MEDICAL COMMUNITY NEWS UCSF
Michael Gropper, MD
Diana Nicoll, MD, PhD, MPA
SUTTER PACIFIC MEDICAL FOUNDATION Bill Black, MD, PhD
Sensory processing disorders (SPD) are more prevalent than autism and as common as attention deficit hyperactivity disorder, yet the condition receives far less attention, partly because it’s never been recognized as a distinct disease. In a groundbreaking new study from UCSF, researchers have found that children affected with SPD have quantifiable differences in brain structure, for the first time showing a biological basis for their neurodevelopmental challenges. SPD affects up to 16 percent of school-aged children who commonly struggle with a wide range of symptoms including hypersensitivity to sound, sight, and touch; poor fine motor skills; and distractibility to irrelevant sensory information. Some SPD children find the sound of a vacuum or blender excruciating, while others have more upstream challenges with bringing together the vision and touch information necessary to write. Furthermore, a sound that one day is an irritant can the next day be sought out. The disease can be baffling for parents and a source of controversy for clinicians. “They are called the ‘out of sync’ kids. Their language is good, but they seem to have trouble with just about everything else, especially emotional regulation and distraction. In the real world, they’re just less able to process information efficiently, and they get left out and bullied,” says Elysa Marco, MD, a child neurologist and neuroscientist who treats affected children at UCSF and led the recent neuroimaging study with postdoctoral fellow Julia Owen, PhD, and senior pediatric neuroradiologist Pratik Mukherjee, MD, PhD. Marco and her colleagues in the UCSF Sensory Processing Group have an ongoing treatment trial using a kid-friendly, engaging computer training intervention for challenges with suppressing distracting stimuli and visual motor control. They are also pioneering cutting-edge genetic investigations and functional brain imaging studies for affected individuals. 24
Traumatic brain injury (TBI), especially due to improvised explosive devices, is a signature injury of the Afghanistan and Iraq wars. The blast waves alone from these devices can cause TBI, even without obvious other acute injury. Since 2000, more than 275,000 veterans have suffered some level of TBI. One of the disabilities that can be caused by TBI is posttraumatic epilepsy, and the severity of the original TBI correlates with the risk of developing epilepsy. Fifty percent of those suffering severe TBI with penetrating injury will develop epilepsy. Although the majority of posttraumatic epilepsy occurs within a few years of the initial injury, epilepsy can be a delayed consequence of head trauma, with seizures not occurring for up to twenty years. In recognition of the significance of TBI in our veteran population, the VA Epilepsy Centers of Excellence (www.epilepsy.va.gov) were established to improve the health and well-being of veteran patients with epilepsy and other seizure disorders through the integration of clinical care, outreach, research, and education. The San Francisco VA is home to the national office for the VA Epilepsy Centers of Excellence, and it also serves as one of sixteen epilepsy centers in the VA. These centers provide comprehensive evaluation for veterans with epilepsy, including state-of-the-art diagnosis in the inpatient epilepsy monitoring unit as well as medical and surgical therapies for epilepsy. The epilepsy centers offer patient and caregiver support groups as well as educational symposia for patients, caregivers, and medical providers. Many veterans also take advantage of a social media platform developed for veterans with epilepsy. The San Francisco VA Epilepsy Center takes pride in providing care and treatment for veterans and in leading the VA’s efforts to improve treatment for veterans with epilepsy and other seizure disorders.
At Sutter Pacific Medical Foundation, we have unique resources to meet the needs of children and adults dealing with developmental disabilities. Our pediatric specialists diagnose developmental disabilities in children and provide genetic screenings for children and adults. The Kalmanovitz Child Development Center provides comprehensive developmental assessment as well as treatment programs for infants, preschoolers, school-age children, and families. Under medical director Barbara Bennett, MD, child development specialists diagnose and treat learning disabilities including attention deficit, speech and language difficulties, and autism. Lalaine Dimagiba-Sebastian, MD, says autism and ADHD are the most common diagnoses in children she sees. She works closely with families to identify early intervention and other appropriate therapies. “Early intervention can help facilitate development,’’ she advises. Families interested in pursuing genetic testing to find the cause of a disability can see Eric Muller, MD, PhD, Technology for genetic testing has advanced rapidly and Dr. Muller often sees adults with disabilities that have not been diagnosed because the right tests did not exist years ago. Dr. Muller works with counselors and social workers to find resources for these adults who have aged out of a system designed to support children with disabilities. He also often sees families with children diagnosed with autism. Genetic testing can identify numerous causes of autism, but a genetic cause for an individual patient’s autism is confirmed less than 3O percent of the time. Dr. Muller‘s priority is to appropriately counsel the family regarding prognosis, if known, and recurrence risk, and then discuss available therapies. He counsels families on the chances of having a second child with autism—usually about 5 to 10 percent, unless the genetic cause is identified, and then the risk can increase substantially. A great source of satisfaction is “when I can confirm a diagnosis and, rarely, recommend a medication or treatment that had not been thought of, based on that result,” Dr. Muller says.
SAN FRANCISCO MEDICINE APRIL 2014 WWW.SFMS.ORG