generation and propagation of epilepsy activity in the context of this disorder as a network disease.  

His findings may help physicians to understand how epilepsy activity initiates in a focal brain area of children with epilepsy propagating later in other areas of the brain. Pinpointing these onset areas, where epilepsy starts, would allow stopping seizures through surgery in children suffering from epilepsy without resecting large brain areas, which may damage physiological brain functions such as the language or movements.

Pediatric epilepsy is a neurological disorder, characterized by recurrent seizures due to abnormal electrical brain activity. It has been estimated that 4-10 out of 100 children suffer from epilepsy. A significant proportion of these children are unable to control their seizures with drugs dealing with recurrent uncontrolled seizures. These seizures may have a severe impact on the quality of child’s life leading to serious cognitive and behavioral problems as well as increased mortality. Therefore, it is critical to develop new strategies for the diagnosis and treatment of uncontrolled seizures in children with epilepsy.

Children with uncontrolled seizures undergoing surgery often require the placement of electrodes inside their brain for identifying the area where seizures are generated. Yet, seizures occur spontaneously and propagate fast from onset areas to areas of spread. Thus, we should have to wait for a seizure to occur and this may take several days. This increases the patient’s time in the hospital and thus the risk of infection from invasive electrodes placed in the patient’s brain. 

In this study, Cook Children’s Neuroscience Research team showed that they can map the onset of this propagating activity without having to wait for a seizure to occur. Such a development can shorten the patient’s stay in the hospital improving the presurgical evaluation procedure.

This study is funded by the National Institute of Neurological Disorders and Stroke and is in collaboration with the University Campus Bio Medico in Rome, Italy, the Boston Children’s Hospital, and Harvard Medical School. Margherita Matarrese, a Ph.D. student of Bioengineering under the supervision of Professor Papadelis serves as first author of this scientific paper.

Coming Soon

The Jane and John Justin Institute for Mind Health at Cook Children’s, opening in October 2023, is bringing together nine specialties under one roof. Pediatric specialists in neurological, developmental and behavioral health are changing the way we deliver health care. Together, we’re healing minds and bodies and sharing smiles that warm the soul and connecting care for kids unlike anyone else.

Her head and arms lift. Her eyes open, turned to the side. Her body goes rigid and she loses bladder control. Sometimes she moans; usually the episodes unfold silently. The next morning, Baylie doesn’t remember.

“It’s very tough to watch. It never gets easy,” said her mom, Brandi Williams. “Most of the time she just goes right back to sleep.”

Diagnosed at age 2, Baylie is among the estimated 12% of epilepsy patients who experience nighttime seizures. An electroencephalogram (EEG) monitoring study at the epilepsy monitoring unit at Cook Children’s found that her seizures occur six or seven times a night – even more than her parents initially realized.

Dave Shahani, M.D. an epileptologist at Cook Children’s, explained that nocturnal seizures cause special concern because of the risk that a child in the throes of a seizure might suffocate on fluffy bedding or soft toys.

“It’s not that they are any different from other seizures per se, but we tend to worry about them more,” he said. Seizures while sleeping are less likely to be witnessed by a parent, he pointed out. “Any number of nighttime seizures is a high number. Even one a month is a high number.”

The U.S. Centers for Disease Control and Prevention estimates that epilepsy affects 470,000 children nationwide. Irregular electrical activity in the brain characterizes this chronic disorder, which encompasses a wide variety of seizure types. Symptoms of epilepsy can look very different in different people.

Someone having a seizure might collapse, twitch or spasm, stiffen, blink rapidly, stare into space, or lose consciousness, for instance. Nighttime seizures pose the added challenge of sleep disruption. And studies have indicated a higher risk for Sudden Unexplained Death in Epilepsy (SUDEP) during sleep. SUDEP is poorly understood but suspected to involve cardiac or respiratory complications.

Damian Campbell, D.O., a pediatric neurologist at Cook Children’s in Prosper, said Baylie’s frequent and consistent sleeping seizures stand out as “the most extreme case that I’ve experienced.” But he’s encouraged about the prospect of surgically correcting her epilepsy.

Doctors think Baylie’s seizures originate from the right frontal lobe of her brain due to focal cortical dysplasia, a jumbling of the neuron cells as her brain developed before birth. In a surgical procedure scheduled for December, her medical team expects to pinpoint the abnormality’s exact location – and eventually reduce or even eliminate her seizures.

In November, as we observe Epilepsy Awareness Month, we’re highlighting Baylie’s story to illustrate the complexity of epilepsy, to share hope, and to feature the work of the neuroscience experts at Cook Children’s who treat the seizure disorders of more than 13,000 infants and children per year.

Starting to Find Answers

Baylie loves to sing and dance, can charm someone she’s just met, and in her dad’s words “she’s amazing.” So the discovery of their daughter’s epilepsy several years ago came as a surprise to Jabyrie and Brandi Williams. None of Baylie’s five older siblings has seizures. And judging just by appearance, nothing seemed obviously wrong with the toddler. But the family noticed occasional behavior they thought was unusual.

“Every once in awhile she would start staring off into space and then she would start laughing after she came out of it. We would snap our fingers and say ‘Baylie, Baylie,’ and she wouldn’t say anything,” Brandi remembered.

“We didn’t think it was anything at first,” Jabyrie said. “She would look around and laugh, and we thought it was an imaginary friend.” The Williamses referred to these strange bouts as “blanks.”

Then they picked up on other odd signs… dizziness after her blank spells, dark circles under her eyes, and complaints about feeling tired. She struggled to follow directions at home. At gymnastics, she couldn’t focus enough to complete a step-by-step routine. “Walk the beam and then do a handstand and do a cartwheel,” Brandi said. “Her mind couldn’t process doing those things in a certain order.”

After a referral from a pediatrician, Baylie underwent various tests, including an MRI, spinal tap and electroencephalogram (EEG). In 2020, they sought a second opinion at Cook Children’s, where she came under the care of both Dr. Campbell and Dr. Shahani. Further tests showed that Baylie’s “blanks” and trouble concentrating stemmed from the disorganized layering of neuron cells on one side of her brain.

She currently takes two medications that mostly control her daytime seizures. At full-day pre-kindergarten she hasn’t had a seizure during nap time. But a stressful day, Brandi said, might trigger a breakthrough seizure during waking hours. And the nighttime seizures still happen regularly.

“Focal cortical dysplasia can’t be fixed with medication. You can suppress the seizures, but you can’t fix anything. Surgery is the only thing that could fix it,” Brandi said.

Dr. Campbell characterized Baylie as a good candidate for epilepsy surgery. He cited the higher likelihood for surgical success in patients whose seizures onset lies in just one part of the brain instead of generalized in multiple locations. A lesion in Baylie’s right frontal lobe “as a result of being malformed, doesn’t respect the organization of how the brain produces electricity,” Dr. Campbell said.

Dr. Shahani concurred in the assessment of good surgical potential. The four medications Baylie tried didn’t stop her nighttime seizures. “Without any change in her treatment plan, she will continue to have seizures for the rest of her life,” he said.

Next Step, Surgery

A stereo EEG is scheduled for Dec. 13 to precisely locate the source of her brain’s erratic electrical waves. Daniel Hansen, M.D. a neurosurgeon at Cook Children’s Jane and John Justin Neurosciences Center, will make small incisions in Baylie’s scalp and skull to place electrodes that record brain activity. Those findings could pave the way next spring for either a resection (removal of a small amount of brain tissue), or thermal ablation (a probe that uses heat to destroy the area causing the seizures). Cook Children’s performs more than 30-40 epilepsy surgeries annually.

The odds are stacked in Baylie’s favor. Dr. Shahani explained that the target area doesn’t involve critical parts of her brain that control language or motor skills. ‘She presents as a very good candidate for potential seizure freedom,” he said.

For epilepsy patients whose seizures resist medication, alternatives may include dietary therapy or implanted devices such as vagus nerve stimulators. “Early recognition and early treatment always lead to better outcomes,” Dr. Shahani said. And from Dr. Campbell: “Earlier detection is better because uncontrolled seizures can affect patients cognitively over time.”

They encouraged parents to call a neurologist or epileptologist if they suspect their child might be having seizures. Videos can be a valuable diagnostic tool by capturing a recording of the twitches, spasms, “blanks” or other concerns. Seizures often go undiagnosed or misdiagnosed because they occur so uniquely in each person, Dr. Shahani said.

“It makes it challenging and extremely rewarding to help identify what is a seizure. Parents are our greatest asset because they know their child the best.”

Back in Rowlett, the Williams family keeps Baylie on an evening routine – dinner, medicine, bath, in bed by 8:30pm. She sleeps in her own bedroom, protected from falls by a guard around the edge of her mattress. A camera keeps watch.

“In the beginning she was sleeping with us because we were nervous,’ her mom said. “But we had to come to the agreement that we have to let her be a kid.”

Brandi and Jabyrie expressed optimism that this treatment path will put an end to Baylie’s nighttime seizures and allow her to come off the meds. They urged other parents to know that the signs of epilepsy can be silent and easy to miss. Their advice? Ask questions, pay attention to seizure triggers, and advocate for your child.

“We want answers, and that’s what Cook Children’s gave us,” Brandi said. “If we never would have switched to Cook Children’s we just would have been chasing seizures for the rest of her life. We want her to be as independent and normal as possible. Being on medication for the rest of her life just wasn’t what we wanted for her, if we could help it.”

Left uncontrolled over time, seizures can cause buildup of brain scarring, Dr. Campbell said. Nighttime occurrence interferes with the restorative sleep that children need. He applauded the Williamses for their willingness to follow the recommendation for surgery to stop Baylie’s seizures.

“I hope that this article helps other families with the expected fear with hearing someone say ‘Maybe we should consider surgery,’” Dr. Campbell said. “It is a scary conversation. But I think over time we’ve become optimistic that her story will make it less anxiety-producing for families.”

Luke Waggoner’s epileptic seizures were getting worse, striking multiple times a day sometimes in back-to-back clusters that sent him to the hospital.

The seizures caused the 13-year-old Arlington boy to jerk or jump uncontrollably. He might fall backward so forcefully that he’d bruise. Other seizures left Luke mute, confused and unresponsive.

Luke has Lennox-Gastaut syndrome, a rare type of difficult-to-control epilepsy. His seizures are medically refractory, having failed many medications and other non-pharmacological treatments. Even with five different medications taken multiple times daily, Luke was still having breakthrough seizures, the erratic misfires between neurons in his brain. These seizures often resulted in trips to the emergency room and frequent admissions to the hospital. The medications and frequent seizures also make it hard for him to think and speak clearly.

In the midst of the setbacks came a new treatment option: deep brain stimulation (DBS), a surgical therapy that utilizes electrodes, wires and a generator to modulate the brain’s abnormal electrical impulses. The movement disorders team at Cook Children’s has been utilizing DBS for dystonia since 2007 in children as young as 7 years of age. DBS was recently approved by the U.S. Food and Drug Administration (FDA) for adult patients with Lennox-Gastaut syndrome.

Luke was facing the prospect of undergoing a corpus callosotomy for his epilepsy. This irreversible neurosurgical procedure permanently severs most of the connections between the two halves of the brain to prevent drop seizures, the most dangerous and disabling seizures often seen in Lennox-Gastaut syndrome. Based on extensive experience with pediatric DBS, the movement disorders and epilepsy teams collaborated with Luke’s family about the potential to offer DBS to Luke as an alternative to callosotomy. If the DBS did not work, callosotomy remained an option.

After much discussion and planning, the decision was made to implant temporary electrodes in two sites on each side of Luke’s brain to assess the impact on his seizures and potential unwanted effects. In April 2021, Luke had the temporary leads implanted. After several days of continuous monitoring on the specialized epilepsy unit trying different stimulation settings, the sites for permanent leads were chosen in consultation with Luke and his family. A detailed proposal including the data from the trial was used to get insurance approval for the placement of DBS.

Then in a two-part landmark surgery at Cook Children’s – on July 8, when electrodes were implanted in his thalamus; and on July 14, when wires were placed through his neck to the generator in his abdomen – Luke became the first pediatric patient in North Texas to undergo DBS for intractable epilepsy since the FDA approved the treatment. He also became the first child in the United States to receive the newly approved sensing lead technology DBS system for epilepsy.

“Deciding to do the DBS and for Luke to be the first pediatric patient at Cook Children’s for epilepsy was a very difficult decision, and we did not take it lightly,” said his mom, Ami Waggoner. “We just knew we had to do something to try to help him.”

Cynthia Keator, M.D., medical director of the Epilepsy Monitoring Unit at Cook Children’s, expressed optimism about the potential to mitigate Luke’s seizures for years ahead. Other desired outcomes from the ongoing brain stimulation? Better cognitive function, fewer meds, greater independence and a more normal lifestyle.

“Our hope is that not only will this immediately start to show improvement in his seizures, but give him a chance to have a better quality of life, to be able to go back to school in person, to be able to go outside and not worry about falling down or having a seizure, and to be able to taper off of some of his medications,” Dr. Keator said.

Since 2007, the Jane and John Justin Neurosciences Center at Cook Children’s has established a record of excellence in deep brain stimulation, providing the surgical therapy to almost 150 patients with a movement disorder called dystonia, currently FDA-approved for pediatrics. Luke is a pioneer in DBS because of his underlying condition … epilepsy rather than dystonia.

Ami and Tim Waggoner said their son already has made big strides since his two DBS surgeries in July. His seizure count is down from the pre-surgery norm of five to 10 per day, she said, and the seizures that still occur aren’t the dangerous variety that requires additional “rescue” medications. Luke is able to read, play with Legos and his beloved trains, and go for short trips in the car. He started weaning off one of the drugs he takes. They are amazed at the change.

“You can just look in his eyes and see he’s more with it,’’ Ami said. “This is all really, really exciting. He knows he’s feeling better.” And from Tim: “I’m seeing more energy, fewer seizures, clearer speech and he is able to do more! It is just amazing the difference in just over a month since turning on the generator.” 

Let’s take a closer look at epilepsy facts, the precision involved in deep brain stimulation, and the route Luke took to becoming the first patient to undergo this new treatment for childhood epilepsy.

Epilepsy explained

The U.S. Centers for Disease Control and Prevention estimates that 3.4 million people nationwide have epilepsy, including 470,000 children. There is no cure and often no identifiable cause. Epilepsy is a chronic disorder that results from sudden intense bursts of electrical activity in the brain, manifesting a range of seizure types.

Someone who’s having a seizure might collapse, twitch or spasm, stiffen, blink rapidly, stare blankly, or lose consciousness depending on the type. Medication successfully controls the seizures in up to 80% of children with epilepsy.

Luke was diagnosed at age 5 with generalized epilepsy, which affects both hemispheres of his brain. Big sister Lexi didn’t know what was happening when she witnessed the first seizure.

“He couldn't hear me. And he started walking in a circle and then he just fell over and turned blue. Seeing that freaked me out,” Lexi remembered. “The first few years were really hard for me to understand and get used to it. But now it's to the point where it's just a part of our everyday lives.”

Medications helped at first, his mom said, but the seizures started getting more dangerous and debilitating about three years ago. Ami, who is a nurse, could administer the rescue medications at home when the seizures got especially bad. But even then, about twice a month Luke required hospitalization and intravenous therapies to stop the back-to-back clusters.

Dr. Keator said electroencephalography on Luke found the two distinct patterns of brain waves indicative of Lennox-Gastaut syndrome, (slow spike-and-wave complex and generalized paroxysmal fast activity). A vagus nerve stimulator, which uses a pacemaker-like device implanted in his chest, worked for a while for Luke, but the seizures and hospital stays kept recurring.

Game-changer potential

Warren Marks, M.D., director of the Movement Disorders Program at Cook Children’s, visited Luke’s hospital room in February 2021. Dr. Marks mentioned the prospect of deep brain stimulation, which had been approved by the FDA since 2018 for adults with epilepsy. Cook Children’s anticipated that the FDA’s green light for DBS in epileptic children was on the horizon, and Luke seemed like an ideal candidate.

“Dr. Marks just really believed he could help Luke. He gave us a spark of hope,” Ami recounted. “We were on board from the beginning because of the trust I have in the physicians and Luke’s neurology team. They're just amazing. They have never, ever given up.”

Dr. Marks explained that DBS sends small electrical impulses to targeted areas of the brain to alter the abnormal movements seen in dystonia as well as tremors and Parkinson’s disease. Results were encouraging in the almost 150 dystonia patients who underwent DBS in the past 14 years at Cook Children’s. Dr. Marks thought the therapy held promise for epilepsy patients too.

Collaboration between the Cook Children’s movement disorders and epilepsy teams had already been underway to adapt technology and share expertise, Dr. Marks said. The next step was a weeklong trial in April to gather data on Luke’s tolerance for different electrical amplitudes. And the doctors needed to know exactly where to implant the DBS devices.

“We recorded and stimulated different places in the brain to decide which seemed to be beneficial, but also which didn’t cause him unwanted side effects,” Dr. Marks said. “When you stimulate the brain in these areas, sometimes you get thing that you don’t want. We were trying to find one target that would give us the best chance of success.”

Not only did the April testing phase produce essential data, but during that practice run Luke spoke more clearly and felt better than he had in years, his mom said. So DBS was scheduled for July. John Honeycutt, M.D., medical director of Neurosurgery at Cook Children’s, is the surgeon who implanted several electrodes bilaterally in the centromedian nucleus of Luke’s thalamus, the relay center for transmitting signals in the brain.

The DBS system consists of three main components:

• Leads (pronounced “leeds”) – tiny electrodes embedded deep in the brain to deliver the electricity directly to the target area. They’re held in place by caps screwed into the skull.
• Generator – a mini-computer under the skin of the chest (the abdomen, in Luke’s case). Wires run through the neck to connect leads to a generator. In some cases, the battery is rechargeable.
• Programmer – a tablet that talks to the generator, regulating the strength and frequency of electrical impulses per second. Settings can be adjusted based on the patient’s response via Bluetooth connection.

Dr. Marks described DBS as flexible, specific and less invasive than other surgical approaches. Primary candidates are the patients like Luke whose seizures originate in both halves of the brain. “This has the potential to be an absolute game-changer,” Dr. Marks said. “It’s essentially like delivering medication without all the medication side effects. That’s one way to think about this. We are directly targeting the area of interest without bathing the rest of the brain with unwanted chemicals.”

The mechanism of action of a DBS in epilepsy is not fully understood. Scientific studies have supported that certain thalamic nuclei of the brain, specifically the centromedian nuclei, are generators of the slow spike-and-wave complex and paroxysmal generalized fast activity seen in patients with Lennox-Gastaut syndrome. Studies have shown favorable seizure reduction over time possibly through modulation of network excitability through stimulation of the centromedian nucleus of the thalamus. 

Doctors will continue to monitor Luke and adjust his settings as needed. Dr. Keator hailed Luke’s patience, good humor and cooperative attitude. He considers the medical team at Cook Children’s his best friends and ploy for pranks. “He’s just a trooper, and he lets us try new things with him, which we appreciate,” Dr. Keator said. “He’s just ready to get his life going, and he’s motivated. And that makes our job a lot easier.”

Luke said having epilepsy “can be a little tough at times.” He’s glad for all the care he received at Cook Children’s and the chance to potentially pave the way for DBS in other children who have seizures. “And I hope I get better so I can go on beach vacations and go places to ride lots of trains,” he said.

His parents look forward to the possibility of Luke’s epilepsy improving to the point that he can go to school, sleep over at a friend’s house, or travel without having a seizure. They are cautiously optimistic that deep brain stimulation will provide long-term relief for Luke and other children with epilepsy. And they hold out hope that this latest twist in Luke’s journey can blaze a trail for wider options in epilepsy care.

“I prayed a lot about it. I believe a lot of things happen for a reason. I think Luke is here to show us a story, to teach us something, to show us how brave he is,” Ami said. “His attitude the whole time has been basically ‘I just want to do this to help other kids.’”

Imagine living through a tornado. The wind howling over the sound of sirens. Lightning illuminates your home. Then, you hear it - the roar. You watch the ceiling start to give way. Fear turns to panic. Running on adrenaline, your body prepares for the worst.

This is what trauma can feel like. While a severe weather event can be traumatic, there are many reasons a person may experience trauma. It is defined as anything that overwhelms a person’s ability to cope. But trauma isn’t always easy to spot, even though its effects can last a lifetime.

“There are three different kinds of trauma. The first is acute, or a one-time event like a dog bite or car wreck,” said Denise Coover, LCSW, a trauma informed care specialist at Cook Children’s Medical Center. “Then there’s chronic trauma, where you may have several things happening at once, like domestic violence at home and bullying at school. Complex trauma happens when traumatic experiences occur within the context of a close relationship, such as sexual abuse committed by a family member, or someone who should keep you safe.”

During a traumatic event, the body releases two major stress hormones: norepinephrine and cortisol. Similar to adrenaline, norepinephrine boosts the heart rate and controls the fight-or-flight response. Cortisol is your body’s main stress hormone and slows non-essential functions, like digestion, when a threat is perceived.

“If your body experiences this stress response on a regular basis, it can cause long-term health problems,” said Kia Carter, M.D., co-medical director of Psychiatry at Cook Children’s. “A lot of people don’t realize that chronic exposure to stress hormones can cause high blood pressure, obesity, diabetes, issues with sleep and fatigue, as well as feelings of depression and hopelessness.” 

These hormones can also increase your memory of the event, leading to flashbacks, nightmares and PTSD. But when it comes to memory overall, people who’ve experienced significant trauma may find it hard to remember in general. This is due to the part of the brain that stores memory, the hippocampus, being overexerted.

The amygdala is another part of the brain affected by the stress response. This region controls emotions and can cause someone to react differently to something as simple as a door slamming. You can think of the amygdala as the brain’s ‘watchdog.’

“If someone has experienced something like domestic violence or a shooting, they may be sensitive to loud noises,” said Dr. Carter. “That’s because their amygdala is working overtime to keep them safe. We call this hypervigilance.”

For children, hypervigilance can make it hard for them to concentrate at school and follow directions. Instead of focusing on the classroom, their brain may be trying to anticipate what bad thing is going to happen next.

The prefrontal cortex is connected to the amygdala and is responsible for rational thinking. Chronic stress in childhood can damage the prefrontal cortex, which is still developing, and lead to a survival response being triggered even when there is no danger.

Understanding Trauma

According to the National Council for Behavioral Health, 70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. That's 223.4 million people. 

“Sometimes, when people experience trauma, they will compare themselves to others. For example, they may say, ‘I’m not a Syrian refugee so I haven’t experienced real trauma,’” said Coover. “But it doesn’t matter, if something overwhelmed your ability to cope, that makes it traumatic for you.”

At Cook Children’s, 94% of hospitalized psychiatry patients in 2020 reported experiencing at least one form of trauma. Untreated trauma in children can cause a number of problems including behavioral issues, mood swings, depression, anxiety, self-injury, hopelessness and thoughts of suicide. Kids may feel isolated because of how the traumatic event has affected them. Coover says it’s important for parents and teachers to be aware of the signs of trauma because they’re not always obvious.

“A child who’s falling asleep at school may seem like a problem student, but when you start digging into their history you may realize that they don’t feel safe at home and they’re in survival mode. But when they’re in the classroom, they feel safe so all of the sudden they can sleep,” she explained.

Another sign of trauma in both children and adults is physical pain without a known reason, called somatic symptoms. This is often seen in the form of migraines, stomach aches, and rouge pain the body that is not associated with injury. This phenomenon has been documented by experts such as psychiatrist Bessel van der Kolk in his book ‘The Body Keeps the Score.’ Kolk claims that stress and trauma becomes stored in the body if not addressed, and can eventually lead to illnesses such as autoimmune disorders and cancer.

“Whether you remember the trauma or not, your body always does,” said Coover. “I’ve had parents tell me this or that happened but their child was too young for it to affect them and I have to tell them, “No, that’s not the case.’”

Some examples of childhood trauma include:

• Physical, sexual and emotional abuse
• Neglect
• Domestic violence
• Homelessness
• Parents with untreated mental illness and/or substance abuse
• Divorce
• Bullying
• Losing a parent
• Incarceration of a parent

“Domestic violence is one that seems to surprise people, because they think if the child isn’t being hit it doesn’t affect them,” Coover said. “But it absolutely does, even if they just hear it. Sometimes what they’re imagining is even worse, or maybe it’s spot on. And kids tend to blame themselves for their parents fighting. They take on that guilt even though it’s not theirs to carry.”

Experts like Coover and Dr. Carter also warn that isolation triggered by the COVID-19 pandemic has led to even more traumatic experiences for many kids, especially those growing up in unhealthy environments. With so many students being forced into virtual school last year, their ability to escape and connect with people outside of their home was taken away.

“We are starting to see more kids talk about the effect the pandemic has had on them,” said Dr. Carter. “I had a patient tell me recently they’d been home alone for many months and hadn’t been able to see their friends or other people. They said they were tired of living that way, this patient became hopeless about life changing, which resulted in this patient attempting suicide.” 

The Power of Sharing

Dawn Hood-Patterson, Ph.D., thinks about trauma in the context of her own life. At 17, she was living in Colombia with her family when her trauma story began.

“I lived in Colombia during the time when Pablo Escobar had a grip on many regions in the country—there were car bombs, protests and the sound of gunshots. During that period of unrest, my dad was murdered outside our home,” she said. “So when I think about my trauma story, I think about what fostered my capacity for dealing with that.”

Dr. Hood-Patterson attributes her resilience in part to her parents who gave her a loving and supportive home. She also credits the school counselors who recognized that her frequent stomach aches were not just random pain, but the result of the stress that comes with living in a country experiencing civil unrest.

“It was all the adults who recognized the trauma was bearing impact on my life, and who said, ‘This trauma is real and we see Dawn in the midst of it,’” she said. “These same people gave me tools that helped me make meaning out of the chaos. And they said, ‘Here are some friends around you that have experienced similar things so you don’t feel so alone.’”

As program manager of Community Health and Adverse Childhood Experiences at the Center for Children’s Health, led by Cook Children’s, Dr. Hood-Patterson is using her experience to help people in North Texas. She’s part of the team behind The ACEs Task Force.

Adverse Childhood Experiences (ACEs) is a term based on a study conducted between 1995 and 1997 by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC). The study, which involves 10 questions about what a person experienced before the age of 18, shows ACEs are associated with high-risk behaviors, chronic disease and reduced quality of life in adulthood. In 2019, The ACEs Task Force unveiled their “Blueprint for Safe, Healthy and School-Ready Children”. The plan includes 25 ways pregnant women, families, children and caregivers need to be supported in order to counteract adversity. Access to health care, healthy food, quality, affordable and safe housing are among the top concerns. Transportation, mental health services, substance use disorder treatment and high quality, affordable child care are also priorities for the task force.

Currently, Dr. Hood-Patterson and team are working on a project that would create support groups for parents and caregivers living with adversity. The so-called ‘Caregivers Alliance’ is part of the Build-a-Bridge program, led by Cook Children’s, and is in the early planning phases. It would focus on giving people a chance to share their stories of trauma and connect.

“This was born out of conversations that we had with community partners where we learned that a lot of people who are struggling with adversity often feel like they have a laundry list of things to do,” she said. “For families who receive things like housing assistance or SNAP benefits, every conversation they have is about updating paperwork and not missing deadlines. We envision this alliance to be a space where people can be seen and heard, and support one another.”

The Caregivers Alliance would also include access to education from the Center for Children’s Health for topics like car seat safety, water safety, safe sleep practices and more.

“I’m a believer that something powerful happens when we share out stories with each other,” said Dr. Hood-Patterson. “When we have the opportunity to share our stories, whether they’re of triumph or trauma, it hones our ability to make meaning out of the seemingly meaningless chaos of suffering.”

One year into COVID-19, it’s clear the pandemic is taking a toll on the mental wellbeing of children and teens.

In March, a record 43 patients were admitted to Cook Children’s Medical Center after attempting suicide. This staggering figure is nearly double the number of suicidal patients seen during the same time period of 2020. Even worse, kids are dying. Last year, Cook Children’s recorded seven suicide deaths, marking the first time suicide was the leading cause of trauma deaths at the hospital, surpassing child abuse and car wrecks.

“The mental health crisis was already happening, then it met a global pandemic and these are the consequences,” said Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s.

“They’re less engaged and have less interaction with others, and instead are spending more time online and in virtual settings. And it’s hard for them to be hopeful about anything because so many things, like prom and graduation parties, are canceled.”

The issue is not unique to North Texas. Doctors and nurses from across the nation are reporting similar statistics. In February, NPR released an article titled “Child Psychiatrists Warn That The Pandemic May Be Driving Up Kids' Suicide Risk.” It found that children’s hospitals across the U.S. are seeing up a 250% increase in suicidal patients in emergency rooms since the pandemic began. While there are no nationwide numbers on child suicides in 2020 available yet, experts agree there is reason to be concerned.

The Impact

More children are suffering from stress, anxiety, depression, and suicidal thoughts than at any time in recent memory. Pediatricians like Kathleen Powderly, M.D. from Cook Children’s Pediatrics Magnolia say children as young as 7 are needing help.

“I’ve had a couple of elementary school students, which you don’t see very often, who are actively suicidal or have already had a suicide attempt. I’ve also managed more kids on antidepressants since the pandemic because it’s hard to get into doctors right now,” Dr. Powderly said. “COVID-19 is not as impactful in terms of volume of cases in pediatrics, but our volume of psychiatric patients has increased quite a bit.”

Previously, Dr. Powderly was the medical director of Cook Children’s Hospitalist Group, the attending physicians who care for children in the hospital. She says her team was seeing an increase in suicidal patients before she transitioned into the office setting five years ago and that the pandemic created a perfect storm. On top of the stressors kids were already dealing with, they’re now struggling with isolation, virtual school, and a loss of activities.

“We’re not going to be able to flip the switch and just go back to normal when this is over,” said Dr. Powderly. “This is going to take some time to come out of. I’ve even had patients tell me they’re struggling with being around people.”

Members of Cook Children’s Youth Advisory Council shared similar experiences in a recent meeting. The teens said they feel more anxious being around their friends in person because they’re so used to only seeing people online now. In addition to new stressors, there is a severe lack of mental health resources across the board.

A Growing Need

“There weren’t enough psychiatric beds to begin with, and then COVID happened and the capacity was reduced because you can’t have patients sharing rooms,” said Dr. Pyrc.

The need for more inpatient psychiatric beds for children and teens has been known for years. In 2017, Cook Children’s opened the Rees-Jones Behavioral Health Center to help address the issue. The unit has 15 inpatient beds available for children between the ages of 2 and 12. As we reported when the center opened, the kids who end up here are patients with complex trauma, medical and social needs. 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.

Teenagers who need inpatient psychiatric care have to be treated elsewhere but often end up waiting on the medical floor of Cook Children’s until a bed opens up in the community, which can take days. With more kids needing these services, it’s not uncommon for Cook Children’s to have a dozen or more patients waiting in a regular hospital room for a transfer to a psychiatric facility that can care for them.

“There are just not enough resources in general,” said Dr. Pyrc. “It’s an awful place to be in. This is a national problem, but it affects us here locally. We need more funding and we need more mental health professionals to care for these patients.”

On the outpatient side, finding a licensed therapist to see a child can take months. The waitlist just to see a counselor at Cook Children’s can be as high as 250 days at any given time. Even with easier access to appointments with virtual visits, there are not enough mental health professionals to meet the need.

Kia Carter, M.D., co-medical director of Psychiatry at Cook Children’s, has been a vocal advocate for increased mental health funding. Testifying in front of the Texas Senate’s Committee on Health and Human Services recently, she said early identification, intervention and treatment is essential to preventing further complications from mental illness. But there are roadblocks.

“We get insurances denying a specific level of care saying that a child doesn’t need an inpatient level of care. We also get a lot of pushback about medication,” Dr. Carter said.

She also asked lawmakers for increased support and to consider giving mental health care providers more leverage with insurance companies.

Hoping for JOY

In the meantime, Cook Children’s aims to bring awareness to the mental health crisis affecting children and teens with the launch of a new suicide prevention campaign.

The Joy Campaign is an acronym that stands for:

Just breathe.

Open up.

You matter.

“If we can just get kids to slow down, realize that what they are experiencing is temporary and that they have a long life ahead of them, I think we can make an impact,” said Dr. Powderly.

For the next month, Cook Children’s will be releasing a series of articles on Checkup Newsroom weekly that address many of the issues at play, such as the pandemic, the role of over-the-counter medications, social media, as well as how minorities and LGBTQ+ young people are impacted. We’ll also be speaking with families who have lost a child to suicide to examine the effects on parents and siblings.

If you feel your child might be struggling, here are some of the warning signs to watch for:

• Anger
• Declining grades
• Lack of concern about appearance and hygiene
• Changes in eating and/or sleep
• Self-injury such as cutting
• Less motivation
• Alcohol/drug use
• Acting highly anxious or agitated
• Recklessness
• Giving away possessions 

If you’re concerned about your child’s mental health, seek help early. Schedule an appointment with a licensed counselor. If your child is actively suicidal, call 911 or take them to the nearest emergency room.

Read this story in Spanish here.

But for some patients with severe seizures who have not responded to medications or who have had significant side effects with medications, epilepsy surgery might be the best option. The goal of epilepsy surgery is to identify and resect the area of the brain that is responsible for the generation of seizures. However, identifying this brain area can be challenging.

Thanks to new techniques developed by Christos Papadelis, Ph.D., director of Research at the Jane and John Justin Neurosciences Center at Cook Children’s, the ability to better locate the source of epilepsy has improved. Working with researchers at Boston Children’s Hospital, Massachusetts General Hospital, and Harvard Medical School, Dr. Papadelis developed a novel biomarker, or medical sign, that can identify the area in the brain causing seizures with non-invasive strategies and high precision. Using premiere imaging technology such as magnetoencephalography (or MEG) and high-density electroencephalography (or EEG), the team measured the magnetic and electric activity generated by the human brain to locate the biomarker and source of seizures. This work was recently published in the Annals of Neurology, a widely-respected journal produced by the American Neurology Association.

Improvement in precision of locating the source of seizures decreases the risk that a child will suffer from disability due to surgery. It also increases the odds that children will recover function and improve their quality of life without negative consequences. While still not easy, this research will allow parents to feel even more confident about their decision to move forward with such a complex procedure as epilepsy surgery.

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.

Learn more:

• Scott Perry, M.D.
• Jane and John Justin Neurosciences Center 
• Cook Children's plays vital role in successful CBD study involving epilepsy patients 
• Drug in Cook Children's epilepsy trial shows positive results in separate trial
• Texas legalizes non-euphoric cannabidiol for seizures in epileptic patients
• Cook Children's Epilepsy Monitoring Unit

But other than that it would be hard to notice a difference in him and any other 5-year-old boy after becoming the first child at Cook Children's to undergo a trailblazing endoscopic epilepsy surgery.

Owen’s story begins at 8 months of age when his parents notice weakness on his right side. His parents know something isn't right with their son and they make an appointment for Monday with their pediatrician. But over the weekend they become afraid when they see Owen has stopped using the right side of his body.

His parents rush Owen to the nearest emergency room in Cleburne, Texas. From there, he's airlifted to Cook Children’s by CareFlight.

His initial scans show a large stroke in the left side of his brain which is soon discovered to be related to a new diagnosis of acute myeloid leukemia. He endures four phases of chemotherapy and fortunately enters remission where he remains today. While his stroke left him with right-sided weakness requiring ongoing aggressive therapy, it's his seizures that prove to be the most debilitating obstacle to overcome.

“We were so fortunate,” Allison Turner, Owen’s mom, said. “That's the day we met (Kenneth Heym, M.D.), who would become Owen’s oncologist. He happened to be on call that weekend. He met us there. He told us at that point, our kid was one of the sickest in the hospital. If we had waited to bring him in until the next day, Owen may not have made it.”

Owen’s first seizures occur in the days following the stroke, but they are controlled with medication. He’s even able to stop taking medication shortly after his initial diagnosis, but the seizures returned around age 3. His parents describe his seizures as periods of suddenly pausing in activity with a decreased response to them and sometimes unprovoked laughter. Other events are described as a sudden fall to the ground or stiffening and shaking of his arms and legs posing a significant risk of injury. Despite trials of at least six different medications – nothing helps his daily seizures.

His neurologist at Cook Children’s, Howard Kelfer, M.D., refers Owen to the Cook Children's Justin Comprehensive Epilepsy Program for epilepsy surgery evaluation. Once Cynthia Keator, M.D., took over his case, she begins a workup to determine where in the brain his seizures were arising, understanding the likelihood of seizure control with medications is minimal. Owen’s evaluation in the EMU (epilepsy monitoring unit) captures many seizures starting from the left hemisphere. Additional evaluation with a MEG (magnetoencephalogram) scan shows multiple areas of abnormal electrical activity throughout the left hemisphere both in front and behind the region of his prior stroke.

Given that his seizures arise from such a large area of Owen's brain, the epilepsy team feels his best chance of seizure freedom is to disconnect the left side of his brain from the right by cutting the fibers (corpus callosum) that connects the two sides of the brain.

One traditional approach to this type of surgery is corpus callosotomy, which often involves a large incision on the patient’s skin, opening a large hole in the skull, and then cutting the corpus callosum in half. While considered by many to be the “gold standard” with good seizure control rates, after-surgery care involves a lengthy recovery in the hospital and then at home. While Owen’s family wants better seizure control, they’re reasonably hesitant to undertake such an invasive surgery.

Fortunately, Cook Children’s neurosurgeon, Daniel Hansen, M.D., is one of only a few pediatric neurosurgeons in the United States who has experience doing similar procedures, using less invasive endoscopic techniques. Endoscopes (small video cameras with channels for operating tools) allow the surgeon to perform surgery through much smaller openings in the skull. When successful, this means a smaller incision, less surgical blood loss, quicker operating time, shorter hospital recovery, and the same chance of seizure freedom post-operatively as if undergoing a more traditional open surgery.

Owen’s family understood that endoscopic epilepsy surgery is the leading edge of advancement and their child would be the first such surgery at Cook Children’s, and one of only a few in the country that have been reported.

“Giving their consent and placing trust in our team, we went forward with surgery,” Dr. Hansen said. “The operation itself went well. We were able to completely disconnect the two hemispheres of the child’s brain using a bony opening not much larger than an inch square, and his recovery in the hospital was quick.”

“After everything we’ve been through, I don’t know if you ever say you are comfortable. I guess we’ll always be on guard,” Allison said. “But we’re a little more relaxed now. Before the surgery, we never knew when a seizure would come on. Owen couldn’t go outside and play without one of us with him.”

Owen is now 9 months out of surgery and the family has noticed no seizures since. He’s an active young boy who is making steady strides in kindergarten now that his uncontrolled seizures have stopped. While it remains too early to speak to years of seizure control, doctors say this is an encouraging start.

Given the successful outcome with Owen, Cook Children’s has since performed two additional procedures with similar favorable results. The Epilepsy team hopes to expand the number of children who are candidates for this type of surgery in the future. Such children will have medically refractory epilepsy and will have undergone a thorough evaluation by the team at Cook Children’s. Potential surgeries that can be performed endoscopically include complex surgeries including corpus callosotomy, single lobe disconnections, focal lesion resection, and functional hemispherectomy. As the team’s experience grows with this technology and technique, its use may expand beyond this short list.

And in the process changing more lives for the better.

“It has been such a relief for us. It was a huge decision to disconnect his brain. Just saying those words … But this was the best thing for him,” Allison said. “He has flourished. He’s made improvements by leaps and bounds. Just the progress in everything. His speech, school work, everything. His whole body is functioning with just the use of one side of his brain. He can’t throw a football with his right hand and he has problems with his fingers on his right hand. He can’t pick up a Cheerio with his right hand. But other than that, I don’t know if anyone would notice a difference in him and any other child.”

At Cook Children’s SPORTS Rehab, we’ve noticed a shift in what we see in our clinic. Over the past decade, the three major changes we’ve seen are the number of overuse injuries, the amount of early sports specialization and the way we treat concussions.

The first two issues I mentioned go hand-in-hand. It’s no coincidence that we are seeing more overuse injuries at the same time we are seeing early sports specialization. Overuse injuries come from repetitive micro-trauma to tendons, bones, and joints caused by repeating the same type of activity over and over.

If kids are playing the same sport all year around they are repeating the same movement patterns over and over again. Growing up in the 1980s and 1990s there wasn’t the opportunity to play year round sports like there is now. You may have had a favorite sport, but you had to wait for that season to roll around, and in the mean time you would play another sport if you wanted to stay active.

Now, if your favorite sport is baseball, you can find leagues to play in all year round, and the same is true for most other sports. As a result of this early specialization, we are seeing more and more overuse injuries in our young athletes.

In our baseball and softball players we are seeing more elbow and shoulder injuries, and the number one risk factor for overuse injuries of the shoulder and elbow is the volume of throws. If an athlete is playing baseball year round, the volume of throws is going to be significantly greater than an athlete that takes a break to play another sport.

A recent study showed that 15-19 year olds accounted for 56.7 percent of the ulnar collateral ligament reconstructions (Tommy John) performed between 2007-2011.This means over half of these surgeries are being performed on patients who haven’t even finished their freshman year of college. While early specialization is a contributor to the uptick in these overuse injuries it is not the only factor. Things like poor mechanics, poor flexibility and inadequate strength all contribute to overuse injuries. As more and more kids participate in athletics there becomes more and more need for good conditioning and injury prevention programs. Increased sports participation is a great problem to have, because that means our kids are being active, but it also increases the need for our coaches, and we as parents, to be more aware of ways to keep our kids safe from these overuse injuries.

Treatment of concussion has been a popular topic in the news as of late, and this is an area that has changed significantly over the last decade and continues to evolve as we learn more about these injuries. Ten years ago we tried to grade concussions based on the severity. The concussions were graded 1-3 based on the patient’s symptoms and whether they lost consciousness. In some cases of Grade 1 concussions, the athlete was allowed to return to activities the same day as the injury.

We then switched to saying the athlete either has a concussion or they don’t, and all athletes that were deemed to have a concussion were disqualified from participation until cleared by a physician. In most cases we would shut these athletes down completely; limiting TV, school, phone time and interaction with other people in an attempt to let them get complete cognitive rest until their symptoms resolved. Then once symptoms resolved we would start a return to school and return to play protocol.

Now kids still have to be cleared by a physician, and they still have to follow a return to play protocol, but we have realized that completely isolating these kids while they recover and limiting their interaction with friends was doing more harm than good.

So after a brief period of brain rest (approximately three days), we start slowly integrating kids back into activities of daily life as tolerated. It is important to have a physician that deals with concussions involved in the patients return to activity so that they are getting the appropriate accommodations at school and home to allow for the appropriate amount of rest, but that will still allow enough activity to stimulate the patient enough to promote recovery and keep them from becoming isolated.

For more on the specifics of how treatments have changed for all of these areas, and for information on other changes in sports medicine, we would love for you to attend our annual Cook Children’s Sports Medicine Symposium July 21, 2016.

SPORTS Symposium

Education is the key to keeping our young female athletes in their sport vs. being on the sideline with an injury. To learn more Cook Children’s has an annualSPORTS Symposium to educate those who work with our athletes: Coaches, athletic trainers, physical therapists and school nurses.

Please join us on July 21, 2016, to learn more about the female athlete in the morning and what is sending athletes to the ER in the afternoon.

Click here to register and attend the event. Click here to register for the Web cast.

Early Bird Special Ends June 30, 2016

But at least for a few hours, Burman allows someone to take care of her at Cook Children’s new hair and nail salon, Mirror Mirror.

As Burman let Marti Galbreath, a hairstylist, massage her scalp with shampoo, the tension of the last five weeks disappeared for a little while. And that’s why a children’s hospital houses a hair and nail salon.

Following the birth of their two biological children, Shelly and Brian Burman felt the need to help other kids who did not have the same loving home.

“We just knew in our hearts we were going to adopt and it was going to be children with special needs,” Burman said. “We just didn’t know where that was going to take us and some days we still don’t know where that’s going to take us. But we’ve loved every bit of it.”

The Burmans have adopted 18 children, all with their own unique challenges and special needs. Two of those children have died because of their health complications.

The Burman household bustles with energy most days with the age range of the children, including their two birth kids, ranging from 2 months to 18 years old. The youngest child is what brings Shelly Burman to Cook Children’s.

Catie Jane Burman was adopted at birth in Philadelphia. Brian and Shelly were told their daughter had spina bifida. After an examination back home in Mansfield, they discovered Catie Jane’s condition was much worse than first imagined. She is missing most of her brain and her rib cage is too small to allow her lungs to support her as she grows older.

After the diagnosis of Catie Jane, Shelly and her youngest daughter left Mansfield where they have been at Cook Children’s for the past five weeks. Catie Jane has had to revive twice at Cook Children’s and one of those times she was without a heartbeat for 20 minutes.

Shelly has not left the medical center once during her five-week stay. Brian and their oldest daughter, Madelaine, take care of the other children at the house.

“I have felt lonely and very isolated over the past five weeks,” Burman says as she gets her hair cut. “I’ve been very conflicted because you have a child on life support and you’ve got children at home who are asking, ‘Mommy when are you coming home?’ It’s very emotional. You don’t get to leave much. Cook Children’s is a wonderful place. I love the nurses and doctors, but you always know you are in a hospital.”

But for a little while, Burman finds a sense of normalcy at Mirror Mirror.

“When I walked in here, I really felt like I could cry because I’ve felt so lost and helpless lately,” Burman said. “To come down here for a few minutes and not listen to monitors and be stressed at every little moment has been wonderful. But yet I’m still close enough if something should happen I can be right there. It’s a chance for me to come and relax for a little bit and feel special for a little while.”

As Galbreath listens to her first customer talk she marvels at Burman’s amazing story and feels a sense of duty to make her stay at Mirror Mirror special.

“It’s really rewarding,” Galbreath said. “It’s very heartwarming. I feel honored and blessed that I can be that person for her to let her escape and let a big breath out while she relaxes.”

The opening day of Mirror Mirror on Sept. 16, 2015, is the culmination of three years of planning.

Erica Garza is the manager and brings with her 15 years of industry experience, including owning her own shop. She also has experience with Cook Children’s.

“My son was a patient at Cook Children’s for the first five years of his life, so this place is very near and dear to my heart,” Garza said.

Mirror Mirror is open to all Cook Children’s patients and visitors. Garza said the salon is perfect for moms like Burman, as well as patients.

“I started at Cook Children’s in October of last year and I would hear different patients and families ask in our gift shop for shampoo or conditioner,” Garza said. “They would say they needed a haircut. I was talking to some nurses who were saying how grateful they are that we have opened. They have patients who start to lose their hair to chemotherapy and the nurses were cutting the kids hair. A lot of the patients have special requests like Mohawks or putting yellow in their hair. They are about to go through something that may not be so fun, so this gives them a chance to be creative and have some fun.”

While the staff’s skilled at their jobs, at no point did Garza lose sight of where the salon was located during interviews. “It was the biggest thing we asked,” Garza said. “’Do you care about these kids?’ We wanted to make sure everyone was here for the right reason.”

Every person hired has experience working at Cook Children’s or working with children with special needs.

But this is a full service hair and nail salon and with that comes a special skill you expect from your stylist at home – the ability to just listen.

“It gives people a chance to just get away for a short amount of time and get their mind off of everything that’s going on,” Garza said. “And sometimes people just want to talk about what they are going through and we are there for that too.”

Last night, NBC 5 Investigates released an enlightening report looking at the rates of concussions in North Texas districts. This report showed a much higher rate with more than 2,500 concussions reported in just 41 districts.

There are still a lot of misconceptions about concussions, what they are and what they might mean to your student athlete.

Here are 5 concussion MYTHS:

1. It was just a “mild” concussion.

Concussions are brain injuries, period.

One might classify a concussion as mild if symptoms were brief and not severe. However, you cannot predict whose symptoms will be severe based on the way the child was injured or even the symptoms right after the injury.

Even seemingly minor trauma can cause headaches and other symptoms for weeks.

2. If the child/athlete didn’t lose consciousness, it wasn’t a concussion.

Symptoms of concussion vary from child to child but passing out or blacking out are not required to make the diagnosis. Basically if a child has a fall or other injury that results in any neurologic symptoms, they can be diagnosed with a concussion.

Some examples of concussion symptoms are headache, nausea/vomiting, vision changes or problems with concentration and memory. Some of these symptoms may take time to develop, so it’s possible to diagnose a concussion a few days after the injury.

3. Concussions are only a problem for football players.

Almost all sports can cause concussions, including the cheerleaders on the sideline of the football games. Some other sports that are known to have higher incidents are soccer, baseball and softball. Other common causes are kids riding bikes and falling off playground equipment.

4. All concussions need either an MRI or CT of their head.

Most concussions can be diagnosed based on telling your doctor the story of the injury and the related symptoms along with a physical exam. Imaging is not necessary because a CT or MRI will most likely be normal even in the midst of a severe concussion.

Also remember that a CT of the head does not come without risk. While we should perform them when necessary, we should make sure we are not using them in situations where they will not provide useful information.

5. Don’t let your child sleep after a concussion.

Treatment of concussions is evolving. If you suspect your child has sustained a concussion, you should immediately seek medical attention and advice from a doctor about how you should treat your child’s symptoms.

There have been some changes in the treatment of concussions. First, we no longer require that you keep someone with a concussion awake for a set period of time. In fact, after their evaluation, the doctor may recommend that you allow them to sleep in order to help their brain heal. Your doctor might also prescribe some time away from TVs and other screens, school or homework or other activities that might cause their brain to work harder.

Concussions are much more common than we previously thought. I believe that the UIL will make changes to better track the risk of concussions for our high school athletes, which will hopefully lead to better ways of evaluating and treating concussions. In the mean time, don’t buy these common concussion myths.