Checkup Newsroom

Teen with Frightening Form of Epilepsy Now One Year Seizure Free

Fri, 22 Nov 2019 14:11:00 -0600

Sitting outside of a movie theater, Damian Wells hoped he’d embarrassed himself for the last time.

Moments earlier, the 15-year-old Weatherford, Texas teen was watching a movie with his younger sisters when all of the sudden, a fit of cursing and yelling came over him. He wasn’t doing it on purpose, but he couldn’t stop. The strangers staring at him didn’t know what was happening.

Feeling he had no other choice, it was then that Damian decided to stop going out in public.

“Everyone in the theater began pointing and laughing at him. People didn’t get it, they looked at him like he was crazy,” said Patricia Wells, Damian’s mother.

Being misunderstood is something Patricia had grown used to over the years of caring for Damian. Teachers, family members and even some doctors couldn’t comprehend how a boy who seemed so normal one moment could have frightening, emotional outbursts for no apparent reason the next.

WARNING - Some may find this video difficult to watch. It shows Damian Wells during a seizure.

It’s hard to say how Damian ended up at this point.

At the age of 5, he was diagnosed with epilepsy. Patricia remembers holding her little boy as he would scream, a look of terror on his face. She used to call these spells, but in reality they were seizures. The medication he was prescribed helped keep the seizures at bay for many years, but something changed around the time he turned 12.

“He could be watching the Disney Channel and he would go into a rage, just out of the blue,” said Patricia. “It was like watching a horror movie and your child was right in the middle of it.”

Damian underwent an electroencephalogram (EEG), used to detect abnormal electrical activities in the brain. The test should have revealed if the fits were caused by epilepsy. It didn’t. Instead, doctors were left with little explanation and suspected his problems were psychological.

“I knew that couldn’t be right,” said Patricia. “Over time, we were told he had Tourette’s, PTSD (post-traumatic stress disorder) and many other mental disorders. None of them ever made sense.”

Damian’s life began to deteriorate. He experienced up to 50 fits a day, and by the tenth grade could no longer go to school. Scared he would hurt someone or himself, his family turned to a psychological facility for help. Shortly after, Damian ended up in the Pediatric Intensive Care Unit (PICU) at Cook Children’s. He’d been given a toxic dose of a drug used to treat behavioral issues.

While he didn’t know it at the time, this hospital stay would be the turning point for Damian.

This would be the first time he’d meet Scott Perry, M.D. an epileptologist and medical director of the John and Jane Justin Neurosciences Center at Cook Children’s.

“I was consulted by the PICU to check on a child they believed had Tourette’s,” said Dr. Perry. “Once I met the family, I realized that wasn’t the case. They described a look he would get right before a fit. It was a distinct frown, followed by fidgeting and cursing. That information was key.”

The frown they were describing is called Chapeau de gendarme, a tell-tale sign of frontal lobe seizures.

Because Damian had this stereotyped behavior (i.e. he always had a frown, followed by fidgeting, followed by cursing), Dr. Perry was confident epilepsy was to blame. He just had to prove it.

Once again, Damian underwent an EEG and once again, it didn’t reveal much. Dr. Perry wasn’t giving up though. He ordered more tests and compared those tests to the EEG results.

“I knew I was looking for something in the frontal lobe of the brain because of his stereotyped behaviors, the brief duration of each event, and the circumstances in which it occurred. When seizures come from the frontal lobe, strange, hyperactive behaviors develop,” said Dr. Perry. “I’ve never seen anyone curse during a seizure before, though, so that was unique.”

Dr. Perry’s suspicions were right. Using various tests, he was finally able to pinpoint the very spot in Damian’s brain where the seizures were occurring.

“As a mom, I spent every day afraid I was going to lose my son,” said Patricia. “Dr. Perry always said, ‘I’m going to fix this, I’m going to figure this out,’ and he did. He’s an angel. He saved my son’s life.”

In September 2015, Damian underwent a brain resection, meaning the portion of his brain where the seizures were occurring was removed.

“I was scared. I really didn’t want to do it but I knew I would never be able to live a normal life if I didn’t,” said Damian.

The section that was taken out was only about 3 centimeters long, but having it removed has made a world of difference for Damian. He hasn’t had a single seizure since.

He’s a senior in high school now with plans to graduate early. He’s also being weaned off his seizure medication and if all goes well, he’ll be working toward a driver’s license soon.

“If there’s one thing I could tell people, it’s don’t underestimate someone with epilepsy,” said Patricia. “And if you’re a parent like me, don’t ever give up.”

“The moral of the story is, it’s all about the story,” said Dr. Perry. “Damian’s parents said he had this look on his face every time, that’s what I needed to know.”

Learn more:

10 ways to avoid test stress

Fri, 06 Apr 2018 15:15:32 -0500

Today’s students have greater demands than ever before, with homework and a greater emphasis on scoring high on standardized tests like the State of Texas Assessments of Academic Readiness (STAAR).

Parents can help by making sure that children plan accordingly for testing days at school. Find out from your children and the school how they’re doing and the likelihood of not performing well on tests. This will help alleviate fears by pacing preparation for the tests, creating a plan to help kids succeed and encouraging them to problem-solve their worries.

Here are steps you can take to help your child during this stressful time:

Ask for help. If your child is especially anxious about test taking, set up a meeting with the teacher and school counselor to come up with a plan to ease fears on test day.
Go online and get sample items of practice tests from previous years and, if needed, practice with your children at home.
Practice deep breathing exercises at home. Then on test day, they will be able to put these practices into action.
Make sure your child gets plenty of rest. Studies have found that people who get eight hours of sleep before taking a math test are nearly three times more likely to figure out the problem than people who stay awake all night.
Control your children’s anxiety by making sure they are prepared. Focus on good study habits and the importance of not waiting until the last minute to cram before the test. There’s still time. Also, make sure your child has everything he or she needs going into the test. Even if it’s a new sharpened pencil. Make a check list the night before to avoid stress.
Stay away from entertainment as test time approaches. It’s not easy, but your child needs to study and not spend all night watching TV, looking at Facebook^® or being on the computer. You can wait on that until after the test.
Help your child keep mistakes in perspective. Everyone makes them and nobody is perfect. As you move closer to tests and studying, use wrong answers as a learning opportunity.
Eat right. Make sure your child has had enough sleep, exercise and healthy food. Avoid heavy food or desserts that may upset the stomach. Avoid high sugar foods that may keep your child up all night and make sure your child has a healthy breakfast (low-sugar cereal or oatmeal) the morning of the test.
Expect distractions. Let your child know someone in the class will have sniffles. Some kid will be banging his pencil on the desk. Someone may be humming. Those kids have their own stress. Just warn your child this is going to happen, but don’t let it be a bother.
After testing is completed, create ways to celebrate with your child. What you want to focus on in this celebration is the success of managing their stress, and not whether they passed or failed, which they won’t know for weeks.

Get to know Lisa Elliott

Lisa Elliott is a licensed psychologist and clinic manager of Cook Children’s Psychology Clinic, located at 3201 Teasley Lane, Ste. 202, Denton, TX 76210. Cook Children’s Psychology provides care focused on children’s behavior, from ages 3 years through 17. The Behavioral Health Center brings all services together in an expanded space that will provide a talented, dedicated team of caregivers, physicians and professionals with the facilities, resources, tools and programs they need to ensure that these most vulnerable children receive the high quality treatment they need and deserve. Click to learn more. To make an appointment, call our Intake Department at 682-885-3917.

New Behavioral Health Center Offers Hope for Children in Crisis

Tue, 06 Jun 2017 10:16:48 -0500

On the top floor of the brand new South Tower building at Cook Children’s Medical Center sits a facility most people will never see. The doors are locked from inside and out. The only access granted comes with the swipe of a badge. Visitors must sign in while security cameras follow their every move. And the patients receiving care for severe psychological disorders here are under constant supervision.

This is the Rees-Jones Behavioral Health Center, one of the few places in North Texas that offers inpatient psychiatric care for children between the ages of 2 and 12. The kids who end up here are among the sickest of the sick. They are often suicidal or have tried to hurt someone else. Eight out of 10 have had something traumatic happen to them. They have either been abused physically or sexually, or they have experienced some sort of neglect.

“The issues our patients face run the whole gamut,” said Hari Kumaresan, M.D., medical director of Psychiatry at Cook Children’s. “We treat common problems like depression, anxiety, mood disorders and ADHD (attention-deficit/hyperactivity disorder) along with issues like autism and schizophrenia.”

The Rees-Jones Center opened its doors in March of 2017, but its mission began nearly three decades ago when Cook Children’s first launched a psychiatric program in 1990. Today, that program sees more than 800 children a year through inpatient hospitalization and the Partial Hospitalization Program (PHP), which treats children during the day while allowing them to return home to their families at night.

While Cook Children’s capacity to help kids with behavioral health disorders has grown to an all-time high, so has the number of patients in need of such services.

When children attempt suicide

For decades, those most at risk of attempting suicide have been teenagers and young adults. But something strange and downright scary is happening now. Young children, still learning the basics of reading and writing, are increasingly ending up at Cook Children’s Medical Center after attempting to kill themselves.

“This is a nationwide phenomenon. If we look back, even 10 years ago, suicide attempts were common in teenage years,” said Dr. Kumaresan. “What we are seeing over the past few years is an increase in preteens, some as young as 7 and 8 years old, having persistent suicidal thoughts and attempting suicide.”

Since 2015, the number of patients who have ended up in medical/surgery units or the intensive care unit at Cook Children’s for injuries related to a suicide attempt has increased significantly. There’s no data available yet to say for certain how many more of these cases there have been, but it’s safe to say the percentage is in the double digits.

It’s not just happening here either. According to research recently released by the Pediatric Academic Society, the number of children admitted to 32 children’s hospitals for suicidal thoughts and actions has doubled over the past decade. The children in the study range in age from 5 to 17. The largest uptick was seen among girls.

“There have been studies that looked at the role of electronics and social media. There also have been studies that looked at changes in family structures over the past few decades. They have all come back negative,” said Dr. Kumaresan. “We’re still trying to understand what’s driving the increases we are seeing, but we do know there is a need for the kind of integrated care we offer at Cook Children’s.”

What affects the mind, affects the body

For years, mental and physical health were widely considered to be two separate entities, posing separate issues for patients. Today, many hospitals are turning their backs on that notion and offering ‘integrated care,’ where behavioral and medical providers work together.

“The artificial divide between mind and body was done for learning purposes. It doesn’t work in real life,” said Dr. Kumaresan.

At Cook Children’s, integrated care often begins in the Emergency Department (ED) where staff can expect to perform about 10 behavioral health assessments each day. The assessments take place in specially-designed rooms free of anything a patient could use to harm themselves or someone else, including standard medical equipment. Physicians are trained to ask critical questions and to make sure the patient is medically stable. Then, if the patient is not medically ill, a psychiatry intake coordinator is brought in to do an in-depth interview and exam. If the child or teen is in imminent danger of harming themselves or others, or is actively psychotic, they will be admitted to inpatient psychiatry.

“Ninety-eight percent of the children admitted to the inpatient program come in through the emergency department,” said Lisa Farmer, director of the Psychiatry Department at Cook Children’s. “Most suffer from sort of mood disorder such as depressive disorder, major depression or disruptive mood dysregulation disorder.”

Much like suicidal patients, the number of children and teens arriving at the ED in need at psychiatric evaluations is at an all-time high, and continues to rise. The good news is, relief should come soon. These types of cases tend to decrease in the summer months while kids are out of school and away from common stress factors.

The haunting role of trauma

Nearly 82 percent of patients who end up receiving inpatient psychiatric care at Cook Children’s have experienced some type of significant trauma such as abuse or neglect, witnessing domestic violence, living with a caregiver with severe mental illness or substance abuse issues, or many other adverse childhood experiences. Often, these children suffer from some type of mood disorder such as Disruptive Mood Dysregulation Disorder (DMDD), anxiety or depression.

But there’s also an increased risk of these children being misdiagnosed.

“Traumatized children do not always exhibit the internalizing behaviors such as withdrawal, depression and anxiety. Instead, they may exhibit aggressive behavior,” said Dr. Kumaresan.

He says reactions to trauma may be confused with attention deficit hyperactivity disorder (ADHD) when kids act out in combative and impulsive ways.

Trauma can also play a role in overall health well beyond childhood.

“We know that trauma impacts physical health,” said Dr. Kumaresan. “It affects blood pressure and blood sugars as well as increases the chances of using substances such as cigarettes, drugs and alcohol.”

Further evidence of this can be found in the Adverse Childhood Experiences study conducted by Kaiser Permanente and the Centers for Diseases Control and Prevention (CDC). In 1995, researchers began collecting information via questionnaires about participants’ childhood experiences. Since then, the CDC has tracked the medical status of those surveyed. The results show that experiencing things like abuse, neglect, divorce or having a parent addicted to drugs or alcohol increase the risk of experiencing health problems later in life.

There is hope and help

Helping children overcome the symptoms of behavioral health disorders is not an easy task. It takes a village and there aren’t enough people enlisted in the fight.

“This isn’t a problem that can be solved by someone sitting in an office writing prescriptions,” said Dr. Kumaresan. “It requires a lot of collaboration with schools, families, legal systems and physicians. Across the country, we need more child psychiatrists, more child psychologists and more patient beds.”

With the opening of the new Rees-Jones Center, the number of beds available to psychiatric patients at Cook Children’s increased from 11 to 15. It’s a 45-percent increase in capacity and could result in nearly 600 admissions a year.

“We strongly believe kids will do well if they can,” said Dr. Kumaresan. “But we have to give them the tools and support they need.”

For parents, this means talking to your primary care provider if you are concerned about your child’s behavior. You can also contact Cook Children’s Psychiatry Intake department at 682-885-3917. They can do an assessment over the phone and recommend resources. Parents should go to the ED if their child is at risk of hurting themselves, others or is actively psychotic.

“Families should know that 1 in 5 children struggle with behavioral health issues and there is hope,” said Farmer. “Mental illness is treatable and there are things we can do to help their children.”

Get to know Hari Kumaresan, M.D.

I was drawn to child psychiatry by a desire for staying in the present moment, which seems to be a natural ability in most children. Moving to the U.S. from India, I did my psychiatry residency at SUNY Upstate Medical University, Syracuse NY. I followed up with Child and Adolescent Psychiatry Fellowship training at University of Medicine and Dentistry, Piscataway, NJ.

I have worked with the most vulnerable families in community mental health systems in Staunton, Virginia and more recently in Dallas, TX. I believe in learning by sharing our experience, which has led me to mentor residents and fellows in child psychiatry at the University of Virginia and more recently at the University of Texas Southwestern in their clinical rotations. Experiences as Chief Resident as well as Regional Medical Director in a busy non-profit clinic have helped me understand and navigate health care systems.

When I’m not working, my two kids, family and friends help me stay in the present moment.

Click to learn more about the Rees-Jones Behavioral Health Center.

Teacher appreciation

Tue, 06 May 2014 12:22:28 -0500

Every child’s greatest advocate should be the parent. After all no one knows your child, better than you. So as we celebrate Teacher Appreciation Week (May 5-9), I thought I would offer some tips for talking to your child’s teacher and hopefully making the relationship between you and your child’s teacher as comfortable as possible:

Health. Often, teachers don’t know about your child’s health history. Many kiddos have severe nut allergies and teachers need to be aware of those food allergies, as well as if your child needs special medication or an EpiPen^® injection. You should let your teacher know if your child has asthma, is diabetic or has any other serious health condition.
Educational Diagnoses. Teachers may not know your child has been diagnosed with a learning difference, dyslexia or an attention deficit problem. This is an opportunity to let teachers know about a 504 plan or IEP for your child. This is also a great time to let your teacher know what your child’s learning style is such as whether they are an auditory, visual, or kinetic learner. Sharing your child’s areas of strengths and weaknesses is also helpful.
Emotional and Family. Inform your teacher of any emotional factors that may impact your child such as divorce, death, illness or a parent being stationed overseas. It’s helpful for teachers to know the emotional factors that are impacting your child’s life which may help your teacher to understand and communicate better with your child.
Schedule conferences. Teachers are bombarded with information at meet and greets during orientation and other group events throughout the school year. It’s hard to keep everyone and everything straight. My advice is to set up a conference with your child’s teacher as early as possible. One teacher told me she found it really helpful when parents provided a list of bullet points that included helpful information about their child, including the health and educational diagnoses, the strengths and weaknesses of the child, how the student learns the best, what the student responds to best when giving direction or correction, and some points about the student’s social and personality style. Go in and set up an appointment one on one, especially if your child has special needs or considerations.
Be a team player. Every teacher I have spoken with has told me what they appreciate more than anything is for the parent to ask the teacher, ‘how can we help you? What information do you want to know?’ Most teachers prefer that team approach.
Be honest with yourself about your child. This is sometimes the most difficult for parents, but it’s so important. Know your child’s strengths and weakness. One of our biggest problems in today’s society is not teaching accountability. Set that example. Make sure your child knows his or her responsibility. Teachers have a difficult enough job without always blaming them, the school or another child. Please make sure you know how your child contributed to a situation and then take appropriate action from there.

Of course every child is different, and special, which makes communication between you and your teacher so important in having a great school year; and appreciating one another.