Pediatric Neurology
Therapeutics
Suzanne Goh, M.D.
sgoh@gohmd.com
415-317-4514
OVERVIEW
When 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 Seizures
o Tics
o Other 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)
1
Potential alternatives to meds (supplements, acupuncture,
neurofeedback, etc.)
*supplements may be needed during psychopharm therapy to
counteract med toxicities (e.g. carnitine)
2
Trying relationship-based behavior programs in addition to
ABA-based
Complex Cases
• Multiple neurological symptoms
o
o
o
o
o
o
Intellectual disability
Epilepsy
Low tone, incoordination, weakness
Headaches
Vision and hearing problems
Movement disorder, tics, etc.
• Multi-system dysfunction
• Minimal improvement with behavioral and
educational intervention
Complex Cases
The more severe and complex the
phenotype, the more likely a
causative mutation can be found.
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