New Center For Childhood Epilepsy, MontefioreSleep Center is one of only a few in the country for children

Mother-of-three Karen Maulen, of Cortlandt Manor, N.Y., is grateful for many gifts in her life, including her two-week stay at the new children’s epilepsy management center at the Children’s Hospital at Montefiore, in the Bronx. Those two weeks in February, she says, helped turn her daughter’s life around, and onto the road to a more productive life. The Clinical Neuroscience Center is a state-of-the art, with eight beds for children with epilepsy. Besides high-tech monitoring equipment to watch patients 24 hours a day, the rooms include big screen televisions, video games, Internet access and, of course, pull-out couches for parents like Karen Maulen, to stay overnight. Maulen’s 17-year-old daughter, Carolyne, has experienced seizures since birth due to a brain trauma that occurred in the womb. When she turned 16, she began to have memory and cognition problems taking the medication she had been on for years, so her doctors began to experiment with different doses and drugs. “Her seizures started becoming more frequent due to the changing of her medications,” Maulen says. By the time she was referred to Shlomo Shinnar, M.D., Ph.D., director of Montefiore’s Comprehensive Epilepsy Management Center, Carolyn had switched medications three times. “I feel like a supreme-being had a hand in getting us to Dr. Shinnar and the new Center,” Maulen says. Carolyne was one of the first patients in the new unit. “I learned more in 13 days in that hospital about my daughter’s care and condition than I did over 16 years.” Although it has been a long road, Carolyne’s medications have been tweaked, and she has gone more than a month without a seizure; she used to experience seizures weekly. Her new regimen includes the drug Lamictal (see sidebar). “Many children with epilepsy come into the hospital quickly and bounce in and out, but these new units are designed to do state-of-the-art monitoring, with the hope of not just stabilizing the patient this visit, but getting a handle on what is going on to better treat them down the road,” Dr. Shinnar says. This is precisely what occurred with Carolyne, Maulen says. “We basically hope that by having you in for four, five or six nights, we can prevent you from bouncing in and out of the ER and have a long-term impact,” Dr. Shinnar says. The recently re-modernized Center, which was established in 1991, has more than 300 admissions a year including children with severe epilepsy who fail medication, as well as children with newly diagnosed episodes that may or may not be seizures. “We can’t always cure it, but can usually make things better and most of the time can eliminate or substantially reduce the seizures,” Dr. Shinnar says.

The Clinical Neuroscience Center also has two beds for children with sleep disorders. With a staff imported from Yale University, the Sleep Disorders Center at Montefiore is one of the only sleep centers devoted entirely to children. With overnight monitoring, the Center specializes in diagnosing and treating obstructive sleep apnea (OSA), sleep walking, night terrors and movement disorders during sleep. “Sleep is vitally important. You can’t have normal daytime function without normal nighttime function,” says Lewis Kass, M.D., medical director of the children’s sleep center. “If something seems amiss, ask your pediatrician because sleep is often overlooked,” Dr. Kass advises. Sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. Obstructive sleep apnea is far more common and occurs when air cannot flow into or out of the person's nose or mouth, though they continue trying to breathe. “If a child has OSA, when they get to be school age, you will see poor school performance, inattentiveness, impulsivity and behavioral disorders across the board,” Dr. Kass says. “Parents commonly say ‘My kid is just such an unhappy kid. He or she is so irritable and flies off the handle’ and that is probably because they are not getting good sleep.” The biggest cause of OSA are tonsils and adenoids but obesity, which used to be considered a rare cause of sleep apnea in children, is now reaching epidemic proportions, Dr. Kass says. “Now I take care of two obese kids with OSA a week. That’s 25 percent of patients,” he adds. If OSA is caused by tonsils or adenoids that obstruct breathing, removal can help, Dr. Kass says. But if a child is obese, and obesity is the cause of the breathing problem, Continuous Positive Airway Pressure (CPAP) becomes the option. CPAP is a machine that helps a person who has sleep apnea breathe more easily during sleep. Used at home every night during sleep, CPAP increases air pressure in the throat, preventing collapse of the airway when a person inhales. CPAP also may help the person's bed partner sleep better. It has a mask that covers the face, a mask that covers the nose (nasal continuous positive airway pressure, or NCPAP), or prongs that fit into the nose. The mask that fits over the nose is used most frequently. The Children’s Hospital at Montefiore is located at 3415 Bainbridge Ave., in the Bronx. For more information, call (718) 741-CHAM (2426).

New Sleep Apnea Tool May Help in Diagnosis High-tech airway scans can help doctors better diagnose and treat obstructive sleep apnea (OSA) in children, according to the results of a study by Cincinnati researchers. As many as 1 percent to 3 percent of otherwise healthy preschool children in the U.S. have OSA, according to the American Sleep Apnea Association, in Washington, D.C. “That means about 60,000 to 70,000 children in the Bronx alone will have sleep apnea,” says Lewis Kass, M.D., medical director of the children’s sleep center at Montefiore. Called "cine Magnetic Resonance Imaging", the new technology is a high-tech type of magnetic resonance imaging (MRI) that takes a moving picture of the airway and then plays it back like a movie. The study, which was conducted at the Cincinnati Children’s Hospital Medical Center and published in the April 2003 issue of the journal Radiology, aimed to visualize the difference in airway movement in children with and without the condition. “The gold standard is the sleep study, but a sleep study is expensive, time-consuming and labor-intensive,” Dr. Kass says. X-rays of the skull and airway may also be used to help diagnose OSA, but study researchers say that unlike the new MRI, neither X-rays nor sleep studies can provide detailed information on why it occurs. “The information provided by the [cine] MRI scan can help direct the physician to the cause of the problem — which may be treated surgically or non-surgically,” says lead study author Lane F. Donnelly, radiologist in chief at the Cincinnati Children’s Hospital Medical Center.

Advice for Mothers to Sleep On By Kirsten Matthew

If you long for the weekends, just to get an extra hour or two of sleep, you’re not alone. Recent studies show that three out of four American women do not get the eight or more hours of recommended sleep per night during the workweek. Among women aged 30 to 60, sleep deprivation is impairing both health and performance, making them more prone to depression, relationship problems, and even coronary heart disease. "Many women, particularly working moms, exist in a constant state of sleepiness," says Suzanne Griffin, M.D., clinical assistant professor of psychiatry at Georgetown University Hospital in Washington, D.C., and mother of two. "Unfortunately, for many women it's more than just the physical demands on time that make it difficult to get a full night's rest. Sleep loss in women is often the result of hormonal shifts or particular health conditions, such as arthritis and depression, that are more likely to affect women than men." Several gender-specific conditions contribute to widespread sleep loss in women: A woman's sleep is disturbed 2.5 days on average during the menstrual cycle; more women than men (58 percent versus 48 percent) suffer from nighttime pain, including pain due to arthritis and headaches, according to the National Sleep Foundation. For many mothers with children, changes in their maternal makeup — i.e., a high sensitivity to the sounds of their children — cause them to wake more easily and sleep less efficiently, even after their children are grown. "Adequate sleep is critical for good health in women of all ages," Dr. Griffin says. "Anyone who has trouble sleeping should see their doctor." Although many women experience difficulty sleeping, only 4 percent of adults currently see a physician about their sleep problems, according to a 1999 Omnibus Sleep in America Poll, the last time for which data was available. The average woman gets only about six-and-a-half hours of sleep per weeknight, a recent National Sleep Foundation poll found. Nearly two-thirds of women say sleep loss interferes with their relationships with their spouse or children, and more than half say it interferes with their daily activities. Seventy-four percent of women agree that "feeling tired all the time is a problem" in their lives. "There are ways to treat the problem, including changes in bedtime sleep habits as well as prescription medications that are safe and help you sleep without grogginess," Dr. Griffin says. To help maintain a healthier lifestyle, Dr. Griffin recommends women examine their sleep habits and adjust them as needed. She suggests the following tips to help women get their proper rest: • Avoid alcohol and foods or beverages high in caffeine, sugar and salt. • Exercise regularly, but finish any workout at least three hours before bedtime. • If you have trouble falling asleep, try warming up your feet. Inadequate vasodilation (opening of blood vessels to increase blood flow) can cause sleep problems. • If you can't fall asleep after a reasonable period, get up, go into a darkened or dimly lit room, and participate in a quiet activity such as reading or listening to soothing music.