Cardon Children’s Medical Center opened The Children’s Postinfectious Autoimmune Encephalopathy (CPAE) Center of Excellence, a leading edge clinic that is only the second of its kind in the U.S. to treat and conduct research on neuropsychiatric disorders that historically have been misdiagnosed or undiagnosed in children. We’ll sit down with Dr. Christopher Spiekerman, a pediatrician with Cardon Children’s Medical Center.
JOSE: CARDON CHILDREN'S MEDICAL CENTER HAS OPENED THE VALLEY'S FIRST CLINIC TO TREAT NEUROPSYCHIATRIC DISORDERS, THE FIRST IN THE U.S. TO TREAT AND CONDUCT RESEARCH ON NEUROPSYCHIATRIC DISORDERS WHICH HAVE HISTORICALLY BEEN UNDIAGNOSED OR MISDIAGNOSED IN CHILDREN. JOINING ME TO TALK ABOUT THE NEW CENTER IS DR. CHRISTOPHER SPIEKERMAN, PEDIATRICIAN WITH CARDON CHILDREN'S MEDICAL CENTER. WELCOME TO "HORIZONTE."
DR. CHRISTOPHER SPIEKERMAN: THANK YOU.
JOSE: IN DOING THE PREPARATION, I SAW A BIG LONG TITLE FOR WHAT THE CLINIC IS ABOUT AND CPAE THE ACRONYM?
DR. CHRISTOPHER SPIEKERMAN: CHILDHOOD PEDIATRIC AUTOIMMUNE ENCEPHALOPATHY. THAT IS A BIG WORD IN MEDICINE. THE HARD PART ABOUT MEDICINE IS WE GET THE BIG WORDS, AND PEOPLE DON'T UNDERSTAND WHAT IT IS WE'RE TRYING TO GET TO THE POPULATION. THIS IS A AUTOIMMUNE, ENCEPHALOPATHY, IT AFFECTS THE BRAIN, AND IT IS AN ACUTE SITUATION THAT CAUSES ESSENTIALLY A CHANGE IN YOUR CHILD OVERNIGHT.
JOSE: AND AS I UNDERSTAND IT, WHAT HAPPENS IS THERE'S AN INFECTION, AND THE AUTOIMMUNE SYSTEM REACTS THE WRONG WAY?
DR. CHRISTOPHER SPIEKERMAN: CORRECT, INSTEAD OF REACTING TO THE PATHOGEN, FOR EXAMPLE, WE'LL GIVE YOU AN EXAMPLE OF STREP, WHICH IS THE MOST COMMON. IT INSTEAD ATTACKS THE STREP IT ATTACKS THE BRAIN. THE ANTIBODIES THAT ARE SUPPOSED TO GO TOWARDS, IF I GIVE YOU A VACCINE, THAT'S MAKING AN ANTIBODY. FLU, EVERYBODY KNOWS.SO I INJECT YOU TO THAT AND YOU'RE IMMUNE TO THE FLU. THE PROBLEM IS THERE'S ANTIBODIES INSTEAD OF ATTACKING THE STREP ATTRACT THE BASE OR PART OF THE BRAIN.
JOSE: WE DESCRIBED THE INTRODUCTION OF MISDIAGNOSIS OR NOT BEING DIAGNOSED AT ALL.
DR. CHRISTOPHER SPIEKERMAN: PHENOMENAL QUESTION. IT'S A RELATIVELY NEW DISEASE, FOR A PHYSICIAN IT'S EXCITING, FOR A PARENT FRIGHTENING. A LOT OF TIMES IF IT DOESN'T EXIST IN A MEDICAL BOOK OR GOING THROUGH MEDICAL SCHOOL, THE PROCESS DOESN'T EXIST. WE HAVE NOW -- THE NEATEST PART ABOUT THE CLINIC THAT WE HAVE IS NOT ONLY ARE WE THE SECOND -- US AND THE UNIVERSITY OF ARIZONA. WE DIAGNOSE, WE TREAT, WE TRAIN OTHER PHYSICIANS. SO THAT'S PRETTY UNIQUE. WE WERE JUST AT THE RED ROCKS IN SEDONA. DR. MICHAEL DANES DID A TALK. AND WE’RE EDUCATING NOW THE NEXT GENERATION TO PHYSICIANS.
JOSE CARDENAS: WHAT ARE THE SYMTOMS? AS I UNDERSTAND IT COULD BE OVERNIGHT--
DR. CHRISTOPHER SPIEKERMAN: DO YOU HAVE CHILDREN?
JOSE: I HAVE THREE GROWN SONS AND SIX GRANDCHILDREN.
DR. CHRISTOPHER SPIEKERMAN: OH. CONGRADULATIONS! THAT’S GREAT SO CAN YOU IMAGINE IF YOUR CHILD GOES TO BED ONE NIGHT AND YOU SON IS A NORMAL HAPPY, HEALTHY CHILD SO THE NEXT MORNING HE WAKES UP AND IS SCARED TO GET UP BECAUSE HE’S SCARED TO PUT HIS FEET ON THE CARPET. THEN YOU GET HIM OUT OF BED BUT HE HAS TO WASH HIS FEET 15 TIMES BEFORE HE CAN PUT ON HIS SHOES. THIS ISN'T RIGHT. HE LOVES WAFFLES, SO YOU GET HIM WAFFLES AND ALL OF A SUDDEN, YOU PUT WAFFLES IN FRONT OF HIM. I CAN'T EAT THAT. HE SAYS WHY? I FEEL LIKE I'M GOING TO CHOKE ON IT. AND ASK YOU THE PARENTS AND YOU SAY TO THEM, YOU LITERALLY, THE CHILD THAT YOU WENT TO BED TONIGHT IS THAT THE SAME CHILD YOU SEE THIS MORNING? THEY'LL SAY, NO. AND SO IF WE CAN TRAIN THROUGH THE UNIVERSITY OF ARIZONA, THROUGH BANNER CARDONS, OTHER PHYSICIANS, NURSE PRACTITIONERS, ALLIED HEALTH PROFESSIONALS TO RECOGNIZE THIS QUICKLY, IT'S VERY EASY TO TREAT, AND SO WHAT WE'RE TRYING TO DO AT THE CENTER IS REPRODUCE SOMETHING SO WE'RE KIND OF THE CLEVELAND CLINIC WHEN IT COMES TO THIS DISORDER AS FAR AS TRAINING PEOPLE. SO WE'RE GOING TO TRY TO GET TO –
JOSE: THE REVERENCE TO A CLINIC AS PRESTIGIOUS AS THE CLEVELAND CLINIC.
DR. CHRISTOPHER SPIEKERMAN: YES, CLEVELAND CLINIC IS THE CLEVELAND CLINIC, THAT'S OUR GOAL. IF YOU DO SOMETHING IN ARIZONA, MIGHT AS WELL DO IT WELL. AND ITS GONNA BE SOMETHING WHERE HOPEFULLY PUT A FEATHER IN OUR CAP, WE'RE TRAINING IN THE UNIVERSITY OF VIRGINIA, THE UNIVERSITY OF WISCONSIN, WE HAVE PLACES AS FAR AWAY AS AUSTRALIA, GREAT BRITAIN, THAT WANT TO SEE WHAT WE'RE DOING HERE IN ARIZONA.
JOSE: AND TWO CENTERS, BOTH OF THEM IN ARIZONA?
DR. CHRISTOPHER SPIEKERMAN: UH-HUH.
JOSE: I WANT TO TALK MORE IN DETAIL ABOUT THIS EFFORT HERE, BUT BEFORE THAT, AS I UNDERSTAND IT, IN THE PAST, BECAUSE OF THE MISDIAGNOSIS OR LACK OF DIAGNOSIS, MANY OF THE CHILDREN WERE CREATED WITH DRUGS LIKE RITALIN.
DR. CHRISTOPHER SPIEKERMAN: AND ANTIDEPRESSANTS. NOW HERE'S THE THING YOU GOT TO REMEMBER IS THERE IS A ROLE THAT PSYCHIATRIC COMPONENT WITH THE DIAGNOSIS. THE PART WE'RE TREATING, WHICH IS SO UMPORTAN, IS MULTIFACTORIAL. SO PEOPLE HAVE MISDIAGNOSED THIS A LOT, AND IF THEY DO, SOMETIMES THEY GET DOWN THE WRONG MEDICAL PATH. BUT THE NEAT PART ABOUT OUR CLINIC IS WE HAVE NEUROPSYCHOLOGISTS.PSYCHOLOOGIST. NURSE PRACTICIONERS. IMMUNOLOGIST. A WHOLE MYRIAD OF PEOPLE THAT TREAT THE WHOLE CHILD. YOUR BASIS FOR WHOLISTIC MEDICINE.
JOSE CARDENAS: SO IF YOU SAID IT’S EASY TO TREAT, IF YOU KNOW WHAT IT IS, WHAT DOES THAT MEAN AND HOW LONG DOES IT TAKE TO GET YOUR KID BACK TO NORMAL?
DR. CHRISTOPHER SPIEKERMAN: YEAH. HERE’S THE GREATEST PART ABOUT IT. REMEMBER, IN ANY PART OF MEDICINE. IT IS A CONSTELLATION OF SYMPTOMS BASED ON SEVERITY. SO I’M NOT GONNA TELL YOU THE ONES THAT ARE ABOSLUTELY HAVING A TERRIBLE TIME WITH IT ARE GONNA GET BETTER IMMEDIATELY BUT I WILL SAY THE KIDS WITH THE MIDLER OR MODERATE CASES, IF YOU CAN PICK UP THESE KIDS IN ABOUT TWO WEEKS, YOU HAVE THE OPPORTUNITY TO CHANGE THEIR LIFE IRREVOCABLY FOREVER. BECAUSE IF YOU MISS THIS AND IT BECOMES TO BE MORE OF THE SEVERE TYPE, HAVE YOU PROBLEMS AND THEY GET SEEN IN MY CLINIC AND THEN HAVING TO DEAL WITH THE PSYCHIATRIC COMPONENT, NOT ONLY WITH THE IMMUNOLOGIC COMPONENT AND ALSO THE MEDICATION MANAGEMENT, THAT IF WE COULD HAVE GOTTEN THIS EARLIER WEEK WE WOULDN'T HAVE TO WORRY ABOUT IT.
JOSE CARDENAS: I KNOW THERE ARE MANY AREAS ARIZONA DOES LEAD THE NATION, HOW IS IT THESE EFFORTS AND THIS PARTICULAR FOCUS CAME TO BE CENTERED HERE IN ARIZONA?
DR. CHRISTOPHER SPIEKERMAN: THERE WAS A BRILLIANT GENTLEMAN BY THE NAME OF PAUL RYAN WHO IS A DEAR FRIEND OF MINE, WHO HAS A GRANDSON AND WENT TO THE UNIVERSITY OF ARIZONA BECAUSE IT FOUND THEM TO BE -- THERE'S A DR. MICHAEL DANES AND SYDNEY RICE, WHO ARE THE COLLEAGUES I HAVE WORKED WITH MANY YEARS IN ARIZONA AND SOME OF THE FINEST PHYSICIANS YOU EVER WANT TO MEET. AND HE WENT AROUND THE COUNTRY AND IDENTIFIED THE UNIVERSITY OF ARIZONA AS THE PLACE THAT HAD THE BEST INFRASTRUCTURE. DR. FAYEZ GHISHAN IS ONE OF THE MOST AMAZING MEN. SO THEY HAD THE LOVE FOR AUTOIMMUNE PROCESSES. RIGHT HERE IN ARIZONA. AND THEY WERE KIND ENOUGH TO SAY, HEY, DR. SPIEKERMAN, WE WOULD LOVE TO DO THAT UP IN PHOENIX. LET'S GET THIS OUT THERE TO OTHER PEOPLE. YOU CAN TELL I'M PASSIONATE ABOUT IT.
JOSE: SO IS HE, I HAD THE PRIVILEGE OF MEETING HIM AND HE TALKED ABOUT THE LOST GENERATION OF KIDS WHO WEREN'T DIAGNOSED PROPERLY WHICH IS HIS MOTIVATION.
DR. CHRISTOPHER SPIEKERMAN: ABSOLUTELY. IF YOU'VE SEEN WHAT I HAVE SEEN AND WHAT PAUL HAS SEEN, IT'S ABSOLUTELY HEART BREAKING, BECAUSE AGAIN, WITH EARLY RECOGNITION AND PROPER TREATMENT, IT'S A PIECE OF CAKE. I'M USING ON AVERAGE WHEN I SEE THEM IN THE BEGINNING FLARING STAGES, IF YOU CATCH IT WITHIN TWO WEEKS. ONE OR TWO WEEKS, ANTIBIOTICS AND NAPROSYN. THEY DO GREAT. THOSE ARE THINGS WE USE ON AN EVERYDAY BASIS, IF YOU CAN RECOGNIZE WHAT THIS IS, THEN YOU CAN USE THINGS THAT EVERY PRIMARY CARE PHYSICIAN IS EXTREMELY COMFORTABLE WITH USING. SO I'M NOT ASKING THEM TO DO, YOU KNOW, COMPLETELY RESEARCH-BASED SITUATION WHERE THEY'RE GOING TO GET ESSENTIALLY OVER THEIR SKIS AND GET SCARED. SO WHAT WE'RE TRYING TO EDUCATE THE GENERAL POPULATION IS HOW EASY THIS PROCESS IS TO IDENTIFY AND TREAT. THE HARDEST PART ABOUT IT, IT'S A CLINICAL DIAGNOSIS. THERE IS A LOT OF OVERLAP. THE MOST IMPORTANT THING WHAT YOU LEAVE WITH THE VIEWERS TONIGHT AND THE PEOPLE THAT LISTEN TO US, IT IS A DIAGNOSIS OF EXCLUSION. YOU HAVE TO LOOK AT EVERYTHING ELSE. IS IT PURELY PSYCHIATRIC?IS IT PURELY IMMUNE? PURELY INFECTIOUS?
JOSE: IF IT HAPPENS OVERNIGHT, IT PROBABLY IS THIS CONDITION?
DR. CHRISTOPHER SPIEKERMAN: AGAIN, I'M A PHYSICIAN, SO MY JOB IS TO BE EVIDENCE BASED. I WAS TRAINED AS A SCIENTIST AT THE UNIVERSITY OF COLORADO. IF YOU RULE OUT THE OTHER STUFF THAT YOU WOULD NEED TO ARE MORE COMMON THAN THIS, THIS IS PERHAPS 1-2% OF THE POPULATION. REMEMBER, WE'RE TALKING MILD TO SEVERE. THEN YOU COULD SAY, YEAH, IF YOU RULE OUT ALL THE OTHER STUFF, I WOULD CERTAINLY LOOK AT THIS HIGH ON THE DIFFERENTIAL. AND THAT'S WHAT WE'RE HERE FOR, EDUCATION.
JOSE: AND THE EDUCATION DIRECTED AT PHYSICIANS?
DR. CHRISTOPHER SPIEKERMAN: ACTUALLY EVERYBODY.
JOSE: YOU, TOO?
DR. CHRISTOPHER SPIEKERMAN: ABSOLUTELY. IF YOU CAN TELL A PARENT THIS IS SOMETHING IF IT HAPPENS TO YOUR KID OVERNIGHT. IF YOU DID A SUPER BOWL COMMERCIAL, YOU WOULD NEVER HAVE IT AGAIN. THAT WOULD BE GREAT TO RAISE MONEY FOR. THESE ARE THE THINGS THAT HAPPEN, IF IT HAPPENS, CALL YOUR PHYSICIAN. THIS IS HOW YOU TREAT IT. YOU COULD DO IT. THAT'S PROBABLY NOT A GREAT IDEA BUT I'VE GIVEN YOU AN EXAMPLE BECAUSE PARENTS CAN PICK IT UP.
JOSE: WE'VE GOT ABOUT 30 SECONDS LEFT. WHAT IS THE SINGLE MOST IMPORTANT THING THAT PEOPLE CAN DO OR SHOULD KNOW ABOUT?
DR. CHRISTOPHER SPIEKERMAN: IF YOUR KID WAKES UP AND IS COMPLETELY DIFFERENT KID, GO TO YOUR PEDIATRICIAN AND HAVE THEM ENTERTAIN THIS DIAGNOSIS.
JOSE: AND IS THERE A PLACE THEY CAN GO?
DR. CHRISTOPHER SPIEKERMAN: SO BANNER CENTER. CPA IS NOT ONLY AT UNIVERSITY OF ARIZONA BUT BANNER CARDONS. TALK WITH THE NEUROLOGY DIVISION AND THEY CAN GET AHOLD OF OUR CLINIC.
JOSE: THEY CAN GET THE INFORMATION ON THE WEBSITE?
DR. CHRISTOPHER SPIEKERMAN: BANNER DOES A PHENOMENAL JOB AT OUTREACH.
JOSE: DR. SPIEKERMAN, THANK YOU FOR JOINING US. TO TALK ABOUT THIS EXTREMELY IMPORTANT TOPIC.
DR. CHRISTOPHER SPIEKERMAN: THANK YOU.
JOSE: THANK YOU FOR WATCHING. FOR "HORIZONTE" AND ARIZONA PBS, I'M JOSE CARDENAS. HAVE A GOOD EVENING.
Dr. Christopher Spiekerman, a pediatrician with Cardon Children's Medical Center
