Inside Pediatrics Spring 2025

DIVISION ROUNDS (cont.)

PULMONOLOGY

NEUROLOGY

New MEG at UAB to enhance neuroimaging possibilities

The complexity of the human brain has long been an enigma that neuroscientists have sought to untangle. Now, new technology at UAB is acting as a critical tool to help researchers and clinicians interpret the brain in unprecedented ways. UAB recently invested in a new MEG, which stands for magnetoencephalography. It is used on pediatric and adult patients, so it benefits patients at both UAB and Children’s of Alabama. The technology measures the magnetic fields that come from the brain’s nerve cells in an effort to analyze their function—and does so at millisecond intervals. These implications are significant not only for localizing abnormalities in the brain in patients with diseases such as epilepsy but also for studying how the brain performs normal functions like speaking, hearing and seeing. “It’s not invasive,” said Ismail Mohamed, M.D. , professor in the UAB Division of Pediatric Neurology, Department of Pediatrics. “You don’t have to put electrodes in the brain, and it has no risks. You can potentially measure brain activity across multiple sessions. You can potentially measure them across a lifetime span. You can use it to learn things about how our brain functions.” For the patient, the experience is similar to getting an MRI, Mohamed said, but the measurements are taken in a different way. “MRI looks at structure, but MEG primarily looks at the brain waves itself,” Mohamed explained.

Helping children with Down syndrome manage sleep apnea Obstructive sleep apnea (OSA) is significantly more common in children with Down syndrome (80%) than in the general pediatric population (5%). But for some of these patients, the indicated first-line and supplemental treatments (adenotonsillectomy and continuous positive airway pressure therapy) aren’t always effective. That’s why the Children’s of Alabama Sleep Disorders Center is using a new and innovative approach. In July 2024, sleep specialist Mohini Gunnett, M.D. , worked with pediatric otolaryngologist Philip Rosen, M.D. , to implant the first Children’s patient with an upper airway hypoglossal nerve stimulation (HGNS) device to assist with management of their obstructive sleep apnea. This device, which is currently approved for patients with Down syndrome, works by producing gentle pulses to the nerve that protrudes the tongue forward during inspiration in sleep to help open the airway. “We see firsthand how frustrated families become when their child with Down syndrome does not respond or tolerate conventional options to treat their sleep apnea,” Gunnett said. “Since the FDA approval in 2023 of this device for adolescents with Down syndrome over the age of 13 for management of OSA, we have had a growing interest in patients and families seeking this procedure,” Rosen said. “Families are coming with optimism and appropriate questions during our initial consultations, as we determine together whether their child would be an appropriate candidate that would benefit from this device.” “We have already seen significant improvement and control in OSA with the few initial patients implanted with the device at our center,” Gunnett said. “I am excited to see how this device may provide short- and long-term benefit to our children with Down syndrome who are impacted by the physical and neurocognitive effects of OSA during their pivotal developmental years.” Currently, Children’s of Alabama is the only accredited pediatric center consulting for HGNS implantation in patients with Down syndrome in Alabama and the Florida Panhandle.

One significant implementation of the MEG is for use in epilepsy surgery to determine where in the brain seizures originate. It can also be used for functional brain mapping—to localize areas important for language, sensory and motor function. “It also has a lot of potential research use for the prediction of disease outcomes—studying things like dementia or Alzheimer’s disease,” Mohamed said. UAB was among the first medical centers in the country to obtain a MEG, having done so originally in 2001; however, evolving technology has created a need for replacing the old technology with a new one. The new machine was installed in September 2024. UAB is one of fewer than 30 clinical centers in the nation that houses this technology.

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