Repeat Concussions, Epilepsy Gene, Skin Patch for EoE, Food Insecurity Screening, New Director of Academic General Pediatrics Fellowship

Happy unofficial start to summer 2019! If you find yourself looking for something good to read on the beach, in the backyard, or floating on a boat, here you go. Discover which Children’s Hospital of Philadelphia docs and researchers have been in the news recently. We’re covering the risk of repeat concussions, a best method to screen for food insecurity, and a newly discovered causative gene for severe childhood epilepsy.

Increased Risk of Repeat Concussions

A new study from the Center for Injury Research and Prevention (CIRP) at CHOP and the Centers for Disease Control and Prevention found one in six children who has a concussion will experience a repeat concussion within two years. Researchers identified 536 children ages 5 to 15 years who had an initial visit for a concussion at a CHOP location between July 1, 2012, and June 30, 2013. After reviewing patients’ electronic health records for a two-year follow-up period, the researchers discovered 8 percent of these patients were diagnosed with a second concussion within the first year, and 16 percent had a second concussion within two years, including 3 percent who were diagnosed with two additional concussions.

“Knowing a child’s increased risk for repeat concussions can help families make better decisions about their child’s health,” said Christina Master, MD, a study author, co-lead for CIRP’s concussion research program, and a sports medicine pediatrician at CHOP. “We know that having a lot of symptoms or a long recovery time from your initial concussion are associated with a subsequent concussion within a couple of years. By looking at the number of symptoms and length of recovery, clinicians can give families data on which to make informed decisions about future risk.”

The study, led by Allison Curry, PhD, MPH, director of Epidemiology and Biostatistics at CIRP, appeared online in May in the Journal of Pediatrics. View Fox News clip or go to CHOP News for more information. 

Identified: Severe Childhood Epilepsy Causative Gene

A new gene associated with severe childhood epilepsy has been discovered by a team of researchers at CHOP who are affiliated with the CHOP Epilepsy Neurogenetics Initiative (ENGIN). By using a novel computational approach, the investigators systematically compared clinical data of patients with severe childhood epilepsies through an analysis strategy, looking for common genetic causes in patients who present similar symptoms.

This is the first time such an analysis of clinical data has been used to identify novel genetic causes of neurological disorders. This new computational method has the potential to help patients with a variety of complex and difficult-to-diagnose conditions. The findings appeared in the American Journal of Human Genetics.

“Genetic data are incredibly valuable, but when we do whole exome sequencing, this is really only half of the story,” said Ingo Helbig, MD, pediatric neurologist in the Division of Neurology at CHOP, and first author of the study. “Genetic epilepsies can present with a wide range of symptoms, and what we really want to understand is which medications work and how we can improve outcome. Genetic testing alone does not give us this information. However, when we merge genetic information with large-scale clinical data, the combination can be very powerful.”

Learn more about the study in the CHOP press release.

Skin Patch Treatment for Children With Eosinophilic Esophagitis

A new study from a group of CHOP researchers shows a skin patch may be useful in treating children with eosinophilic esophagitis (EoE), a painful, chronic condition triggered by a food allergy that causes redness, swelling, and itching in the esophagus. This is the first study to examine how this treatment, called epicutaneous immunotherapy, may help children with milk-induced EoE.

The pilot study followed 20 children ages 4 to 17 with EoE. The patients adhered to a milk-free diet for nine months, then re-introduced milk into their diet for the next two months. After 11 months, almost half of those wearing the skin patch had fewer EoE symptoms, including less inflammation when they underwent an endoscopy, compared to the placebo group.

“This study shows great promise for an immunotherapy that aims to desensitize children to milk,” said Jonathan Spergel, MD, PhD, chief of the Allergy Program at CHOP, and lead author of the study. “Our next step would be to launch a much larger study to confirm our results. Currently, there’s no cure for EoE, so this would be the first strategy to treat the underlying cause of the disease.”

Dr. Spergel discussed the study in MD Magazine, and the findings appeared online in the journal Clinical Gastroenterology and Hepatology. Read more about this research in the CHOP press release. 

Screening for Food Insecurity: The Method Matters

An electronic tablet-based screener with questions on food insecurity is preferred by caregivers as compared to a verbal, face-to-face interview, according to findings of a randomized study conducted by CHOP PolicyLab researchers. The study included more than 1,800 caregivers visiting CHOP’s Emergency Department.

“The results of this study suggest that written, tablet-based screening is a feasible and effective tool that may allow us to streamline routine inquiry into food insecurity and possibly other [social determinants of health] SDOH while improving detection and enhancing patient and provider comfort,” said Danielle Cullen, MD, PhD, MSHP,  a physician in CHOP’s emergency department and instructor at PolicyLab. “This puts us one step closer to ensuring we’re helping families connect with the appropriate resources to address social and environmental challenges.”

The team will continue their research with an even closer look at the screening and referral process. “It is our hope that these findings will help us build and inform programs that successfully connect families with desired resources, in order to reduce family-level food insecurity and improve health outcomes for children,” Dr. Cullen said.

Read Dr. Cullen’s blog Food for Thought: How we Screen for Food Insecurity Matters to learn more.

Dr. Katherine Yun Named Director of Academic General Pediatrics Fellowship

Congratulations go out to Katherine Yun, MD, MHS, a pediatrician with CHOP’s Refugee Health Program and a faculty member at PolicyLab, who was recently named the director of the Academic General Pediatrics (AGP) Fellowship at CHOP. Offering research training and mentorship, this fellowship addresses key clinical, health services, and policy issues in primary care pediatrics. The goal of the AGP fellowship is to prepare trainees to improve health and healthcare for underserved children through primary care research and leadership. 

Making Dr. Yun an excellent choice for this position is her area of expertise: refugee and immigrant health, especially the well-being of children in immigrant families in the United States. Her work focuses on the prevalence of chronic, non-communicable conditions and insurance coverage among refugees in the U.S., and differences in primary and dental care use by children in different types of immigrant families. Of concern to her are equity in access to healthcare and documenting the impact of health policies on immigrant children and families. 

ICYMI

Catch up on our headlines from our May 17 In the News:

• Vajravelu Honored With Early Investigators Award
• Understanding Stress Biology May Lead to Treatments for Psychiatric Disorders
• CAR Researchers Share Findings at 2019 INSAR Annual Meeting
• Google Search Content Could Inform Family Education and Support
• Pediatric Telehealth Research Network Gets Funding Boost
• Four Proposals Receive Seed Funds to Develop Medical Devices for Children

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