The Pediatric Neuromuscular program assumed overall coordination and direction of the Comprehensive Neuromuscular Care Center in July 2011. The following accomplishments are noted with increase in total number of outpatient visits and encounters (with 60% of all neuromuscular families and 80% of DMD families from outside Cincinnati Children’s service areas – i.e. other states and cities in the US and other countries):
- Establishment of an interdisciplinary cardiac-pulmonary clinic for the extended neuromuscular evaluations
- Provision of additional DMD/BMD carrier clinics with Cardiology, ophthalmology evaluations, health psychologist and neuromuscular neuropsychology services
- Initiation of muscle and nerve ultrasound services in the outpatient clinic is expected in the fall 2012
The pediatric NM clinic was one of the 3 (with Asthma and Rheumatology) clinics at Cincinnati Children's to successfully engage in the EHR process for review of history and Peds QL, thereby laying the infrastructure for efficient use of electronic medical records for monitoring patient outcomes.
Skelton lab: The development of a brain specific CrT knockout mouse to understand CNS specific effects of the loss of Cr has demonstrated that female carrier mice did not have learning and memory deficits despite having significantly lower Cr than WT, providing insight into the necessary levels of Cr for proper brain function. CrT knockout mice were found to have an exaggerated response to serotonin releasing drugs, expanding the role of Cr in serotonin signaling.
Vorhees lab: Hypothesizing that inhibiting the serotonin reuptake transporter would prevent the adverse effects of MDMA (Ecstasy), the selective serotonin reuptake inhibitor (SSRI) antidepressant, citalopram caused long-term reductions in hippocampal 5-HT and impairments in learning and memory for both allocentric and egocentric abilities. Animals were exposed during a stage of brain development approximating human 3rd trimester, raising concerns about the safety of antidepressants when used during pregnancy.
Williams Lab: Focusing on understanding the brain regions involved in egocentric learning and memory, specific dopaminergic lesions in rats demonstrated that lesions in the lateral portion of the dorsal striatum ,but not the medial portion dorsal striatum lesions produced 30-40% increases in errors during egocentric learning with increases in latency to escape, improving our understanding of regional specificity for egocentric learning and memory.
Neonatal Neurology Program
The Neonatal Neurology team provides consultation services to Newborn Intensive Care Units at Cincinnati Children’s Hospital, Good Samaritan Hospital and University Hospital of Cincinnati for the acute management of seizures and other neurological disorders of the newborn. We have worked closely with neonatology to develop protocols for EEG monitoring and treatment of neonatal seizures. We are in the process of expanding neonatal electrophysiology services to neonatal intensive care units in Dayton and Northern Kentucky.
We have also created and continue to expand a multi-disciplinary follow up clinic including participants from Occupational Therapy, Speech Therapy, Nutrition, Neonatology and Neurology which provides subsequent care for these infants following discharge from the Neonatal Intensive Care Unit and continuing through the first several years of life. This consistent and comprehensive outpatient care facilitates longitudinal identification of risk factors for poor neurologic development and areas where targeted interventions may improve long term outcomes.
Using lessons learned from our experiences creating multi-disciplinary care for patients from the neonatal intensive care period through early childhood, we are also working with Cardiology to develop similar cardiac intensive care protocols and outpatient follow up for survivors of complex congenital heart disease requiring cardiac surgery.
Movement Disorder and Tourette Syndrome Program
The Movement Disorders and Tourette Syndrome Clinic has a regional and national reputation and we see referrals from multiple states in the region for second opinions. The clinic program offers a full spectrum of pharmacological services for movement disorders, collaboration with and referral to neurosurgery for deep brain stimulation, and collaboration with psychology for behavioral treatments for Tourette Syndrome. Clinic director Donald Gilbert is a member of the NIH taskforce on Pediatric Movement Disorders and of the Medical Advisory Board for the Tourette Syndrome Association. He has also been a visiting professor and speaker at conferences on Movement Disorders in Children in Minneapolis, Savannah, and Boston. The clinic is active in multiple phases of research, with 14 publications in the last year and with two clinical trials of new medications for Tourette Syndrome. The research program includes studies of the physiology of motor cortex and brain neuroplasticity in children and adults. We currently have 3 NIH grants active for studies in Tourette Syndrome and ADHD.