1. Pediatric Neurology Therapeutics Suzanne Goh, M.D. sgoh@gohmd.com 415-317-4514

2. OVERVIEW When should I refer a child to a pediatric neurologist? 1Unusual movements or “spells” 2When thinking about meds for problem behaviors 3Complex cases

3. When to refer… 1Unusual movements or “spells” o Seizures o Tics o Other movement disorder …how are these different from stereotypies?

4. Medications for problem behaviors 1Combinations of meds at low doses sometimes work better than single meds at high doses 2Challenges with long-term use (side effects, lose efficacy over time, higher and higher doses needed, tapering off) 1Potential alternatives to meds (supplements, acupuncture, neurofeedback, etc.) *supplements may be needed during psychopharm therapy to counteract med toxicities (e.g. carnitine) 2Trying relationship-based behavior programs in addition to ABA-based

5. Complex Cases Multiple neurological symptoms o Intellectual disability o Epilepsy o Low tone, incoordination, weakness o Headaches o Vision and hearing problems o Movement disorder, tics, etc. Multi-system dysfunction Minimal improvement with behavioral and educational intervention

6. The more severe and complex the phenotype, the more likely a causative mutation can be found. Complex Cases

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

8. 80% of children with autism had blood tests showing mitochondrial dysfunction mitochondria