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University of
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1919 Green Rd.
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Marquette
Extraordinary
pediatric specialty care,
where
when
you need it.
Traverse City
With locations throughout Southeast Michigan
and Ohio, and through unique partnerships with
other Michigan hospitals, C.S. Mott Children’s
Hospital specialists are committed to being
where you and your patients need us. Our goal
is to coordinate with referring physicians to keep
care close to the patient’s home through their
existing providers whenever possible.
For more information about the services offered
at our subspecialty locations, call M-LINE or visit
www.mottchildren.org/locations.
Flint
Grand Rapids
Lansing
Dexter
Chelsea
Jackson
Ann Arbor
Howell
Brighton
M-Line: 800-962-3555
Livonia
Ypsilanti
Saline
Toledo
Executive Officers of the University
of Michigan Health System
The Regents of the University
of Michigan
Colleagues in Care Staff
Ora Hirsch Pescovitz, M.D., Executive Vice
President for Medical Affairs
Julia Donovan Darlow
Mary Masson, Robin Phillips: Contributing Writers
Laurence B. Deitch
James O. Woolliscroft, M.D., Dean,
U-M Medical School
Denise Ilitch
GLC Custom Media: Editorial Management,
Design and Production
Douglas Strong, Chief Executive Officer,
U-M Hospitals and Health Centers
Andrea Fischer Newman
Kathleen Potempa, Dean, School of Nursing
Olivia P. Maynard
Andrew C. Richner
S. Martin Taylor
Katherine E. White
UMI-102
Mary Sue Coleman (ex-officio)
Jennifer McIntosh: Editor
Leisa Thompson Photography and Edda Pacifico:
Photographers
The University of Michigan is a
non-discriminatory affirmative
action employer.
© 2012 The Regents of the
University of Michigan
Office of Referring Physician
Communications
2901 Hubbard, Suite 2600
Ann Arbor, MI 48109-2435
Issue 2 FALL 2012
Bringing research into practice
IN THIS ISSUE
Fetal Repair for Spina Bifida
Genetic Testing
Integrated Solid Tumor Treatment
Gene Therapy for Brain Tumors
Family-Based Care for Eating Disorders
OCD Imaging Research
of note
GENETIC TESTING
All in the family
Pediatric genetic testing helps diagnose a wide range of conditions
The Michigan Medical Genetics
Laboratories (MMGL), based in the
University of Michigan’s Department
of Pediatrics, perform sophisticated
biochemical and molecular genetics
testing. Since genetic diseases affect
a significant number of patients admitted to C.S. Mott Children’s Hospital,
the labs use state-of-the-art techniques
to support the diagnosis and care of
these patients.
“If a pediatrician has a patient with
birth defects, developmental delay or
autism, or a suspected genetic disorder, our laboratory offers a wide variety
of genetic testing to address those
problems,” says Jeffrey Innis, M.D.,
Ph.D., medical director of the MMGL.
“For example, we offer comprehensive
autism testing that includes chromosomal microarray analysis for
microdeletions and microduplications.
We are also developing test panels of
genes covering a wide variety of disorders using exome DNA sequencing.”
The MMGL can also test for:
Fragile X syndrome
Rett syndrome
PTEN macrocephaly autism
Other gene-specific tests for
patients with autism
Biochemical genetic disorders
(inborn errors of metabolism)
“Many community hospitals across
the state send their genetic testing to
labs that are outside of the state,” says
On the cover: Two-year-old Caleb, a
“Little Victor” from the Mott Children’s
Hospital Craniofacial Anomalies Clinic,
marvels in the twinkling lights of the
two-story Charles Woodson Lobby in
the new C.S. Mott Children’s Hospital.
Learn more about the new facility at
www.mottchildren.org/newhospital
2 Colleagues in Care
Innis, “However, I believe that we offer
a better quality assay here at the University of Michigan. Physicians can get
data about genome-wide coverage at
over 300,000 separate positions in
the genome for gene dosage abnormalities or chromosomal defects and
can link with divisional medical geneticists and/or MMGL professional staff
for help or advice.”
Additionally, the University of Michigan offers supportive services to assist
patients and their families. “Our stellar group of physician scientists are
trained in medical genetics to help
with the interpretation of this complex
information,” explains Innis. “We hold
daily clinics here at UMHS, as well as
frequent outreach clinics in Traverse
City and Marquette. Families can meet
with experts who can explain exactly
what DNA test results mean for their
children, now and in the future.”
Jeffrey Innis, M.D., Ph.D., medical
director of the Michigan Medical
Genetics Laboratories, discusses
test results with a colleague.
ONLINE Get more information about how to
send lab samples to the MMGL at Colleagues
in Care Online at med.umich.edu/cic-peds
REFERRALS Physicians may refer patients
to the Pediatric Genetics Clinic by calling
M-LINE at 800-962-3555.
FROM THE NATIONAL POLL ON CHILDREN’S HEALTH:
Top 10 Children’s Health Concerns
Percent rated as a “Big Problem” by parents in 2012
visit www.mottnpch.org for more information
exercise 39%
h
g
u
o
n
e
t
o
N
.
1
besity 38%
o
d
o
o
h
d
il
h
C
.
2
%
tobacco use 34
&
g
in
k
o
m
S
.
3
33%
4. Drug abuse
%
5. Bullying 29
6. Stress 27% 23%
se
7. Alcohol abu cy 23%
n
8. Teen pregna 22%
ty
9. Internet safe neglect 20%
&
10. Child abuse
CANCER
Rajen Mody, M.D., oncologist
and co-director of the Solid Tumor
Oncology Program, connects
with a patient in the infusion
clinic at Mott.
Our entire team
of subspecialists
comes together in
one clinic setting
to care for children
with solid tumors.
Erika Newman, M.D.
M-LINE For referrals, call
M-LINE at 800-962-3555.
RESEARCH For a list of
pediatric cancer clinical trials
currently accepting patients,
see Colleagues in Care
Online at med.umich.edu/
cic-peds
One of a Kind
U-M’s Pediatric Solid Tumor Oncology Program
Given the rare and complex nature of pediatric cancers, collaboration among pediatric
specialists from multiple disciplines is the best
approach to treating these difficult diseases. The
Solid Tumor Oncology Program at University of
Michigan C.S. Mott Children’s Hospital is one
of the nation’s largest multidisciplinary programs
caring for children with solid tumors, and it’s the
only program of its kind in Michigan.
“Our goal is to provide integrated, comprehensive care for children with cancer,” says
Erika Newman, M.D., pediatric surgeon and
co-director of the program. “Our pediatric oncology specialists include surgeons, oncologists,
radiologists, pathologists, interventional radiologists, radiation oncologists and a wide array of
supporting ancillary services, such as physical
and occupational therapists, nutritionists, social
workers and child life specialists. All these professionals come together to provide coordinated
care in one setting for kids with cancer.”
In addition to a weekly cancer clinic held
at Mott, clinicians collaborate at weekly
multidisciplinary tumor boards, where they create and implement individualized treatment
plans for each child. Treatment options include
the full range of therapies, including surgery,
radiation therapy, chemotherapy, stem cell therapy and combinations of these therapies when
appropriate.
Additionally, patients in the Solid Tumor Program have access to Phase 1 Clinical Trials,
which may offer hope when standard therapies
fail. As active members of the national Children’s Oncology Group, pediatric oncologists
collaborate with leading pediatric cancer centers across the country to find and offer the most
promising therapies currently available.
“Our program offers care for all types of solid
tumors, including rhabdomyosarcoma, Wilms
tumor, neuroblastoma, hepatoblastoma, hepatocellular carcinoma, osteosarcoma, Ewing’s
sarcoma and others,” says Newman. “Additionally, we have 24/7 availability for referring
physicians and families, for their convenience
and peace of mind.”
800-962-3555 M-LINE 3
of note
Eating disorders
FAMILY FOCUS
Intensive partial hospitalization for eating disorders
In the past 20 years, previous theories
about the demographics related to eating disorders have been invalidated.
Eating disorders are equal opportunity
problems that can affect people of any
gender, race, age or socioeconomic
background, not just high-achieving
adolescent girls.
As the understanding of eating disorders has changed, so have treatments.
Experts now know that eating disorders
are highly treatable illnesses with several contributing causes. However, left
untreated, eating disorders may result in
significant psychosocial disability, serious
medical complications or even death.
The University of Michigan Comprehensive Eating Disorders Program
at C.S. Mott Children’s Hospital
takes a comprehensive, family-based
approach to treatment. “This program
is a collaboration between our pediatrics and psychiatry departments,”
says David Rosen, M.D., adolescent
medicine specialist. “We can provide
our patients and their families with integrated counseling, medical care and
nutritional restoration, all in a familyfriendly environment.”
BETTER SOLUTIONS TO
DIFFICULT PROBLEMS
“The typical treatment for eating disorders in our state has been outpatient
care that is often highly disjointed,”
says Daniel Gih, M.D., child and adolescent psychiatrist. “Patients may have
multiple therapists and doctors who
don’t communicate with each other
regularly, and patients only see those
specialists once a week or so.”
If patients required medical intervention, they were treated as inpatients,
which also wasn’t ideal. “Medical hospitalization diminishes the psychotherapeutic focus of treatments,” explains
Gih. “The only other alternatives have
4 Colleagues in Care
been out-of-state programs that require
three months away from family.”
A better solution is a partial hospitalization program. “Partial hospitalization
combines outpatient and inpatient care,”
says Rosen. “Instead of a few hours of
treatment a week, patients have several
hours a day. Patients eat two meals a
day here, so we can more actively
support nutritional rehabilitation. However, patients go home every day and
sleep in their own beds, which is less
intrusive and less costly than inpatient
hospitalization.”
Partial hospitalization is a
validated, family-based treatment
model widely considered the
most effective treatment for
eating disorders.
David Rosen, M.D.
support for FAMILY
Additionally, this program integrates the
concept of family-based treatment. “We
concentrate on the family, because they
are the best people to help a young person with an eating disorder,” explains
Rosen. “They know the child the best,
and they are best suited to support and
encourage positive changes in behavior.”
“Family-focused programs are the most
effective form of treatment for anorexia
and bulimia, particularly in adolescents,”
says Gih. “For example, patients get therapeutic meals with their families that are
supervised by trained staff, so parents can
learn to promote success and recovery
from an eating disorder.”
“By the time we meet many families,
they are very frustrated, and they believe
nothing works,” acknowledges Rosen.
“So, our goal is to empower them to help
their son or daughter get better.”
Eating disorders are dangerous illnesses
that can spin out of control very fast. “These
kids don’t get better by themselves,” says
Rosen. “Children and young adults with
suspected eating disorders need timely
and focused evaluation. We’re here to
give primary care physicians a team to
partner with to get their patients access to
comprehensive evidence-based treatment
as quickly and easily as possible.”
Renee Hoste, Ph.D., provides intensive treatment for eating disorders
in a partial hospitalization setting.
M-LINE Refer a patient to the Comprehensive
Eating Disorders Program by calling M-LINE at
800-962-3555.
Online Visit uofmhealth.org/eatingdisorders
for more information about the program and treatment options.
FEATURE
Cormac Maher, M.D., associate professor of Neurological Surgery, says
fetal myelomeningocele repair can
result in substantial improvements in
quality of life.
Early
Intervention
Prenatal repair offers new hope
for babies with spina bifida
800-962-3555 M-LINE 5
FEATURE
A
prenatal diagnosis of
myelomeningocele can
be terrifying for expectant parents. But new,
delicate neurosurgery –– performed
in the womb months before birth —
now offers hope for much better outcomes for babies with spina bifida.
C.S. Mott Children’s Hospital
and Von Voigtlander Women’s Hospital is the only health center in the
region to offer fetal intervention surgery for myelomeningocele, providing a multi-disciplinary team of
experts to provide care for mother
and baby before and after surgery.
The surgery, performed at 19–25.6
weeks gestational age, allows the
defect to be closed early, preventing
further damage to the spinal cord and
improving neurologic function. During the surgery, an incision is made
in the mother’s abdomen and uterus.
The fetus’ neural tube and layers of
the back are then surgically closed.
“This new surgery is the only thing
we have been able to offer patients
in many decades that is a significant
change in treatment,” says Marjorie
Treadwell, M.D., professor of Obstetrics and Gynecology and director of
the Fetal Diagnosis Center at U-M.“It
has changed how we counsel people
with a fetus diagnosed with spina
bifida. Extensive research has shown
that fetal intervention surgery leads
to improvements in level of function
and quality of life for the children.”
GOOD NEWS FOR MOMS
In a landmark study known as the
MOMS study, an NIH-sponsored
multi-center clinical trial assessed the
best treatment for myelomeningocele: fetal surgery or surgical repair
after birth.
According to the study, published
in the New England Journal of Medicine, at age 12 months, children who
had fetal surgery had a decreased
risk of death and less need for shunting when compared to children
6 Colleagues in Care
who received surgery shortly after
birth. At 30 months of age, those
who received fetal surgery also
scored better on mental and motor
function tests, had less hindbrain
hernation and were more likely to
walk independently. However, fetal
surgery was also associated with an
increased risk of preterm delivery
and uterine dehiscence at delivery.
Although fetal surgery improved
outcomes, children with spina bifida
still require long-term care. Survivors of myelomeningocele frequently
suffer lifelong disabilities, including
paralysis, bladder and bowel problems, hydrocephalus (excessive fluid
pressure in the brain) and cognitive
impairments.
“We are excited to be able to
bring this treatment to this region
because for the right patient, this
can really be helpful,” says Cormac
Maher, M.D., associate professor
of Neurological Surgery at U-M.
“Reducing the need for lifelong
shunting and improving the Chiari II
malformation can result in substantial improvements in quality of life.”
THE RIGHT TEAM
FOR THE RIGHT CARE
A multi-disciplinary team from the
U-M Fetal Diagnosis and Treatment
Center will perform the new surgery, along with counseling for the
families. The team’s preparation
included a visit to Children’s Hospital
Marjorie Treadwell, M.D.,
and George Mychaliska,
M.D., were instrumental in
bringing fetal intervention
surgery for patients with
myelomeningocele to U-M.
of Philadelphia, one of the sites that conducted the MOMS
study. U-M staff have been working for about seven years
to build a fetal therapy center and preparing to provide
this new intervention for myelomeningocele, says George
Mychaliska, M.D., director of U-M’s Fetal Diagnosis and
Treatment Center.
Fetal intervention surgery
leads to improvements in
level of function and quality
of life for the children.
Marjorie Treadwell, M.D.
Who is a candidate for fetal
myelomeningocele repair?
Good candidates for prenatal surgery for spina bifida are mothers
aged 18 or older with normal karyotype and FISH. Suspected
lesion should be T1–S1 with hindbrain herniation, and gestational
age should be 19 to 25 weeks.
Patients should be excluded as candidates for this surgery if any
of several factors exist, including:
Multiple gestation
History of singleton delivery prior to 37 weeks or any uterine
anomalies or pregnancy complications that raise the risk of
preterm labor
Maternal BMI ≥ 35 or pregestional insulin-dependent diabetes
“This is a huge breakthrough for patients with spina
bifida,” says Mychaliska, who is also the Robert Bartlett,
M.D., Collegiate Professor of Pediatric Surgery. “We have
an experienced multi-disciplinary team that is interested
in counseling the families. They get the perspective
of the neurosurgeon, maternal-fetal medicine and the fetal
surgery specialists, along with social work and genetic
counseling, all in one integrated setting.”
U-M also offers a multi-disciplinary spina bifida clinic to
follow patients after they are born. “This is not just about
the surgery, but about providing them with social support
and long-term ongoing care,” says Treadwell.
THE RIGHT
PATIENTS FOR THE
BEST RESULTS
“The excellent results of the
MOMS trial were predicated
on choosing the right patients
and having an experienced
team in place to ensure great
outcomes,” says Mychaliska.
“Most moms come to us with
the attitude of ‘I’ll do anything
for my baby.’ But we recognize the procedure is not for
everyone.”
Treadwell said the process
begins with careful screening and counseling with the
mothers. Evaluation of potential patients for the surgery
includes fetal ultrasound,
MRI and echocardiography.
Maternal history of HIV, hepatitis B or C, hypertension, renal
disease or other conditions that would be a contraindication
for surgery or general anesthesia
Fetal anomaly not related to myelomeningocele
Kyphosis > 30°
Maternal-fetal Rh isoimmunization, Kell sensitization or history
of neonatal alloimmune thrombocytopenia
Patient does not have a support person, is unable to comply
with follow-up or is deemed by a social worker unable to
handle the implications of fetal surgery
Genetic counseling and a social work evaluation are also
important parts of the screening process. Several members
of the medical team contribute to still deeper evaluation.
Prenatal surgery does come with significant risk to the
mother. Most women will need C-sections with subsequent
pregnancies and pre-term delivery is expected for the
fetus that undergoes the surgery.
“I am very much an advocate for mother and fetus. We
have to make sure it’s the right thing for both of them. But for
the right candidate, we believe this surgery can really make
a difference for the whole family’s future,” says Treadwell.
M-LINE To refer a patient to the Fetal Diagnosis and Treatment
Center, call M-LINE at 800-962-3555.
WEB EXCLUSIVE Get more information about the MOMS study
and the diagnosis and treatment of myelomeningocele at Colleagues
in Care Online at med.umich.edu/cic-peds
800-962-3555 M-LINE 7
DISCOVERIES
Pedro Lowenstein,
M.D., Ph.D., and
Maria Castro, Ph.D.,
are beginning clinical
trials of gene therapy
for glioblastomas.
ON THE
HORIZON
Breakthrough research in gene therapy
shows promise for treating brain tumors
8 Colleagues in Care
A
lthough the incidence of brain tumors in children is relatively low
(approximately 3,000 annually in the U.S.), brain tumors account for
nearly 20 percent of all cancer in children up to 15 years of age,
and are the leading cause of cancer deaths in pediatric oncology.
Five-year survival rates from brain tumors are approximately 66 percent for
children ages 0–19 years, but vary according to tumor type. Glioblastomas are
particularly lethal.
The good news is that new techniques in gene therapy to treat glioblastomas
have shown remarkable survival rates of approximately 70 percent in animal
trials. Human trials with adults, led by preeminent researchers Maria Castro,
Ph.D., and Pedro Lowenstein, M.D., Ph.D., will begin shortly at the University of
Michigan, and the trials may soon include pediatric patients.
challenges of treating children
The difficulty in cancer treatments for children — particularly in brain tumors — is that radiation and chemotherapy
target developing cells with fast duplication rates. “However, children’s brains are composed of nothing but cells
that multiply and grow quickly,” explains Karin Muraszko,
M.D., pediatric neurosurgeon and chair of the Department
of Neurosurgery at the University of Michigan. “Standard
therapies can have devastating side effects on a developing brain, in addition to being generally ineffective in
treating glioblastomas.”
“Developing new therapies for brain tumors has been
a major goal throughout my career in pediatric neurosurgery, and Dr. Castro’s and Dr. Lowenstein’s research has
had a similar focus,” continues Muraszko. “Our hope is that
their new therapies will be successful in killing the tumor
without killing brain cells, especially in children.”
ON THE BRINK
“We have developed a new gene therapy for brain tumors,
specifically glioblastomas,” explains Castro. “The therapy
consists of two genes. One kills the cancer cells, and the
other one trains the immune system to recognize and
destroy malignant cells that remain or even recur.”
These two therapeutic genes are encoded in adenoviruses that act as vectors to deliver the genes.
“Our first adult patients will be treated with this therapy
very soon,” continues Lowenstein. “When we establish that
it is safe in adults, we hope to quickly expand the trial to
pediatric patients. Because this therapy uses the immune
system to eliminate the tumor, it will be interesting to see
whether our predictions will hold with pediatric patients,
given the differences between the immune systems of
adults and children.”
Doctor bios
Maria Castro, Ph.D., and Pedro Lowenstein, M.D., Ph.D.,
aren’t just a highly respected research team; they are also
married to each other. Both researchers are native Argentineans, but met when they were both working in the U.S.
Castro has a Ph.D. in biochemistry from the National
University of la Plata in Argentina. Lowenstein received his
M.D., followed by his Ph.D., in medicine from the University of Buenos Aires. Castro and Lowenstein served as
professors of molecular medicine at the University of Manchester in the United Kingdom, and more recently served
as co-directors of the Gene Therapeutics Research Institute
at Cedars-Sinai Medical Center in Los Angeles.
Lowenstein and Castro currently hold faculty appointments
in the University of Michigan Medical School’s department of Cell and Developmental Biology, and Lowenstein
is also a professor in the department of Neurosurgery.
RIGHT PLACE AND TIME
“The advantage of the gene therapy is that patients will
need less chemotherapy and radiation, but it’s critical in
children,” explains Castro. “Those aggressive treatments
leave kids with very bad sequelae, such as behavior and
memory problems. These gene therapies would circumvent the side effects of conventional therapy.”
“This is a new, exciting phase for the treatment of brain
tumors both in adults and children because it’s the first ever
trial in human brain tumors that uses two different adenoviral
vectors. It’s really a first for mankind,” says Lowenstein. “The
University of Michigan is in a prime position to capitalize on
this new technology because of the strength of their neurosurgical teams and the pediatric oncology group. It’s the
best place to spearhead this new technology.”
WEB EXCLUSIVE Read more about Dr. Castro and Dr. Lowenstein’s cutting-edge gene therapy research at Colleagues in Care
Online at med.umich.edu/cic-peds
ONLINE Get a list of clinical trials in pediatric oncology
currently recruiting patients at Colleagues in Care Online at
med.umich.edu/cic-peds
M-LINE Refer a patient for a pediatric oncology or neurosurgery
evaluation by calling M-LINE at 800-962-3555.
800-962-3555 M-LINE 9
discoveries
The Ultimate Gift
How a patient’s brain touched his doctor’s heart
by Shawn Hervey-Jumper, M.D.
He was shy and soft-spoken. We talked mostly about his recently
altered mood, high school life and music. Accompanied by his
mother, he was brought to the pediatric emergency room because of
the daily headaches, suicidal thoughts and severe depression he had
experienced over the past several weeks.
One look at his head CT scan and I feared the worst — he had a
large mass in his thalamus. Knowing that our conversation would forever change the course of his life, I began to explain his symptoms as
they related to his brain imaging. His questions were so very mature,
far beyond his years, and he seemed relieved to know that what he
was feeling emotionally had a clear and definable cause.
With time, we discovered he had a highly malignant brain tumor —
glioblastoma multiforme — centered in one of the most eloquent
areas of his brain. Knowing the nature of this aggressive disease, we
were certain this brain cancer would eventually take his life.
Over time, I came to know the young man quite well. No matter
how he was feeling, the time of day or night, or present circumstance,
his smile could light up
the room. He was a master chef and would often
come to clinic appointments with home-cooked
treats for the staff. With
a wonderful mixture of
simple childlike innocence, intelligence and
a great sense of humor,
he navigated his way in
and out of the hospital,
through several surgeries, chemotherapy and
Laurence Carolin,
radiation. But despite our
15, donated his brain
best efforts, his cancer
to cancer research.
progressed.
Eventually, he became
paralyzed on the right
side of his body. He
began sleeping more
and his thoughts started
to slow. Then one day he
came into clinic with a
very special note. It was a
document signed by both
he and his mother. With
the same quiet resolve
that he displayed during
10 Colleagues in Care
our first encounter and throughout treatment, he described for us
his understanding that cancer would soon take his life. He was sad
thinking about his mother and how lonely she would be after his passing. He expressed his main disappointment was that he would not
have a “useful life.” Having recently donated his Make-a-Wish funds
to feed malnourished children in other countries, he still feared that
his short life would be a waste. “What else do I have to give to society
but myself?” he said.
He wanted to donate his brain for research. He wanted to give us
his tumor after his death, so that we could try to better understand
his disease, hopefully offering improved treatments in the future. He
wanted to be useful in a way that made sense to him.
Eventually, the day did come. With teary eyes and a heavy heart, I
collected supplies; sterile specimen cups, culture media, ice, forceps.
As I walked to meet him in the morgue, my initial thoughts wandered
to days past. I felt an overwhelming sense of guilt and failure. What
could we have done differently? Would more chemotherapy have
been helpful? How about more radiation? Were
there any additional experimental protocols we
could have offered him?
Upon seeing his body, I was moved so deeply
that I could not help but cry. However, even after
death, his face was still able to make me smile.
We would carry out his last wish. With care, we
extracted his brain and harvested the tumor.
Throughout the procedure, in my mind I could
not help but rehearse his course of treatment.
To this day, the image of the young man, lifeless in the morgue, is my personal symbol of
helplessness. The runaway train that was his
cancer traveled at a pace we could not halt. But
through his fight with disease, he had touched
and will touch many other lives.
As a neurosurgeon-in-training, I try to take
good care of my patients through the most
challenging time of their lives with care and
compassion. However, I will be forever struck by
the concern of someone so young for his fellow
man. His gift — his willingness to offer himself,
even in defeat, with the hope of improving someone else’s life — pierces to the very core of what
makes us all human.
Like him, I too just want to be useful in some
small way. In the meantime, to my patient, my
friend: We are sincerely thankful for the gift of
your tumor, and will start working right away.
GETTING
THE PICTURE
U
Using functional MRI to craft better OCD treatments
niversity of Michigan
researchers are working
to improve the treatment
of children with obsessive compulsive disorder (OCD), a
common anxiety disorder that affects
approximately 3 percent of children
and adolescents. OCD is characterized by intrusive, distressing
thoughts (the obsessions) that lead to
performing “neutralizing” behaviors
(the compulsions). Obsessions and
compulsions tend to occur around
certain topics, including contamination/cleaning, safety/checking and
symmetry/ordering, and can interfere with schoolwork, friendships
and family functioning.
While OCD can be very disabling,
it is treatable with specific psychotherapy techniques and medications.
Kate Fitzgerald, M.D., child psychiatrist at the University of Michigan, is
using functional MRI to understand
the brain basis of psychotherapeutic
methods to help these children.
“At its core, we think OCD is a
hypersensitivity to making mistakes,
particularly in key ‘security concern’
domains such as checking that doors
are locked at night to make sure our
family is safe,” explains Fitzgerald.
“From an evolutionary standpoint,
these areas of concern are important for all human beings to stay safe
and feel secure. So, all of us may be
more sensitive to making mistakes
in security concern domains, but in
patients with OCD, a general hypersensitivity to errors may turn into
obsessions and compulsions once
security concerns have been tapped.”
“This is the core process – hypersensitivity to making mistakes – that
we look at with the fMRI,” continues
Fitzgerald. “Kids with OCD have
an exaggerated response in their
anterior cingulate cortex when they
make even a simple cognitive error.
The more hyper the response is,
the lower their symptoms are, suggesting that this hyperactivity may
somehow be compensating to push
down symptoms.”
Fitzgerald is studying exposure/
response prevention psychotherapy
Children with OCD
show hyperactivity in
the anterior cingulate
cortex when they
monitor performance
to detect mistakes.
treatment in conjunction
with the fMRI scans. “We
are predicting that this hyperactivity in
the brain is going to further increase
with effective treatment,” she explains.
“We’ll compare the fMRI before and
after therapy, so we can assess how
improvement in symptoms maps into
changes in the brain. In the long run,
determining the brain changes that
occur with effective treatment will
help us customize better treatments
for individual children with OCD.”
JOIN THE STUDY Eligible OCD
patients may qualify for free treatments. To
refer a patient, call M-LINE at 800-962-3555
or email ocdkids05@umich.edu
Doctor bio
Kate Dimond Fitzgerald, M.D., is a child
psychiatrist and a child and adolescent
psychiatry anxiety disorders specialist.
She is co-director of the Pediatric Anxiety
and Tic Disorders Clinic and assistant
professor, Department of Psychiatry.
With funding from the National Institute
of Mental Health and the Dana Foundation, Dr. Fitzgerald studies the relationship between brain development and
anxiety in youth, particularly obsessive
compulsive disorder.
800-962-3555 M-LINE 11