

Durham’s keynote lecture was part of the Timothy M. George, MD, Memorial Lecture Research Symposium: Access to Care in Pediatric Neuroscience, a mini symposium featuring presentations by pediatric neuroscience and pediatrics faculty members. Dell Med assistant professor of neurosurgery Kevin Kumar, MD, PhD, discussed microglia replacement therapy for pediatric brain tumors, a specialty area of his clinical research. Other Dell Med faculty speakers included assistant professor of pediatrics Ryan Lowery, MD, clinical assistant professor of pediatrics Michelle Gallas, DO, and associate professor of pediatrics Maria Monge, MD.

Timothy George, MD, was a professor of neurosurgery at Dell Med and a pediatric neurosurgeon at Dell Children’s when he died unexpectedly in 2019. Dr. George graduated from New York University Grossman School of Medicine before completing his neurosurgery residency at Yale University and his pediatric neurosurgery fellowship at Northwestern University. He joined the faculty of Duke University in 1996 and in 2006 moved to Dell Children’s. His research interests included Chiari malformation and the genetic mechanisms of neural tube defects.

Previous memorial lecture guest speakers have included John (Jay) Wellons III, MD, MSPH, professor of neurological surgery and pediatrics and chief of pediatric neurological surgery at Vanderbilt University Medical Center, and Bermans J. Iskandar, MD, professor of pediatric neurosurgery at the University of Wisconsin School of Medicine and Public Health.

More than 60 patients and family members gathered at Dell Children’s for the third annual Neurofibromatosis Family Day Meeting on Saturday, November 2, 2024. Co-sponsored by the Dell Children’s Neurofibromatosis Center of Excellence, the pediatric neurosciences program, and the Children’s Tumor Foundation, this free meeting allowed patient families affected by NF to learn the latest developments in clinical care and research through presentations and Q&A sessions in both Spanish and English. Attendees also received guidance on school resources and heard firsthand accounts of experiences from other NF families. Young children enjoyed activities throughout the day, such as a magician show and hands-on crafts.

Pediatric neuroscience presentations included “A Clinical Overview of NF1 in Children” by Manikum Moodley, MD, professor of neurology and co-director of the Neurofibromatosis Center of Excellence; “Neurosurgical Problems in Patients with NF” by neurosurgery assistant professor M. Omar Iqbal, MD; “Genetics of NF1” by genetic counselor Natalie Lillie, MS, CGC; “Unlocking School Resources for Students with NF” by social workers Kayla Richards, LCSW, and Keshayka Williams, LCSW; and “Gene Therapies Overview: What Is It?” by neurofibromatosis center coordinator Karla Robles-Lopez, MD, PhD.

The Dell Children’s Neurofibromatosis Clinic is the only Central Texas member of the NF Clinic Network of the Children’s Tumor Foundation. It provides accelerated access for patients with neurofibromatosis as well as comprehensive, multidisciplinary, state-of-the-art care in a family-centered environment. With subspecialty expertise, the clinic is committed to providing the best care to patients and families at each stage of the disease, as well as offering transitional care into the adult NF program.

The late Arnold Gold, MD, was a New York City child neurologist and a long-term member of the Child Neurology Society, but many people will be surprised to learn that he was by birth a Texan. Gold’s foundation continues to promote his passion for humanism in medical care, supporting Gold Humanism Honor Society chapters at many medical schools, the annual white coat ceremony for new medical students, and the Gold Humanism Award at the CNS’s annual meeting. The Gold Foundation’s website describes humanism in healthcare as a respectful and compassionate approach that is sensitive to the values and the cultural backgrounds of all people. Few people exemplify these qualities as well as the 2024 Gold Humanism Award winner, Dave F. Clarke, MD.

Clarke is professor of neurology and chief of the epilepsy program at Dell Children’s Medical Center. He has published dozens of articles and held important leadership positions. His extraordinary dedication to advancing care for epilepsy around the world was recognized by the American Epilepsy Society with its 2023 J. Kiffin Penry Award.

Fewer people know about Clarke’s parallel career as a humanitarian. Although he trained in Michigan and Toronto and has spent his academic career in the United States, he has never abandoned his native Caribbean islands. The stunningly beautiful region has few medical specialists, so general physicians and nurses usually care for children with neurological disease. Tests such as EEG and MRI are not always available, and many routine medications are not on the islands’ formulary.

For almost two decades, Clarke has returned to the islands two or three times per year for weeklong free clinics, during which he sees dozens of children with epilepsy and other conditions with local practitioners. He often convinces colleagues in neuropsychology, neurology, and nursing to volunteer as well. Between patients, he finds time for lectures and bedside teaching. After returning home, he is readily available to the island physicians who call for patient care advice or for help with a difficult EEG.

Clarke’s advocacy in the region resulted in five new epilepsy drugs being added to the government’s approved drug formulary. He arranged for the donation of several EEG machines to island clinics, provided instruction about basic EEG interpretation, and arranged for technician training. His efforts represent humanism on a large scale.

In honor of National Epilepsy Awareness Month, UT Health Austin featured a story on a Texas teen who credits pediatric epilepsy program chief Dave Clarke, MD, with her freedom from epilepsy. “Dr. Clarke has hope and faith that everyone can live a normal life, and that has inspired me to believe in my own possibilities,” said 19-year-old McKell Koncsol, who has been seizure-free since 2020. Read the incredible story and watch the accompanying video.