pediatric neurology therapeutics

Pediatric Neurology Therapeutics

Suzanne Goh, M.D.sgoh@gohmd.com

415-317-4514

OVERVIEWWhen should I refer a child to a

pediatric neurologist?

1 Unusual movements or “spells”

2 When thinking about meds for problem behaviors

3 Complex cases

When to refer…

1 Unusual movements or “spells”

o Seizureso TicsoOther movement disorder

…how are these different from stereotypies?

Medications for problem behaviors

1 Combinations of meds at low doses sometimes work better than single meds at high doses

2 Challenges with long-term use (side effects, lose efficacy over time, higher and higher doses needed, tapering off)

3 Potential alternatives to meds (supplements, acupuncture, neurofeedback, etc.)

*supplements may be needed during psychopharm therapy to counteract med toxicities (e.g. carnitine)

4 Trying relationship-based behavior programs in addition to ABA-based

Complex Cases• Multiple neurological symptoms

o Intellectual disabilityo Epilepsyo Low tone, incoordination, weaknesso Headacheso Vision and hearing problemso Movement disorder, tics, etc.

• Multi-system dysfunction• Minimal improvement with behavioral and

educational intervention

The more severe and complex the phenotype, the more likely a

causative mutation can be found.

Complex Cases

Researchers identified a form of autism (with epilepsy and intellectual disability) that is likely treatable with dietary amino acid supplementation.

80% of children with autism had blood tests showing mitochondrial dysfunction

mitochondria