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16 CHILDREN’S MEMORIAL HERMANN HOSPITAL PEDIATRIC NEUROSCIENCE

SUMMER JOURNAL A PUBLICATION OF C HILDREN’ S M EMORIAL H ERMANN H OSPITAL AND M CG OVERN M EDICAL S CHOOL AT UTHEALTH In This Issue

True Stories of Strength, Courage 01 and Perseverance

Pediatric Clinical Trials for Management Rare Disorders Darius Sonia: The Perfect Early Biomarkers of Autism 02 Candidate for Selective 14 Spectrum Disorder in Infants Dorsal Rhizotomy with Tuberous Sclerosis Complex

Inside the Texas Comprehensive Continuation Study for 04 Spasticity Center Individuals Diagnosed with Autism Spectrum Disorders and A Fresh Start for Cristian Serrato: Tuberous Sclerosis Complex 05 Deep Brain Stimulation Transforms a Life Intra Erythrocyte Dexamethasone 15 in the Treatment of Using Sophisticated Brain-imaging Telangiectasia 07 Techniques to Help Make the Treatment Decision for Patients with Spastic News of Note Children’s Memorial Hermann Hospital and the McGovern Intractable Epilepsy 16 Medical School Welcome Toward a New Paradigm for the Dr. Michael Watkins 08 Treatment of Intractable Epilepsy Dr. David Sandberg Awarded the Inaugural Dr. Marnie Rose Brain Tumor Treatment Professorship in Pediatric Methotrexate Infusion Directly into 10 the Fourth Ventricle in Children with Malignant Fourth Ventricular Dr. Manish Shah Named to Houston Brain Tumors 17 Business Journal’s 40 Under 40

Riley Lentz: No Stone Unturned Seven Pediatric Neuroscience 12 18 Specialists Named to Top Doctors 13 Detecting Pediatric Brain Tumors Lists for 2015 19 Selected Publications

MEMORIAL HERMANN-TEXAS MEDICAL CENTER True Stories of Strength, Courage and Perseverance

Children are our future. If we give them the tools they need to succeed, including health, their lives will unfold in wonderful, unexpected ways. In this inaugural issue of the Children’s Memorial Hermann Hospital and McGovern Medical School at UTHealth Pediatric Neuroscience Journal, we tell the stories of three families who made courageous decisions to improve the lives of their children. We’re grateful to Sarah Sonia, the mother of Darius Sonia; Lusi and Guadalupe Serrato, the parents of Cristian Serrato; and Melissa Saban, the mother of Riley Lentz, for sharing their experiences at Children’s Memorial Hermann Hospital. Born seven weeks early, Darius suffered an intraventricular hemorrhage in the first few days of life that left him with spasticity in the lower limbs. A beneficiary of the expertise of Dr. Manish Shah, the leading neurosurgeon in the area for selective dorsal rhizotomy, the eight year old is now taking karate lessons and talking about playing high school football. Until she was six, Cristian was walking, talking and eating normally. Then one by one, she started losing her developmental milestones. When she presented with rapid onset -parkinsonism, her multidisciplinary physician team made a bold move to recommend deep brain stimulation, a procedure that changed her life. After recurrence of her malignant brain tumor (medulloblastoma) despite multiple treatments, Riley was among the first partici- pants enrolled in the phase II clinical trial of direct delivery of methotrexate into the fourth ventricle of the brain, an innovative therapy that minimizes the side effects of chemotherapy by decreasing systemic drug exposure. In January, her mother posted her daughter’s positive results on her Facebook page. Physicians affiliated with Children’s Memorial Hermann Hospital, the Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center and McGovern Medical School are engaged in a broad and intensive research program focused on the mechanisms, treatment and cure of neurological disease and injury. In this issue we report on a team of physicians who believe that the future of epilepsy treatment lies in the study of brain networks using (MEG). Other teams focus on clinical trials for rare disorders, including autism spectrum disorder in infants with tuberous sclerosis complex and a new treatment for ataxia telangiecstasia, a progressively disabling, life-threatening disease for which no therapy is currently available. We would like to take this opportunity to congratulate Dr. Manish Shah on being named to the Houston Business Journal’s 40 Under 40 Class of 2015 and to welcome Dr. Michael Watkins as the newest member of our team of affiliated pediatric physicians. Dr. Watkins focuses his practice on the treatment of epilepsy in children, particularly intractable epilepsy, including the use of magnetoencephalography (MEG) in the evaluation of pediatric patients with medically refractory seizures. We hope you find the information in ourPediatric Neuroscience Journal interesting and useful. If you have questions about our programs, please feel free to contact us directly.

With best wishes,

DAVID I. SANDBERG, M.D., FAANS, FACS, FAAP IAN J. BUTLER, M.D. Director of Pediatric Neurosurgery, Children’s Memorial Hermann Hospital and Memorial Professor and Director of Child and Adolescent Neurology, Distinguished Chair in West Hermann Mischer Neuroscience Institute at the Texas Medical Center Syndrome Research, McGovern Medical School at UTHealth 713.500.7142 Associate Professor, Dr. Marnie Rose Professorship in Pediatric Neurosurgery, Department of Pediatric Surgery and Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UTHealth

Co-director, Pediatric Brain Tumor Program, The University of Texas MD Anderson Cancer Center 713.500.7370

CHILDREN’S MEMORIAL HERMANN HOSPITAL 01 NEURO-ONCOLOGY

or four days a week of hour-long therapy PEDIATRIC SPASTICITY MANAGEMENT sessions after the surgery.” Selective dorsal rhizotomy (SDR) is a neurosurgical procedure that selectively Darius Sonia: The Perfect destroys problematic nerve roots in the and is most often done in chil- dren to relieve the symptoms of spastic Candidate for Selective diplegia or . Performed correctly in the right surgical hands, the Dorsal Rhizotomy procedure provides an immediate, per- manent reduction in spasticity and offers caring and informed mother, children who follow a program of intensive a knowledgeable physical postoperative therapy the potential to walk therapist and an expert in independently within one to two years. the surgical management After the ADHD evaluation, Sonia had JFSLDOofA spasticity haveWUMTIH transformed the life of reservations about starting her son on eight-year-old Darius Sonia. medication. “I wasn’t sure about it, but Born seven weeks early, Darius suf- it turned out to be a good decision,” she fered an intraventricular hemorrhage says. “He took it for two years with good in the first few days of life – a common results. In the meantime, we changed occurrence with premature birth. The therapists and I started reconsidering BCPNEGR“hemorrhage left him with a single signifi- dorsal rhizotomy.” cant deficit: spasticity in the lower limbs. MANISH N. SHAH, M.D. Director, Pediatric Spasticity and Movement Disorder Surgery; Assistant Professor, “MOST PROVIDERS USE LONGER INCISIONS AND CUT ONLY ABOUT Department of Pediatric Surgery, McGovern 30 PERCENT OF THE ROOTLETS. EVIDENCE SHOWS THAT THIS Medical School at UTHealth

APPROACH OFTEN FAILS IN THE LONG TERM, WITH A RETURN OF THE The new therapist was Christine SPASTICITY. WE SEE MANY PATIENTS WITH FAILED RHIZOTOMIES AND Hill, PT. Hill thought Darius would do UNFORTUNATELY, THERE’S NOTHING WE CAN DO FOR THEM SURGICALLY. well with SDR and suggested they ask for a referral to Manish N. Shah, M.D., IT’S A ONE-SHOT PROCEDURE. IF PARENTS ARE CONSIDERING who directs the Texas Comprehensive RHIZOTOMY, WE STRONGLY ENCOURAGE THEM TO BE EVALUATED AT Spasticity Center at McGovern Medical CHILDREN’S MEMORIAL HERMANN HOSPITAL IN HOUSTON.” School, Children’s Memorial Hermann Hospital and the Memorial Hermann Mischer Neuroscience Institute at the “Darius has been in therapy since he Texas Medical Center. Fellowship-trained was three months old,” says his mother in pediatric neurosurgery, with special Sarah Sonia, who moved to Houston expertise in the surgical management of from Shreveport, Louisiana, in 2008, spasticity and dystonia in children, Dr. a year after her son’s birth. “In therapy Shah is the leading neurosurgeon in the he learned to stretch his muscles and area for selective dorsal rhizotomy and improve his range of motion, but eventu- also is an expert in pediatric epilepsy, ally the tightness would come back. When craniofacial surgery and craniocervical he was about five, I started considering spine surgery. He was recruited from a dorsal rhizotomy, which requires a year Washington University in St. Louis of intensive following after completing his fellowship at St. the surgery. But a pre-surgery evaluation Louis Children’s Hospital under world- showed he had ADHD. We didn’t think he renowned pediatric neurosurgeon Tae could concentrate well enough to do three Sung Park, M.D.

02 MEMORIAL HERMANN-TEXAS MEDICAL CENTER “We do selective dorsal rhizotomy parents are considering rhizotomy, we An intraventricular hemorrhage in the first few with a single incision at one to one-and- strongly encourage them to be evalu- days of life left Darius Sonia with spasticity in his a-half levels of the spine and cut 75 to 80 ated at Children’s Memorial Hermann legs. Thanks to the surgical skill of Dr. Manish percent of the nerve rootlets,” Dr. Shah Hospital in Houston.” Shah, Darius participates in activities that once says. “Most providers use longer inci- Darius was the perfect candidate for seemed unattainable. sions and cut only about 30 percent of SDR, according to well-established crite- the rootlets. Evidence shows that this 30 ria for success: the spasticity was limited and unroofed the spinal percent rootlet-cutting approach often to his legs, he had good trunk control and canal in the mid-lower back. After expos- fails in the long term, with a return of no previous orthopedic procedures, he ing the dorsal sensory nerve roots, he the spasticity. We see such patients with could tolerate physical and occupational divided them into rootlets and tested failed rhizotomies and unfortunately, therapy and he had strong family support. them one by one, cutting about 75 per- there’s nothing we can do for them In June 2015, Dr. Shah took Darius to cent of the most spastic rootlets. The surgically. It’s a one-shot procedure. If the OR, where he performed a one-level surgery took two and a half hours.

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Darius spent 48 hours on bed rest and was up and active immediately after- Inside the Texas Comprehensive Spasticity Center ward. After a four-day stay at Children’s Memorial Hermann Hospital, he was transferred to Shriners Hospital for Children in the Texas Medical Center for inpatient rehabilitation. Therapy began as soon as he was admitted. “When I went to see Darius to remove the bandage a week and a half after sur- gery, he was already up roaming the hallway in a wheeled walker,” says Dr. Shah, who is an assistant professor in the division of Pediatric Neurosurgery at McGovern Medical School and direc- tor of pediatric spasticity and movement disorder surgery. “What a sweet kid! Like Darius Sonia, children with spasticity, Dr. Manish Shah heads the Texas Comprehensive He’s enthusiastic and adorable and very movement disorders or cerebral palsy have Spasticity Center, where a multidisciplinary motivated to walk. We all win the lottery complex care needs and typically see multiple approach ensures comprehensive treatment for in different ways. He was premature and providers for different opinions before their par- each child. had the intraventricular hemorrhage, but ents make a treatment decision. In the process his mom educated herself about his condi- they lose valuable time and, in many cases, suffer irreversible damage. Specialists affiliated with tion and found excellent therapists. In our the Texas Comprehensive Spasticity Center aim to end the cycle of referral from specialist to experience young patients with a strong specialist by offering carefully coordinated multidisciplinary care in a single location. desire to succeed and good family support A collaboration of Children’s Memorial Hermann Hospital, the Memorial Hermann Mischer can achieve independent walking.” Neuroscience Institute at the Texas Medical Center and McGovern Medical School, the Texas Darius was released from Shriners Comprehensive Spasticity Center is led by Manish N. Shah, M.D., an assistant professor in the Hospital a week earlier than expected. division of Pediatric Neurosurgery and director of pediatric spasticity and movement disorder “The surgery was a good decision for surgery. The team of affiliated physicians includes a pediatric neurologist who specializes in move- him,” his mother says. “He always wanted ment disorders, three pediatric neurosurgeons, pediatric orthopedists and a pediatric physical to participate in some kind of sport but medicine and rehabilitation specialist, plus physical and occupational therapists, a clinical trial because of his balance problems, I never program manager and physician assistants and medical assistants who coordinate care. This thought he’d be able to. Now he’s taking multidisciplinary approach ensures the most comprehensive specialized treatment for each patient, karate, doing kicks and punches, and beginning with evaluation – observation, videos and medical tests – and continuing through treat- talking about how he wants to play foot- ment and therapy. ball and be a quarterback. His muscles are “No other group of specialists in the region sees spasticity patients together for an hour in one getting stronger and he’s doing things he room,” Dr. Shah says. “We all work together to determine in one session what the child needs, couldn’t do before the surgery.” so that parents know exactly what the treatment options are before they leave the Center. This Darius turned eight in August 2015. approach saves children years of bouncing from provider to provider with no real treatment decision He continues therapy three times a week made. They often need to be seen by three or four specialists. By the time they see all of these and sees Dr. Shah every three months in providers – and many have long scheduling wait times – the has caused irreversible follow-up, which will continue for at least damage to their joints and muscles. They may need to see an orthopedic surgeon. If they do, we another year. can refer them down the hall. If we determine that they need a new brace, we can refer them to “We like to follow patients over time as occupational therapy. If a child is a candidate for selective dorsal rhizotomy, we can schedule the part of their care team so we can continue surgery and arrange a transfer to Shriners Hospital for Children for inpatient rehabilitation after to help them improve their mobility,” he discharge from acute care. We also ensure that parents have access to home therapy after their says. “We’re not the kind of practice that stay at Shriners. operates on kids and discharges them “The process we’ve created fills an enormous care gap in the community and illustrates how into the wild. We’re very committed to much of a challenge it is for these parents to coordinate care for their children,” Dr. Shah says. the long-term welfare of our patients and “We all work very well together to ensure that patients are appropriately diagnosed and receive their families.” treatment in a timely fashion.”

04 MEMORIAL HERMANN-TEXAS MEDICAL CENTER When Cristian started school, she A Fresh Start for began to lose her voice, so her parents put her in speech therapy. “Then we noticed she wasn’t walking normally, so Cristian Serrato: Deep Brain she started physical therapy,” her mother says. “And then she had problems with Stimulation Transforms a Life her hand movements, so we added occu- pational therapy.” uch of neurology is detec- By the time Cristian was seven, she was tive work. Like good in therapy sessions five days a week. “The sleuthing, successful prac- more she grew, the worse the symptoms tice demands profound got,” Lusi Serrato says. “Eventually, she JFSLDOA WUMTIHknowledge, honed investigative skills, could no longer talk and we thought, persistence and a measure of artistry. In ‘How do we communicate with her?’ We the case of Cristian Serrato, diagnosis learned sign language and got her an iPad. and treatment of a challenging disorder She got very good at it.” required all of these talents and more – the combined expertise of a multidisciplinary team of subspecialists affiliated with PEDRO MANCIAS, M.D. BCPNEGR“ Professor, Department of , Children’s Memorial Hermann Hospital, McGovern Medical School at UTHealth the Memorial Hermann Mischer Neuroscience Institute and McGovern Medical School at UTHealth. In 2012, Cristian’s pediatrician referred her to Pedro Mancias, M.D., a pediatric neurologist whose clinical “DYSTONIA WAS THE BASELINE FROM WHICH CRISTIAN OPERATED. interests are neuromuscular disorders, WHEN WE REMOVED IT, SHE WAS LEFT WITH WEAKNESS AND A LONG and nerve conduction studies. “Cristian had a history of mild ROAD OF THERAPY AHEAD. BUT THE PSYCHOLOGICAL EFFECT OF THE delays in speech and walking, and by the SURGERY HAS BEEN REMARKABLE. AT HEART SHE IS A HAPPY TEENAGE time I saw her she had experienced two GIRL AND IT HAS BEEN VERY REWARDING TO WATCH HER IMPROVE.” years of regression in those abilities,” says Dr. Mancias, who is the Adriana Blood Professor of Pediatrics at McGovern Born at term, Cristian was a small baby – Medical School. “She also had a known just 4 pounds, 3 ounces. “From the begin- deletion in chromosome 19, but at the ning we had problems, but it was only time it was discovered, its importance was later that they became serious,” says her unknown. We initiated a thorough evalu- mother, Lusi Serrato. “As a baby she never ation including MRI, EMG, metabolic learned to roll over or sit up by herself, so studies, and a biopsy we started home therapy very early. She of muscle and conjunctiva. Cristian has was almost two when she learned to walk been through a lot in her 13 years of life.” and she took longer than normal to reach The results of every test came back her other milestones as well.” negative, but she continued to worsen Until the age of six, Cristian was walk- to the point that her body had twisted ing, talking and eating normally. “Then into a contracted dystonic state. “We one by one she started losing all the began researching the deletion in chro- milestones she’d met,” says Guadalupe mosome 19 and learned that it’s very Serrato, her father. “I have videos of her close to the gene ATP 1A3, which is going to the park, playing on the jungle associated with two very rare conditions – gym, playing with her friends and then she alternating hemiplegia and rapid onset could no longer do any of those things.” dystonia-parkinsonism,” Dr. Mancias

CHILDREN’S MEMORIAL HERMANN HOSPITAL 05 NEURO-ONCOLOGYPEDIATRIC SPASTICITY MANAGEMENT

School, and her two fellows, Nivedita Thakur, M.D., who is now an assistant professor in the department of Pediatrics, and Allison Boyle, M.D., an assistant pro- fessor in the department of Neurology. “UT MOVE got involved to determine whether there might be other more beneficial medications and to explore surgical interventions,” Dr. Thakur says. “Cristian’s disease was progress- ing and affecting all parts of her body. She couldn’t sit in a chair. Her trunk was twisted, her left leg wouldn’t straighten at all and her right leg was always turned when she walked. Her right hand was curled into a tight fist. What we saw was a child who was deteriorating rapidly with a dwindling quality of life. The most remarkable thing was that she was still a happy girl and very resilient.” Cristian was not a typical candidate for deep brain stimulation based on the litera- ture. “As physicians we have to be safe and carefully consider the risk versus the ben- efit, but ultimately we have to be able to think outside the box,” Dr. Thakur says. “Cristian simply had no other options. A multidisciplinary team came together to consider DBS for her – a bold move in a Cristian Serrato’s physician team recommended “With almost every follow-up visit to very rare condition – and made that rec- deep brain stimulation for a rare movement disor- Dr. Mancias, we tried a new drug,” Lusi ommendation to her parents.” der. Now the teenager is making dramatic progress Serrato says. “He talked to us about deep In addition to Dr. Mancias, Dr. Furr- in outpatient rehabilitation. brain stimulation, but we were trying to Stimming, Dr. Thakur and Dr. Boyle, avoid putting her through brain surgery. Cristian’s medical team included Manish says. “Another patient we followed for He described it in a way that wasn’t so Shah, M.D., who is director of the Texas many years presented with alternat- scary, but we thought this is our child ing hemiplegia. Eventually, through and we’d be opening her brain. I said ERIN FURR-STIMMING, M.D. advances in genome sequencing, we let’s wait until it’s the last resort. If I had Assistant Professor, Department of discovered she had a deletion on ATP known then what I know now, I wouldn’t Neurology, McGovern Medical School at UTHealth 1A3. Cristian presents with rapid onset have put her through all those years of dystonia-parkinsonism that we believe is medications.” associated with the chromosome 19 dele- When a trial of levadopa-carbidopa NIVEDITA THAKUR, M.D. tion, and we’re investigating the genetics failed to lead to improvement, Dr. Assistant Professor, Department of further. This is how one patient can help Mancias involved his colleagues at UT Pediatrics, McGovern Medical School at another, and hopefully will help other MOVE, the Movement Disorders and UTHealth patients down the road.” Neurodegenerative Diseases Program at The first goal in the treatment of McGovern Medical School and Mischer ALLISON BOYLE, M.D. movement disorders is always medical Neuroscience Institute. In 2013, Cristian Assistant Professor, Department of management, but Cristian had adverse began seeing movement disorders spe- Neurology, McGovern Medical School effects that made increasing the pre- cialist Erin Furr-Stimming, M.D., an at UTHealth scription to effective doses impossible. associate professor at McGovern Medical

06 MEMORIAL HERMANN-TEXAS MEDICAL CENTER Comprehensive Spasticity Center and has one place to the next, but when we get in adults than in children, which is the expertise in the surgical management of there, she usually prefers to sit in a regu- advantage of being treated at a children’s pediatric spasticity and dystonia, and lar chair,” her father says. “Now that she’s hospital housed within an adult hospital, neurosurgeon Albert Fenoy, M.D., who beginning to be able to swallow, she has both of which are teaching hospitals for a specializes in deep brain stimulation, strong preferences in food – macaroni, hot medical school,” Dr. Thakur says. “We all spinal cord stimulation and spasticity dog mustard only, hamburger mustard work together as a team, but at the same implantation surgery, as well as pain man- only, pizza, no broccoli.” time we maintain our independent think- agement and complex spine surgery. Cristian’s ability to walk improved ing processes. That kind of close teamwork The Serratos agreed to the surgery, after the surgery. “We both have to tell is based on the long-term experience of which Dr. Fenoy and Dr. Shah performed her to slow down because she’s always in working together and it gives our patients in late October 2015 with Cristian under a hurry,” Guadalupe Serrato says. “She more confidence in treatment decisions.” general anesthesia. Using MRI and intra- remembers what she could do when she Meanwhile, the Serratos are watch- operative CT visualization, the surgical was six and wants to have it all back. She’s ing their daughter come out of her shell. team made two burr holes in her very social and interacts well with other “She’s always ready to try new things,” and descended microelectrodes into kids and adults. She laughs. She listens. Lusi Serrato says. “She likes everyone the brain to verify neuronal activity and She’s a normal teenage girl trapped inside she meets and greets them with a smile. confirm that they had reached the target her body.” Here is my daughter, trapped inside this areas. Then they placed the DBS leads, The Serratos had researched rapid body, and she’s amazing! She inspires me test stimulated to check her response, onset dystonia-parkinsonism online and every day. We’ve seen what this surgery placed extensions from the electrodes to found very little information. “Some of has done for Cristian and want others to the neurostimulator and implanted it in these conditions have been studied more hear her story.” her chest under the clavicle. After the surgery Dr. Thakur and Dr. Boyle worked together to program the Using Sophisticated Brain-imaging Techniques to Help Make the neurostimulator, and they continue Treatment Decision for Patients with to fine-tune the settings. “We follow Cristian closely in clinic once a month,” To advance the standard of care for children with spastic cerebral palsy, researchers at Children’s Dr. Thakur says. “Dystonia was the base- Memorial Hermann Hospital and McGovern Medical School are developing sophisticated brain- line from which she operated. When we imaging techniques to complement clinical judgment in treatment decision-making. removed it, she was left with weakness “Cerebral palsy (CP) remains one of the most common neurological complications of birth, affect- and a long road of therapy ahead. But the ing about one in 500 infants,” says Manish N. Shah, M.D., who directs the Texas Comprehensive psychological effect of the surgery has Spasticity Center at McGovern Medical School, Children’s Memorial Hermann Hospital and the been remarkable. At heart Cristian is a Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center. “The most common happy teenage girl and it has been very form of CP is spastic cerebral palsy associated with prematurity and intraventricular hemorrhage. rewarding to watch her improve.” The hemorrhage causes periventricular leukomalacia, which results in an axonal injury that can be Cristian started therapy at TIRR seen on diffusion tractography MRI. The end result of the axonal injury is rigidity and spasticity.” Memorial Hermann Outpatient Sectioning 75 to 80 percent of the dorsal roots by selective dorsal rhizotomy (SDR) has been Rehabilitation-Kirby Glen in January. shown to permanently eliminate spasticity in patients with . “With intensive physical Occupational therapist Carly Thom, therapy, patients who have had the specific surgery we perform at Children’s Memorial Hermann OTR, works with her two days a week. Hospital can learn to walk, which vastly improves their quality of life,” says Dr. Shah, an assistant “Now that Cristian can open her hands, professor in the division of Pediatric Neurosurgery and director of pediatric spasticity and move- we’re working on relearning how to use ment disorder surgery at McGovern Medical School. “We have solid clinical criteria that define the them,” Thom says. “She’s very motivated optimal SDR candidate, but there are no imaging metrics to help us determine the best candidates and excited about everything new we do. for surgery and provide feedback on the effectiveness of physical therapy after surgery.” She can’t communicate verbally, but that Dr. Shah and his team believe that the next step in advancing treatment is to identify the imaging doesn’t stop her from communicating. paradigms that best delineate the course of patients with spastic diplegia before and after SDR. “By She’s a unique child.” doing so, we’ll be better able to classify patients and intervene early on, before spasticity causes As a sixth-grader at Deep Water Junior damage to muscles and joints that leads to orthopedic deformities and more surgeries down the High School in Deer Park, Texas, Cristian road to correct them,” he says. “Imaging studies that provide in-depth information particular to keeps a full morning-to-afternoon sched- each patient will also allow us to design postoperative physical therapy specific to the patient, ule. “She uses a to get from and will illuminate us about long-term changes in cortical plasticity that result from the surgery.”

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years, with zero morbidity and a high suc- INTRACTABLE EPILEPSY cess rate in localizing seizures. “Surgery is a very effective treatment in cases of focal epilepsy, but the average Toward a New Paradigm length of time from seizure onset to sur- gery is 17 to 23 years,” says MEG expert Michael Funke, M.D., Ph.D., medical for the Treatment director of Memorial Hermann Magnetic JFSLDOASource ImagingWUMTIH and an associate profes- of Intractable Epilepsy sor in the division of Child and Adolescent Neurology in the department of Pediatrics an MEG-based analysis of the explored, including less invasive tech- at McGovern Medical School. “No one epileptic network in children niques that will disable the network while test alone can determine the area of the improve the way physicians preserving brain tissue.” brain generating the child’s seizures, so treat intractable epilepsy? The issue is relevant. Approximately we use many noninvasive pre-surgical BCPNEGR“Physician researchers affiliated with 2.2 million people in the United States tools to localize seizures, including brain Children’s Memorial Hermann Hospital have epilepsy, and 150,000 new cases imaging with 3 Tesla MRI, PET, SPECT, and the Mischer Neuroscience Institute are diagnosed each year. One in 26 people fMRI and diffusion tensor imaging, a at Memorial Hermann-Texas Medical will develop epilepsy in his or her lifetime, promising method for characterizing Center are among a small group of spe- with the highest incidence in children microstructural changes in neuropathol- cialists worldwide who believe that the younger than age 15 and adults over the ogy before and after treatment. We also future of epilepsy treatment lies in the age of 65. One-third of children with epi- use neurophysiological testing of brain study of brain networks using magne- lepsy do not respond to anticonvulsant function in real time using EEG and toencephalography. Their aim is to use medication taken on a daily basis to pre- MEG. This technology is excellent, but we MEG-guided computational network vent seizures. believe the first step in advancing epilepsy analysis for evaluation and surgical plan- “The goal of epilepsy treatment is to treatment is to look beyond the focal point ning, with the ultimate goal of making control seizures as quickly as possible and better define brain networks in chil- epilepsy surgery an option for more to optimize cognitive development and dren who don’t respond to medication.” children – and eventually leading to the improve quality of life,” Dr. Von Allmen development of new surgical approaches. says. “Once a child fails two or three dif- MICHAEL FUNKE, M.D., Ph.D. ferent anti-seizure medications with the Associate Professor, Director of MEG, GRETCHEN VON ALLMEN, M.D. proper drug and dosing, the chance of Department of Pediatrics, McGovern Medical School at UTHealth Associate Professor, Chief of Pediatric becoming seizure free with subsequent Epilepsy, Director of the Pediatric Epilepsy Program, Department of Pediatrics, drugs is less than 2 percent. These chil- McGovern Medical School dren are placed into the intractable Dr. Funke and Dr. Von Allmen are category. Persistent seizures, especially in among a handful of researchers around “MEG allows us to create a dynamic early childhood, have a detrimental effect the world engaged in the investigation model of the epileptic network that can on cognitive and social development and of the use of MEG to map brain networks be manipulated in a search for ways to on quality of life. The longer a child con- before and after treatment for epilepsy. disable the network in children with tinues to have seizures, the greater the “Some research groups are using fMRI intractable epilepsy,” says Gretchen Von damage to the brain.” in an attempt to identify abnormal epi- Allmen, M.D., chief of pediatric epi- Children’s Memorial Hermann Hospital leptic networks, but MEG has several lepsy at Children’s Memorial Hermann and Mischer Neuroscience Institute are advantages,” Dr. Funke says. “MEG is Hospital, director of the Pediatric pioneering sites for robotic stereoelec- the only modality that provides real-time Epilepsy Program at McGovern Medical troencephalography (SEEG), a technique neurophysiological data, without the School at UTHealth and an associate pro- that helps to localize the seizure focus limitations of EEG. The procedure is fessor in the department of Pediatrics. with precision in a minimally invasive completely noninvasive with a very short “It also will allow us to test the predic- fashion. The Institute was the second site test duration, which makes it appropriate tive accuracy of the MEG model against in the nation where affiliated physicians for patients of all ages, including babies. actual surgical results. Eventually, new used the technique, and they have man- While MEG is currently used to local- surgical and nonsurgical methods can be aged more than 75 patients in the past two ize sources of epileptiform activity in

08 MEMORIAL HERMANN-TEXAS MEDICAL CENTER preparation for epilepsy surgery, it can Dr. Funke is a bridge between the two Dr. Michael Funke and Dr. Gretchen Von Allmen also be used to analyze brain function worlds, which leads to new ideas. So the are among a handful of researchers using MEG networks during epileptic seizures.” question at hand is if resective surgery is to map brain networks before and after epilepsy Dr. Funke brings to the table 22 years the best and only approach to intractable treatment. Here, a patient is fitted with an EEG of experience working with MEG and a epilepsy. There have been no significant cap prior to testing. wealth of connections in the international changes in seizure freedom rates post community of researchers using the neu- surgery for more than 20 years, despite no biomarkers that predict the response roimaging technique for research on brain significant advances in pre-surgical tools to VNS therapy in patients with intrac- networks. He and Dr. Von Allmen are to localize the epileptogenic zone and in table epilepsy,” Dr. Von Allmen says. currently collaborating with researchers surgical techniques. Today, there is much “Based on outcome definition, there are in Spain: Fernando Maestú and Ricardo more evidence to suggest that epilepsy and up to 60 percent of positive responders Bajo at the Laboratory of Cognitive the brain in general are network based, in this patient population, but a much and Computational Neuroscience at rather than focus based. We believe a new lower number for seizure freedom. We Complutense University of Madrid; and approach is required that can identify the hope to improve those statistics through Pablo Cuesta, Ph.D., a neuroscientist at epileptic network generating the seizures. our study of epileptic networks before and the Universidad Polytécnica de Madrid. From there, we can search for new ways after the therapy.” “Based on their record of publication to stop the epileptic activity and spare the The brain is dynamic, with a multitude and grant funding, they are among the best brain’s normal functional networks.” of systems working together depending groups in the field,” Dr. Von Allmen says. The research teams in Houston and on the task at hand. “With technology “In addition to global collaboration, we Madrid are in the process of gathering like MEG that records data from the brain have an excellent team that makes full use preliminary data that will pave the way in very high resolution, we can use math- of the interplay between clinical care and for an application for federal funding to ematical algorithms to discover where research. Because I see patients, I bring pursue the use of MEG to identify epilep- the connections lie and which areas of up clinical questions that people focused tic networks. They are also developing the brain are driving the activity in par- solely on research might not consider. a pilot study to test a novel approach to ticular situations,” Dr. Funke says. “The These interactions between clinical care predict the efficacy of vagal nerve stimu- functional connectivity of networks is a and basic science are important in moving lation (VNS) in pediatric patients with relatively new topic for research. We are our discipline forward through discovery. intractable epilepsy. “Currently, there are all learning as we go.”

CHILDREN’S MEMORIAL HERMANN HOSPITAL 09 NEURO-ONCOLOGY

in August 2015 and a new methotrexate BRAIN TUMOR TREATMENT dose-escalation study available only at Children’s Memorial Hermann Hospital in collaboration with the Memorial Methotrexate Infusion Hermann Mischer Neuroscience Institute at the Texas Medical Center.

Directly into the Fourth DAVID I. SANDBERG, M.D., FAANS, FACS, FAAP Director, Pediatric Neurosurgery, Mischer Neuroscience Institute; Associate Professor, Ventricle in Children Department of Pediatric Surgery and Vivian L. Smith Department of Neurosurgery; Dr. Marnie Rose Professorship in Pediatric Neurosurgery with Malignant Fourth at McGovern Medical School at UTHealth “This radically new approach to che- Ventricular Brain Tumors motherapy allows us to circumvent the blood-brain barrier and deliver agents ranslational studies conducted directly to the tumor site to decrease by David I. Sandberg, M.D., systemic drug exposure and minimize FAANS, FACS, FAAP, have side effects,” says Dr. Sandberg, who demonstrated the safety of is director of pediatric neurosurgery at JFSLDOA WUMTIHinfusing chemotherapeutic agents directly Children’s Memorial Hermann Hospital into the fourth ventricle to treat children and Mischer Neuroscience Institute. with recurrent malignant tumors in this “Now that we’ve determined that meth- location in the brain. The results of these otrexate can be infused into the fourth studies led to a pilot clinical trial completed ventricle without causing neurological toxicity, and that some patients with BCPNEGR“ “THIS RADICALLY NEW APPROACH TO CHEMOTHERAPY ALLOWS recurrent medulloblastoma experi- ence a beneficial anti-tumor effect both US TO CIRCUMVENT THE BLOOD-BRAIN BARRIER AND DELIVER within the fourth ventricle and at distant AGENTS DIRECTLY TO THE SITE OF DISEASE WHILE MINIMIZING SIDE sites, we’ve taken the study a step fur- EFFECTS BY DECREASING SYSTEMIC DRUG EXPOSURE.” ther to determine the optimum dose of the agent.”

Dr. David Sandberg’s innovative clinical trial offers new hope for children with malignant tumors located in the fourth ventricle.

10 MEMORIAL HERMANN-TEXAS MEDICAL CENTER The pilot clinical trial was conducted at Children’s Memorial Hermann Hospital. Chemotherapy is delivered directly into the brain via Children’s Memorial Hermann Hospital To date, three patients have participated a catheter surgically placed into the fourth ventricle and The University of Texas MD Anderson in the clinical trial, the only such study and attached to a ventricular access device. Cancer Center, where Dr. Sandberg is under way in the world. co-director of the Pediatric Brain Tumor “Despite advances in pediatric oncol- 1 Sandberg DI, Rytting M, Zaky W, Kerr M, Program. Five patients – three with medul- ogy, we’re still seeing too many children Ketonen L, Kundu U, Moore BD, Yang G, Hou P, loblastoma and two with ependymoma – die of malignant brain tumors, and Sitton C, Cooper LJ, Gopalakrishnan V, Lee DA, received 18, 18, 12, 9 and 3 cycles of the treatments currently available are Thall PF, Khatua S. Methotrexate administra- chemotherapy, respectively, through a not satisfactory for children,” says Dr. tion directly into the fourth ventricle in children catheter surgically placed into the fourth Sandberg, an associate professor with with malignant fourth ventricular brain tumors: ventricle and attached to a ventricular joint appointments in the department of a pilot clinical trial. Journal of Neuro-Oncology. access device. No serious adverse events Pediatric Surgery and the Vivian L. Smith 2015 Oct;125(1):133-41. doi: 10.1007/s11060- or new neurological deficits were attrib- Department of Neurosurgery at McGovern 015-1878-y. Epub 2015 Aug. uted to treatment with methotrexate. The Medical School. “Many suffer extreme tox- results were published in the Journal of icity from chemotherapy and radiation, Neuro-Oncology in 2015.1 and I believe we can do better. I hope to The new dose-escalation study will improve on what we can currently offer as enroll a minimum of 12 patients at treatment – with fewer complications.”

CHILDREN’S MEMORIAL HERMANN HOSPITAL 11 BRAIN TUMOR TREATMENT

Riley Lentz: MARCIA KERR, RN, CCRC Clinical Trial Program Manager, Department of Pediatric Surgery, McGovern Medical No Stone Unturned School at UTHealth

ifteen-year-old Riley Lentz is no Among the trials Kerr coordinates is one DAVID I. SANDBERG, M.D., FAANS, FACS, FAAP Director, Pediatric Neurosurgery, Mischer stranger to hospitals. Diagnosed led by David I. Sandberg, M.D., FAANS, Neuroscience Institute; Associate Professor, with malignant medulloblas- FACS, FAAP, director of pediatric neuro- Department of Pediatric Surgery and Vivian L. Smith Department of Neurosurgery; Dr. Marnie toma in 2008, she underwent surgery at Children’s Memorial Hermann Rose Professorship in Pediatric Neurosurgery JFSLDOtwo open brain surgeries to remove the Hospital, the Memorial HermannA at WUMTIHMcGovern Medical School at UTHealth tumor and later, two noninvasive radio- Mischer Neuroscience Institute at the surgical CyberKnife® procedures. When Texas Medical Center and McGovern was a dose-escalation study to determine the tumor recurred in 2013, she was given Medical School. the optimum dose of the agent.” high-dose chemotherapy and received a Before his arrival in Houston in 2012, Riley was among the first participants stem cell transplant to help her body Dr. Sandberg conducted translational enrolled in the clinical trial at Children’s BCPNEGR“bounce back after the infusions. studies that demonstrated the safety Memorial Hermann Hospital, the only “After the chemo, we went until April of infusing chemotherapeutic agents such study under way in the world. In a or May of 2015 before they found another directly into the fourth ventricle to treat surgery that took place on Nov. 3, 2015, small spot and opted to try the CyberKnife children with recurrent malignant brain Dr. Sandberg removed as much of the for the second time,” says Riley’s mother, tumors in this location. The promising tumor as possible and placed a reservoir Melissa Saban. “At her three-month results of those studies led to a pilot clini- for the direct delivery of chemotherapy – follow-up MRI, we learned that the pro- cal trial completed in August 2015 and a a catheter and plastic disk covered by a cedure didn’t help.” new methotrexate dose-escalation study rubber balloon underneath the skin at the back of Riley’s neck. Riley and other children who partici- “AFTER RILEY’S ONCOLOGIST TOLD US HER BODY WOULDN’T TOLERATE pate in the trial undergo three cycles of ANY MORE SYSTEMIC CHEMO, I STARTED LOOKING FOR OTHER OPTIONS. chemotherapy and an MRI before and I WAS FORTUNATE TO FIND ANOTHER PARENT ON THE FACEBOOK PAGE after treatment. Each cycle includes an infusion on Monday and Thursday for WHOSE CHILD HAD JUST FINISHED THE CLINICAL TRIAL IN HOUSTON.” three weeks, followed by a rest week. Over the next three months, Saban and Somewhere along the way, Saban joined available only at Children’s Memorial her former husband, Jeff Lentz, made a Facebook group called Parents of Kids Hermann Hospital in collaboration with the 16-hour round trip twice a week from with Medulloblastoma, a forum for par- Mischer Neuroscience Institute. their home in Greenbriar, Arkansas, to ents who want to share their knowledge “Delivering chemotherapeutic agents Houston. “Riley’s dad didn’t want me to and experience. “I had heard about a clini- directly to the site of disease minimizes make the trip alone,” she says. “Both of cal trial of direct infusion of chemotherapy the side effects for children like Riley us have remarried and have other kids, into the fourth ventricle around the time by decreasing systemic drug exposure,” which made it difficult to find childcare Riley had the stem cell transplant in 2013,” says Dr. Sandberg, an associate professor that would allow us to stay in Houston she says. “After her oncologist told us her with dual appointments in the Vivian L. during Riley’s treatment. So we chose to body wouldn’t tolerate any more systemic Smith Department of Neurosurgery and drive down and back the same day.” chemo, I started looking for other options. the Department of Pediatric Surgery at On January 29, 2016, just before Riley I was fortunate to find another parent on McGovern Medical School. “After we completed the clinical trial, Saban posted the Facebook page whose child had just determined that methotrexate can be an update on her Facebook page. “The finished the clinical trial in Houston.” infused into the fourth ventricle without treatment is working – the plan is to con- Through Parents of Kids with causing neurological toxicity, and that tinue the same treatment and then start Medulloblastoma, Saban connected with some patients with recurrent medul- another round at Arkansas Children’s Marcia Kerr, RN, CCRC, research coor- loblastoma experience a beneficial Hospital. We are beyond excited!!!!” dinator for pediatric neuroscience at anti-tumor effect both within the fourth “Once we’ve shown that the treatment McGovern Medical School at UTHealth. ventricle and at distant sites, our next step is safe and the child is responding to it,

12 MEMORIAL HERMANN-TEXAS MEDICAL CENTER NEURO-ONCOLOGY

Detecting Pediatric Brain Tumors

Pediatric brain tumors are the second most common cancer in children, with approximately 2,500 to 3,500 brain tumors diagnosed in the United States each year. Brain tumors in children are different from those in adults in cell type, presentation and responsiveness to treatment. “Because the brain is still developing, it’s important for children and adolescents to be diagnosed and treated by a physician team that specializes in pediatric brain tumors,” says David I. Sandberg, M.D., FAANS, FACS, FAAP, director of pediatric neurosurgery at Children’s Memorial Hermann Hospital and Mischer Neuroscience Institute and co-director of the Pediatric Brain Tumor Program at The University of Texas MD Anderson Cancer Center. “Tumors present in a variety of ways depending on their location in the brain. The most common signs and symptoms are headache and vomiting due to elevated intracranial pressure. In infants and young children, irritability or a fontanelle that is fuller than normal may signal elevated intracra- nial pressure.” Other signs and symptoms include motor weakness, sensory changes, personality changes, unsteady gait, difficulty with muscle control, lethargy, seizures, vision changes, speech problems and endocrine disorders. Riley Lentz was among the first participants in a new Sandberg,” she says. “He’s personable The Pediatric Brain Tumor Program brings study to determine the optimum dose of methotrexate and caring and extremely passionate together a team of experts affiliated with delivered directly to the fourth ventricle of the brain. about what he’s doing to help kids. And Children’s Memorial Hermann Hospital and he was great with Riley.” The University of Texas MD Anderson Children’s we’re happy if we can find a pediatric As for Riley, she takes it all in her stride. Cancer Hospital to serve physicians, patients oncologist to continue it,” Dr. Sandberg “We’ve been fighting cancer for so long that and families with new and advanced methods of says. “Riley came to us from Arkansas and it’s become a part of her daily life,” Saban diagnosing and treating childhood brain tumors. had a dramatic response. Her parents are says. “We’ve always been honest with her The program team includes board-certified unbelievably dedicated, leaving no stone and we always listen to what she tells us. specialists in neuro-oncology, pediatric neu- unturned to help their daughter, includ- She’s never said, ‘Okay, I’m done with this.’ rosurgery, radiation oncology, neuroradiology, ing making the 16-hour round-trip drive She takes it with a grain of salt and is doing neuropathology, neuropsychology and sur- to Houston twice a week. They’re good amazingly well considering how much she’s vivorship. Additional support is provided by people, and Riley is the sweetest kid. been through and how different her life is psychologists, nutritionists, social workers and We’re thrilled to get this kind of positive from the lives of other kids.” Child Life specialists, as well as developmental response to the treatment without the tox- and education specialists. icity of systemic chemotherapy, and we’re FOR MORE INFORMATION ABOUT THE CLINICAL For more information about the Pediatric grateful to Riley’s oncologist for continu- TRIAL, VISIT CHILDRENS.MEMORIALHERMANN.ORG/ Brain Tumor Program, please contact the divi- ing the treatment in Little Rock.” PEDIATRIC-BRAIN-TUMOR-TRIAL OR CONTACT sion of Pediatric Neurosurgery at McGovern Saban describes the family’s experience MARCIA KERR AT 713.500.7363 OR VIA EMAIL AT Medical School at 832.325.7242 or visit in Houston as very positive. “I loved Dr. [email protected]. childrens.memorialhermann.org/pbtp.

CHILDREN’S MEMORIAL HERMANN HOSPITAL 13 Clinical Trials for Rare Disorders

Early Biomarkers of Autism Spectrum of infants with TSC, study participants Disorder in Infants with Tuberous will be evaluated longitudinally at ages HOPE NORTHRUP, M.D. Sclerosis Complex 3, 6, 9, 12, 18, 24 and 36 months. At Professor, Director of Division of Medical each age, the children will undergo stan- Genetics, Department of Pediatrics, McGovern Medical School at UTHealth Investigators at Children’s Memorial dardized evaluation using cognitive and Hermann Hospital and McGovern adaptive measures. At ages 24 and 36 Medical School are enrolling three- months, the researchers will perform a at Children’s Memorial Hermann month-old to 12-month-old infants with formal assessment for autism. Clinical Hospital, one of only five TSC Centers a diagnosis of tuberous sclerosis complex data, including medication use, seizure nationwide participating in the study. (TSC) in an innovative study to identify history, EEG activity, genotypic varia- TO LEARN MORE ABOUT THE STUDY, CONTACT ELIDA early markers of autism. Children’s tion and co-morbidities, will be recorded SALAZAR AT [email protected] OR Memorial Hermann Hospital is the only to determine if specific clinical factors are 713.500.5766. institution in Houston participating in modifying the course of development. the five-year multicenter study. The diagnosis of TSC is based on With funding from the National established clinical criteria and will Continuation Study for Individuals Institute of Neurological Disorders not require genetic testing prior to Diagnosed with Autism Spectrum and Stroke, the researchers are using enrollment. Throughout the study, the Disorders and Tuberous Sclerosis behavioral testing, MRI imaging and investigators will recommend early inter- Complex techniques to vention services for any child who shows identify children at risk for developing signs of autism. Researchers at Children’s Memorial autism starting at three months of age and Principal investigator at the Houston Hermann Hospital and four other insti- continuing until 36 months of age. site is Hope Northrup, M.D., professor tutions across the country are working to Autism spectrum disorder is common of pediatrics and director of the division learn more about the developmental phe- in the population of children with TSC of Medical Genetics at McGovern Medical notype of autism spectrum disorder (ASD) with about 50 percent of such patients School. Dr. Northrup is director of the and intellectual disability (ID) in children affected. To characterize the development Tuberous Sclerosis Center of Excellence with tuberous sclerosis complex (TSC). Participants in the Early Biomarkers of Coronal T2 image demon- Autism Spectrum Disorders trial may strates multiple bilateral enroll in this clinical research continu- cortical tubers (arrows). ation study for children and adolescents ages three to 21 who have a diagnosis of TSC and ASD and/or ID. The goal of the multicenter study, con- ducted as part of the Rare Disease Clinical Research Network and sponsored by the National Institutes of Health, is to gain a better understanding of autism spectrum disorder and intellectual disability that will lead to the development of effective treatments and interventions. Participation in the study involves five visits over a two-year period. Three of the visits will occur at Children’s Memorial Hermann Hospital and involve a blood draw, physical and neurological exams and development testing. Two visits will occur as phone calls and involve

14 MEMORIAL HERMANN-TEXAS MEDICAL CENTER NEURO-ONCOLOGY answering questionnaires about behavior and development. Principal investigator at the Houston site is Hope Northrup, M.D., professor of pediatrics, director of the division of Medical Genetics at McGovern Medical School and director of the Tuberous Sclerosis Center of Excellence at Children’s Memorial Hermann Hospital, one of only five TSC Centers nationwide participating in the study.

TO LEARN MORE ABOUT THE STUDY, CONTACT ELIDA SALAZAR AT [email protected] OR 713.500.5766.

Intra Erythrocyte Dexamethasone in the Treatment of Ataxia Telangiectasia

Children’s Memorial Hermann Hospital is one of four hospitals in the United States selected as a site for the international multicenter phase III clinical trial of a novel experimental combination product assess the effect of two dose ranges of This trichrome stain of a muscle biopsy shows for the treatment of ataxia telangiecta- EDS on neurological symptoms of AT degeneration of the fiber inside the red ring. sia (AT). A rare, progressively disabling patients. Under a European Horizon and life-shortening genetic disease for 2020 program, an international patient MARY KAY KOENIG, M.D. which no therapy is currently available, registry will also be set up, with the aim Associate Professor & Director, AT is characterized by severe progressive of establishing and maintaining a com- Mitochondrial Center of Excellence; neurodegeneration from early infancy. prehensive clinical database of patients Co-director, Tuberous Schlerosis Center of Excellence, Department of Pediatrics, Specific features include progressive with AT and closely related conditions. McGovern Medical School at UTHealth ataxia of the trunk and limbs, involuntary The registry will enable the monitoring movements, oculomotor apraxia, difficul- of AT epidemiology, the development of NIVEDITA THAKUR, M.D. ties in speech and swallowing and delayed an evidence-based natural history of the Assistant Professor, Department of Pediatrics, peripheral neuropathy. condition, identification of biomarkers McGovern Medical School at UTHealth The study, if successful, could con- and development of clinical guidelines. stitute the basis for FDA approval of Principal investigator for the trial at EryDel’s experimental combination Children’s Memorial Hermann Hospital, product EryDex System (EDS). EDS expected to begin in summer 2016, is JOHN M. SLOPIS, M.D. Professor, Department of Pediatrics, delivers dexamethosone sodium phos- Mary Kay Koenig, M.D., associate pro- McGovern Medical School at UTHealth phate by encapsulating the drug into red fessor, director of the Mitochondrial cells taken from the patient’s own blood, Center of Excellence, co-director of the which are then immediately infused into Tuberous Sclerosis Center of Excellence of Texas MD Anderson Cancer Center, who the patient. EryDel recently completed and Endowed Chair of Mitochondrial holds a joint appointment as professor in a pilot phase II trial in AT patients that Medicine. Co-investigators are Nivedita the department of Pediatrics at McGovern demonstrated the statistically significant Thakur, M.D., an assistant professor in Medical School. The researchers’ long- efficacy of EDS on both primary and sec- the department of Pediatrics at McGovern term goal is to develop a center in Houston ondary outcome measures. Medical School, and John M. Slopis, M.D., for patients with ataxia telangiectasia. The phase III trial will be a ran- professor and medical director of the TO LEARN MORE ABOUT THE STUDY, EMAIL domized, prospective, double-blind, Neurofibromatosis Program in the depart- [email protected]. placebo-controlled study designed to ment of Neuro-oncology at The University

CHILDREN’S MEMORIAL HERMANN HOSPITAL 15 The professorship is funded by a gift Dr. David Sandberg Awarded from the Dr. Marnie Rose Foundation, News of Note the Inaugural Dr. Marnie Rose established by Lanie and Jerry Rose in Professorship in Pediatric Neurosurgery memory of their daughter. The founda- Children’s Memorial Hermann Hospital tion was created to raise funds in support and McGovern Medical School Welcome DAVID I. SANDBERG, M.D., FAANS, FACS, FAAP of brain cancer research and other special Director, Pediatric Neurosurgery, Mischer Pediatric Neurologist Neuroscience Institute; Associate Professor, projects benefiting children. Department of Pediatric Surgery and Vivian L. A 2000 graduate of McGovern Medical Smith Department of Neurosurgery; Dr. Marnie School, Dr. Rose was diagnosed with a MICHAEL W. WATKINS, M.D. Rose Professorship in Pediatric Neurosurgery Assistant Professor, Department of at McGovern Medical School at UTHealth rare type of brain cancer in the first year Pediatrics, McGovern Medical School at of her pediatric medical residency at UTHealth Pediatric neurosurgeon David I. Children’s Memorial Hermann Hospital, Sandberg, M.D., FAANS, FACS, the medical school’s pediatric teaching Michael W. Watkins, M.D., has joined the FAAP, is the inaugural recipient of hospital. In 2002, she agreed to share faculty of McGovern Medical School and the Dr. Marnie Rose Professorship in her cancer journey, personal life and the medical staff of Children’s Memorial Pediatric Neurosurgery at UTHealth’s professional responsibilities as a medical Hermann Hospital and the Memorial McGovern Medical School. Dr. Sandberg resident with a TV crew from the ABC Hermann Mischer Neuroscience Institute is director of pediatric neurosurgery reality series Houston Medical. The criti- at the Texas Medical Center. Dr. Watkins at Children’s Memorial Hermann cally acclaimed hospital series followed focuses his practice on the evaluation and Hospital, the Memorial Hermann the lives of doctors, nurses and other treatment of epilepsy in children, partic- Mischer Neuroscience Institute at the healthcare professionals and patients ularly intractable epilepsy, including the Texas Medical Center and McGovern use of magnetoencephalography (MEG) Medical School, where he holds joint fac- Pediatric neurosurgeon Dr. David Sandberg in the evaluation of pediatric patients ulty appointments in the department of (center) with Lanie and Jerry Rose, who estab- with medically refractory seizures. Pediatric Surgery and the Vivian L. Smith lished the Dr. Marnie Rose Foundation in memory An assistant professor in the depart- Department of Neurosurgery. of their daughter. ment of Pediatrics, division of Child Neurology, Dr. Watkins received his med- ical degree at McGovern Medical School at UTHealth and completed residen- cies in general pediatrics and pediatric neurology at the same institution. He was chief pediatric neurology resident in 2012 and was awarded the UTHealth Child and Adolescent Neurology Resident Excellence in Teaching Award in 2013. Following residency, Dr. Watkins completed fellowships in clinical neurophysiology and in clinical magne- toencephalography and neurosurgical epilepsy at McGovern Medical School. His research interests include surgical outcomes following epilepsy surgery, as well as the use of MEG in the evaluation of epileptic networks in patients with intrac- table epilepsy and West syndrome. Dr. Watkins is a member of the American Epilepsy Society, American Clinical MEG Society, Child Neurological Society, American Academy of Pediatrics and American Academy of Neurology.

16 MEMORIAL HERMANN-TEXAS MEDICAL CENTER NEURO-ONCOLOGY at Memorial Hermann-Texas Medical will contribute to the discovery of new Center and aired nationally on ABC for and better ways to prevent, diagnose and 40UNDER40 six weeks in the summer of 2002. treat childhood brain tumors. I’m hon-

OctOber 30-NOvember 5 In the show’s debut episode, Dr. Rose ored to be the recipient of the first Dr. 2015 SectiON b stunned viewers by pulling off her wig, Marnie Rose Professorship in Pediatric revealing that she was both a doctor and Neurosurgery.” a patient. Viewers were inspired by her Barbara J. Stoll, M.D., dean of determination to keep working despite McGovern Medical School and the her illness, her candor about her disease H. Wayne Hightower Distinguished cover story and her positive attitude in the face of Professor, expressed her gratitude to the adversity. Dr. Rose died in August 2002, Rose family for their generosity. “I am 40 UNDER40 Houston’s heavyweight champs have only just entered the ring a few weeks after the final episode of delighted that Dr. Sandberg, a nationally chriS curry/hbj

platinum sponsor golD sponsor Houston Medical aired. known pediatric neurosurgeon and neu- “We are proud to honor Marnie’s legacy roscientist, is the inaugural Dr. Marnie and recognize Dr. Sandberg’s pioneering Rose Professor,” Dr. Stoll says. “We are work,” says Sallye Wolf, executive direc- very grateful to the Rose family for their the 2015 award, according to the Houston tor of the Dr. Marnie Rose Foundation. gift and for their vision. Dr. Marnie Rose Business Journal. “Dr. Giuseppe Colasurdo, president of was an extraordinary young physician. Dr. Shah directs the Texas UTHealth, and Dr. Sandberg, an honor- We are honored to have a professorship Comprehensive Spasticity Center at ary board member of the foundation, have in her memory at our school. Endowed McGovern Medical School, Children’s a strong relationship with the Rose family. professorships recognize and support Memorial Hermann Hospital and Mischer It is only fitting that the Dr. Marnie Rose outstanding faculty. They are important Neuroscience Institute. He is also direc- Professorship in Pediatric Neurosurgery to academic health centers because they tor of pediatric spasticity and movement be awarded to Dr. Sandberg. His innova- help us recruit and retain the most tal- disorder surgery and runs a laboratory tive research and care for children affected ented faculty in the country.” where researchers use advanced neuro- by brain tumors honors Marnie’s passion imaging techniques to investigate basic for helping children and the Foundation’s Dr. Manish Shah Named to Houston brain function in children. commitment to brain cancer research.” Business Journal’s 40 Under 40 “I am proud to be recognized along Dr. Sandberg has pioneered innova- with so many respected individuals in the tive treatment approaches for malignant MANISH N. SHAH, M.D. Houston area,” Dr. Shah says. “On a daily pediatric brain tumors. He was princi- Director, Pediatric Spasticity and Movement basis, I have the privilege of helping chil- Disorder Surgery; Assistant Professor, pal investigator of a recently completed Department of Pediatric Surgery, McGovern dren achieve a better quality of life despite pilot clinical trial investigating, for the Medical School at UTHealth having a frightening and often debilitat- first time in humans, direct delivery of ing neurological disease. That is reward chemotherapy into the fourth ventricle Manish N. Shah, M.D., a pediatric neu- enough. To be recognized for that work of the brain. The trial’s promising results rosurgeon affiliated with Children’s is an exceptional honor.” have led to a new methotrexate dose-esca- Memorial Hermann Hospital and Dr. Shah is an assistant professor in the lation study available only at Children’s the Memorial Hermann Mischer department of Pediatric Neurosurgery at Memorial Hermann Hospital in col- Neuroscience Institute at the Texas McGovern Medical School and the lead- laboration with Mischer Neuroscience Medical Center, has been named to the ing neurosurgeon in the area for selective Institute. Houston Business Journal’s 40 Under 40 dorsal rhizotomy. He is fellowship-trained “The courage of our patients and their Class of 2015. in pediatric neurosurgery, with special families inspires us on a daily basis to pro- The prestigious award annually recog- expertise in the surgical management of vide the best care available for pediatric nizes 40 of the Greater Houston area’s spasticity and dystonia in children, and brain tumors,” says Dr. Sandberg, who most prominent up-and-coming profes- performs selective dorsal rhizotomies and is co-director of the combined Pediatric sionals under the age of 40. Honorees pump placement using advanced Brain Tumor Program at Children’s must be nominated and are chosen by techniques. An expert in pediatric Memorial Hermann Hospital and The judges based on leadership, a track epilepsy, craniofacial surgery and cra- University of Texas MD Anderson Cancer record of overcoming challenges and niocervical spine surgery, Dr. Shah was Center. “The support we’ve received their community involvement. Nearly recruited from Washington University in from the Dr. Marnie Rose Foundation 400 professionals were nominated for St. Louis after completing his fellowship

CHILDREN’S MEMORIAL HERMANN HOSPITAL 17 NEURO-ONCOLOGYNEWS OF NOTE

at St. Louis Children’s Hospital under world-renowned pediatric neurosurgeon DAVID I. SANDBERG, M.D., FAANS, FACS, FAAP Director, Pediatric Neurosurgery, Mischer Your Personal Eye Doctor Tae Sung Park, M.D. LASIK | CATARACT | COSMETIC WITH YOU EVERY STEP OF THE WAY Neuroscience Institute; Associate Professor,

• I see you through each and every stage of treatment: “Caring for people’s eyes is great, but from your initial consultation to your final post-op visit. what really makes me most proud is hearing my patients talk about how well Department of Pediatric Surgery and Vivian L. He received his undergraduate• I review all diagnostic tests with you and discuss your degree best treatment options. I care for them and treat them as people. It’s the hug or high five that celebrates • I perform all examinations to ensure your optimal another successful procedure that tells Smith Department of Neurosurgery; Dr. Marnie results and overall satisfaction. the story of TRUE CARE. That’s the TOP from Princeton University• I invest in the industry’s bestand and latest LASIK his medidifference- that my practice offers: the and Laser Cataract technologies to provide experience of being treated like a person consistently safe and predictable outcomes. and not just another set of eyes.” DOCTORS Rose Professorship in Pediatric Neurosurgery • I give you my mobile phone number, so I’m just a call away if you have 2015 cal degree from Vanderbiltquestions after your procedure. University at McGovern Medical School at UTHealth

colbystewartmd.com School of Medicine in Nashville, 7I3-558-8732 I4I5 N Loop W | Ste 4OO | Houston Tennessee. As a resident in neurological MANISH N. SHAH, M.D. Director, Pediatric Spasticity and Movement surgery at WashingtonDr. Stewart University Gives Green Bank Five Starsin St. He chooses Green Bank for financing and commercial banking services. Disorder Surgery; Assistant Professor, Green Bank’s clients appreciate innovation and craftsmanship. Their bank account is no exception. We build Louis, Dr. Shah was awardedlasting relationships and tailor each the account to fit theirdepart unique needs. - Department of Pediatric Surgery, McGovern From business loans and lines of credit, to multiple checking account options and treasury management solutions--we have the account to fit every business. ment of Neurosurgery’sCall Green BankMedical today and experience superior banking. Student Medical School at UTHealth For this, our third-annual list of the best physicians in town, we once more put out a call to over 15,000 board-certified doctors in the Houston area. We asked each to use our secure website to recommend two physicians to whom they would entrust their own families. Teaching Award and the department’s HOW WE After the nominations were tallied,Houstonia compiled a list of top vote recipients in each PAUL MCGUIRE | 713.316.7055 | GREENBANK.COM CAME UP WITH specialty, making certain that all physicians were currently certified by their respective THE LIST medical licensing boards. Greenbriar Tanglewood Kingwood Houstonian Woodlands GREEN BANK, N.A. MEMBER FDIC EQUAL OPPORTUNITY LENDER 63 Annual Resident Research Symposium IAN J. BUTLER, M.D. Research Award. Director, Division of Child and Adolescent Neurology; Professor, Department of “Dr. Shah is an extraordinarily gifted FAAP, director of pediatric neurosur- Pediatrics, McGovern Medical School at physician who is bringing innovative gery and an associate professor with UTHealth treatments to our community and who joint appointments in the department of will be a national leader in the field of Pediatric Surgery and the Vivian L. Smith MARY KAY KOENIG, M.D. Associate Professor & Director, pediatric neurosurgery,” says David I. Department of Neurosurgery, and Manish Mitochondrial Center of Excellence; Sandberg, M.D., FAANS, FACS, FAAP, N. Shah, M.D., director of the Texas Co-director, Tuberous Schlerosis Center of Excellence, Department of Pediatrics, director of pediatric neurosurgery at Comprehensive Spasticity Center, direc- McGovern Medical School at UTHealth Children’s Memorial Hermann Hospital, tor of pediatric spasticity and movement Mischer Neuroscience Institute and disorder surgery and an assistant professor JEREMY LANKFORD, M.D. McGovern Medical School. “I feel very in the department of Pediatric Surgery. Assistant Professor, Department of fortunate to have the opportunity to work Pediatric neurologists named Top Pediatrics, McGovern Medical School at alongside Dr. Shah each day. It’s a credit Doctors are Ian J. Butler, M.D., professor, UTHealth to our city and our medical institutions to director of child and adolescent neurol- attract individuals of his caliber.” ogy and Distinguished Chair in West The 40 Under 40 honorees were pro- Syndrome Research; Mary Kay Koenig, PEDRO MANCIAS, M.D. Houston Professor, Department of Pediatrics, filed in a special edition of the M.D., associate professor, director of McGovern Medical School at UTHealth Business Journal released last October. the Mitochondrial Center of Excellence, co-director of the Tuberous Sclerosis

Seven Pediatric Neuroscience Center of Excellence and Endowed Chair GRETCHEN VON ALLMEN, M.D. Specialists Named to Top Doctors Lists of Mitochondrial Medicine; Jeremy Associate Professor, Chief of Pediatric for 2015 Lankford, M.D., assistant professor and Epilepsy, Director of the Pediatric Epilepsy Program, Department of Pediatrics, director of the Child Neurology Residency McGovern Medical School Seven physicians affiliated with Program; Pedro Mancias, M.D., Adriana Children’s Memorial Hermann Hospital, Blood Professor of Pediatrics and assis- the Memorial Hermann Mischer tant dean for diversity and inclusion; and Neuroscience Institute at the Texas Gretchen Von Allmen, M.D., associate Medical Center and McGovern Medical professor in the department of Pediatrics, School at UTHealth were named to chief of pediatric epilepsy at Children’s Houstonia magazine’s 2015 listing of Memorial Hermann Hospital and direc- Top Doctors in Houston. Physicians tor of the Pediatric Epilepsy Program. named to the list were selected based on Dr. Butler also was selected by his nominations solicited from nearly 16,000 peers as Texas Super Doctor. Following medical professionals practicing in eight an extensive nomination and research counties in the Greater Houston area. process conducted by Key Professional Pediatric neurosurgeons included on Media Inc., the results were published the Houstonia magazine list are David in the June 2015 issue of Texas Monthly I. Sandberg, M.D., FAANS, FACS, magazine.

18 MEMORIAL HERMANN-TEXAS MEDICAL CENTER Debnam JM, Mahfouz YM, Ketonen Hope OA, Lankford J. Best Practices L, Slopis JM, McCutcheon IE, Guha- in Neurological Care: Epilepsy. Future Selected Thakurta N. Multidetector CT with Medicine. 2014 Feb;6-30. 3-dimensional volume rendering in the Publications evaluation of the spine in patients with Jeter CB, Patel SS, Morris JS, Chuang Neurofibromatosis type 1: a retrospec- AZ, Butler IJ, Sereno AB. Oculomotor Arrey EN, Kerr ML, Fletcher S, Cox CS, tive review in 73 patients. 9:15, executive function abnormalities with Sandberg DI. Linear Non-Displaced 2014. [Epub 2014 Sep] increased tic severity in Tourette syn- Skull Fractures in Children: Who should drome. J Child Psychol Psychiatry. be observed or admitted? J Neurosurg Dickerson AS, Pearson DA, Loveland 2015;56(2):193-202. Pediatrics. 2015;4:1-6. KA, Rahbar MH, Filipek PA. Role of parental occupation in autism spec- Khiewvan B, Macapinlac HA, Lev D, Bonfante E, Koenig MK, Adejumo RB, trum disorder diagnosis and severity. McCutcheon IE, Slopis JM, Al Sannaa Perinjelil V, Riascos RF. The neuroimag- Res Autism Spectr Disord. 2014 Sep G, Wei W, Chuang HH. The value of ing of Leigh syndrome: Case series and 1;8(9):997-1007. ¹ F-FDG PET/CT in the management review of the literature. Pediatr Radiol. of malignant peripheral nerve sheath 2016 Jan 6. [Epub ahead of print] Epilepsy Phenome/Genome Project tumors. Eur J Nucl Med Mol Imaging. Epi4K Consortium.1 Copy number 2014 Sept;41(9):1756-66. [Epub 2014 Butler IJ, Lankford J, Hashmi S, Human variant analysis from exome data in 349 Apr] MT. Biogenic amine metabolism in patients with epileptic encephalopathy. juvenile neurocardiogenic syncope with Ann Neurol. 2015 Aug;78(2):323-8. Kivlin CM, Watson KL, Al Sannaa GA, dysautonomia. Ann Clin Transl Neurol. [Epub 2015 Jul 1] Belousov R, Ingram DR, Huang KL, May 2014;1:251-57. CD, Bolshakov S, Landers SM, Kalam EuroEPINOMICS-RES Consortium; AA, Slopis JM, McCutcheon IE, Pollock Chance A, Sandberg DI. Epilepsy Phenome/Genome Project RE, Lev D, Lazar AJ, Torres KE. Poly in patients with closed neural tube Epi4K Consortium.1 De novo muta- (ADP) Ribose Polymerase Inhibition: defects. Child Nerv Syst. 2015 tions in synaptic transmission genes A Potential Treatment of Malignant 3(2):329-332. including DNM1 cause epileptic enceph- Peripheral Nerve Sheath Tumor. Cancer alopathies. Am J Hum Genet. 2014 Oct Biol Ther. 2015 Dec 9;e1108486. [Epub Chevallier JA, Von Allmen GK, Koenig 2;95(4):360-70. [Epub 2014 Sep 25] ahead of print] MK. Seizure semiology and EEG findings in mitrochondrial diseases. Fakhri A, Shah MN, Goyal MS. Lalani SR, Liu P, Rosenfeld JA, Watkin Epilepsia. 2014 May;55(5):707-12. Advanced Imaging of Chiari 1 LB, Chiang T, Leduc MS, Zhu W, Ding Y, [Epub 2014 Mar 7] Malformations. Neurosurg Clin N Am. Pan S, Vetrini F, Miyake CY, Shinawi M, 2015 Oct;26(4):519-26. Gambin T, Eldomery MK, Akdemir ZH, Cykowski MD, Hicks J, Sandberg DI, Emrick L, Wilnai Y, Schelley S,Koenig Olar A, Bridge JA, Greipp PT, Navarro Ghali MG, Srinivasan VM, Jea MK, Memon N, Farach LS, Coe BP, P, Kolodziej S, Bhattacharjee MB. Brain A, Slopis JM, McCutcheon IE. Azamian M, Hernandez P, Zapata G, Metastasis of Crystal-Deficient, CD68- Neurofibromas of the phrenic nerve: Jhangiani SN, Muzny DM, Lotze T, Clark Positive Alveolar Soft Part Sarcoma: a case report and review of the lit- G, Wilfong A, Northrup H, Adesina Ultrastructural Features and Differential erature. World Neurosurg. 2015 Dec A, Bacino CA, Scaglia F, Bonnen PE, Diagnosis. Ultrastruc Pathol. 20;pii:S1878-8750(15)01783-0. Crosson J, Duis J, Maegawa GH, Coman 2015;39(1):69-7. D, Inwood A, McGill J, Boerwinkle Hecht JT, Bodensteiner JB, Butler E, Graham B, Beaudet A, Eng CM, Derksen A, Ritter C, Athar P, Kieseier IJ. Neurologic Manifestations of Hanchard NA, Xia F, Orange JS, Gibbs BC, Mancias P, Hartung HP, Sheikh KA, Achondroplasia. Handbook of Clinical RA, Lupski JR, Yang Y. Recurrent Lehmann HC. Sural sparing pattern Neurology: Neurologic Aspects of Muscle Weakness with Rhabdomyolysis, discriminates Guillain-Barré syndrome Systemic Disease Part I. Eds: J. Biller and Metabolic Crises, and Cardiac from its mimics. Muscle Nerve. 2014 J.M. Ferro, Elsevier, Philadelphia, PA. Arrhythmia Due to Bi-allelic TANGO2 Nov;50(5):780-4. [Epub 2014 Sep 24] Vol. 119 (3rd Series):551-63, 2014. Mutations. Am J Hum Genet. 2016 Feb 4;98(2):347-57. [Epub 2016 Jan 21]

CHILDREN’S MEMORIAL HERMANN HOSPITAL 19 SELECTED PUBLICATIONS

Lankford J, Numan M, Hashmi S, Rebsamen M, Pochini L, Stasyk T, de Soler-Alfonso C, Enns GM, Koenig MK, Gourishankar A, Butler I. Cerebral Araújo ME, Galluccio M, Kandasamy Saavedra H, Bonfante-Mejia E, Northrup blood flow during HUTT in young RK, Snijder B, Fauster A, Rudashevskaya H. Identification of HIBCH gene muta- patients with orthostatic intolerance. EL, Bruckner M, Scorzoni S, Filipek tions causing autosomal recessive Leigh Clin Auto Res. 2015;25:277-84. PA, Huber KV, Bigenzahn JW, Heinz syndrome: a gene involved in valine LX, Kraft C, Bennett KL, Indiveri C, metabolism. Pediatric Neurology. 2015 Luna B, Bhatia S, Yoo C, Felty Q, Huber LA, Superti-Furga G. SLC38A9 March;52(3):361-65. Sandberg DI, Duchowny M, Khatib Z, is a component of the lysosomal Miller I, Ragheb J, Prassana J, Roy D. amino acid sensing machinery that Subbiah V, Bupathi M, Kato S, Proteomic and Mitochondrial Genomic controls mTORC1. Nature. 2015 Mar Livingston A, Slopis J, Anderson PM, Analyses of Pediatric Brain Tumors. 26;519(7544):477-81. [Epub 2015 Jan 7] Hong DS. Clinical next-generation Molec Neurobiol. 2015;52(3):1341-6. sequencing reveals aggressive cancer Sandberg DI. Endoscopic Resection biology in adolescent and young adult Mosquera RA, Koenig MK, Adejumo of Intraventricular Brain Tumors in patients. Oncoscience 2(7):646-58, RB, Chevallier J, Hashmi SS, Mitchell Children. World Neurosurgery. 2015 2015. [Epub 2015 July] SE, Pacheco SE, Jon C. Sleep disordered [Epub ahead of print] breathing in children with mitochon- Szafranski P, Von Allmen GK, Graham drial disease. Pulmonary Medicine. Sandberg DI, Rytting M, Zaky W, BH, Wilfong AA, Kang SH, Ferreira 2014;article ID 467576, 8 pages. Kerr M, Ketonen L, Kundu U, Moore JA, Upton SJ, Moeschler JB, Bi W, BD, Yang G, Hou P, Sitton C, Cooper Rosenfeld JA, Shaffer LG, Wai Cheung Numan MT, Alnajjar R, Lankford J, LJ, Gopalakrishnan V, Lee DA, S, Stankiewicz P, Lalani SR. 6q22.1 Gourishankar A, Butler I. Cardiac Thall PF, Khatua S. Methotrexate microdeletion and susceptibility to pedi- asystole during head up tilt (HUTT) Administration Directly into the Fourth atric epilepsy. Eur J Hum Genet. 2015 in children and adolescents: Is this Ventricle in Children with Malignant Feb;23(2):173-9. [Epub 2014 May 14] benign physiology? Pediatr Cardiol. Fourth Ventricle Brain Tumors: A 2015;36:140-45. Pilot Clinical Trial. J Neurooncol. Theeler BJ, Ellezam B, Yust-Katz 2015;125(1):133-141. S, Slopis JM, Loghin ME, de Groot Papanna R, Moise KJ Jr, Mann JF. Prolonged survival in adult neu- LK, Fletcher S, Schniederjan R, Sandberg DI, Kerr ML. Ventricular rofibromatosis type I patients with Bhattacharjee MB, Stewart RJ, Kaur S, Access Device Placement in the Fourth recurrent high-grade gliomas treated Prabhu SP, Tseng SC. Cryopreserved Ventricle to Treat Malignant Fourth with bevacizumab. J Neurol. 2014 human umbilical cord patch for in-utero Ventricle Brain Tumors: Technical Note. Aug;261(8):1559-64. [Epub 2014 spina bifida repair. Ultrasound Obstet Childs Nerv Syst. 2015 Nov 23. [Epub May 25] Gynecol. 2016 Feb;47(2):168-76. ahead of print] 1 Gretchen Von Allmen, M.D., is listed as an Parikh S, Goldstein A, Koenig MK, Shinnar S, Cnaan A, Hu F, Clark P, author in the first, second and third papers Scaglia F, Enns GM, Saneto R, et al. Dlugos D, Hirtz DG, Masur D, Mizrahi under the Childhood Absence Epilepsy Study Practice Patterns of Mitochondrial EM, Moshé SL, Glauser TA, Childhood Group and the Epilepsy Phenome/Genome Disease Physicians in North America. Part Absence Epilepsy Study Group.1 Project Epi4K Consortium. 1: Diagnostic and Clinical Challenges. Long-term outcomes of generalized Mitochondrion. 2014:14;26-33. tonic-clonic seizures in a childhood absence epilepsy trial. Neurology. 2015 Parikh S, Goldstein A, Koenig MK, Sep 29;85(13):1108-14. [Epub 2015 Scaglia F, Enns GM, Saneto R, Anselm I, Aug 26] Cohen BH, Falk MJ, Greene C, Gropman AL, Haas R, Hirano M, Morgan P, Sims Simard-Tremblay E, Berry P, Cook WB, K, Tarnopolsky M, Van Hove JL, Solfe L, Owens A, Mazzanti M, Novotny EJ, DiMauro S. Diagnosis and management of Saneto RP. High-fat diets and seizure mitochondrial disease: a consensus state- control in myoclonic-astatic epilepsy: A ment from the Mitochondrial Medicine single center’s experience. Seizure. 2015 Society. Genetics in Medicine. 2014. Feb;25:184-6. [Epub 2014 Oct 23]

20 MEMORIAL HERMANN-TEXAS MEDICAL CENTER CHILDREN’S MEMORIAL HERMANN HOSPITAL 21 Memorial Hermann Health System NonprofitOrg. 7737 Southwest Freeway U.S. POSTAGE PAID Houston, TX 77074 Permit No.3156 Houston, TX childrens.memorialhermann.org/neuro 832.325.7242

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