February 22, 2022, Filed Under: NewsLaser Interstitial Thermal Therapy Adapted for Infants Dave Clarke, MD Elizabeth Tyler-Kabara, MD, PhD Winson Ho, MD Dave Clarke, MD, Elizabeth Tyler-Kabara, MD, PhD, and Winson Ho, MD, of the Pediatric Neurosciences Program recently performed laser interstitial thermal therapy on a four-month-old infant. This is likely the youngest patient to undergo the procedure. Although laser interstitial thermal therapy is increasingly utilized in the surgical treatment of epilepsy, it is seldom employed in individuals less than two years old. Placement and stabilization of the laser fibers rely on stereotactic navigation techniques that assume maturity of the patient’s skull configuration. However, laser interstitial therapy is a particularly intriguing option for individuals who may have multiple epileptogenic zones that could require multiple procedures over time, such as individuals with tuberous sclerosis complex (TSC). The team adapted a Navigus biopsy skull mount and used electromagnetic navigation to position the laser fiber in an infant. The four-month-old child with TSC had experienced numerous clinical and electrographic seizures per day. Noninvasive testing (MRI, magnetoencephalography, scalp EEG, and SPECT) localized the seizure onset to a left frontal premotor cortical tuber, but several other tubers were present. The child underwent successful laser ablation of the epileptogenic tuber and remained seizure-free several months after surgery. This new technique shows the feasibility of laser surgery for very young patients and should be particularly useful for individuals who might require multiple procedures. Lee JJ, Clarke D, Hoverson E, Tyler-Kabara EC, Ho WS. MRI-guided laser interstitial thermal therapy using the Visualase system and Navigus frameless stereotaxy in an infant: technical case report. J Neurosurg Pediatr 2021;1-4.
February 22, 2022, Filed Under: NewsPandemic Adaption of Neuropsychological Presurgical Testing Nancy Nussbaum, PhD The COVID-19 pandemic altered virtually every facet of health care. Nonemergency procedures were postponed to preserve hospital bed capacity, routine health care was often deferred, cumbersome patient and provider screening procedures were implemented, and telemedicine was embraced to reduce the exposure risk for both patients and health care workers. The presurgical neuropsychological evaluation of children with drug-resistant epilepsy is particularly challenging under these conditions. The standard test instruments have only been validated for in-person use, and we cannot assume that remotely administered tests are equally valid. Environmental distractions are more difficult to control when the patient is at home. Cooperation with testing is improved by establishing rapport with the patient and family, but this is more difficult with remote testing. The remote examiner could also miss subtle clues about the child’s effort level or understanding the task at hand. Nancy Nussbaum, PhD, and her colleagues at Dell Medical School explored these pandemic-related challenges as they related to pediatric patients with drug-resistant epilepsy, analyzing evidence-based methods of virtual evaluation to develop a systematic decision-making process for remote neuropsychology. In this article they provide several scenarios to guide the use of virtual neuropsychological assessment and discuss the potential pitfalls of remote testing. The need for remote test validation remains, of course, but in the meantime, the models presented here may be useful for other multidisciplinary surgical teams who need to utilize remote neuropsychological testing. Nussbaum NL, Young SR, DeLeon RC, Engelmann ML, Schraegle WA. The future is now: pediatric neuropsychological presurgical epilepsy evaluation in the age of COVID-19. Epileptic Disord 2021;23:274-280.
November 13, 2021, Filed Under: NewsBermans Iskandar, MD, Presents the Inaugural Timothy M. George Memorial Lecture in Pediatric Neurosurgery Elizabeth Tyler-Kabara, MD, PhD, with Bermans J. Iskandar, MD Bermans J. Iskandar, MD, Professor of Pediatric Neurosurgery at the University of Wisconsin, presented the first annual Timothy M. George Memorial Lecture in Pediatric Neurosurgery at Dell Children’s Medical Center on November 12, 2021. Iskandar discussed the role of folate in central nervous system repair, folate-driven mechanisms of transgenerational epigenetic inheritance, and the importance of epigenetics in tissue regeneration and healing. Timothy M. George, MD, was a professor of neurosurgery at Dell Medical School and a beloved pediatric neurosurgeon at Dell Children’s Medical Center when he died unexpectedly at age 59 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 the then new Dell Children’s Hospital. His research interests included Chiari malformation and the genetic mechanisms of neural tube defects. Tim was a superb pediatric neurosurgeon. His quiet confidence and unfailing empathy and compassion endeared him to colleagues and patients alike. Timothy M. George, MD
October 29, 2021, Filed Under: NewsCongratulations, Dr. Clarke! Congratulations to Dave Clarke – chief of the comprehensive epilepsy program at UT Austin Pediatric Neurosciences at Dell Children’s – for being recognized by the Austin Black Business Journal and Community News as one of its 2021 Top Ten Doctors in Austin. Dr. Clarke is one of several UT faculty members who will be honored at a reception on November 20. The journal recognizes physicians who have achieved professional excellence and who have actively paved the way to success for others. Congratulations, Dr. Clarke!
October 15, 2021, Filed Under: NewsWelcome to Our Newest Faculty Members! Vandana Vedanarayanan Duriel Hardy Sara Pavitt Our pediatric neuroscience team expanded this summer with the addition of new pediatric neurology faculty members. Dr. Vandana Vedanarayanan joined us after completing her residency in pediatric neurology at the University of Mississippi and will focus on general child neurology. Dr. Duriel Hardy has moved to Austin from Philadelphia where he completed his residency in child neurology and a fellowship in multiple sclerosis and neuroimmunology disorders at Children’s Hospital of Philadelphia and the Hospital of the University of Pennsylvania. His research and clinical interests are in multiple sclerosis and neuroimmunology. Dr. Sara Pavitt recently completed a headache fellowship at the University of California San Francisco, after completing her child neurology residency at Stanford. Welcome to Texas ya’ll!
October 15, 2021, Filed Under: NewsAudrey Brumback to Serve on CNS Committee on Leadership, Diversity, Equity, and Inclusion Dr. Audrey Brumback was recently appointed to the newly formed Child Neurology Society Committee on Leadership, Diversity, Equity, and Inclusion. Dr. Brumback also serves as an elected member of the CNS board of directors. The LDEI committee has already designed several strategic initiatives to begin their work of making the field of Child Neurology diverse, equitable, and inclusive. “We’re just getting started. The goal is to bring about lasting change in everything from patient care to medical education and research,” Brumback said. Thank you Dr. Brumback for giving your time to this important work and to the Child Neurology Society.
October 11, 2021, Filed Under: NewsIntroducing Our New Pediatric Neurology Textbook for Residents and Students Pediatric Neurology Clinical Assessment and Management, recently published by Springer, was edited by our chief Dr. E. Steve Roach. The book is intended to introduce child neurology to residents, students and others who are just getting started in the field. Roach commented “Information about childhood neurological disorders has increased exponentially in the last few years, making it difficult for people just starting to learn the field to know where to start. We challenged each contributing author to clearly summarize the essential information in their areas of interest for people who are just beginning a career in neurology. We see the book as a gift from one generation of child neurologists to the next.” The book features a stellar array of contributing authors, including our own Drs. Kristina Julich (neurogenetics), Louisa Keith (infections of the nervous system), and Collin Swafford (stroke in children). Many of the chapters were contributed by senior physicians who have made major contributions to the study of pediatric neurology and the book will be a useful tool for both child and adult neurology residents throughout their training and as they prepare for their board examinations.
October 1, 2021, Filed Under: News“R” is for Roach In the run-up to the recent 50th annual meeting of the Child Neurology Society in Boston, CNS executive director Roger Larson ran down and back up the alphabet with his own personal review and observations about the history of the society. His article on countdown day 31 “R” was all about our chief, E. Steve Roach. Read all about it here: “R” is for Roach
September 24, 2021, Filed Under: NewsNeurofibromatosis Clinic Recognized Congratulations to the staff of our Neurofibromatosis Clinic for being accepted as a member of the NF Clinic Network of the Children’s Tumor Foundation – a major accomplishment for a new program. The NF Clinic Network recognizes clinics that provide comprehensive medical care to individuals with NF, foster patient education, and encourage participation in clinical research trials and the NF registry. Our clinic is co-directed by pediatric neurologist Dr. Manikum Moodley, MD, FRCP, who joined us in 2019 after serving for many years as co-director of the Neurofibromatosis Program at the Cleveland Clinic, and pediatric neuro-oncologist Dr. Virginia Harrod, MD, PhD. Both Dr. Moodley and Dr. Harrod have extensive experience with the diagnosis and management of neurofibromatosis. Our clinic coordinator is Karla Robles Lopez, MD, PhD, from the the Pediatric Neuroscience Program staff. This program is just one of many ways that UT Health Austin Pediatric Neurosciences at Dell Children’s is improving the care of children with neurological disease.
August 16, 2021, Filed Under: NewsBrumback Awarded NIH Funding for Autism Research Audrey Brumback, MD, PhD, has been awarded a $553,729 grant from the National Institutes of Health to study how the thalamus is involved in brain functions that pose challenges for people with autism spectrum disorder. Dr. Brumback and her team will use mouse models to map the brain circuits involved in social/emotional behaviors as well as cognitive functions like attention and working memory. Dr. Brumback intends to use the results of these studies to design future treatments for the symptoms of autism spectrum disorder. Dr. Brumback is also a member of a multidisciplinary UT Austin team that was recently awarded a multi-million-dollar grant from the Maternal and Child Health Bureau to establish the Autism Consortium of Texas Leadership Education in Neurodevelopmental and Related Disabilities program (ACT LEND). The ACT LEND program aims to increase the capacity of the workforce to better serve individuals with autism spectrum disorder (ASD) and other developmental disabilities (DD), especially those of underserved racial, ethnic, and rural populations in Texas. Dr. Brumback will oversee the training of medical students and residents who participate in the program. As a core team faculty member, Dr. Brumback will also provide mentorship as well as clinical and research opportunities for all ACT LEND trainees.
