Preventing and Treating Concussions

CHOC Children’s multidisciplinary team of concussion experts can help prevent and treat concussions, as well as help patients ease back in to school and sports. Careful supervision is essential for young persons with concussions, since their brains are still developing.

In this episode of CHOC Radio, Dr. Sharief Taraman, a pediatric neurologist, Dr. Jonathan Minor, a sports medicine specialist, Jenn Ahlswede, a speech language pathologist, and Mollee Oh, a physical therapist and rehabilitation supervisor, discuss:

  • SCAT3, an assessment tool parents and coaches can use immediately after an incident occurs
  • The film “Concussion,” and how concussions affect kids and teens differently than adults
  • Recommendations for cognizant and physical rest periods after sustaining a concussion

Hear more from CHOC experts in this podcast.

CHOC Radio theme music by Pat Jacobs.

Kara’s Story: A Journey with Epilepsy

Heidi Sexton knew her young epileptic daughter, Kara, needed more help. Anti-seizure medications didn’t help, hospital visits were frequent, and seizures and tantrums continued.

“It was time,” Heidi recalled. “I went in to the next doctor’s appointment with my questions: What else can we try? This isn’t working.”

Dr. Mary Zupanc, director of CHOC Children’s comprehensive epilepsy program, offered her recommendation: Kara needs brain surgery.

A little girl’s long road

Though no doubt a staggering consideration, brain surgery would be the next landmark on a long medical history that belied Kara’s short three years of life.

At just 13 months old, she underwent emergency brain surgery after her frontal lobe hemorrhaged, caused by a previously undiscovered vascular malformation. The hemorrhage in Kara’s brain led to right-side hemiplegia, leaving her no use of her right hand and limited the use her right leg.

Kara underwent physical therapy and began walking at age 2. Life was relatively normal for the Sexton family until just after Kara’s third birthday, when she began acting strangely.

Kara’s body would stiffen, she’d fall down and stare off into space, Heidi recalled. It wasn’t until a visit to the Julia and George Argyros Emergency Department at CHOC Children’s Hospital that the Sextons would learn Kara was having seizures.

At the CHOC Children’s Neuroscience Institute, Kara underwent an electroencephalogram, or EEG, a test that monitors for electrical activity in the brain. Next, she spent six days undergoing long-term video EEG monitoring. From there, Dr. Zupanc, also CHOC’s neurology division chair, made an official diagnosis of epilepsy and prescribed an anti-epileptic medication.

Exploring other options

Nonetheless, Kara’s seizures continued. Kara’s three older siblings were acutely aware of their sister’s disorder, daily counting Kara’s seizures and agonizing over each hospital visit. The family began to placate Kara in hopes of staving off outbursts and tantrums, Heidi said.

“Kara had between two and four seizures a day,” she said. “It really messed with her behaviorally. She’s a lovely kid, but she suffered serious temper tantrums. It was physically and emotionally exhausting.”

A second six-day monitoring session led Dr. Zupanc to change Kara’s medication and, as a precaution, begin evaluating her as a candidate for epilepsy brain surgery.

Further tests and scans revealed that the left hemisphere of Kara’s brain was significantly injured and atrophied – likely related to her earlier hemorrhage. In addition, Kara’s new anti-epileptic medication wasn’t working.

Dr. Zupanc concluded that the next step was a hemispherectomy, a surgical procedure in which one side of the brain is removed or disconnected.

Kara

“On scans, Kara’s hemisphere was completely white,” Heidi said. “The only thing her left hemisphere was doing was causing seizures. There was no question.”

A change of course

Nearly 11 months after the seizures first surfaced, Kara underwent surgery at CHOC to remove a portion of her brain’s left side, and disconnect the remaining portion from the right hemisphere. Performed by neurosurgeon Dr. Joffre Olaya, the procedure lasted six hours.

After 16 days recovering in the hospital’s pediatric intensive care unit, Kara went home just after her fourth birthday.

Much to her parents’ and siblings’ relief, Kara hasn’t had a seizure since her surgery eight months ago. Kara still relies on an anti-epileptic medication, but she may be able to stop taking it completely or use a lower dose of medication soon if her progress continues.

Though considering a second brain surgery was daunting for the Sextons, Heidi and her husband knew the procedure was the right choice to help their daughter.

“I looked at it in a sense of quality of life for Kara,” Heidi said. “Hopefully now she’ll be able to drive one day. Continued seizures would have impaired her cognitively forever, and I didn’t want that.”

Though she still requires extensive care, Kara is doing well physically and emotionally and is looking forward to preschool.

Kara isn’t fully aware of her journey in the last year, but she understands the meaning of the scar on her head just above her ear.

“She knows now that she doesn’t have seizures and Dr. Olaya and Dr. Zupanc fixed her,” Heidi said.

Read other stories about CHOC patients:

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  • CHOC Walk in the Park: Justin’s Helpers
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  • A Bright Future: Ian and Micah’s Story
    Even though I’ve been hanging around CHOC Children’s for a long time now, I am continually surprised by the courage, tenacity and strength of the patients I meet. It’s especially ...

 

Signs, Myths of Autism Spectrum Disorder

Autism_baby_smallerAutism Spectrum Disorder remains a mysterious but prevalent disorder that now is believed to affect one in 88 children and one in 54 boys in the United States. It’s also the fastest-growing serious developmental disability in the country.

There is no medical detection or cure for autism. However, learning as much as possible about the condition helps families understand and better assist their child with autism, says Dr. Joseph H. Donnelly, a CHOC neurologist and the medical director of The Center for Autism & Neurodevelopmental Disorders.

“The most obvious signs of autism emerge between 12 and 18 months of age,” says Dr. Donnelly.

Here are some signs that may indicate your child is at risk for an autism spectrum disorder:

  • No big smiles or other warm, joyful expressions by 6 months of age or older
  • No back-and-forth sharing of sounds, smiles or other facial expressions by 9 months
  • No babbling by 12 months
  • No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
  • No words by 16 months
  • No meaningful, two-word phrases (not including imitating or repeating) by 24 months
  • Any loss of speech, babbling or social skills at any age

Parents of children showing these symptoms should ask their pediatrician for an immediate evaluation, advises Dr. Donnelly.

It’s a myth that children with autism lack strengths, says Dr. Donnelly. In fact, people with autism can have significant strengths and sometimes perform better, or are more capable, in certain areas than typical children.

“Never assume a child cannot do something. Try everything and discover a child’s strengths, weaknesses and learning style.” he says. “Children with autism can have learning disabilities like a typical child and this needs to be addressed the same way as with any child.”

Here are some other common myths about autism:

  • All children with autism don’t speak.
  • Children with autism all have an intellectual disability.
  • Autism is an emotional disorder.
  • People with autism don’t exhibit emotions.
  • People with autism can’t lead a meaningful life.

Common medical problems associated with autism include seizures, gastrointestinal problems, allergies and sleep difficulties, Dr. Donnelly says. Autism is often associated with varied behavioral problems like attention deficit hyperactivity disorder, anxiety and obsessive-compulsive disorders.

“Treatment is available.  Seek help from your pediatrician or someone with expertise in autism,” advises Dr. Donnelly.

Related articles:

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  • Can children outgrow autism?
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    CHOC Children’s and the William and Nancy Thompson Family Foundation (Thompson Family Foundation) recently unveiled a new collaboration that expands our region’s capacity to serve children with autism spectrum disorders ...

Kids and Concussions: Learn How to Play it Safe

boy playing soccerUNDERSTANDING CONCUSSIONS

“The word concussion comes from the Latin word to shake violently. It’s a force that causes a temporary injury to the brain or spinal cord,” says Dr. Taraman. “A lot of times, people may hit their head and don’t realize it was
a concussion.”

Signs of concussion may include:

  • Forgetfulness
  • Confusion
  • Loss of consciousness

PLAY IT SAFE

If a child is injured during a sports practice, parents and coaches should make sure the young athlete stops playing. “The child needs to avoid any further hits, jolts, shakes or bumps to the head or spine,” says Dr. Taraman. “Make sure they don’t go back [in the game] and get a second hit. Not only is it unsafe, it’s going to make the recovery take longer and affect the child.”

SIDELINE TIME

“The vast majority of concussions will resolve themselves and heal relatively well,” says Dr. Taraman. After being diagnosed, parents should follow the Graduated Return to Learn & Play Guidelines advised by their doctor. This includes “slowly ramping up from a total rest period of 24 to 48 hours not visiting social media, texting, etc so the brain can heal,” says Dr. Taraman.

The guidelines include five stages of activity levels, such as:

  • No physical activity
  • Sports-specific exercise
  • Non-contact training drills

FAST FACTS

  • How many hours should a child rest after an on-field head injury: 24-48
  • What is the number of sports-related concussions that occur every year in the U.S.: 30,000
  • What is the percentage of sports-related concussions involving children between the ages of 8 and 13: 40%

View the full feature on Kids and Concussions

Dr. Sharief Taraman
Dr. Sharief Taraman
CHOC Neuroscience Institute

PHYSICIAN FOCUS: DR. SHARIEF TARAMAN

Dr. Taraman is a pediatric neurologist and assistant professor at University of California, Irvine. He specializes in concussion management.

Dr. Taraman’s philosophy of care: “I love pediatrics. My daughter was born my first day of medical school. I try to help parents understand the balance of the risks and benefits of participating in sports.”

EDUCATION:
Wayne State University School of Medicine
University of Michigan (B.S., Biochemistry)

BOARD CERTIFICATIONS:
Neurology with special qualifications in child neurology

More about Dr. Taraman | More about the CHOC Neuroscience Institute

This article was featured in the Orange County Register on September 30, 2013 and was written by Shaleek Wilson.

Kids and Headaches

girl_headacheWHAT IS A HEADACHE?

A headache is pain or discomfort in the head or face area. It can be acute (sudden) or chronic (recurrent). “For a child with an acute headache, you want to make sure there are no other problems that need to be addressed, such as an infection,” says Fernandez. If a child has chronic headaches, but their neurological (nervous system) exams are normal, migraines may be the problem.

MORE ABOUT MIGRAINES

Although there are no blood tests to determine if a child has a migraine, family history usually helps physicians pinpoint the diagnosis. Migraines can be brought on by food triggers, such as chocolate, cheeses and foods with preservatives such as nitrates. Nitrates can be found in favorite childhood foods including hot dogs and bologna, says Fernandez. Environmental elements including glare and sun exposure can also set them in motion. So how can you tell if your child has a migraine? Pay attention to these common symptoms:

  • Abdominal discomfort
  • Nausea and/or vomiting
  • Pain on one or both sides of the head
  • Facial pallor (paleness) during headache
  • Relief of headache pain with sleep

PAIN RELIEVERS

Responding quickly is key to treating headaches and migraines. Over-the-counter pain relievers such as ibuprofen should be taken right away. “If you wait too long, nothing is going to help,” says Dr. Fernandez. Letting your child rest in a dark room or applying cold compresses are other ways parents can help ease the pain.

How can children practice proper headache hygiene?

Establishing good habits can help keep headaches at bay. These headache hygiene measures can help:

  • Regulate your child’s sleep
  • Find ways to help them cope with stress
  • Avoid triggers
  • Eat nutritious meals consistently
  • Drink at least 8 glasses of fluid per day for adequate fluid intake
  • Exercise at least 5 times per week for 30 minutes or more. This can help with stress and depression as well.

FAST FACTS

  • When tension headaches occur most often: 9-12 Years Old
  • When migraines may start: 5-8 Years Old
  • When cluster headaches usually start: 10 Years Old

View the full feature on Kids and Headaches

Dr. Amanda N. Fernandez
Dr. Amanda N. Fernandez
CHOC Neuroscience Institute

PHYSICIAN FOCUS: DR. AMANDA N. FERNANDEZ

Dr. Fernandez completed her pediatric residency at Kings County Hospital in Brooklyn, NY and her fellowship in Pediatric Neurology at the University of Miami/Jackson Memorial Medical Center. She is a member of the American Academy of Neurology, American Epilepsy Society and the Child Neurology Society.

Dr. Fernandez’s philosophy of care: “My philosophy is family-centered; looking at the child’s whole picture of health. It’s not just treating the pain or headache, but understanding the other psycho-social reasons for their pain.”

EDUCATION:
University of the East, Ramon Magsaysay Memorial Medical Center, Philippines

BOARD CERTIFICATIONS:
Pediatrics and Child Neurology

More about Dr. Fernandez | More about the CHOC Neuroscience Institute

This article was featured in the Orange County Register on September 9, 2013 and was written by Shaleek Wilson.