Neuroscience Institute: 2012

Winter 2013

Brain WavesNeuroscience Institute

Referrals: 888-890-0818

www.lebonheur.org/neuroscience

A pediatric partner

with The University

of Tennessee Health

Science Center/College

of Medicine and

St. Jude Children’s

Research Hospital

Memphis, Tennessee

Le Bonheur’s Neuroscience Institute will open

a six-bed Neurosurgical Intensive Care Unit

(Neuro ICU) in January 2013. Located on the

hospital’s Sixth Floor,

the unit will care

for patients after an

elective neurosur-

gery. This primarily

includes brain tumor,

epilepsy and spine

surgery patients.

Frederick Boop,

MD, chairman of

the Department

of Neurosurgery

and co-director

of Le Bonheur’s

Neuroscience Institute, and Stephanie Storgion,

MD, pediatric critical care specialist, will serve as

the unit’s medical directors.

“Le Bonheur is one of the few children’s hospi-

tals in the country to have the volume to support

a dedicated pediatric Neuro ICU,” said Boop.

The Neuroscience Institute performs approxi-

mately 750-800 neurosurgeries each year.

“We hope that

by having a dedi-

cated Neuro ICU

with dedicated

nurses and staff,

we can provide

a higher level of

care for these

patients,” added

Boop.

“As our

Neuroscience

Institute continues

to grow, so does

the complexity of the patients referred here from

around the country and around the world. We are

now at a point where a dedicated critical care unit

for neurosurgery patients will take us to the next

level of capability.”

Le Bonheur to open Neurosurgical ICU

A new neurosurgical intensive care unit will provide dedicated care for children post-brain surgery.

In 2012, Le Bonheur’s Neuroscience Institute offered care for thousands of children affected by tumors, epilepsy and other neurological conditions. Highlights include:

By the Numbers*

6,170 Patient days

2,430 EEG lab tests

912 Sleep studies

165 Magnetoencephalography (MEG) studies

2,026 Epilepsy Monitoring Unit monitored days

8,424 Neurology clinic visits

Joint St. Jude and Le Bonheur brain tumor program survival rates include: 1 YEAR 5 YEARMedulloblastoma 82.6 percent 72.3 percentEpendymoma 97 percent 68.8 percentGlioma 91.7 percent 66.7 percentCraniopharyngioma 100 percent 100 percent

84 percent of patients are seizure free six months after epilepsy surgery.

*annualized numbers are based on actual data from January-October 2012

820

800

780

760

740

720

700

680

660

Since 2010, neurosurgeries have grown 13.6 percent.

2010 2011 2012

80

70

60

50

40

30

20

10

0

Epilepsy surgeries 2010-2012

2010 2011 2012

Potter joins neuropsychology

team

Brian S. Potter, PsyD, is

the newest member

of the clinical neurosciences

team at Le Bonheur. The

pediatric neuropsycholo-

gist will help the Institute

provide a seamless transi-

tion between inpatient

and outpatient services.

Potter previously worked at Nationwide

Children’s Hospital and was a clinical assis-

tant professor at The Ohio State University,

Department of Pediatrics, Division of Neuro-

psychology.

He received a Doctor of Psychology

from Antioch University and completed a

post-doctoral fellowship in pediatric neuro-

psychology at Texas Children’s Hospital and

Baylor College of Medicine.

Neuropsychology services expand

Neuropsychology

services at Le Bonheur

are expanding to enhance

the level of comprehen-

sive care for Neuroscience

Institute patients.

“Neuropsychologists

play a key role in a surgery

evaluation and add to the

multidisciplinary approach

at Le Bonheur,” said

Pediatric Neurologist Amy

McGregor, MD.

Pediatric neuropsycholo-

gists work to identify

cognitive changes associated with neurological conditions

like epilepsy, brain tumors and autism spectrum disorders.

Evaluation services include testing for IQ, academic

achievement, memory, attention, executive function and

behavioral/mood.

The team – two neuropsychologists and three

neuropsychology examiners – currently sees inpatients in

the hospital’s Neuroscience

Unit and will open an out-

patient clinic in the begin-

ning of 2013. They have also

conducted several research

studies within the Institute

to enhance the care offered

at Le Bonheur.

“We assess neurocogni-

tive functioning associated

with a patient’s medical

condition, such as epilepsy,

and document current

performance, possible

cognitive changes, and assist

with differential diagnosis. These comprehensive services

are part of being a Level 4 epilepsy center,” said Nancy

Clanton, PhD, one of the team’s neuropsychologists.

“Now, with the addition of an outpatient clinic, we’ll be

able to expand our services to assess neurocognitive effects

of a greater variety of central nervous system disorders

for children.”

Neuropsychologist Nancy Clanton, PhD, evaluates patient Madison Hodge. Le Bonheur will begin providing outpatient

neuropsychology services in 2013.

Brian S. Potter, PsyD

Institute adds new neurointerventional surgeons

Elijovich named medical director of Interventional Neuroradiology

Lucas Elijovich, MD, is the new medical director of Interventional Neuroradiology

at Le Bonheur. He practices with Semmes- Murphey Neurologic and Spine Institute.

He also serves as a medical director of the NeuroICU at Methodist University Hospital. Elijovich completed a fellowship in interven-tional neuroradiology at St. Luke’s and Roosevelt Hospitals, The Hymann-Newman Institute of Neurology and Neurosurgery. Elijovich attended medical school at Univer-sity of Texas Medical Branch. He serves as an assistant professor of Neurology and Neurosurgery at The University of Tennessee Health Science Center.

Elijovich will work closely with Semmes-Murphey neurosurgeon Adam Arthur, MD. Arthur is an associate professor for The Uni-versity of Tennessee Health Science Center (UTHSC), Department of Neurosurgery. He also serves as director of Cerebrovascular and Endovascular Neurosurgery for Semmes-Murphey Neurologic and Spine Institute and as medical director of Vascular and Endovascular Neurosurgery at Methodist University Hospital. Arthur completed fellowship training in interventional neuroradiology and vascular neurosurgery with UTHSC and residency training in neurosurgery at the University of Utah.

Lucas Elijovich, MD

Adam Arthur, MD

Neurosurgeons present researchClinicians from Le Bonheur Children’s

shared their research at the 41st Annual Meeting of the American Association of Neurological Surgeons/ Congress of Neurological Surgeons, Section on Pediatric Neurological Surgery.

The topics of the presentations and posters included:

• Neo-adjuvant chemotherapy improves survival for infants with ependymoma: Preliminary results of St. Jude young children (SJYC07) trial

• Progression of craniopharyngioma following conformal radiation

• Intraoperative MRI for cervical spinal cord tumors

• Intraoperative confirmation of accurate ventricular catheter placement

• Prognostic factors associated with survival and decision-making in pediatric cranial gun-shot wounds

• Safety of corpus callostomy and vagus nerve stimulation in pediatric epilepsy

New family epilepsy support group

A new support group for families who have a child living with epilepsy, Epilepsy Partners, now meets monthly at Le Bonheur. The group allows caregivers to connect with others experiencing similar situations. The meetings will include discussion on subject areas including navigating school services, accessing community resources and talking to children about their diagnosis, with experts in these areas available to provide information and guidance. 

The group meets the third Thursday of every month, from 6-7:30 p.m. in the neurology clinic waiting area on the lobby level of Le Bonheur Children’s Hospital. Child care is provided.  For any questions about Epilepsy Partners, please call 901-287-7151. 

Save the date, May 3-4, for the Greater Mid-South Pediatric

Neurology Update The seventh annual Greater Mid-South

Pediatric Neurology Update is set for May 3-4 at The Westin Memphis, Beale Street.

The seminar has been designed to encompass state-of-the-art practices and trends in treating pediatric neurology patients. Faculty who are both clinically and academically oriented will address relevant issues and provide valuable information and insight into situations commonly presented to subspecialists in pediatric neurology. This will be performed using case-based learning and didactic lectures with time for questions and answers.

The featured speakers are Jong Rho, MD, and Jonathan Mink, MD, PhD. Rho is the head of the Division of Paediatric Neurology at Alberta Children’s Hospital and professor, Departments of Paediatrics and Clinical Neurology at the University of Calgary, Canada. Mink is the chief of Child Neurology at University of Rochester Medical Center, Rochester, N.Y. He is also professor of Neurology, Neurobiology & Anatomy, Brain & Cognitive Sciences, and Pediatrics.

For more information about Mid-South Pediatric Neurology Update, visit www.methodistmd.org or call 901-516-8933.

IN BrIef

Researchers study bed alarms for nocturnal seizures

Seizures that occur during sleep are particularly concerning to parents of children with epilepsy. The risk of death can be decreased with night-

time monitoring or supervision. Several products are available that claim to reliably detect seizure activity without frequent false alarms.

Le Bonheur’s Neuroscience Institute is the only center to review all three of the bed alarms on the market for home use. Two of the studies are complete, and the third is underway. Patients in Le Bonheur’s Epilepsy Monitoring Unit were enrolled in the studies.

“With all of the seizure alarms on the market, it may be difficult for families to decide which one would fit their needs. The goal of evaluat-ing the available models on the market is to provide more information to families who have children with epilepsy. They should then be equipped to make an educated decision on which alarm would be best for their children,” said Neurologist Stephen Fulton, MD.

The first study is “Prospective Study of 2 Bed Alarms for Detection of Nocturnal Seizures,” which was published in the Journal of Child Neurol-ogy in October 2012. This study reviewed two models of the Medpage bed alarm. The researchers, led by Stephen Fulton, MD, found that these products do not adequately detect nocturnal seizures.

The second study, “Prospective Study of the Emfit Movement Monitor,” has been accepted for publication. In this research, the Emfit movement monitor proved to perform better than the Medpage bed alarms. The Emfit detected 84 percent of nocturnal tonic-clonic seizures. The team, led by Kate Van Poppel, MD, added that advancements in these alarms to detect respiration or heart rate may improve the ability to detect seizure events.

The third study that is now underway involves the Smart Watch, which uses a watch-like device to detect excessive and repetitive move-ment and signal a family member’s Android smart phone.

Neurologists edit comprehensive pediatric epilepsy text

Neurologists at Le Bonheur Children’s

Hospital recently published Epilepsy in Children and Adolescents, an illustrated guide to the assessment, diagnosis and treatment of epilepsy in children and adolescents. The text offers the latest recommendations for best practice.

James W. Wheless, MD, served as the primary editor. He was joined by four colleagues in editing the book including Amy L. McGregor, MD, also of Le Bonheur’s Neuroscience Institute. Other Le Bonheur contributors include Neuroradiologist Asim Choudhri, MD, and Neurologists Stephen Fulton, MD, and Kate Van Poppel, MD.

The book provides an overview of the classification of epilepsy syndromes including:

• Diagnostic evaluation of childhood epilepsies• Principles of treatment• Generalized seizures and generalized epilepsy syndromes• Partial onset seizures and localization-related epilepsy syndromes• Epilepsies relative to age, etiology or duration• The full range of treatment options: medical, dietary, surgicalEpilepsy in Children and Adolescents is

available at wiley.com. A 20 percent discount can be applied with the code ECA12.

James W. Wheless, MD Amy L. McGregor, MD

Non-Profit Org.

US POSTAGEPAID

Memphis, TNPermit No. 3093

848 Adams AvenueMemphis Tennessee 38103

Brain Waves is a quarterly publication of the Neuroscience Institute at Le Bonheur Children’s Hospital. The institute is a nationally recognized center for evaluation and treatment of nervous system disorders in children and adolescents, ranging from birth defects and learning and behavioral disorders to brain tumors, epilepsy and traumatic injuries.

Institute co-directorsFrederick Boop, MDAndrew Papanicolaou, PhDJames W. Wheless, MD Adam Arthur, MDParas Bhattarai, MD Asim F. Choudhri, MD Nancy Clanton, PhDLucas Elijovich, MDStephanie Einhaus, MDJulius Fernandez, MDStephen Fulton, MD Masanori Igarashi, MDPaul Klimo, MDAmy McGregor, MDKathryn McVicar, MDRobin L. Morgan, MDBasanagoud Mudigoudar, MDMichael S. Muhlbauer, MDShalini Narayana, MBBS, PhDBrian Potter, Psy DRoozbeh Rezaie, PhD Robert Sanford, MDNamrata Shah, MDKate Van Poppel, MD Matthew Whitehead, MD

/ lebonheurchildrens@LeBonheurChild /lebonheurchildrens

Dwivedi N, Michael C, Lew DB, Arnold S, Igarashi M, Bertorini T, Thompson JW, Myers LK, Brown ML. A fatalpresentation of dermatomyositis with facial swelling. Int J Pediatr Otorhinolaryngol. 2012;76:745-749.

Papanicolaou AC. Consciousness Cognitive Critique. 2012;5:1-36 http://www.cogcrit/umn.edu.

Van Poppel K, Patay Z, Roberts D, Clarke DF, McGregor A, Perkins FF, Wheless JW. Mesial temporal sclerosis in a cohort of children with SCN1A gene mutation. J Child Neurol. 2012 Jul;27(7):893-7.

Van Poppel K and Boop F. Resective epilepsy surgery in pediatric patients: Part II Invasive evaluations,resection and surgical outcomes. Contemporary Neurosurgery. 2012;34(1):1-8

Van Poppel M, Wheless JW, Clarke DF, McGregor A, McManis M, Perkins FF, Van Poppel K, Fulton S and BoopFA. Passive language mapping with magnetoencephalography in pediatric epilepsy patients. J NeurosurgPediatr. 2012 Aug;10(2):96-102. doi: 10.3171/2012.4.PEDS11301. Epub 2012 Jun 22.

Jiao Y, Lu L, Williams RW, Smeyne RJ. Genetic dissection of strain dependent paraquat-inducedneurodegeneration in the substantia nigra pars compacta. PLoS One. 2012;7:e29447.

Campbell IM, Yatsenko SA, Hixson P, Reimschisel T, Thomas M, Wilson W, Dayal U, Wheless JW, Crunk A, CurryC, Patterson N, Fishman-Shapiro L, Riviello J, Nowaczyk MJM, Rosenfeld JA, Bejjani BA, Shaffer, LG, CheungSW, Lupski JR, Stankiewicz P, Scaglia F. Novel 9q34.11 gene deletions encompassing combinations of fourMendelian disease genes: STXBP1, SPTAN1, ENG and TOR1A. Genetics in Medicine; 2012; 14 (10): 868-876.

Wheless JW, Gibson PA, Rosbeck KL, Hardin M, O’Dell C, Whittemore V, Pellock JM. Infantile spasms (Westsyndrome): update and resources for pediatricians and providers to share with parents. BMC Pediatrics,2012; 12: 108-116.

French JA, Krauss GL, Biton V, Squillacote D, Yang H, Laurenza A, Kumar D, Rogawski MD, Wheless JW & EisaiStudy 304 Co-Investigators. Adjunctive perampanel for refractory partial onset seizures. Neurology, 2012; 79(6): 589-596.

Klimo P Jr, Astur N, Gabrick K, Warner WC Jr, Muhlbauer MS. Occipitocervical fusion using a contoured rodand wire construct in children: a reappraisal of a vintage technique. J Neurosurg Pediatr. 2012 Nov 16.[Epub ahead of print].

Aboud O, Mrak RE, Boop FA, Griffin ST. BioMed Central 10:35. Apolipoprotein epsilon3 alleles are associated with indicators of neuronal resilience. Commentary, 10:36, 2012.

Godfraind C, Kaczmarska JM, Kocak M, Dalton J, Wright KD, Sanford RA, Boop FA, Gajjar A, Merchant TE, Ellison DW. Distinct disease-risk groups in pediatric supratentorial and posterior fossa endymomas. Acta Pathol, Apr 21, 2012.

DiCocco JM, Fabian TC, Emmett KP, Magnotti LJ, Zarzaur BL, Bate BG, Muhlbauer MS, Khan N, Kelly JM,Williams JS, Croce MA. Optimal outcomes for patients with blunt cerebrovascular injury (BCVI): tailoring treatment to the lesion. J Am Coll Surg Apr;212(4):549-57; discussion 557-9, 2012.

Boop FA. Editorial. Programmable shunts versus nonprogrammable shunts J Neurosurg Pediatrics May; 9:1, 2012.

Ditta LC, Qayyum S, O’Brien TF, Choudhri AF, Wilson MW. Chondromyxoid fibroma of the orbit. Ophthal PlastReconstr Surg 2012 (DOI: 10.1097/IOP.0b013e31823bd1e0)

Boop FA, Helton KJ, Ellison DW, McKinnon P, Gajjar A, Pai Panandiker AS. Radiation therapy and adjuvant chemotherapy in a patient with a malignant glioneuronal tumor and underlying ataxia telangiectasia: A case report and review of the literature. DeWire MD, Beltran C, J Clin Oncol, accepted for publication, 2012.

Wait S, Einhaus SE, Choudhri A, Boop FA. Child’s Nervous System. Eight-second MRI scan for evaluation of shunted hydrocephalus. Childs Nerv Syst. 2012 Aug;28 (8):1237-41.doi:10.1007/s00381-012-1769-x. Epub 2012 May 22.

Choudhri AF, Parmar HA, Morales RE, Gandhi D. Imaging of lesions of the skull base. Otolaryngol Clin North Am. 2012 Dec;45(6):1385-404. doi: 10.1016/j.otc.2012.08.008.

Boop FA. Editorial. Craniopharyngioma. J Neurosurg Pediatr. 2012 Oct;10(4):291; discussion 292. doi: 10.3171/2012.5.PEDS12186. Epub 2012 Aug 24.

Merchant TE, Kun LE, Hua CH, Wu S, Xiong, X, Sanford RA, Boop FA. Disease control after reduced volume conformal and intensity modulated radiation therapy for childhood craniopharyngioma. Int J Radiat Oncol Biol Phys. 2012 Dec 11. pii: S0360-3016(12)03729-7. doi: 10.1016/j.ijrobp.2012.10.030. [Epub ahead of print].

Landau E, Boop FA, Conklin HM, Wu S, Xiong X, Merchant TE. Supratentorial Ependymoma: Disease control, complications and functional outcomes after irradiation. Int J Radiat Oncol Biol Phys. 2012 Dec 11. pii: S0360-3016(12)03733-9. doi: 10.1016/j.ijrobp.2012.10.033. [Epub ahead of print].

Broadway SJ, Ogg RJ, Scoggins MA, Sanford R, Patay Z, Boop FA. Surgical management of tumors producing the  thalamopeduncular syndrome of childhood. J Neurosurg Pediatr. 2011 Jun;7(6):589-95. doi: 10.3171/2011.4.PEDS119.

DeCuypere M, Klimo P. Spectrum of traumatic brain injury from mild to severe. Surg Clin N Am 92:939-957, 2012

Qaddoumi I, Sane M, Li S, Kocak M, Pai-Panandiker A, Harreld J, Klimo P, Wright K, Broniscer, Gajjar A. Diagnostic utility and correlation of tumor markers in the serum and cerebrospinal fluid of children with intracranial germ cell tumors. Childs Nerv Syst 28:1017-1024, 2012

Hasan KM, Molfese DL, Walimuni IS, Stuebing KK, Papanicolaou AC, Narayana PA, Fletcher JM. Diffusion tensor quantifica-tion and cognitive correlates of the macrostructure and microstructure of the corpus callosum in typically developing and dyslexic children. NMR Biomed. 2012;25(11):1263-70 (PMID: 22411286)

Simos, P.G., Rezaie, R., Fletcher, J.M., Papanicolaou, A.C. Time-constrained functional connectivity analysis of cortical net-works underlying phonological decoding in typically developing school-aged children: A magnetoencephalography study. Brain and Language, 59 (4): 3604 – 10, 2012

Smyrnis, N., Mylonas, S., Mylonas, M.C., Rezaie, R., Siettos, C.I., Ventouras, E., Ktonas, P.Y., Evdokimidis, I., Papanicolaou, A.C. Single-trial magnetoencephalography signals encoded as an unfolding decision process. Neuroimage, 2012 Feb 15;59 (4): 3604-10.

Fulton S, Van Poppel K, McGregor A, Ellis M, Patters A, Wheless J. Prospective study of 2 bed alarms for detection of nocturnal seizures. J Child Neurol. 2012 Oct 17.

Klimo P, Panandiker ASP, Thompson CJ, Boop FA, Qaddoumi I, Gajjar A, Armstrong GT, Ellison DW, Kun LE, Ogg RJ, Sanford RA. Management and outcome of pediatric focal low-grade brainstem tumors: The St. Jude Experience. Journal of Neurosurg-Pediatrics (in press).

Sullivan LM, Stelow EB, Early SV, Choudhri AF, LeGallo RD. Oropharyngeal teratoma in a newborn. Arch ofOtolaryngol. (in press).

Li W, Wait SD, Ogg R, Scoggins M, Zou P, Wheless JW, Boop FA. Functional MRI of visual cortex performed inchildren under sedation to assist in pre-surgical planning in children. J. Pediatr. Neurosurg, 2013 (in press).

Taylor DR, Wait SD, Wheless JW, Boop FA. Amygdalar neuromelanosis and intractable epilepsy withoutleptomeningeal involvement. Child’s Nervous System, 2013 (in press).

VanPoppel K, McGregor A, Fulton SP, Ellis M, Patters A, Wheless JW. Prospective study of the Emfit movement monitor. J. Child Neurol, 2013 (in press).

Wheless JW, Phelps SJ. Clobazam: A newly approved but well-established drug for the treatment ofintractable epilepsy syndromes. J. Child Neurol, 2013 (in press).

Rezaie R, Zouridakis G, Choudhri A, Wheless JW, Volgyi E, VanPoppel K, Clanton NR, Papanicolaou AC.Functional connectivity in tuberous sclerosis complex with autistic spectrum disorder. J. of Ped. Neurol, 2013(in press).

Zouridakis, G., Paditar, U., Situ, N., Rezaie, R., Castillo, E., Levin, H., Papanicolaou, A.C. Functional connectivity changes in mild traumatic brain injury assessed using magnetoencephalography. Journal of Mechanics in Medicine and Biology, (in press).

Tsiaras, V., Simos, P.G., Rezaie, R., Castillo, E.M., Sheth, B.R., Fletcher, J.M. Papanicolaou, A.C. Classification of autistic individuals based on common spatial patterns in baseline magnetoencephalographic recordings. Human Brain Mapping, (in press).

Neuroscience research: 2012Peer-reviewed journal articles