Soliz initially shrugged it off as a pulled muscle. But the pain grew progressively worse. Soon, he was experiencing sharp pain throughout the day, using walls for support as he walked and struggling to find a comfortable position to sleep.

Soliz underwent an MRI, revealing a large tumor in his spine. Recognizing the critical diagnosis of this bone tumor, an orthopedic surgeon in Ventura County near Soliz’s home referred him to Cedars-Sinai.

An image-guided biopsy performed by interventional neuroradiologist Marcel Maya, MD, co-chair of the Department of Imaging at Cedars-Sinai, made the diagnosis of an aneurysmal bone cyst, a rare, blood-filled tumor that can grow rapidly and, as in Soliz’s case, destabilize the spinal column and compress the spinal cord.

Although the tumor was benign, its location made it dangerous, said his surgeon, Tiffany Perry, MD, associate professor of Neurosurgery and co-director of Spine Oncology.

“Spinal fluid normally surrounds the cord, providing space for the cord and the nerve roots as they exit the spinal column,” Perry said. “But in Ryan’s case, the tumor was taking up about 80% of the spinal canal and was blocking the flow of fluid and compressing the cord, causing weakness in his legs.”

For Soliz, the diagnosis quickly became about more than treating a rare tumor—it was about saving his ability to walk. Three days after his outpatient appointment in the neurosurgery clinic, Soliz began losing feeling in his legs, prompting doctors to act emergently. By the time he was admitted to the ICU, he had lost the ability to walk.

“It was a roller coaster of emotions. I was terrified thinking I might never be able to walk again,” Soliz said.

A Rare Tumor and Emergency Surgery

Aneurysmal bone cysts are uncommon, and involvement of the spine with significant spinal cord compression is particularly unusual, Maya said.  

“Although these tumors are benign, they can be locally very aggressive—destroying bone, bleeding significantly and, when they occur in the spine, compressing the spinal cord,” Maya said.

After Soliz was seen in the outpatient clinic, his case was reviewed by a spine tumor board, a group of specialists at Cedars-Sinai from different disciplines that discusses complex spinal tumors. The board ensures patients like Soliz receive coordinated care, formulating a comprehensive, individualized treatment plan for each patient. Maya said the multidisciplinary tumor board allows specialists in neurosurgery, imaging, interventional neuroradiology, pathology and other disciplines to develop a coordinated treatment strategy from the outset. Given the rapid decline of Soliz’s condition, his care team implemented the developed plan in an expedited manner.

Before removal of the tumor, Michael Alexander, MD, vice chair of Neurosurgery, performed a preoperative embolization of the tumor. This minimally invasive procedure blocked blood flow to the tumor, reducing the risk of major blood loss during surgery.

Following the embolization, Perry resected the tumor during a five-hour surgery, ultimately relieving the pressure on Soliz’s spinal cord and preserving his ability to walk.

In addition to Perry, Maya and Alexander, many Cedars-Sinai specialists contributed to Soliz’s care, including the pathologists who confirmed his diagnosis. The specialists and staff in the Neuroscience Critical Care Unit were also instrumental in his recovery, providing attentive care before and after surgery that helped him begin walking again.

“Ryan’s case reflects the importance of every team bringing its expertise together toward one shared goal—taking care of every patient and ensuring the best outcomes possible within our abilities,” Perry said.

A Recurrence, and Off to College

After surgery, Soliz spent time in rehabilitation recovering his strength. But in April, the tumor returned.

Alexander performed another embolization, blocking the blood vessels supplying the tumor. The approach allowed Soliz to avoid another operation to remove it and instead take medication to suppress the tumor’s growth.

Today, Soliz is in good health, golfing and hiking, and preparing to start his freshman year at the University of Hawaii, where he will be followed by a specialist throughout the school year. During breaks, he will continue his medical care at Cedars-Sinai.

Despite everything he has been through, Soliz is looking ahead to college and to a possible career in healthcare.

“I’ve always had huge respect for healthcare workers, but being a patient made me realize I want to work in healthcare and help others as a nurse,” he said.

For Perry, Soliz’s story feels personal.

“I have a daughter one year older than Ryan who just went through the college application process and moved away,” Perry said. “I could only imagine what Mrs. Soliz was feeling. I knew we had to work together for Ryan. He has amazing things he will do—and I cannot wait to see how he changes the world.”

Read more from Cedars-Sinai Stories and Insights: Seeking a Second Opinion for a Spine Condition

, a national recognition awarded to programs that bring together specialists across disciplines to advance care for patients with complex skull base tumors through clinical expertise, research, education and innovation. These programs offer advanced surgical approaches to treating skull base tumors, including some cases considered inoperable elsewhere.

The designation recognizes Cedars-Sinai’s collaborative approach to treating tumors that develop at the base of the skull—an anatomically complex area where tumors grow near nerves and blood vessels that control vision, hearing, facial movement and swallowing.

“There is very precious real estate, and treatment often requires expertise from multiple specialties,” said Vladimir Ljubimov, MD, assistant professor of Neurosurgery at Cedars-Sinai, where he and other neurosurgeons at Cedars-Sinai Medical Center and Torrance Memorial Medical Center collaborate with a range of specialists to remove some of the most complex tumors.

The Cedars-Sinai Newsroom spoke with Ljubimov about what skull base surgery involves, why a multidisciplinary team is essential, and how advances in surgical techniques are expanding treatment options for patients.

What is skull base surgery?

Skull base surgery involves treating tumors that develop in one of the body's most anatomically complex regions. But the goal isn't simply to remove the tumor—it's to do so while preserving the nerves and blood vessels that control critical functions. Even a small injury to one of these structures can have life-altering consequences, including stroke, vision loss or facial paralysis. That's why skull base surgery requires advanced techniques, meticulous planning and close collaboration among specialists.

Treatment is tailored to each patient. Depending on the tumor's location, we may perform a traditional craniotomy, in which surgeons temporarily remove a small section of the skull to reach the tumor. We also use minimally invasive endoscopic techniques through the nose, orbit, or mouth, or combine multiple surgical approaches. These techniques allow us to safely treat tumors that were once considered extremely difficult or even impossible to reach.

What does a multidisciplinary skull base team involve?

Skull base surgery is truly a team effort. Neurosurgeons and otolaryngologists often work together during surgery, especially for minimally invasive endoscopic procedures performed through the nose or ear. Depending on where the tumor is located, other specialists may join the team. For example, ophthalmologists and oculoplastic surgeons help us safely treat tumors near the eye while preserving vision and appearance. Plastic surgeons may assist with reconstruction when needed. We also collaborate with endocrinologists, neuro-oncologists, neurologists and radiation oncologists, depending on the patient's diagnosis.

Every case is reviewed by our multidisciplinary team before surgery. Together, we evaluate imaging, discuss treatment options and determine the safest, most effective approach. Just as important as removing the tumor is reconstructing the skull base afterward. Our specialists work together to rebuild these structures, helping prevent complications such as cerebrospinal fluid leaks or infection while allowing patients to recover safely. After surgery, we continue coordinating care, which may include hormone management, radiation therapy, chemotherapy or rehabilitation.

What are the symptoms of a skull base tumor?

Not all skull base tumors are cancerous. Many are benign, but because of where they're located, they can still cause serious problems by pressing on the brain, nerves or blood vessels.

Skull base tumors include tumors such as pituitary tumors, tumors that arise from the lining of the brain (meningiomas), rare tumors that develop near the pituitary gland (craniopharyngiomas), tumors of the bone and cartilage (chordoma, chondrosarcoma), as well as cancers that have spread to the skull base from other parts of the body.

Symptoms vary depending on where the tumor is located and may include vision changes or vision loss, double vision, dizziness, balance problems, headaches, nausea or hormonal changes.

What are the latest advances in skull base surgery?

One of the biggest advances is the development of sophisticated endoscopic techniques that allow us to reach tumors through the natural openings of the nose, avoiding large incisions in many cases. These approaches give us access to areas that were once considered too risky to operate on, including tumors deep within the skull base and around the cavernous sinus.

As technology continues to advance, we're able to treat increasingly complex tumors with greater precision while reducing complications and improving quality of life for our patients.

How should patients look for the right skull base surgeon for them?

Patients should look for a program that offers multidisciplinary care. Complex skull base conditions often require expertise from multiple specialists, and having those experts work together from the beginning leads to more comprehensive treatment planning.

At Cedars-Sinai, we evaluate each case as a team and offer the full spectrum of surgical and nonsurgical treatment options. If a patient has been told their tumor is too difficult to remove or has limited treatment options, seeking a second opinion at a high-volume skull base center can help determine whether additional approaches may be available.

Read more from Cedars-Sinai Stories and Insights: From Vacation Vertigo to an Acoustic Neuroma Diagnosis

Under the new guidance, students in early education and kindergarten through first grade will have no weekly classroom screen time. Students in grades 2 and 3 will be limited to 1 hour and 40 minutes per week, with those in grades 4 and 5 limited to 2 1/2 hours, students in grades 6 through 8 limited to 6 hours per week, and high school students limited to 10 hours per week.

The limits include time spent on screen-based homework.

“Screen time is literally changing the trajectory of brain development. It’s growing the visual cortex at the expense of the areas responsible for language, reading and social skills,” said Jane Tavyev Asher, MD, pediatric neurologist and director of the Division of Pediatric Neurology at Cedars-Sinai Guerin Children’s. “Parents should actually be very delighted that their kids are going to have less screen time in the school setting, and they should view the school as working as their partner in helping with their child’s brain development.”

As the new policy takes effect this school year, the Cedars-Sinai Newsroom spoke with Tavyev Asher about why reducing screen time can benefit children’s brain development—and how parents can reinforce healthy screen habits at home.

Why were these new screen time policies needed?

Research continues to show that excessive screen time can affect how children’s brains grow and develop. During childhood, the brain is building important skills for language, reading, attention and social interaction. We want the brain to develop for reading, language and social skills. And screen time is really growing the visual cortex at the expense of all of the other parts of the brain.

Sharply reducing screen time at school can help create more opportunities for students to have active learning, conversation and deeper cognitive development in the long run.

Now that schools are seeing the neuroscience behind what screen time does to the developing brain, many are beginning to embrace this research and implement limits. They want what’s best for students’ brain development, just as parents do. At the end of the day, we’re all working toward the same goal: helping our children learn, grow and thrive.

Why is limiting screen time especially important during early childhood?

Early childhood is a critical period for learning to speak, read, write and develop social skills. During these years, the brain’s auditory and language centers are rapidly developing through conversation and human interaction.

For example, speech development begins around age 1, when children start learning how to speak. This process depends on the development of nerve signals and the continued growth of the auditory cortex, which develops significantly during the first few years of life. The auditory cortex is also the part that builds not just language but also social interaction.

Excessive screen use may interfere with these processes by overstimulating visual pathways while reducing opportunities for face-to-face communication, language development and recognizing social cues such as facial expressions and body language.

How can screen use affect brain development in middle schoolers?

Higher-level cognitive functions really begin to take off around age 12. This is when intellectual curiosity starts to develop. It’s a stage where children naturally begin making connections between ideas, such as reading one thing, connecting it to something else they’ve learned, asking questions, and wanting to find the answers. That’s exactly how we want their brains to develop.

But if everything is fed to them passively through AI or excessive screen-based learning, that part of the brain isn’t being exercised in the same way. They’re consuming information rather than actively thinking, questioning and making connections. It’s wonderful that our schools are finally coming to this realization and changing the way the curriculum is given to our children.

What screen time advice do you have for parents of high schoolers?

For a high schooler, I would try to keep the same guidelines in the home that you’ve done for the younger children. The reason for that is they still have that developing brain, and screen time is still very addictive.

I think at this age, they really do have the understanding as to why screens are not ideal for them. By the time they’re in high school, teenagers can understand the logic behind reducing screen time. This is the time when their intellect is developing. They can read the studies about it. As parents, this is also an ideal time to expose them to the studies that are showing what screen time addiction is doing to the brain in the long run.

How should parents approach smartphones for middle and high school students?

The smartphone is really the worst form of screen time because it is so easily accessible in the pocket. It’s easier to become addicted to that. So, it’s important to monitor how children access and use their smartphones.

There is so much social growth that happens in middle school. If you can just get the kids over that hump without a phone, then you can keep them from getting addicted to that phone.

There’s a program called “Wait Until 8th.” It’s a movement where parents sign a pledge to delay giving their child a smartphone until at least the end of eighth grade or until they’re 13 years old. When families make this commitment together, it creates a community where fewer kids have smartphones early on, which helps reduce the peer pressure to get one before they’re ready. It gives parents support in setting healthy boundaries and makes it easier for children to wait alongside their friends.

If you need to be in touch with your teenager, give them a simple flip phone that has no internet access. This way, they can call who they need to call. In some phones, you can also program who they call or receive calls from.

How can parents set and enforce screen time limits at home?

Parents have a huge influence on how children develop their relationship with screens. It’s much easier to not introduce screens than to set limits or take it away later in life. Instead of focusing only on taking screens away, parents can help children discover other activities, like reading, creative play, spending time outdoors and connecting as a family.

It’s important to point out that parents should model habits they hope to see by practicing healthy screen use themselves, since children are more likely to follow behaviors they observe at home.

Firstly, implement a no-screen-time rule at least two hours before bedtime. This will help kids avoid bright lights right before bed, promoting deeper sleep. Secondly, avoid screens during mealtime. Mealtime is a great time for the family to sit together and have conversations. There are so many positive studies about what family mealtime does for children’s social development and for their cognitive development.

Read more from Cedars-Sinai Stories and Insights: A Family Guide to Teens, Screens and Social Media

But one of the unwanted consequences of spending lots of time in the water is ear infections, commonly known as swimmer’s ear. The Cedars-Sinai Newsroom spoke to Abhita Reddy, MD, a pediatric otolaryngologist and head and neck surgeon at Cedars-Sinai Guerin Children’s, about what causes swimmer’s ear, how parents can protect their children, and how physicians diagnose and treat the condition.

What is swimmer’s ear?

Swimmer’s ear, properly known as otitis externa, is an infection of the ear canal where you often have drainage. You can have fluid sitting in the ear canal. Sometimes it looks like fluffy tissue that drains. It can cause discomfort and can also cause hearing impairment if left untreated.

What causes swimmer’s ear?

Swimmer’s ear occurs most commonly in the summertime when people are swimming in contaminated water like lakes or rivers, even sometimes in the ocean. We also see it a lot when people go surfing or do water sports, or when kids are going under water frequently or diving deep. Swimming in chlorinated or saltwater pools is less likely to cause swimmer’s ear.

How do you know if your child has swimmer’s ear?

Parents usually know when their child is getting an external infection like swimmer’s ear when they see drainage coming out of the ear, not something brown that looks like wax, but oftentimes it’s white or yellow, and it can smell bad. Swimmer’s ear is often associated with children having pain in their ear, and sometimes it can be associated with small children not letting you touch their ear, so if you tug at their ear or pull their ear it hurts a lot.

How does swimmer’s ear differ from other ear infections?

The biggest difference between a middle ear infection, known as otitis media, versus an outer ear infection, known as otitis externa, or swimmer’s ear, is that middle ear infections, which are behind the eardrum, do not have drainage coming out unless your child has ear tubes. Usually when children have middle ear infections they tug or pull at their ears, which makes it feel better. They also may develop a fever. The opposite is true with swimmer’s ear, or otitis externa, which hurts when you tug on the ear.

How are these infections treated?

Swimmer’s ear is often treated with ear drops because it’s very easy for the drops to get to the area where the infection is. With middle ear infections we often must treat it with antibiotics because unless you have ear tubes, it’s very hard for the drops to reach the infected area.

How can you prevent swimmer’s ear?

When parents ask me how to prevent their kids from getting swimmer’s ear, it often has nothing to do with swimming at all. I just tell them not to use cotton swabs such as Q-tips in their kids’ ears. When you use Q-tips in your children’s ear, it can offset the pH balance inside the ear canal, or cause small breaks in the canal skin, which can then increase the risk of getting ear infections. It is also helpful to consider using earplugs or swim caps for children. Parents can also try to dry the ear if the ear is very wet after a swim. Parents can use a hair dryer around a shoulder length away from their child’s ear on the lowest setting for about 10 seconds at a time, and that can dry out the ear canal and help prevent swimmer’s ear.

Read more from Cedars-Sinai Stories and Insights: How to Treat Sleep Apnea in Children

Fires can leave behind more than visible damage. The lingering smoke and airborne contaminants from the recent warehouse fire in the Boyle Heights neighborhood in Los Angeles may continue to affect air quality for weeks or even months. Exposure to pollutants released during the fire and after it was extinguished can significantly increase the risk of developing respiratory problems and other health issues. 

While some people experience only temporary irritation, others, especially children, older adults, and those with underlying medical conditions or breathing issues, may face more serious or long-term health effects.

The Cedars-Sinai Newsroom recently spoke with Irina Dralyuk, MD, director of Pediatric Pulmonology at Cedars-Sinai Guerin Children's, about the health risks associated with fire and smoke exposure, who is most vulnerable and what people can do to protect themselves.

What are the health dangers following a fire like the warehouse fire in Boyle Heights?

Following a fire, air quality can be affected for an extended period of time. Fires release a variety of chemicals and fine particles into the air, and many of those substances may not be immediately identified as materials continue to burn and break down.

The first few weeks after a fire are generally the most concerning, but people should remain cautious for at least two to three months. For individuals with respiratory diseases, weakened immune systems or heightened sensitivity to environmental pollutants, the health effects can last much longer, potentially up to a year.

Who should be especially cautious following a fire?

Several groups are at higher risk, including infants and young children, especially babies born prematurely, older adults, people with weakened immune systems, and those with chronic lung conditions such as asthma, chronic obstructive pulmonary disease (COPD) or cystic fibrosis.

However, even people with healthy lungs should take smoke exposure seriously. Environmental hazards from a fire can trigger inflammation or respiratory problems in otherwise healthy individuals, so everyone should take steps to protect themselves when air quality is poor.

What precautions can people take after a fire?

One of the most effective ways to reduce exposure indoors is by using air purifiers. It's important to choose a purifier that's appropriately sized for the room and to replace filters regularly. Home HVAC [heating, ventilation and air conditioning] filters should also be changed according to manufacturer recommendations.

If possible, limit activities that bring smoky outdoor air into the home. During periods of poor air quality, consider using fans instead of air conditioning, as it typically draws outside air into your living space. When spending time outdoors, wear a well-fitting mask on days when air quality is poor, especially during the weeks and months following a fire.

When should people seek medical attention?

Even mild symptoms such as an itchy or scratchy throat, irritated eyes, or persistent coughing are signs that smoke may be affecting your body and should not be ignored.

People experiencing coughing, wheezing, shortness of breath or difficulty breathing should see a doctor or head to an urgent care. Depending on the symptoms, a doctor may recommend diagnostic tests such as a chest X-ray or lung function tests. Your doctor might also listen to the lungs and determine whether medications, including inhalers, nebulizer treatments or oral medications, are needed to reduce inflammation, open the airways and improve breathing.

Read more from Cedars-Sinai Stories and Insights: What Parents Should Know About Teen Vaping

“Spinal CSF leaks can be incredibly debilitating, and in many cases we haven’t understood why they happen,” said Wouter Schievink, MD, co-senior author of the study and professor of Neurosurgery at Cedars-Sinai.

The brain and spinal cord are bathed in protective cerebrospinal fluid. A tear or hole in the membrane that surrounds the spinal cord can allow this fluid to leak out, leading to nausea, neck stiffness and severe headaches that worsen when standing. Current treatments for spinal CSF leaks focus on sealing the leak after it occurs. Patients are often treated with epidural blood patches, which can provide temporary relief, or may require specialized surgery to repair the tear when symptoms persist.

Spinal CSF leaks are associated with genetic connective tissue diseases that affect tissues supporting the body’s structure, but for many patients without a diagnosis of connective tissue disorder, the cause of the ruptured membrane is unknown.

“Because some patients with unexplained spinal CSF leak show subtle signs of connective tissue disease, even though they do not have a defined diagnosis, we sought to find a genetic cause,” Schievink said.

Investigators, including lead author of the study Cassie Parks, MD, PhD, and co-senior author Hal Dietz, MD, analyzed whole-exome sequencing from 42 patients with unexplained spinal CSF leak and compared the results with more than 3,800 individuals without the condition. They tested how the genetic variants they detected behave in human cells and laboratory mice.

The study found that about 1 in 5 patients with this type of spinal CSF leak had changes in the FBN2 gene, and that these changes appeared significantly more often in patients with CSF leak than in those without the condition.

Additional experiments showed that these genetic changes disrupt the way cells attach to the supportive tissue surrounding the spinal cord, potentially weakening this protective layer. In laboratory mice carrying the same mutations, the spinal lining was more prone to tearing and leaking.

Together, these findings suggest that defects in connective tissue caused by FBN2 variants may increase a person’s risk of developing spinal cerebrospinal fluid leaks.

“By identifying a genetic contributor, we now have the first understanding of cellular events that may be targetable for prevention or treatment of spontaneous CSF leaks,” said Dietz, professor of Genetic Medicine at the Johns Hopkins University School of Medicine.

“Potential future treatments can include medications that strengthen connective tissue or target the biological pathways affected by the FBN2 gene,” Schievink added.

Additional authors include Mukti Singh, Elizabeth Wohler, Renan Martin, Silke Peeters, Emily Juzwiak, Xinyi Sun, Bart Loeys, Nara Sobreira and Claire Baldock.

Funding: This work was supported by the Howard Hughes Medical Institute, the Marfan Foundation, the Pease/Scheeler Fund and the Biotechnology and Biological Sciences Research Council.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

At the crib side, a guitarist and singer serenades newborns hooked up to loud, beeping and flashing monitors. The sounds of gentle humming and guitar strumming do more than soothe a fussy baby—they stabilize vital signs, aid neurological and auditory development, and enhance the overall wellbeing of infants in the NICU.

“Music therapy is a clinical and evidence-based practice using music to address nonmusical goals,” said Laura Cellini, Guerin Children’s board-certified music therapist. “Listening to music can help lower and stabilize heart rate, improve oxygen saturation levels and support a more regulated, calming state for newborns.”

According to Cellini, research has shown that music therapy can also help reduce NICU stays by as many as 12 days.

During a typical session in the NICU, Cellini works one-on-one with each infant, tailoring the therapy to meet every baby’s individual needs. She carefully monitors each newborn’s response to the music, including signs of overstimulation, and adjusts her music accordingly.

The music therapy program was made possible through a generous donation from 14-year-old twins Joey and Ryder Corleto, who spent considerable time in the NICU at Cedars-Sinai shortly after birth. Wanting to give back to the Cedars-Sinai community, the siblings chose to dedicate their bar and bat mitzvah gifts to help launch the program.

Their mother, Melissa Corleto, vividly remembers the challenges of spending time in a noisy NICU with the twins.

“When they look back at pictures of themselves as babies, it’s hard for them to imagine that this is where they started—at just 2.5 and 3.5 pounds,” Melissa said. “The idea of giving back to the NICU really resonated with them. As a family, we decided this was the meaningful way they wanted to give back.”

Music has always played a major role in the twins’ lives. Ryder is an avid drummer, while Joey is a competitive dancer. The twins said it felt natural to use their funds to help launch a music therapy program, especially one designed to soothe babies and support early brain development.

The bedside therapy sessions are also a welcome change of pace for parents and medical staff.

“The NICU can be a very traumatic and stressful environment, and music therapy helps create a sense of calm for the babies, their families and even the staff,” said Ashley Richardson, RN, assistant nurse manager of the NICU at Guerin Children’s.

For Jason Park, whose son Logan Park has spent more than two months in the NICU, watching his baby remain calm and relaxed as Cellini sang and played music at his bedside brought a sense of much-needed comfort and relief.

“I think the music brings a lot of joy to parents, especially for families like ours who have been here in the NICU for a long time,” Park said. “When the session ended, I was actually sad to hear it stop.”

Read more from Cedars-Sinai Stories and Insights: Strengthening Children’s Health

The at-home monitoring device is designed to track early signs of asthma and provides clinicians with continuous or on-demand remote monitoring of lung sounds. The real-time data enables healthcare professionals to monitor a child’s condition between clinic visits and respond early if a child’s symptoms worsen.

The easy-to-wear device, called AeviceMD, was developed by Aevice Health, a Singaporean digital health company and a graduate of the Cedars-Sinai Accelerator program.

“I saw strong potential in this technology to support how we monitor and manage children with reactive airway issues like asthma outside of the clinical setting,” said Irina Dralyuk, MD, a pediatric pulmonologist at Guerin Children’s. “Being able to assess respiratory symptoms in real time, especially overnight, provides valuable information that can guide earlier intervention and help prevent more serious breathing complications.”

About 4.5 million children in the United States have asthma, making it one of the most common chronic pediatric diseases. Traditionally, doctors have monitored children with asthma through periodic clinic visits and caregiver-reported symptoms such as rapid breathing, chest congestion and breathing difficulties.

However, asthma symptoms often fluctuate widely between visits, and self-reported symptoms are often unreliable. This makes managing worsening symptoms between appointments very difficult.

The wearable stethoscope allows parents to utilize the device at home to record lung sounds and securely share recordings with their doctors. The data enables doctors to build a more complete picture of disease progression, track medication use and assess how patients’ symptoms evolve in response to their treatment plan.

“What we’re trying to do is prevent exacerbations, reduce hospitalizations and emergency department visits, and limit the need for interventions such as systemic steroid use to control asthma symptoms,” Dralyuk said. “Intervening early could decrease chronic inflammation and improve lung function and health over time.”

Children can wear the device, about the size of a half-dollar coin, on the chest for up to 10 hours a day. It is designed for use in children 3 and older.

“We built AeviceMD to make this kind of continuous symptom visibility possible. Having our technology deployed at a large, world-class health system like Cedars-Sinai validates our belief that there is a critical, unmet patient need,” said Adrian Ang, CEO of Aevice Health.

The device is the result of a multiyear collaboration with Cedars-Sinai that began in 2022 and included clinical input from physicians at Guerin Children’s. The collaboration included key regulatory milestones and a pilot program to evaluate the device’s effectiveness in pediatric respiratory monitoring. In 2023, the device received clearance from the U.S. Food and Drug Administration.

“This collaboration demonstrates the importance of providing clinical and operational support to help advance a company’s promising technology toward real-world patient benefit,” said Nirdesh K. Gupta, PhD, managing partner of Cedars-Sinai Intellectual Property Company. “It’s an exciting example of how innovation can directly impact care and improve the way we manage chronic conditions like asthma.”

Read more from Cedars-Sinai Stories and Insights: Common Breathing Problems in Kids and How to Treat Them

Neuro NICU is a specialized program that brings together multidisciplinary pediatric specialists to deliver advanced, coordinated care for newborns with complex neurological conditions. Housed within the Neonatal Intensive Care Unit at Cedars-Sinai, the program is designed to provide timely intervention during the crucial period of early brain development.

The Neuro NICU’s comprehensive, multidisciplinary model of care includes leading experts in neonatology, neurology, neurosurgery, neuroradiology and genomics. The staff also includes specially trained NICU nurses and social workers adept at deploying around-the-clock care tailored to the unique needs of newborns and their families.

“The newborn brain is fundamentally different from that of a child or an adult, which is why neurological care at this stage requires highly specialized expertise,” said David Rowitch, MD, PhD, deputy director for Research at Guerin Children’s. “Understanding how the developing brain responds to injury and how to interpret imaging in this context is critical. The Neuro NICU allows us to bring that expertise together in a coordinated way for each patient.”

The Neuro NICU team, led by co-directors Yolanda Brown-Madan, MD, and Xin Ye, MD, is equipped to treat patients with a wide range of neurological conditions, including neonatal seizures, stroke, severe congenital neurological disorders, brain malformations, as well as birth complications and traumatic injuries to the brain or the nervous system.

A defining feature of the Neuro NICU is the early integration of genomics, which allows the team to deliver precision gene therapies and genetic diagnoses to infants sooner. Guerin Children’s is among the first programs to offer rapid whole‑genome sequencing for babies in a NICU setting, with genetic results delivered in a matter of days.

Research at Guerin Children’s has shown that more than 40% of children seen by pediatric neurologists have an underlying genetic condition. Having genetic information readily available can directly influence clinical decisions and improve the ability to personalize care for vulnerable newborns.

“Our comprehensive approach in the Neuro NICU enables Guerin Children’s to deliver a seamless continuum of care as patients improve and grow beyond their stay,” said Shervin Rabizadeh, MD, MBA, chair of the Department of Pediatrics and deputy director of Guerin Children’s.

The Neuro NICU also employs state-of-the-art, infant‑specific technologies, including continuous video electroencephalography (EEG) monitoring, which provides real‑time data to help clinicians intervene quickly during critical moments.

That same level of technological capability extends beyond the unit. Designed to function as a regional center for neonatal neurological care, the Neuro NICU extends its reach to affiliated partners and hospitals in the greater Los Angeles area and beyond. Specialized neonatal transport services allow teams to initiate critical therapies before a baby arrives at Guerin Children’s.

“Our goal is to ensure that newborns receive the right care at the right time, regardless of where they begin their medical journey,” said Rangasamy Ramanathan, MD, director of the Division of Neonatology at Guerin Children’s. “Through advanced transport capabilities and virtual collaboration, the Neuro NICU allows us to support community hospitals and families across the region.”

Additionally, the program offers virtual consultations, enabling neurologists to guide care remotely and support physicians at referring hospitals.

“The launch of the Neuro NICU reflects Guerin Children’s’ commitment to advancing research‑driven, specialized, world-class pediatric care for the most vulnerable patients in greater Los Angeles and beyond,” said Ophir Klein, MD, PhD, executive vice dean of Children’s Health and executive director of Guerin Children’s.

Read more from Cedars-Sinai Stories and Insights: Making Strides in Treating the Smallest Heart Patients

annual meeting, April 24–27 in Boston.

The physician-scientists are available for interviews to discuss new research on improving care in neonatal intensive care units, quality improvement efforts and simulation training for neonatal transport and emergency newborn care.

“As Guerin Children’s continues to evolve as a premier destination for specialty pediatric care in Los Angeles, PAS 2026 is an important opportunity for our pediatricians to share scientific and clinical advances in lifesaving newborn medicine,” said Ophir Klein, MD, PhD, executive vice dean of Children’s Health and executive director of Guerin Children’s.

Simulation Workshops

Rangasamy Ramanathan, MD, MBBS, director of Neonatology at Guerin Children’s, and Mahmood Ebrahimi, MD, a registered diagnostic cardiac sonographer and clinical instructor in Pediatrics, will co-lead a hands-on simulation workshop on targeted neonatal echocardiography. The training focuses on using echocardiography to assess how patent ductus arteriosus, a congenital heart defect, affects blood flow in preterm infants. The workshop is scheduled for Friday, April 24, 10:30 a.m. to noon.

A second simulation workshop, co-led by Ebrahimi, will train clinicians in the use of point-of-care ultrasound (POCUS) for real-world neonatal emergencies and critical care scenarios. This session is scheduled for Friday, April 24, 6:30-8 p.m.

Guerin Children’s Experts Presenting Research at the Meeting

Manoj Biniwale, MD, director of NICU Clinical Research, Division of Neonatology at Guerin Children’s, will present research across multiple sessions on several topics, including clinical trial data evaluating different approaches to umbilical cord management in premature infants and a simulation training session to improve how healthcare providers learn and retain critical newborn resuscitation skills.

Kurlen Payton, MD, assistant director of Quality and Safety at Guerin Children’s, will present research on a multicenter quality improvement initiative that increased maternal breast milk use at discharge for very low birth weight infants, improving outcomes and health equity.

Kyle Willsey, DO, pediatric intensivist at Guerin Children’s, and Lauren Collins, RN, will present how simulation training and neonatal transport impact workload and outcomes among pediatric transport teams.

To arrange interviews with Guerin Children’s experts, contact Shishira Sreenivas at Shishira.sreenivas@cshs.org or 202-297-0220.

Every minute counts when someone has a stroke, which occurs when blood flow to the brain is blocked. Without rapid treatment, brain cells begin dying within minutes, often leaving patients with permanent speech, movement or memory disabilities.

“Stroke is one of the most time-sensitive emergencies in medicine,” said Nestor Gonzalez, MD, director of the Neurovascular Laboratory in the Department of Neurosurgery at Cedars-Sinai. “The faster we restore blood flow to the brain, the more brain function we can preserve.”

Gonzalez’s advice is echoed in the American Heart Association and American Stroke Association’s new 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke. In the first update since 2019, the guidelines recommend more reliance on imaging, catheter-based procedures and emergency first responders. The guidelines also introduce the first national guidance for treating stroke in children.

Gonzalez, co-vice chair of the American Stroke Association group that developed the guideline, sat down with the Cedars-Sinai Newsroom to discuss the updates and leading-edge stroke research.

What are the most important changes in the updated guideline for acute ischemic stroke, in which a clot blocks blood flow to part of the brain?

Stroke treatment has advanced significantly over the past few decades, particularly with the development of clot-dissolving drugs and catheter-based procedures that can remove blockages in the brain. Since the previous stroke guidelines were published in 2019, new clinical trials have expanded our understanding of which patients can benefit from these treatments.

Previous guidelines recommended endovascular [minimally invasive] clot-removal procedures within six hours of stroke onset, with only a small group of selected patients eligible for treatment up to 24 hours after onset. The updated guideline broadens those criteria, allowing more patients to be considered for treatment in the 24-hour time frame.

The guidelines also expand treatment options for patients with large-core strokes—cases in which a significant area of the brain is affected. In the past, physicians were often hesitant to treat these patients because the potential benefit was uncertain. However, several recent studies have shown that intervention can still reduce disability in some cases.

The guidelines also expand eligibility for endovascular clot-removal procedures to include patients with preexisting disabilities, reflecting evidence that treatment may help them return to their baseline level of function.

You are a faculty member at Cedars-Sinai Guerin Children’s, and the updated recommendations include the first dedicated guidance for treating stroke in children. Why is that important?

Stroke can occur at any age, including in children. However, because it is rare, clinicians may not immediately consider stroke when a child presents with sudden neurological symptoms.

The updated guidelines provide clinicians with practical guidance for recognizing and managing stroke in children. Until now, there were no dedicated recommendations specifically addressing treatment in this population. The guidelines address early recognition of stroke symptoms, imaging strategies and circumstances in which treatments such as intravenous thrombolysis [clot-dissolving medication given through an IV] or endovascular thrombectomy [procedure removing clots from the brain] may be considered.

Over the past several years, specialized centers have begun applying some of the endovascular stroke treatments developed for adults to pediatric patients, and outcomes suggest that children can benefit from these interventions.

How will the updated guidelines change the treatment stroke patients receive in hospitals?

The guidelines emphasize improving the entire system of stroke care so patients can be evaluated and treated rapidly. That process begins with recognizing symptoms in emergency medical services, prompt evaluation and use of specialized treatment. They also synthesize a large body of research into recommendations that clinicians can apply in real-world practice.

The updated recommendations also highlight the importance of coordinated stroke systems that include rapid imaging, telemedicine support for smaller hospitals, and efficient patient transport to specialized stroke centers capable of performing advanced procedures, like Cedars-Sinai Medical Center.

For adult stroke patients, many of these systems are already in place. But for pediatric stroke, the impact may be even greater, as many hospitals are still developing formal systems for diagnosing and treating stroke in children.

What areas of stroke research are you most excited about right now?

Much of the recent progress in stroke care has focused on treating patients in the acute phase, when a clot suddenly blocks blood flow to the brain. But another challenge is helping patients whose brains receive chronically reduced blood flow, putting them at risk for repeated strokes. Two conditions that can cause this are Moyamoya disease, which often affects children and young adults, and intracranial atherosclerosis, which is more common in older adults.

In Moyamoya disease, the arteries at the base of the brain narrow or become blocked. To treat it, surgeons can perform bypass procedures that create new pathways to restore blood flow to the brain. My research has focused on improving these techniques and understanding how they benefit patients.

In adults with intracranial atherosclerosis, plaque buildup narrows, thickens or hardens the arteries in the brain. Medications help many patients, but in some cases, it is not enough. Working with the National Institutes of Health, we have been studying a surgical technique called indirect revascularization, or EDAS. Originally developed for children with Moyamoya disease, this approach is now being adapted for adults with severe vascular disease. Early clinical trials have shown encouraging results, and we are working to expand those studies to multiple centers to determine whether the technique can improve outcomes for patients who currently have limited treatment options.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Pediatric interventional cardiology has had meaningful advances over the past decade that are changing how children with congenital heart disease are treated at

Congenital heart defects, which arise from abnormal or incomplete formation of the heart, valves and blood vessels, are among the most common birth defects worldwide. The condition affects approximately 40,000 babies each year in the United States.

From less invasive, catheter-based procedures to improved imaging and emerging technologies, innovations are helping reduce risk, shorten recovery times and expand treatment options for the smallest patients with heart problems.

The Cedars-Sinai Newsroom recently spoke with Stephen Nageotte, MD, MBA, an interventional cardiologist and director of the Congenital Catheterization Laboratory at Cedars-Sinai Guerin Children’s and the Smidt Heart Institute. Nageotte treats children and adults using minimally invasive procedures. He shared what’s new in the field and what families need to know:

What are the most significant advances you’ve seen in pediatric interventional cardiology in recent years?

Over the past five years, there have been major advances in three key areas:

• Premature patent ductus arteriosus [PDA] closure. It’s a congenital heart condition in which a connection between two blood vessels in an infant fails to close after birth. This can cause abnormal blood flow to the lungs and breathing difficulties, particularly in premature infants.
• Transcatheter pulmonary valve replacement, which is a minimally invasive procedure in which we replace a faulty heart valve using a catheter instead of surgery.
• PDA stenting. Sometimes babies have heart problems that limit blood flow to the lungs. We can keep a small vessel called the ductus arteriosus open by placing a tiny tube, or stent, inside it to improve blood flow.

All three procedures have evolved significantly and are allowing us to treat patients in less invasive ways, often replacing or delaying the need for surgery.

How has transcatheter PDA closure changed care for premature infants?

Transcatheter PDA closure has become an important option for premature infants with a hemodynamically significant PDA—meaning the vessel is causing strain on the heart and lungs. In fact, Evan Zahn, MD, of the Smidt Heart Institute, helped develop the device cardiologists use to close a PDA during a transcatheter procedure.

The procedure is quick and can be done at the bedside in the Neonatal Intensive Care Unit [NICU], which helps us avoid transporting fragile infants. Research also suggests many babies show respiratory improvement after closure, which may reduce complications associated with long‑term ventilation.

Who is typically a candidate for the transcatheter PDA closure?

These procedures are generally for premature infants who are showing signs that the PDA is affecting their health, such as needing increased respiratory support or showing enlargement of the heart. There’s no strict minimum weight requirement, and the focus is really on whether the PDA is having a meaningful impact on the baby’s heart and lungs. Transcatheter PDA closure is also performed on older kids and adults.

What impact has new device technology had on how these procedures are performed?

One recent advancement is an improved delivery system for PDA closure devices. The device, known as the Amplatzer Piccolo Delivery System, recently received FDA [Food and Drug Administration] clearance to treat premature infants with PDA, including babies weighing as little as 2 pounds. Previously, the procedure required exchanging multiple catheters during the case, which could introduce instability; the newer system allows physicians to navigate and deliver the device using a single, shorter, softer catheter, potentially improving patient stability and precision.

How has transcatheter pulmonary valve replacement expanded treatment options for patients?

The development of newer self‑expanding valves has significantly increased the number of patients who can receive pulmonary valve replacement through a catheter instead of surgery. These procedures are typically considered from late childhood through adulthood and are used for patients with pulmonary valve disease related to congenital heart conditions. Early outcomes have shown good durability and high success rates.

Imaging plays a big role in heart care. What improvements are making the biggest difference?

There have been significant advances in cardiac CT and MRIs. Imaging is faster, clearer and uses lower radiation doses than in the past. These tools help us better understand heart anatomy, blood flow and timing for interventions. There’s also growing interest in using virtual or augmented reality to create 3D heart models for procedure planning, allowing teams to better visualize anatomy before a procedure.

What should families know as they navigate a congenital heart diagnosis?

Early detection and screening are incredibly important, ideally before birth, so families can meet the care team and understand what to expect. At Cedars-Sinai we can identify a defect while a baby is still in the womb and will continue to care for the baby at birth, during childhood, and all the way through adulthood, so the patient never needs to transfer to another institution.

Congenital heart care is lifelong and truly a team effort. Families aren’t expected to understand every technical detail—our role is to guide them, answer questions and be there every step of the way. Building long‑term relationships with patients and families is one of the most meaningful parts of this work.

Read more from Cedars-Sinai Stories and Insights: Making Strides in Treating the Smallest Heart Patients

The discovery, published in Cell, has important implications for understanding how a wide variety of intestinal disorders may develop.

“Our research opens the door to treatments that focus on restoring key molecular signals in vulnerable regions of the colon,” said Ophir Klein, MD, PhD, executive director of Cedars-Sinai Guerin Children’s, executive vice dean of Children’s Health, and the David and Meredith Kaplan Distinguished Chair in Children’s Health. Klein is the senior author of the study.

Prior research has shown that the four sections of the colon—ascending, transverse, descending and sigmoid—have different functions and risks for disease, but it wasn’t clear why these variations exist.

In this study, the investigators showed that the identity of distinct regions of the colon are regulated by the gut microbiome. They identified nicotinic acid, a molecule produced by certain bacteria in the gut microbiome, as a main driver of these regional differences in the colon’s sections. Nicotinic acid, also known as niacin, part of the vitamin B3 family, helps the body convert food into energy and supports the health of cells.

The researchers compared laboratory mice with and without a microbiome. They found that production of nicotinic acid by bacteria in the upper colon activates a protective mechanism in colon cells. In mice without a microbiome, minimal nicotinic acid was produced, and cells in the upper colon became more vulnerable to damage and disease.

Investigators also studied human colon tissue samples. They found that the different sections of the human colon showed regional characteristics similar to patterns observed in mice. And in samples from human patients with Crohn’s disease— a type of bowel disease in which abnormal immune system activity causes inflammation—this protective mechanism was reduced.

“Our work highlights the importance of studying host microbiome interactions with careful attention to specific colon regions, rather than treating the colon as a uniform organ,” said Jeremie Rispal, PhD, a postdoctoral scholar at the University of California, San Francisco, and the first author of the study. “We learned that the microbiome controls regional differences and tissue protection.”

Further study will be needed to confirm the precise mechanisms behind this protective effect and to determine how these findings might be used in new therapies for intestinal disorders.

Additional Cedars-Sinai authors include Manasa Vegesna, Dedeepya Vaka, and Dario Boffelli .

Other authors include Jasmine R. Garcia, Brisa Palikuqi, Seung Woo Kang, Coralie Trentesaux, Juan Du, Nicola R. Realini, Paige N. Spencer, James M. Gardner, Annika Hausmann, Michael G. Kattah, and Ken S. Lau.

Funding: This work was funded by NIH U01DK103147 from the Intestinal Stem Cell Consortium (to O.D.K. and D.B.), RC2-DK140862 (to O.D.K. and D.B.), R01DK103831 (to K.S.L.), F31DK127687 (to P.N.S.), T32HD007502 (in support of P.N.S.), T32CA119925 (in support of S.K.), the Leona M. and Harry B. Helmsley Charitable Trust G-1903-03793 (to the VUMC Gut Cell Atlas of which K.S.L. is a member), the Stanley Cohen Innovation Fund (to K.S.L.), the Benioff Center for Microbiome Medicine (to J.R.), and the PZ00P3_223765 SNSF Ambizione grant (to A.H.). Organoid work was supported by funding from the Kenneth Rainin Foundation and NIH R01 DK14167. The Kattah Lab has received research support from Eli Lilly. J.R. was supported by the Bakar Aging Research Institute postdoctoral fellowship and the Bettencourt Schueller foundation.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

This condition not only can accelerate cognitive decline but is often mistaken for an underlying neurological condition—delaying proper diagnosis and treatment.

In a recent review published in the journal Alzheimer’s & Dementia, Cedars-Sinai researchers explored how UTI-induced delirium affects brain function, why individuals with dementia are especially vulnerable, and the critical need for early recognition and intervention.

“It’s a vicious cycle where dementia increases the risk of infection, and infection-related delirium accelerates cognitive decline,” said Shouri Lahiri, MD, principal investigator of the Critical Care Neurodegenerative Medicine Lab, director of the Neurosciences Critical Care Unit and Neurocritical Care Research at Cedars-Sinai, and senior author of the review.

Previous laboratory studies by Lahiri and his colleagues revealed that the immune system’s response to UTI-induced delirium—specifically the inflammatory protein interleukin-6—can cause changes in the brain. Blocking this pathway reversed delirium-like symptoms in mice.

Lahiri sat down with the Cedars-Sinai Newsroom to discuss UTIs as a potentially preventable and treatable contributor to cognitive decline and the importance of early recognition and swift treatment.

What is delirium, and how is it different from memory loss?

Delirium is a sudden change in thinking and awareness. It affects attention, judgment and short-term memory, and develops over hours or days.

Memory loss from conditions such as Alzheimer’s disease progresses slowly over time. Delirium, by contrast, is acute and usually triggered by a medical illness, such as a urinary tract infection, dehydration or infection elsewhere in the body.

Why can urinary tract infections cause confusion, especially in older adults?

Our research shows UTIs can cause acute brain dysfunction through inflammation. An infection in the bladder releases inflammatory signals into the bloodstream, which can affect the brain and disrupt normal function, leading to delirium.

Older adults are more vulnerable because their brains are often less resilient to physiological stress.

UTIs aren’t the only infections that can trigger this response. Any systemic infection, including pneumonia, gastrointestinal infections or skin infections, can provoke widespread inflammation that affects the brain and causes acute confusion.

Why are people with Alzheimer’s disease at higher risk for UTIs?

People with Alzheimer’s may have challenges upkeeping with hygiene and age-related hormonal changes that increase UTI risk. Alzheimer’s can also impair sensation and communication, making it harder for patients to recognize or report well-known UTI symptoms such as burning or urgency to urinate. As a result, infections may go untreated until they trigger delirium.

For people without dementia, delirium increases the risk of developing dementia by about threefold. Repeated episodes further raise that risk.

Why can a UTI make Alzheimer’s symptoms suddenly worse?

A UTI can cause a rapid cognitive decline that looks like a sudden worsening of Alzheimer’s disease. The key difference is timing. Alzheimer’s progresses gradually, while delirium causes an abrupt change from a person’s baseline.

We believe inflammation related to infection places added stress on an already vulnerable brain, which can worsen dementia symptoms and, in some cases, cause lasting damage.

Is delirium from a UTI reversible?

Early treatment offers the best chance for recovery. When UTIs are identified and quickly treated, delirium symptoms can improve or resolve. However, in some cases, cognitive effects can persist or become permanent. That’s why early recognition is critical.

Because UTIs don’t always cause obvious urinary symptoms, especially in older adults, we need to change the way we diagnose UTIs, using a mix of clinical observations and urinary and blood tests that show infection, to recognize when a UTI is behind sudden confusion.

How can caregivers tell the difference between Alzheimer’s progression and a UTI?

Sudden change is the biggest warning sign. Dementia generally does not cause abrupt declines. If someone with Alzheimer’s suddenly becomes much more confused, less alert or behaves very differently, that may signal delirium.

Other changes to look out for include changes in urination patterns, incontinence, pain, or changes in urine color or odor.

What can caregivers do to help prevent UTIs and delirium?

Caregivers should make sure the person they’re taking care of maintains good hygiene and adequate hydration. Caregivers should also notify a physician if UTIs are recurrent, because treatments are available to reduce repeated episodes.

Also, being aware of sudden changes in mental status and seeking prompt medical care can make a significant difference.

Are UTIs linked to delirium in other neurological conditions?

Yes. Parkinson’s disease is a key example. Many people with Parkinson’s have difficulty fully emptying their bladder, which increases infection risk. UTIs can worsen Parkinson’s movement symptoms, just as they worsen cognition in Alzheimer’s disease.

What is your lab studying next?

We are studying new drugs that target inflammatory pathways involved in UTI-related brain dysfunction, with the goal of advancing them to clinical trials. We are also developing diagnostic approaches to better identify UTIs in patients who  don’t have the well-known urinary symptoms.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

The 39-year-old father, who plays softball and ice hockey and spends weekends off-roading, was no stranger to minor injuries. But the anti-inflammatory drugs prescribed by his primary care physician only gave Starsiak temporary relief. Over the next few months, his hips stiffened, and he began to lose sensation and muscle mass in his leg.

Then, during a business trip, the pain caused Starsiak to reach a breaking point.

“I could not walk from one gate to the next at the airport and ended up having a breakdown, crying because I was in so much pain,” Starsiak said.

After multiple doctor visits, including a trip to the emergency room, an MRI revealed the cause: a 2-centimeter cyst lodged on the front side of a nerve, tucked beneath a joint in his spine. Its location made it particularly difficult to treat.

A physician near his home in Orange County referred Starsiak to Corey Walker, MD, an assistant professor of Neurosurgery and Orthopaedics at Cedars-Sinai, who specializes in minimally invasive and complex spine cases.

Starsiak, a medical device salesman with a focus on orthopedic products, was familiar with surgical options and trusted his instincts in choosing Walker to oversee his care.

“When I met Dr. Walker, I immediately knew he was the right surgeon—someone of integrity who listened carefully and was deeply passionate about his craft,” Starsiak said.

Cyst Removal Without Spinal Fusion

Walker performs endoscopic spine surgery, a minimally invasive technique that uses a small endoscope—about the width of a pen—to navigate hard-to-reach places inside the body. Compared with traditional surgery, the minimally invasive approach typically results in smaller incisions, less tissue damage and faster recovery.

In Starsiak’s case, the cyst was compressing nerves against his spinal canal, interfering with their ability to send signals between his brain and leg. That pressure can lead to loss of strength, sensation and coordination.

Removing the cyst would be challenging. In order to access the nerve and underlying cyst, a surgeon typically would need to remove a spinal joint and fuse the vertebrae with rods and screws to stabilize them.

“That would have been a life-altering operation for someone his age,” Walker said. “Fusion puts added stress on surrounding joints and can lead to future surgeries.”

Instead, Walker took a different approach.

Using an ultra-minimally invasive endoscopic procedure, Walker accessed the cyst through an endoscope with a small camera attached. After locating the affected nerve, he and his team were able to use the endoscope to guide them in removing the cyst—without cutting muscle, removing the joint or injuring the nerve.

“We had what felt like an impossible task,” Walker said. “I’m proud that Cedars-Sinai is able to treat patients who have complex cases.”

For Starsiak, avoiding fusion was critical.

“I was worried a fusion would significantly hamper—if not end—my ability to play sports and lift weights,” he said.

Life-Changing Relief

When Starsiak woke up from the procedure, he immediately felt relieved of the pain and pressure, as if a rock had been removed from his back.

His recovery took about eight weeks, and he focused on restoring mobility and strength in his hips, legs and back. Today, Starsiak is back to his normal routine—playing sports, off-roading and lifting weights at the squat rack.

The experience also changed his mindset.

Before the injury, Starsiak said, he measured success largely by career advancement. As a father of two, losing his mobility forced him to reconsider his priorities.

“The second you lose your health, you realize none of the other things really matter,” he said. “You can’t enjoy success if you’re not healthy.”

For Walker, that impact is what makes the work meaningful.

“As a neurosurgeon, it’s incredible to hone your craft—to work with your hands and see a problem fixed by the end of surgery,” he said. “But what’s even more rewarding is hearing later how it’s changed someone’s life—that’s the best part.”

Read more from the Cedars-Sinai Newsroom: Defying the Odds – Father's Love Leads to Life-Changing Surgery

The study shows for the first time that Chlamydia pneumoniae can reach the retina—the tissue lining the back of the eye—where it triggers immune responses linked to inflammation, nerve cell death and cognitive decline.

“Seeing Chlamydia pneumoniae consistently across human tissues, cell cultures and animal models allowed us to identify a previously unrecognized link between bacterial infection, inflammation and neurodegeneration,” said Maya Koronyo-Hamaoui, PhD, professor of Neurosurgery, Neurology, and Biomedical Sciences at Cedars-Sinai Health Sciences University and the leading, senior author of the study. “The eye is a surrogate for the brain, and this study shows that retinal bacterial infection and chronic inflammation can reflect brain pathology and predict disease status, supporting retinal imaging as a noninvasive way to identify people at risk for Alzheimer’s.”

To conduct the study, researchers used advanced imaging, genetic testing and protein analysis to examine retinal tissue from 104 individuals, some with normal cognition, some with mild cognitive impairment and some with Alzheimer’s disease.

They found significantly higher levels of Chlamydia pneumoniae in the retinas and brains of people with Alzheimer’s disease than they found in people with normal cognition. The higher the bacterial levels detected, the more severe the brain changes and cognitive decline investigators found.

Higher levels of the bacterium were more common in people who carried the APOE4 gene variant, a known risk factor for Alzheimer’s disease.

Investigators also studied human neurons in the lab and in laboratory mice with Alzheimer’s disease. In both, infection with Chlamydia pneumoniae increased inflammation, nerve cell death and cognitive decline, showing the bacterium can accelerate disease processes. The infection also triggered production of amyloid-beta, the protein that accumulates in the brains of people with Alzheimer’s.

The findings were driven by co-first authors Bhakta Gaire, PhD, and Yosef Koronyo, MSc.

“This discovery raises the possibility of targeting the infection-inflammation axis to treat Alzheimer’s,” said Timothy Crother, PhD, co-corresponding author of the study and research professor at Cedars-Sinai Guerin Children's and the Department of Biomedical Sciences at Cedars‑Sinai.

The findings suggest that targeting chronic bacterial infection—and the inflammation it triggers—could represent a new treatment strategy. The research also supports potential use of the retina as a noninvasive way to help diagnose and monitor the disease.

Additional Cedars-Sinai authors include Bhakta Gaire, Yosef Koronyo, Jean-Philippe Vit, Alexandre Hutton, Lalita Subedi, Dieu-Trang Fuchs, Natalie Swerdlow, Altan Rentsendorj, Saba Shahin, Daisy Martinon, Edward Robinson, Alexander V. Ljubimov, Keith L. Black, Jesse Meyer, and Moshe Arditi.

Other authors include Julie A. Schneider, Lon S. Schneider, Debra Hawes, Stuart L. Graham, Vivek K. Gupta, and Mehdi Mirzaei.

Funding: This work has been supported by the NIH/NIA grants R01AG056478, R01AG055865, and AG056478-04S1 (M.K.H.), R01AG075998 (M.K.H. and T.R.C.), and Alzheimer’s Association grant AARG-NTF-21-846586 (T.R.C.). MKH is also supported by The Goldrich and Snyder Foundations. ER has been supported by The Ray Charles Foundation.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

“The natal teeth were little paper-thin teeth that fell out right away, as they didn’t have well-developed roots. And, where I had natal teeth, I had no secondary teeth later in life,” said Graham, a retired professor of Medical Genetics and Pediatrics and former director of the Division of Clinical Genetics and Dysmorphology at Cedars-Sinai. “The condition is called tooth agenesis.”

Tooth agenesis can pose challenges such as difficulty breastfeeding, confidence issues due to missing teeth and costly out-of-pocket expenses for dental work.

Graham experienced those challenges firsthand. Correcting his missing teeth required extensive dental implants, procedures that continued well into adulthood. And as a teen active in sports, he frequently required repairs to fix chipped teeth.

The puzzling condition affected five generations of Graham’s family, beginning with his maternal grandfather. Graham’s mother wore false teeth for much of her life, and several of her siblings showed signs of the condition. Two of his three sons were born with natal teeth, and a granddaughter is also affected.   

Graham had a strong hunch that it was an inherited genetic condition. That curiosity ultimately shaped his career. Graham pursued genetics in medical school, driven in part by a desire to understand the condition affecting his family. Years later, he began a formal search for the responsible mutation.

After more than 12 years of research, the mystery has finally been solved.

In a study published in the International Dental Journal, a team of investigators led by Graham and his longtime Cedars-Sinai colleague Pedro Sanchez, MD, identified a mutation in the KDF1 gene as the likely root cause of natal teeth. While natal teeth are relatively common and occur in approximately 1 in every 1,000 newborns, KDF-1-related multiple natal teeth with tooth agenesis is quite rare.

Finding the Gene Mutation

Finding the mutation was not a simple task. For Graham’s first attempt in 2013, he ran tests on DNA samples he collected from affected and unaffected family members. But the genetic testing tools available at the time were not advanced enough to comb through the 20,000 genes in the human genome.

“In order to make a gene discovery, you have to know it's there, and you have to know what it does,” Graham said. “The same gene can give rise to different genetic diagnoses. And how it does that, it's not always clear.”

Years later, as Graham prepared for retirement, Sanchez, Graham’s mentee and director of Pediatric Medical Genetics at Cedars-Sinai Guerin Children’s, encouraged him to revisit the research.

Sanchez credits Graham with inspiring his own path into genetics. Over the years, the two developed a close professional and personal bond, even co-authoring medical textbooks.

“I know him, I know his family, and I'm the same age as his kids,” Sanchez said. “Knowing this condition had affected them for generations without closure, I felt there was a missing piece. The tools had evolved, and I believed we could work together and find an answer.”

A Detailed Look Into DNA

When Sanchez revisited Graham’s family data with fresh eyes and newer genetic tools, he took a more targeted approach and focused on collecting DNA samples from four family members: Graham and one affected son, as well as Graham’s wife and one unaffected son, who served as controls.

This time, Sanchez deployed whole genome sequencing, a comprehensive test that analyzes a person’s entire DNA sequence.

“I treated them just like a family we see in our clinic,” Sanchez said. “We ended up doing a focused exam, and we sequenced all four of them.”

The strategy worked.

The team pinpointed a mutation in the KDF1 gene, which is known to play a role in epidermal development, including structures like skin and teeth.

The finding doesn’t offer a cure for tooth agenesis, but it opens doors to earlier diagnosis, improved counseling for families and a pathway for research into potential treatments. It may also strengthen advocacy efforts for dental insurance coverage.

For Graham, however, the impact is more than scientific. After decades of questions, the answer is finally in hand, bringing a sense of closure to a family that dealt with this trait for generations. Sanchez said he’s honored to be part of the solution.

“Dr. Graham, as a mentor, taught me to be a physician,” Sanchez said. “It's really nice that he was able to share the findings with his family and finally give the gene variant that has affected them for generations a name.”

Read more from Cedars-Sinai Stories and Insights: How Do Your Genes Fit? Cracking the Code on Breast Cancer Risk

The new study, called BLOOMS (Babies’ Longitudinal Outcomes, Omics and Milestones Study), launched last year with the goal of recruiting approximately 1,000 infants admitted to neonatal intensive care units (NICUs) at Cedars-Sinai and another 1,000 infants admitted to NICUs across three National Health System (NHS) hospitals in the United Kingdom. In addition to Guerin Children’s, BLOOMS brings together an international research team led by investigators at the University of Cambridge in the U.K. and collaborators in Singapore from the Agency for Science, Technology and Research (A*STAR).

Using genomics to address urgent health needs of the sickest, most vulnerable babies in the NICUs, the research aims to predict future health complications that might affect children’s school readiness by age 5.

“The study is part of the ambition at Guerin Children’s to integrate genomics into care across the lifespan,” said David H. Rowitch, MD, PhD, the principal investigator of BLOOMS and deputy director of Research at Guerin Children’s. “With the support of the Wellcome Trust funding and global collaboration across three countries, we are opening new pathways to better understand the challenges associated with NICU admission so that we can effectively support every child’s full potential.”

While most institutions in the consortium can perform whole genome sequencing to identify genetic risks, Cedars-Sinai’s unique expertise in proteomics—advanced tools to study the structure and function of proteins in real time—provides further valuable insights. Cedars-Sinai investigators aim to use proteomics to identify early disease biomarkers that might predict health and neurodevelopmental conditions that affect school readiness.

Having early access to often overlooked yet vital information about at-risk NICU babies could significantly aid in mitigating future health and developmental challenges by understanding disease origins and in driving targeted treatments.

The study will incorporate the outcome of school readiness, a common assessment tool in the U.K. typically used to measure a child’s physical, cognitive, social and emotional development for integrating into the formal schooling system. This important predictor of early life-course trajectory may be positively influenced by early medical and educational interventions.

“By early identification of school readiness issues such as a learning disability—especially in NICU babies—we can enable medical teams to potentially implement timely interventions, including precision medicine approaches based on genetic makeup to improve the life trajectory for these children,” said Catherine Aiken, MD, chief lead investigator of the study and an academic clinical lecturer in the Department of Obstetrics and Gynaecology at the University of Cambridge.

The study will follow the recruited children until they reach the age of 5, with results expected to be reported by 2033.

“International collaboration is key to advancing research and solving global health challenges,” said Neerja Karnani, PhD, deputy director at A*STAR Bioinformatics Institute and senior principal investigator at the A*STAR Institute for Human Development and Potential (A*STAR IHDP).  

Singapore’s participation in BLOOMS, supported by A*STAR BII’s expertise in secure data analytics, will create opportunities to integrate and align early childhood development initiatives and strategies with the U.K.

By pooling diverse genetic data from the participating institutions, the investigators hope to initiate a paradigm shift in diagnosing and treating early childhood diseases, moving toward a more proactive approach to addressing pediatric health complications on multiple continents as early as possible. 

“The BLOOMS study is a testament to Cedars-Sinai's unwavering commitment to advancing pediatric care through leading-edge research,” said Shlomo Melmed, MB, ChB, executive vice president of Medicine and Health Sciences and dean of the Medical Faculty at Cedars-Sinai. “By participating in this global collaborative effort, we are enhancing our understanding of genomics and improving long-term health outcomes for newborns and their families.”

Read more from Cedars-Sinai Stories and Insights: A Map of Disease Beginnings

Pediatric epilepsy affects nearly 470,000 children in the United States, making it the most common childhood brain disorder. There are many types of epilepsy, including Dravet syndrome, a rare and severe form of the condition, caused by a specific genetic mutation that typically begins in the first year of life. It affects 1 in 15,700 children and significantly impacts quality of life.

“Dravet syndrome is the most common genetic epilepsy disorder we see in children that requires specialized care and attention,” said Deborah Holder, MD, program director of Pediatric Epilepsy at Guerin Children’s. “Awareness is critical so families and healthcare providers can recognize the early signs and seek the right interventions.”

With November marking Epilepsy Awareness Month, the Cedars-Sinai Newsroom recently spoke with Holder to learn more about Dravet syndrome, early signs of seizures to watch for, how genetics play a role and why increased awareness and early detection can be life-changing.

What is Dravet Syndrome?

Dravet syndrome is a type of epilepsy that presents in childhood. It's predominantly caused by a mutation in a gene, specifically a sodium channel gene called SCN1A, which is one of the genes that impact how the brain works. It usually starts with seizures in childhood. Most children have their first seizure, usually between one year and 18 months, although it can start as young as six months.

What are the Symptoms of Dravet Syndrome?

Patients with Dravet syndrome typically present with seizures triggered by high fevers, which can be caused by illness, infection or fever occasionally following vaccination. Early seizures are often hemiclonic, meaning they involve rhythmic motor activity on one side of the body. A seizure may occur on the left side of the body the first time and then on the right side of the body the next time. 

A doctor will see a patient come in with these very long, often prolonged seizures, which we call status epilepticus. Such seizures require significant intervention with lots of medications and hospital care.

Children with Dravet syndrome face multiple challenges, including developmental difficulties that may lead to behavioral disorders, delayed language and speech issues, nutrition and sleeping difficulties and abnormalities in gait and walking. Additionally, the condition can affect other parts of the body, such as the heart.

How is Dravet Syndrome Diagnosed?

Because Dravet syndrome is one of the most common genetic epilepsy disorders in children, it’s important to perform genetic testing early. Identifying the underlying mutation allows us to make an accurate diagnosis. Evaluating the child’s seizure patterns and seizure type also helps us gather the information needed to choose the right medications to bring seizures under control.

The challenge with Dravet syndrome lies in the way it affects a child’s genetics. Although patients may appear to have long focal seizures, the medications typically used for focal seizures can actually make their condition worse. This is why it’s really important that we make the genetic diagnosis so we can treat the gene mutation, instead of the seizure type. It’s also important to note that

Is Dravet Syndrome an Inherited Disorder?

Dravet syndrome is not usually inherited from the parents. Many people hear “genetic disorder” and assume it occurs when the gene is passed down from the mother or father, but most genetic epilepsies are what we call “de novo,” meaning the mutation occurs for the first time in the child and is not connected to family history. Even if the parents are completely healthy, a child can be diagnosed with Dravet syndrome. In other words, any baby could potentially be at risk.

How is Genetic Testing Performed for Dravet Syndrome?

Genetic testing now is very easy. We just do a cheek swab. We don't even have to do a blood test. For pediatric patients, we typically do what's called whole exome sequencing, which really sequences all of the genomes we're familiar with today. Instead of doing a panel where we look at the most common genes that cause epilepsy, we really sequence everything. This way, we don't miss any of the genes that we are currently aware of, including SCN1A, the gene that causes Dravet syndrome.

How Do You Treat Dravet Syndrome?

Several anti-seizure medications are specifically approved for Dravet syndrome, including cannabidiol (CBD), which has been formally studied and found effective to manage the condition. However, medications don’t work for everyone, so other approaches can help.

Diet therapy, such as the ketogenic diet—a high-fat, low-carb diet that puts the brain into ketosis—can be very effective. We typically combine medication and diet therapy for the best results.

Additionally, there are several devices and rescue therapies available to help stop prolonged seizures and reduce hospital stays for children with Dravet syndrome. The vagus nerve stimulator is a device commonly used for Dravet syndrome. We place a wire along the vagus nerve, which is a nerve that runs along the neck. The device is designed to continuously monitor the heart rate and, when it detects a rise in heart rate and seizure activity, it sends signals to the brain to both prevent and stop seizures in its tracks.

Currently, there are also a few clinical trials exploring gene-modifying therapies. These approaches aim to directly target the underlying genetic cause, potentially controlling Dravet syndrome more effectively and improving the quality of life for children.

Read more on the Cedars-Sinai Blog: Personalized Epilepsy Treatment for Each Child

To kick-start some Halloween magic, excited parents picked out outfits specially hand-sewn by Cedars-Sinai volunteers to accommodate the hospital’s littlest patients, bringing big smiles and a touch of normalcy in an otherwise stressful time.

“It’s hard to be in the NICU,” said Alva Pantig Gregorio, a clinical social worker who helps parents navigate their child’s stay in the NICU. “Celebrations can be difficult to keep up with when you’re at the hospital with a fragile baby. So, we bring the baby’s first Halloween to them.”

The babies’ costumes, all inspired by children’s books, included pumpkins, a watermelon, a snowman, a caterpillar, an ear of corn and a peanut, complete with a matching hat.  

Lauren Masciarelli’s son, Wesley, surprised everyone by being born two months early, and the doting mom was thrilled to pick out a classic first Halloween costume for her newborn.

“I always liked being a pumpkin as a kid, and I joked with my husband that his first costume next year could be a pumpkin. So, when I saw this, I had to go for it,” Masciarelli said. “This costume is the best quality costume I think he'll ever have in his life.”

Each outfit is lined with Velcro and tailored to accommodate the tubes, wires and other medical equipment. Parents get to take the keepsake costumes home to remember their baby’s first Halloween.

Dana Guerin, director of the Shapell Guerin Family Foundation, stopped by the NICU to join in on the fun celebration.  She was touched by the staff’s and volunteers’ dedication, exceptional care and attention to detail.

“It’s very clear that there is so much hard work and so much love that goes into this event,” Guerin said. “They go the extra mile to bring vulnerable babies, their families and the community together for a day to remember.”

Read more on the Cedars-Sinai Blog: Helmet Safety for Your Kids

The researchers will use stem cells to improve the effectiveness of oral tissue grafting—a procedure thousands of patients undergo each year in which tissue is transplanted from another part of the mouth to improve or repair trauma from significant tissue loss. In about 1 in 4 patients, the grafts fail due to various factors, including lack of blood supply to the graft, infection and poor healing.

The study is funded by a new five-year $5.7 million grant from the National Institutes of Health (NIH) and supports a multidisciplinary team from Guerin Children’s, Virginia Commonwealth University (VCU) and the University of California, San Francisco (UCSF).

"Our goal is to deepen our understanding of the oral mucosa and to learn how to enhance mouth tissue healing,” said Ophir Klein, MD, PhD, co-principal investigator of the study, executive director of Guerin Children’s and executive vice dean of Children’s Health at Cedars-Sinai. “We plan to turn stem cells into personalized oral tissue grafts that we hope will improve outcomes for patients.”

Oral mucosa is the soft tissue lining the inside of the mouth, including the cheeks, gums and tongue. It serves as a protective barrier against bacterial infection and injury, aiding in essential functions like speaking, chewing and swallowing.

For the preclinical research, the team will grow oral tissue in the lab using induced pluripotent stem cells—adult cells that are reprogrammed into cells that can be turned into virtually any cell type—from laboratory mice. The team hopes to be able to produce, in any needed amount, personalized living grafts with blood vessels that closely resemble natural oral tissue.

“Using advanced bioengineering tools, we can create complex tissues with tiny blood vessel networks that build themselves in a short period of time,” said Zev Jordan Gartner, PhD, co-principal investigator on the study and professor of Pharmaceutical Chemistry at the UCSF School of Pharmacy.

This method, Gartner said, will help the team design custom tissue grafts that could potentially be used in any part of the mouth.

Kevin Matthew Byrd, DDS, PhD, co-principal investigator on the study and assistant professor in the Philips Institute for Oral Health Research at the VCU School of Dentistry, said the research could potentially transform reconstructive care for head and mouth injuries.

“By customizing grafts to fit individual patient needs, we are advancing toward more personalized and effective dental treatments,” Byrd said. “This research has the power to notably improve care quality and establish new dental health standards.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

pediatric specialists will join their peers at the American Academy of Pediatrics (AAP) 2025 National Conference & Exhibition Sept. 26-30 in Denver and will be available to comment on breaking news from the conference.

“In just a few short years, Guerin Children’s has assembled a robust roster of world-class pediatric specialists,” said Ophir Klein, MD, PhD, executive vice dean of Children’s Health and executive director of Guerin Children’s. “In our state-of-the-art facility in the heart of Los Angeles, we’ve created a pioneering healthcare destination with physicians and scientists who deliver exceptional multidisciplinary care and drive innovative research to address childhood diseases—from the womb through adulthood.”

One of these experts, neonatologist Theodora Stavroudis, MD, will serve as chair-elect of the AAP Section on Simulation and Innovative Learning Methods. At the conference, Stavroudis will present original research on neonatal resuscitation.

Guerin Children’s will also have a booth in the exhibit hall—Booth 1738—to showcase the institution’s research, medical education programs and clinical innovations.

Some of the Guerin Children’s experts available for interviews include:

Adolescent Health
Michelle Escovedo, MD, adolescent health specialist

Behavior and Development
Cesar Ochoa-Lubinoff, MD, director of Developmental-Behavioral Pediatrics

Cardiology
Evan Zahn, MD, co-director of the Guerin Family Congenital Heart Program
Richard Kim, MD, director of Pediatric and Congenital Heart Surgery

Ear, Nose and Throat
Gene Liu, MD, director of Academic Otolaryngology at Cedars-Sinai

Epilepsy
Deborah Holder, MD, program director of Pediatric Epilepsy 

Gastroenterology
Shervin Rabizadeh, MD, MBA, chair of the Department of Pediatrics and associate director of Guerin Children’s

General Surgery
Eugene Kim, MD, pediatric surgeon-in-chief and deputy director of Guerin Children’s

Genetics 
Pedro Sanchez, MD, director of Pediatric Clinical Genetics
Saquib Lakhani, MD, director of Guerin Children's Early Detection Program
Mustafa Khokha, MD, director of Guerin Children's Genetics Research Center
Joyce So, MD, PhD, chief genomics officer at Cedars-Sinai

Infectious Disease
Priya Soni, MD, assistant professor of Pediatrics

Neurology
Jane Tavyev Asher, MD, director of the Division of Pediatric Neurology

Neurosurgery
Moise Danielpour, MD, director of Pediatric Neurosurgery

Oncology
Leo Mascarenhas, MD, director of Pediatric Hematology and Oncology

Orthopedics
David L. Skaggs, MD, director of Pediatric Spine and Pediatric Orthopaedics at Guerin Children’s

Plastic Surgery
Victor Chien, MD, director of Cleft and Craniofacial Surgery

Contact: 
To arrange interviews with Guerin Children’s specialists, contact Shishira Sreenivas at shishira.sreenivas@cshs.org or 202-297-0220.

So brings more than 15 years of leadership experience in research and clinical care to her new role. She will spearhead Cedars-Sinai’s growing genomics initiatives and serve as a strategic leader for the integration of genomics into clinical practice while overseeing genetics and genomics services across the Cedars-Sinai Health System.

“We are excited to welcome Dr. So to Cedars-Sinai, knowing her exceptional expertise and leadership in clinical genetics will be a significant asset to the burgeoning prenatal, pediatric and adult genetics programs,” said Shlomo Melmed, MB, ChB, executive vice president of Medicine and Health Sciences and dean of the Medical Faculty at Cedars-Sinai. “Her appointment will ensure Cedars-Sinai remains at the forefront of genomic endeavors, benefiting and transforming the lives of our patients.”

So has joined Cedars-Sinai from the University of California, San Francisco (UCSF), where she was chief of the Division of Medical Genetics and medical director of Adult Genetics. She was also director of the institution’s designation as a National Organization for Rare Disorders Rare Disease Center of Excellence. During her tenure, she developed a comprehensive genetics program that included the launch and rapid growth of UCSF’s Adult Genetics and Preventive Genomics Clinic; the expansion of multidisciplinary specialty services in cardiovascular, neurogenetic and cancer genetics; and the implementation of innovative e-consult and telehealth services to improve access to genetic care.

So earned her bachelor’s degree with high distinction in molecular biology and molecular genetics and her medical degree from the University of Toronto. She completed her medical genetics residency at the university’s Hospital for Sick Children and earned her doctorate in molecular genetics from the Max Planck Institute for Molecular Genetics in Berlin and completed a postdoctoral research fellowship in psychiatric genetics at the Centre for Addiction and Mental Health in Toronto.

“I am honored to join Cedars-Sinai as the inaugural chief genomics officer to advance the fields of genetics and genomics with the goal of enhancing patient care and health outcomes,” So said. “Together with our talented team of investigators and clinicians, we will push the boundaries of what is possible in genomic medicine for the benefit of our patients, their families and the wider community.”

So’s current research focuses on optimizing genetic diagnosis and treatment strategies for adults with complex neurodevelopmental, neuropsychiatric and neurological conditions. She also is deeply committed to quality and continuous improvement in the delivery of genetics and genomics clinical services.

“Dr. So’s appointment reinforces our commitment to advancing precision medicine and making leading-edge genomic care accessible to all our patients through all stages of life,” said Ophir Klein, MD, PhD, executive vice dean of Children’s Health and executive director of Guerin Children’s. “We are excited to expand our research and clinical capabilities under her leadership.”

Read more on the Cedars-Sinai Blog: Do Children Need Genetic Testing?

Cedars-Sinai experts recommend getting the flu shot starting in September before flu season begins as early as November. They say vaccination is the most powerful tool to avoid influenza-related hospitalizations or worse. As many as 130,000 people in the U.S. died from the flu last year, according to estimates from the Centers for Disease Control and Prevention.

“By getting the flu shot, you’re not only protecting yourself, you’re protecting your family and vulnerable members of the community who would suffer a more serious illness,” said Jonathan Grein, MD, director of Hospital Epidemiology at Cedars-Sinai and associate professor in the Department of Medicine.

Although vaccination is the best way to prevent the flu, Grein also recommends washing hands thoroughly and often, avoiding others who are sick, and wearing a mask when not feeling well to avoid spreading an illness to others.

The Cedars-Sinai Newsroom spoke with Grein and other Cedars-Sinai specialists about this year’s flu shot recommendations, how to manage flu symptoms and where to seek care during a flu illness.

Who Should Get the Flu Shot?

There are no significant changes to flu shot recommendations this year, Grein said. The vaccine is still advised for eligible adults, teens and children more than 6 months old, according to the Centers for Disease Control and Prevention. Those 65 and older are still encouraged to get a high-dose flu vaccine if available because it elicits a stronger immune response, and older adults’ immune systems weaken with age.

“If a high-dose flu shot is not available, older individuals should receive a standard dose, rather than skipping the shot,” Grein said. “It’s critical for older adults to protect themselves.”

Children 6 months to 8 years old who have never received a flu vaccine should receive two doses, spaced four weeks apart, said Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s.

“Ideally, parents should vaccinate their children before the end of October to ensure protection before peak flu season,” Soni said.

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment through My CS-Link at locations in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

How to Treat Flu Symptoms

Like other upper respiratory infections, flu symptoms include nasal congestion, fever, body aches, cough, sore throat and fatigue. Most people with mild symptoms will improve at home with fluids, a pain reliever such as Tylenol and rest, Grein said. Those at high risk of more serious infection—older adults, immune-compromised individuals and others with chronic health conditions—should speak with their physician soon after symptoms appear to find out whether an antiviral medication like Tamiflu would be right for them.

Those with more severe symptoms—a very high fever, loss of appetite or inability to keep fluids down—should see their physician or visit urgent care, said Jonathan Weiner, MD, chair of the Cedars-Sinai Medical Group’s Department of Primary Care and Acute Care Medicine.

Life-threatening symptoms like difficulty breathing should immediately be addressed in the nearest emergency department.

Flu Treatment for Children

Mild flu symptoms in children look similar to those of an adult and will likewise improve with fluids, rest, and Tylenol or ibuprofen, Soni said. She cautioned against giving children aspirin because of the risk of contracting Reye’s syndrome, a rare but serious illness linked to aspirin. Higher-risk children might need an antiviral treatment prescribed by a physician.

Soni explained that children 2 and younger run a high risk of dehydration, so their parents should make sure they drink and eat enough. She also advised parents to watch for signs that their child’s symptoms might be escalating.

“If a child is struggling to breathe, or showing signs of severe fatigue, vomiting or dehydration, they should be seen promptly by their physician or in the emergency department,” Soni said.

Where to Get Care for the Flu

For children and adults with milder symptoms, a virtual visit through a mobile app like Cedars-Sinai Connect is a great first step to get reassurance or guidance on the best treatment options, Weiner said.

“A physician or other provider can see you, assess how sick you appear and determine if you need to be seen in person or if you can manage your illness at home,” said Weiner, who treats patients in person and via Cedars-Sinai Connect. “If we determine that you need to see your Cedars-Sinai primary care physician or you need to go to urgent care for your symptoms, your provider will see the notes from your virtual visit in your chart because we all share the same Cedars-Sinai medical record.”

If a flu test is needed to rule out other illnesses or for a Tamiflu prescription, Cedars-Sinai Connect providers can order one through a streamlined visit at one of Cedars-Sinai’s urgent care locations. Patients also can get an over-the-counter test at their local pharmacy. Weiner said it’s good to know if you have the flu so you can avoid spreading the illness to others. People are contagious a day before symptoms start and up until their fever has resolved and symptoms are improving—as long as five to seven days after getting sick.

If symptoms do not improve, other causes of upper respiratory tract infections need to be ruled out, which could require in-person treatment, Weiner said. He emphasized that an in-person appointment also is recommended for patients with underlying conditions, high fever, trouble keeping food and liquids down, and for anyone who is having trouble breathing.

Read more on the Cedars-Sinai Blog: Flu and RSV: How to Protect Yourself Now

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The Cedars-Sinai Newsroom recently spoke with Jane Tavyev Asher, MD, director of the Division of Pediatric Neurology at Cedars-Sinai Guerin Children’s, about how screens affect children and teens differently depending on their age, and what parents can do to set healthy boundaries for screen time.

What is the recommended amount of screen time for children in different age groups?

Before the COVID-19 pandemic, the American Academy of Pediatrics had fairly strict guidelines: no screen time at all for children under age 2, and minimal exposure for ages 2 to 5. Ideally, screen time should be under an hour a day. For ages 5 to 11 and older, less than two hours per day.

Since the pandemic shifted much of our education and social lives online, we've had to adapt those guidelines a bit. Still, research continues to support limiting screen time to less than two hours a day for older children as well. Exceeding that amount has been associated with increased risks of anxiety, depression and other emotional challenges.

How can excessive screen time affect young children’s developing brains?

The general consensus among developmental pediatricians is that children under age 3 should have little to no screen exposure. That’s because their brains are in a critical stage of development, with key processes like myelination, the biological process that speeds up the nerve transmission to the brain, and neural pathway formation actively taking place.

When a young brain is exposed to too much screen time, it can overstimulate the visual cortex—the part of the brain that processes images—at the expense of the auditory cortex, which is vital for developing social skills and language. Ideally, we want their early learning to be grounded in real-world, interactive face-to-face experiences—not passive viewing.

How does screen time via social media impact brain development in teenagers?

Adolescence is a time when the brain is deeply focused on social development and seeking acceptance from peers. Before social media, that feedback loop was limited to in-person interactions with a small group of peers. But now, through apps and platforms, teens are exposed to a constant, amplified stream of approval or disapproval on a much larger scale.

That amplification can be harmful. It places undue stress on the adolescent brain, increasing the risk of social anxiety, low self-esteem and even depression.

Does the type of screen make a difference?

Yes, the type of screen can make a difference. A lot of what’s called “educational content” is often just labeled that way for marketing purposes, without clear evidence that it's truly educational. Watching content on a TV screen is generally safer—it’s farther from the eyes and doesn’t strain the neck or vision as much as phones or tablets.

Also, the platform matters. Streaming services like YouTube often auto-play endless content using algorithms to keep kids hooked. There’s no clear stopping point. In contrast, traditional TV typically airs for a set duration, which naturally limits screen time and reduces the risk of overconsumption.

How does screen-based learning in school affect brain development?

We’ve found that when students read something from a book, they tend to retain the information better than when they read the same content on a screen. We don’t fully understand why that is, but it does suggest that traditional learning methods still hold an important place.

That said, screens can be very helpful when used purposefully. For example, watching a video demonstration of a complex science experiment can be far more effective than trying to imagine it from a textbook. In classroom settings, it’s best when screens are used collectively, as part of a group lesson with discussion led by the teacher, rather than having each student isolate on their own individual device.

Are some children more vulnerable than others to the negative effects of too much screen time?

Yes, certain children are especially sensitive. Children with attention-deficit hyperactivity disorder, or ADHD, symptoms can become overstimulated by video games and may struggle even more with attention. Similarly, children experiencing anxiety or depression, or children who face social challenges may be more prone to negative effects from screen exposure, especially if they’re using it as an escape or replacement for in-person interaction.

In these cases, screen time should be monitored closely, and alternative, healthy outlets should be prioritized.

What are some practical tips for parents to set healthy screen time limits?

One of the most beneficial things parents can do is to ensure their children get at least two hours of physical activity each day, ideally outside. This supports not only their physical health but also their energy levels, focus and even vision.

Another important tip is to delay giving your child a smartphone for as long as possible. There’s a movement called “Wait Until 8th” that encourages parents to hold off until at least after eighth grade. The longer you can wait, the more time your child has to build a strong foundation of social and emotional development without the added pressures of smartphone use.

Read more on the Cedars-Sinai Blog: Does My Child Need Growth Hormone Therapy?  

Wei Gao, PhD, director of Neuroimaging Research and professor of Biomedical Sciences and Imaging; Jane Tavyev Asher, MD, director of the Division of Pediatric Neurology at Cedars-Sinai Guerin Children’s; and David H. Rowitch, MD, PhD, deputy director of Research at Cedars-Sinai Guerin Children’s, sat down with the Cedars-Sinai Newsroom to talk about their work.

Mapping Infant Brain Development

Gao said that besides primary motor connections, social-emotional connections are among the first an infant’s brain makes, and that these connections ladder up to other levels of intelligence.

“The first year is where you need to pay very special attention to the social-emotional development of the baby,” Gao said. “You want to provide sensitive support to the baby so the baby can develop a secure attachment with you as a caregiver. That has long-term impacts to their later achievements and quality of life.”

Social-emotional development is the key piece that integrates the core hierarchy of brain development, Gao said. It starts with sensory and motor regions to ensure early survival, then progresses to higher-order cognitive areas to develop more sophisticated social and emotional regulation skills, which are critical for mental wellbeing, learning and adaptation.

Gao and his team previously created one of the first detailed maps of connections established between different regions of the brain during the first two years of life. They aim to better understand typical brain growth trajectories, as well as how risk factors—including maternal health, prenatal exposures to harmful substances, and family environment—can influence brain growth and a child’s development.

The investigators are now conducting the Healthy Brain and Child Development study, which will follow more than 7,000 children from birth to 10 years old. Regular conversations with caregivers and imaging of the children’s brains will help investigators correlate development of brain connections with other factors in a child’s life.

“We want to use advanced imaging as a tool to detect deviations as early as possible so that we can hopefully bring them back to the normal trajectory,” Gao said.

The Effects of Screen Time During Babyhood

Tavyev Asher is a pediatric neurologist who collaborates with Gao. She said a baby’s brain develops sensory abilities first, followed by language and social skills—a process that can be derailed by screen time.

Before the age of 12, the auditory and the visual areas of the brain are being fine-tuned, but looking at a screen develops only the visual cortex of the brain, Tavyev Asher said. The auditory cortex, which supports social interactions, develops through in-person interaction.

“Real life moves at a much slower pace than the rapidly flipping images on a device or screen,” Tavyev Asher said. “The brain is developing its communication patterns in those first few years of life, so you are training that brain exactly what it needs for its future. If you're exposing that brain to a screen, that brain thinks it needs to be able to pay attention to these rapidly changing images but not to the slower things of the real world.”

To make sure language, hearing and social skills develop, Tavyev Asher urged parents and caregivers to prioritize face-to-face interaction with their babies. She also said that early screen time can affect a child’s later learning skills, including reading and writing proficiency.

“Reading comprehension, reading speed, reading fluency and memorization are all going to be enhanced if you're reading from an actual book rather than on the screen,” Tavyev Asher said. “The single most important thing that parents can do for their children right now is to keep them off screens between the ages of 0 and 3.”

The Importance of Genetics

Rowitch, a neonatologist, developmental neuroscientist and expert on pediatric neurological disease, said that genetic tests developed over the past 10 years can analyze all 3 billion base pairs, the letters that make up a person’s genetic code. These tests can offer crucial information on an infant’s brain development as well as the child’s future mental and physical health.

“We find that almost 80% of babies with a genetic condition exhibit a neurological manifestation,” Rowitch said. “For example, that could be weakness of the muscles, seizures or a structural abnormality of the brain that we identify by MRI. It is important to understand and capture these conditions to ensure the correct diagnosis and treatment.”

Pairing genetic testing with a map of normal brain development such as the one created by Gao can help clarify how genetic conditions change development patterns, Rowitch said. This could be especially true for babies born preterm.

“We want to be able to anticipate future health or neurodevelopmental problems,” Rowitch said. “The earlier we detect alterations, the sooner we can intervene to improve the child's developmental trajectory.”

Detecting serious genetic conditions at birth also could have implications for a child’s school readiness and long-term health outcomes.

“Together, these studies emphasize the importance of early brain development. If we understand how genetics affects school readiness, that starts to open up another set of questions,” Rowitch said. “How can we make a child school-ready who might otherwise be in a high-risk category? If we can bring together genetics, brain mapping and cognitive assessment, we can create interventions that can help every child reach their potential.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

The prestigious national honor bestowed annually by the medical association recognizes Sanchez’s outstanding contributions to pediatric medicine, his leadership in advancing health equity and his unwavering dedication to the Hispanic community. And Sanchez himself credits his Hispanic cultural roots and values for leading him to a career in medicine.

“It is truly humbling to be recognized by the National Hispanic Medical Association,” said Sanchez, who is also the director of Pediatric Medical Genetics at Guerin Children’s. “Growing up in a Hispanic household, I learned that the foundation of healing is planted at home and nurtured by trust, respect, culture and faith. As a clinical scholar and physician-scientist, I am reminded every day that our work reaches far beyond the clinic.”

Sanchez will be recognized at the association’s 28th annual conference, “Uniendo Voces: Advancing the Future of Latino Health,” on June 7 in Anaheim, California. Established in 1994, the nonprofit organization represents more than 50,000 licensed Hispanic physicians in the United States.

“At Guerin Children’s, ensuring that children and families from California and beyond receive personalized, inclusive care is a top priority,” said Shervin Rabizadeh, MD, MBA, deputy director of Guerin Children’s and chair of the Department of Pediatrics. “Sanchez has played a leading role in developing culturally responsive pediatric genetic services.”

Sanchez said the award highlights the importance of integrating cultural understanding into every aspect of medical care.

“As pediatric geneticists, we care for some of the most vulnerable members of our community— children and families navigating rare and complex conditions,” said Sanchez. “By building trust, improving access and mentoring the next generation of clinicians, we help create a healthcare system that not only treats disease but honors the unique culture, stories and heritage of all patients.”

Sanchez’s leadership roles are wide-reaching. Most recently, he was named as the Advisory Committee Chair for the American College of Medical Genetics and Genomics Engage, Equip, and Empower (E3): Genomics Pathways Program. The program seeks to inspire and prepare the next generation of leaders in genetics and genomics by providing early exposure to the field to high school, community college and undergraduate students from underrepresented backgrounds.

“Sanchez’s work reflects Guerin Children’s mission to improve bench-to-bedside healthcare for all communities,” said Ophir Klein, MD, PhD, executive vice dean of Children’s Health and executive director of Guerin Children’s. “This award is a fitting tribute to his compassion, expertise and commitment to care for our youngest patients.”

Read more on the Cedars-Sinai Blog: Do Children Need Genetic Testing?

It was in 2023, when Sarah underwent brain surgery with Keith Black, MD, that her mother, Dana, began to uncover the depth of her family’s ties to Cedars-Sinai. What Dana thought were fragments of family history—memories of her grandmother Reba Dubin’s volunteer work and her aunt Maxine Dunitz’s philanthropy—turned out to be a remarkable story of multigenerational dedication to advancing healthcare, championing women’s leadership and transforming a city.

The Pioneering Spirit of Reba Dubin and Maxine Dunitz

Dana’s childhood revolved around Cedars-Sinai, largely because of Helping Hand, which her grandmother Reba founded. The medical center was a constant presence in the family’s conversations, and visits to her grandmother’s house were filled with stories of philanthropy and service. Reba’s impact had started in 1929 when she’d created Helping Hand at Cedars of Lebanon—decades before the hospital merged with Mount Sinai—as a volunteer-run gift shop that was the first woman-run non-profit in Los Angeles. But her contributions went far beyond selling gifts. She was a trailblazer dedicated to supporting women and children in need. Inspired by her own mother’s activism and leadership, Reba, who was a college-educated pharmacist at a time when the roles of women were constrained, was determined to make a difference.

Through Helping Hand, she led initiatives to assist immigrants and refugees, provide medical support to the underserved and offer aid to low-income and expectant mothers. In an interview nearly 60 years after she established Helping Hand, Reba recalled visiting a woman’s apartment where a newborn slept in a dresser drawer for lack of a crib. She saw to it that the woman received a crib. Helping Hand also provided essentials for people in need, such as eyeglasses, artificial limbs and baby supplies—small gestures with big impacts. Over the coming decades, Reba’s work not only supported those who needed it most but also helped cement Cedars-Sinai as a major force for good in Los Angeles. One prominent example: In 1984, Helping Hand funded the first full-time endowed chair at Cedars-Sinai, the Miriam Jacobs Chair of Maternal Fetal Medicine.

Reba’s example inspired her niece, Maxine Dunitz, who first volunteered at Cedars-Sinai in 1948 as a teenager. Years later, Maxine took Reba’s dedication even further. Her generosity helped establish Cedars-Sinai’s Maxine Dunitz Neurosurgical Institute and endow the position held by Black, who serves as the institute’s director. Maxine donated the funds the same year her great-niece Sarah was born. She could not have known that one day, Sarah would walk through the doors of that institute and that Black would free the young woman of a brain tumor. 

Dana and Sarah: A Legacy Comes Full Circle

Dana and her siblings were born at Cedars-Sinai in the 1960s, but her relationship to the medical center became far more personal in 1996. That year, her newborn son Daniel was rushed to Cedars-Sinai for emergency cardiac surgery with Alfredo Trento, MD. Born with an exceedingly rare condition that entailed seven heart anomalies, Daniel underwent a life-saving operation at just 24 hours of age. Dana had never wavered on where to turn for his care.

Then, some 25 years later, her daughter Sarah faced a medical crisis of her own. Athletic, independent and full of life, Sarah had always taken care of her health and rarely needed to see a doctor. She had grown up with a sense of perseverance, shaped by the knowledge that her brother Daniel had defied the odds—and that her mom had borne two other girls, both of whom succumbed to medical conditions in the early months of their lives. When Sarah began having seizures—the same symptom that had presaged the tragic deaths of the sisters she never knew—her family reached out to Cedars-Sinai again. “Through gasps and tears, I asked if we could meet Dr. Black,” Dana recalls.

Uncomfortable in medical settings, Sarah was anxious until she met Black. Unlike in previous medical encounters, where she often felt dismissed, here was a doctor who treated her with respect and compassion. “Dr. Black made me feel seen as a person, not just a case,” said Sarah, recalling that the Patient Relations Department also supported her parents as they dealt with the terrifying prospect of another severely ill child. Sarah was diagnosed with a ganglioglioma, a type of growth that accounts for only 0.4% of all brain tumors.

In July 2023, she successfully underwent surgery with Black. While Sarah lay recovering in her room, Dana, a historian by training, wandered into Helping Hand. What happened next was one of the most powerful experiences of her life. She unexpectedly met a 91-year-old volunteer who remembered her grandmother, Reba, and who brought out scrapbooks dating back to 1929. As Dana turned the pages, she discovered a treasure trove of stories, images, programs and more, and learned the full scope of both Reba and Maxine’s roles in the medical center’s growth. “It was both surreal and deeply nourishing,” said Dana. “My aunt was the reason that the institute existed and that my daughter could see the famous Dr. Black right here in L.A.”

A Sense of Connection

Since receiving her diagnosis, Sarah had been asking herself existential questions: Who am I? Where do I fit in? As her mother shared her discoveries about the family’s history with Cedars-Sinai, Sarah felt an overwhelming sense of belonging—she was part of something bigger than herself. And she had survived a serious health threat thanks to the skill of a surgeon whose position was endowed by her great-aunt. Her own progress was inextricably linked to Cedars-Sinai’s century-long story of progress and growth, highlighting the ties between each patient’s journey and the journey of the institution itself.

Knowing what her ancestors had achieved—and what she owed them—made her even more determined to keep fighting. It deepened her commitment to giving back and embracing life fully. Four months after her surgery, Sarah went bike riding in India. Her remarkable recovery is yet another testimonial to the resilience that runs through her family—and to Cedars-Sinai’s commitment to providing the very best care, and to making progress toward that goal by making sure each patient makes progress in their own health journey.

Read more on the Cedars-Sinai Blog: Faces of Cedars-Sinai--Neurosurgeon Keith Black

“For very young children, use simple explanations when answering their questions,” Hedrick said. “With older children, you want to be honest and open, directly answering questions and using as simple language as possible.”

Playtime can help children express themselves and feel a sense of control. One example, Hedrick said, is focusing on the positive aspects of knowing fire safety.

“For children who haven’t lost their homes but are affected by the fires, involve them in age-appropriate fire drills,” she said. “Or allow other types of play to be related to the fire, because a lot of times it’s easier for kids to express their feelings through play than by outwardly saying, ‘I'm feeling scared.’”

Building simple forts with pillows, blankets and sheets can be a beneficial play activity for children of all ages—even some middle schoolers, Hedrick said.

“The parent can get inside the fort with them and talk about feelings, as the child may feel safer there,” she said.

It also can be helpful for parents to model how to express feelings.

“A parent could say something like, ‘I noticed I was feeling a little scared today; are you feeling scared?’ This gives their child a chance to talk about feelings of fear, anger, sadness,” she said.

Alternatively, when the child says they’re angry, sad or scared, parents should acknowledge those emotions.

“It’s important not to say, ‘You don't have to feel sad or scared or angry,’” Hedrick said. “It's better to say, ‘Of course, that’s how you’re feeling and it’s perfectly normal. At the same time, there are things we can be grateful for—let’s talk about some of those.’”

Tweens and teens especially may find journaling helpful, as well as art, physical activities and supportive connections with their peers.

“Reminders that there is hope, and that the family will get through this together, are important,” Hedrick said.

Read more on the Cedars-Sinai Blog: Art Therapy Helps Children Cope With Trauma

The Cedars-Sinai Newsroom spoke to two infectious disease specialists—Jonathan Grein, MD, director of Hospital Epidemiology, and Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s—to get the facts about how to protect yourself and your family.

Why is measles so dangerous?

Priya Soni, MD: Many people think that measles is just a rash, but it can be life threatening. One in 5 children who develop measles end up in the hospital. One in 20 children develop pneumonia, and this is the leading cause of measles-related deaths. In addition, 1 in 1,000 children can develop a rare complication of brain swelling—encephalitis—that can cause permanent brain damage.

How does measles spread?

Jonathan Grein, MD: Measles is one of the most infectious diseases that we know of, and it's spread very easily through the air, particularly for people who are not immune or have not received the vaccine. It's so infectious that you don't even need to be in the same room at the same time with someone who has measles to potentially get infected.

What are the telltale signs of measles?

Grein: The symptoms of measles can begin like any other viral illness. You may feel feverish, have muscle aches, headaches, very nonspecific symptoms. Patients may then go on to develop cough, runny nose, sometimes redness of the eyes. That all precedes the classic rash that you may be familiar with that typically starts on the face and spreads throughout the body. I think it’s important to know that it is possible to be infectious several days before that rash begins, which is one of the real challenges with trying to control measles from being spread person to person.

What should you do if you think your child has measles?

Soni: If you think your child has measles, the first thing to do is call your pediatrician, but do not go directly to their offices or the Emergency Department without speaking to someone on the phone first. The virus is extremely contagious, so you want to call ahead to let the healthcare providers know what’s going on. Showing up without calling ahead can cause other children in the waiting room to be infected. In addition, you should immediately isolate your child from other children, especially infants who are less than a year of age, as they may not have protection from the virus. You should also isolate your child from any immunocompromised family members.

How is measles treated?

Grein: The treatment for measles is solely supportive. There is no specific measles treatment, but you want to try to control the fever and make sure the patient is hydrated and resting in isolation.

How do we protect against measles?

Soni: Vaccination is the best protection against measles. The MMR vaccine, which is inclusive of measles, mumps and rubella, is 97% effective after two doses. It's one of the most effective vaccines that we have. And it protects children in outbreak situations and other vulnerable community members as well.

Typically, the first dose of the measles vaccine is given at 12-15 months of age. The second dose is given around 4-6 years of age.

If your child is 6-12 months old, they can receive an early dose of the measles vaccine if they're in a high-risk situation such as an outbreak or if they’ve been exposed to the virus. This additional dose that's given earlier than the recommended schedule does not count toward their two-dose series.

Do adults need to get vaccinated against measles?

Grein: Most adults will not need an additional booster dose if they were previously vaccinated. There is a small number of adults who may have received a different version of the measles vaccine between 1963 and 1967. This vaccine was later found to be less effective, and it doesn't provide as long-lasting immunity as the current vaccine. So if you did receive that vaccine, it is recommended that you receive a booster dose with the current MMR vaccine to achieve appropriate immunity.

Read more on the Cedars-Sinai Blog: Why Some Vaccines Last A Lifetime and Others Don't 

Like any typical 10-year-old, Brandon Bateman loved being outdoors and staying active. But when he complained of severe back pain and feeling winded after a short bike ride, his mother knew something was wrong.

“Everything seemed fine before then,” Brandi Bateman said of her son. “Brandon was a very active child. You know, he enjoyed roller coasters, bicycling, gymnastics, jumping off roofs into the pool. You name it, he did it. He loved it all.”

Five years ago, amid the COVID-19 pandemic, a pediatrician suggested genetic testing, which showed Brandon had Marfan syndrome. It’s a genetic disorder that affects connective tissue—the fibers responsible for providing structure and support to organs and tissues in the body. People with Marfan syndrome are often tall and lanky with unusually long limbs, and the condition affects various parts of the body, including the heart, lungs, blood vessels, eyes and skeleton.

February is Marfan Syndrome Awareness Month, highlighting the genetic condition that affects approximately 200,000 people in the United States. The symptoms can vary greatly from person to person. Some patients have mild symptoms, while others, like Brandon, face significant health challenges requiring medical intervention.

Surgery to Breathe Better

Marfan syndrome caused Brandon to develop severe scoliosis—a progressive condition that causes the spine to curve sideways and was the culprit behind his debilitating back pain.

“The scoliosis just got worse,” Bateman said. “It seemed like overnight.”

At the time of his diagnosis, Brandon’s spine was curved at 23 degrees. Four years later, in April 2024, the curve in his spine had nearly tripled to 62 degrees. A typical curvature is about 10 degrees. Brandon’s curvature was so extreme that spinal surgery was recommended.

Initially, Brandon and his family, who live in Tehachapi, California—102 miles from Cedars-Sinai—sought medical care closer to home. But after facing lengthy wait times to see specialists, the Batemans were referred to Kenneth Illingworth, MD, a pediatric spine surgeon at Cedars-Sinai Guerin Children’s.

“In Brandon's case, the scoliosis was so rapidly progressive that he actually started to have stretch marks, which is quite unique,” Illingworth said. “When you have big, big curves, which is not uncommon in kids with Marfan, they start to have long-term health consequences.”

Like most children and teens with Marfan syndrome, scoliosis wasn’t the only pressing issue. In addition to his progressive scoliosis, Brandon had a deep indentation in his chest known as pectus excavatum, a common condition associated with the syndrome that causes the breastbone to sink into the chest. The chest indentation required another surgery. 

“Brandon had a very deep pectus excavatum defect, where his sternum was heading back toward his spine and compressing the area where the heart would be. As a result, the heart was being squished and pushed over,” said Eugene Kim, MD, surgeon-in-chief and associate director of Surgery at Cedars-Sinai Guerin Children’s, director of the Division of Pediatric Surgery and vice chair at the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai.

To fix Brandon’s sunken chest wall, Kim, in collaboration with thoracic surgeon Nguyen Minh Le, MD, performed a minimally invasive procedure that involved creating two small incisions on either side of the chest. A thin, strong titanium bar was scooped underneath the breastbone and muscle, lifting and supporting the sternum and chest wall.

Kim said he placed two bars to spread out the pressure. The bars will stay in place for three years until the chest wall has set in its corrected position.

“My chest doesn't have that indent that it had. It's just straight. And it's like, I feel normal now,” Brandon said.

Kim also performed cryoablation, or freezing of the chest nerves that transmit pain signals to the brain, for pain control after surgery.

“It means kids need far less narcotics for pain after the surgery,” Kim said. “They are out of the hospital in one to two days as opposed to five to seven days.”

Brandon isn’t completely out of the woods. He will always have Marfan syndrome, which means he will need to remain vigilant for other associated complications, especially heart and eye issues related to the condition.

But Brandon and his mother are thrilled with the remarkable results the surgeries yielded and grateful for the multidisciplinary team of specialists who jumped on board to care for him.

“We want doctors who will carry on his care after he turns 18,” Brandon's mother said. “Cedars-Sinai is the best place for that. We have all the specialists he’ll need under one roof.”

Living Life to the Fullest

With successful surgeries and challenging recovery behind him, Brandon is back to being a teenager.

Today, at 15, he is doing the things he loves most—riding his motorbike, jumping on trampolines and living life to the fullest.

“Being able to do those things again feels amazing,” Brandon said. “I don’t feel like I’m limited by my condition anymore. I feel like I can do whatever I want.”

Read more on the Cedars-Sinai Blog: Seeking a Second Opinion for a Spine Condition

Raphael Louise Wasserman, who was born with a serious heart condition, has had more medical interventions in the first months of his life than some adults will ever have. But now, he and his family are looking forward to a life filled with more birthday celebrations than doctors’ appointments.  

Raphael and his twin sister, Antonia, who was born without a heart condition, celebrated their birthdays on Valentine’s Day, Feb. 14, at Cedars-Sinai Guerin Children’s. They were joined by their mothers, friends and family as well as the nurses, physicians and staff members who took care of them.

“Heart defects are the most common birth defect,” said Richard Kim, MD, director of Pediatric and Congenital Heart Surgery and surgical director of the Guerin Family Congenital Heart Program in the Smidt Heart Institute and Guerin Children’s. “Thankfully, we can now intervene early so babies and young children can get better quickly.”

Mothers Claire and Ashley credit the close attention their children received with getting Raphael the care he needed. Soon after he was born, a nurse noticed Raphael had a heart murmur. A couple of days later, he had open-heart surgery to fix the malformations that were preventing his heart from pumping blood properly.

But one issue remained: One of Raphael’s heart blood vessels had become so narrow it was affecting his heart. In August, Raphael became one of the first children to receive the first stent specifically designed for babies and children. The stent was studied at Cedars-Sinai, and Evan Zahn, MD, director of the Pediatric Congenital Heart Program at Guerin Children’s and the Smidt Heart Institute, helped develop it. The stent’s design allowed it to be placed during a minimally invasive procedure rather than through an open-heart surgery.

“It was so rewarding to care for Raphael, who had especially complicated structural heart defects,” said fetal and pediatric cardiologist Myriam Almeida-Jones, MD. “Thanks to our team-based approach and our latest advances, we were able to improve Raphael’s heart so he and his family can have many more milestones to celebrate.”

Read more on the Cedars-Sinai Blog: Q&A—Congenital Heart Defects

Cedars-Sinai has been named a Center of Excellence in Rare Neuroimmune Disorders, one of only 21 worldwide and two in California recognized for advancing research in immune-driven disorders of the central nervous system and providing the highest-quality comprehensive patient care.

The designation is awarded by the Siegel Rare Neuroimmune Association (SRNA), the patient advocacy group formerly known as the Transverse Myelitis Association.

“We’re proud to be known as an exceptional center offering streamlined access to specialists highly trained in addressing the varied and specific needs of patients with rare neuroimmune disorders,” said Paula Barreras, MD, assistant professor of Neurology and director of the new Center of Excellence at Cedars-Sinai. “This meaningful recognition by an organization that works with patients and the medical community helps us offer more people navigating these difficult conditions the services they need, without delay.”

The Center of Excellence in Rare Neuroimmune Disorders at Cedars-Sinai provides multidisciplinary, patient-centered care for people with:

• Acute disseminated encephalomyelitis
• Acute flaccid myelitis
• Idiopathic transverse myelitis
• Infectious myelitis
• MOG antibody-associated disease
• Neuromyelitis optica spectrum disorder
• Optic neuritis
• Neurosarcoidosis
• Paraneoplastic myelitis
  • Non-immune mimics of myelitis; vascular myelopathies; spinal cord stroke and spinal arteriovenous fistulas
  • Myelopathies of unclear cause

These often-complex disorders can affect the brain, spinal cord or optic nerve. Depending on the affected area, symptoms can range from muscle weakness, loss of balance and impaired vision to bladder or bowel incontinence and cognitive and communication changes.

“Because symptoms may span multiple physician specialties, patients who are not seen at a medical center with a multidisciplinary team are likely to experience delays on the road to an accurate diagnosis and treatment plan,” Barreras said.

Cedars-Sinai evaluates patients through comprehensive testing and imaging to pinpoint an accurate diagnosis. Patients are then connected with the appropriate on-site specialists and additional resources they may need, including social and neuropsychological services, help navigating insurance and medications, and physical therapy and rehabilitation.

Nancy L. Sicotte, MD, chair of the Department of Neurology and director of the Multiple Sclerosis and Neuroimmunology Program at Cedars-Sinai, as well as an expert in multiple sclerosis—a more common neuroimmune disease—said the designation also helps expand research and education efforts in rare neuroimmune disorders.

“Patients benefit because they have more opportunities to participate in research that can give them access to the most innovative treatments,” said Sicotte, the Women’s Guild Distinguished Chair in Neurology at Cedars-Sinai. “Our institution benefits from increased opportunities for research funding, and our research fellows benefit as they gain a greater understanding of the mechanisms of rare neuroimmune disorders and ways to improve outcomes for patients.”

In addition to Barreras and Sicotte, Cedars-Sinai’s specialist team for patients with rare neuroimmune disorders includes:

• Marwa Kaisey, MD, assistant professor of Neurology; multiple sclerosis specialist
• Omar Al-Louzi, MD, director of the Visual Outcomes Laboratory in the Department of Neurology; multiple sclerosis specialist with expertise in optic neuritis
• Swaraj Bose, MD, neuro-ophthalmologist and orbital surgeon
• Alexandra Dubinskaya, MD, urology specialist
• Mitzi Gonzales, PhD, neuropsychologist and director of Translational Research in the Jona Goldrich Center for Alzheimer’s and Memory Disorders
• Marcel Maya, MD, interventional neuroradiologist and co-chair of the Department of Imaging
• Christopher Boudakian, DO, medical director of the California Rehabilitation Institute
• Sadie Loera, social worker, Outpatient Neuroscience Department
• Laura Locke, NP, Department of Neurology
• Neurological rehabilitation team, including physical therapy, occupational therapy and speech therapy

“I’m thankful for our enthusiastic and knowledgeable team of clinicians, and I’m proud we can provide world-class care to patients,” Barreras said. “I’m also grateful for increased awareness for rare neuroimmune disorders, which will lead to advances in research and improved treatments. Our goal is to ensure patients are not jumping through hoops to access good care and experience a better quality of life.”

Read more from Discoveries Magazine: No Time for MS

Diego Cruz told his healthcare team that his lifelong dream was to travel to Japan, which got Child Life Specialist Joanne Ordono thinking.

“Because of his physical condition, he can’t travel, but I thought, ‘Why not bring Japan to him?’ And that’s what we did,” Ordono said. “We brought both traditional and contemporary Japan to his hospital room.”

Thanks to the Japanese American Cultural and Community Center in Los Angeles’ Little Tokyo, Cruz had a traditional Japanese experience, starting with a tea ceremony performed by Hirokazu Kosaka, a tea ceremony master. Cruz sipped from a ceremonial bowl filled with matcha tea while Kosaka chanted. 

Next, Kuniharu Yoshida, a calligrapher, brought out his ink and brushes to create a traditional calligraphy scroll that reads, “May your wishes come true.” The calligrapher also helped Cruz write the Japanese character for “strength.” 

Then, musician Chester Ikei played a ukulele and sang traditional Japanese ballads describing the four seasons. 

Cruz, an anime fan, also received gifts from local shop Anime Station. Of course, no cultural experience is complete without food, and Cruz was able to taste mochi and Japanese cheesecake for the first time.

A visibly emotional Cruz took pictures with all his guests and his family members and fought back tears as he expressed his thanks.

“All the years that I’ve had chemotherapy, I missed out on all the things I wanted to do in life,” Cruz said. “While I saw others living a normal life, I’d be here in the hospital. I never thought I’d be able to do these things, so thank you. It means a lot to me.”

Ordono said the afternoon reminded her of the essence of healthcare.

“Obviously, taking care of the patients medically and clinically is super important, but we're treating the whole person,” Ordono said. “It's the emotional and the mental health that is also important, and I believe we got to bring a little bit more joy to this patient today.”

Read more from Discoveries: Innovation and Collaboration in Pediatrics at Cedars-Sinai Guerin Children's

The party featured a dancing gingerbread couple, Santa Claus and Los Angeles Rams cheerleaders, who got the crowd dancing. The children and their siblings got their faces painted and went home with kits to make gingerbread houses.

But the best part was meeting other families, said Benjamin Castillo, whose 5-year-old daughter, Camilla, is undergoing cancer treatments.  

“It’s nice to see other people going through the same thing we are going through,” Castillo said. “We are meeting people in the same situation and it’s good to see our daughter playing with other kids.”

The community came together to support the annual party. The venue was sponsored by the Beverly Hills Police Department, whose officers visit patients at Guerin Children’s every month. Sodexo and Love Catering donated the food.

As they have done for 20 years, students at El Segundo High School donated bags full of new toys.

The party was an especially happy occasion for members of the Guerin Children’s healthcare team who usually see these children in the hospital. 

“It brings out the inner child in me,” said Leo Mascarenhas, MD, MS, division chief and director of Pediatric Hematology/Oncology at Cedars-Sinai Guerin Children’s and medical director of the Sarcoma Program at Cedars-Sinai Cancer. “When I see all these kids having so much fun, it’s one of the reasons why I do what I do, so that kids can live their lives as children.”

Read more on the Cedars-Sinai Blog: Innovation and Collaboration in Pediatrics at Cedars-Sinai Guerin Children's

“Our model, called the Unified Structural and Functional Connectivity model, provides a step toward mapping how different parts of the brain functionally communicate,” said Wei Gao, PhD, director of Neuroimaging Research and professor of Biomedical Sciences at Cedars-Sinai and senior author of the study. “The model shows that certain structural pathways, especially in networks related to emotions, self-awareness, and sensory processing, are heavily used for brain communications. The model also enhances our understanding of how these interactions relate to cognitive function.”

The investigative team—led by Gao, study co-author Pascal Sati, PhD, director of the Neuroimaging Program and associate professor of Neurology, and first author Arzu Silemek, PhD, a postdoctoral fellow supervised by Gao and Sati—found that certain areas serve as crucial hubs, with a significant corridor facilitating overall brain connectivity. They believe this mapping of brain communication could inform future research on cognitive processes and neurodevelopmental disorders. Clinically, they suggested it could improve physicians’ diagnostic tools by providing insights into how structural changes affect brain function, potentially leading to better-targeted interventions for conditions such as Alzheimer’s disease and other cognitive disorders.

Additional author: Haitao Chen

Funding: This work was supported by the National Institutes of Health (R01DA042988 and R01DA043678) and by Cedars-Sinai Precision Medicine Initiative Award and institutional support (to W.G.).

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Delirium causes confusion and behavior changes, affects millions of patients each year and can increase a patient’s risk of long-term neurological problems. It is common in hospitalized patients who are placed on ventilators to assist their breathing.

“Microglia, the resident immune cells in the brain, can be destructive to brain cells in some neurological diseases, but also can be protective,” said Shouri Lahiri, MD, director of the Neuroscience Critical Care Unit and director of Neurocritical Care Research in the Department of Neurology at Cedars-Sinai and senior author of the study. “While previous research has suggested that the action of microglia may cause or worsen delirium, we found that the opposite is true. When we depleted levels of microglia in laboratory animal experiments, delirium-associated brain changes and behaviors increased. And when we restored microglia levels to normal, the changes were almost completely reversed.”

Medications that activate neuron-protecting microglia could be one option for managing delirium. Investigators previously determined that a protein called interleukin-6 damages neurons, and future studies could clarify whether it or other proteins activate neuron-protecting microglia. Future research is also planned to help determine the conditions under which microglia can cause damage to neurons, said Lahiri, an associate professor in the departments of Neurology, Neurosurgery, and Biomedical Sciences.

First authors: Landon Scott, Kevin D. Winzey

Additional authors: Debbie Moreira, Catherine Bresee, Jean‐Philippe Vit, Warren G. Tourtellotte, S. Ananth Karumanchi, and Shouri Lahiri

Funding: F. Widjaja Foundation

Follow Cedars-Sinai Academic Medicine on LinkedIn for more on the latest basic science and clinical research from Cedars-Sinai.

These cells are located in the hippocampus, the brain area affected in the earliest stages of Alzheimer’s disease, the earliest symptoms of which are working memory deficits.

“Working and long-term memory are different types of memory that were previously thought to be supported by different parts of the brain,” said Ueli Rutishauser, PhD, director of Neural Science and Medicine and professor of Neurology, Neurosurgery and Biomedical Sciences at Cedars-Sinai and senior author of the study. “Based on this study and our previous work, we have concluded that the hippocampus, long known to support long-term memory, is often essential for working memory as well. In fact, neurons in the hippocampus that we have named ‘persistently active cells’ are critical for both types of memory. Protecting or restoring these cells could help in treating the devastating effects of memory disorders.”

Additional authors: Jonathan Daume, Jan Kamiński, Yousef Salimpour, Andrea Gómez Palacio Schjetnan, William S. Anderson, Taufik A. Valiante, Adam N. Mamelak

Funding: This work was supported by the National Institutes of Health (U01NS117839 to U.R.), a Postdoctoral Fellowship by the German Academy of Sciences Leopoldina (to J.D.) and a Postdoctoral Award by the Center for Neural Science and Medicine at Cedars-Sinai (to J.D.).

Follow Cedars-Sinai Academic Medicine on LinkedIn for more on the latest basic science and clinical research from Cedars-Sinai.

The research project brings together scientists from Cedars-Sinai, Baylor College of Medicine, the University of Michigan and Rutgers University. The investigators will study a process called fetal reversion, also known as developmental reprogramming, in mouse intestines to understand how adult tissues repair themselves, enabling the creation of a detailed map of healing processes.

“Our goal is to explore whether we can use what we learn about fetal reversion to identify a better way to repair and heal organs such as the intestine,” said Ophir Klein, MD, PhD, executive director of Cedars-Sinai Guerin Children’s and the David and Meredith Kaplan Distinguished Chair in Children’s Health.

The research team includes experts in basic science, regenerative medicine, intestinal physiology, virology, drug screening, and genomics and epigenomics. Their endeavor is called the “Consortium on Intestinal Regeneration and Fetal Reversion: from Atlas to Therapy.”

The Cedars-Sinai Newsroom recently spoke with Klein, the project’s coordinating principal investigator, to learn more about the five-year grant, the team’s research goals and how the grant will help advance our understanding of injury repair.

Can you provide a high-level overview of the team’s research interests and how this grant supports its ongoing work?

The fundamental question that we're interested in understanding is how adult tissues repair themselves. We are using the intestine as our model, and we believe that many elements of the repair processes we discover will be more generalizable beyond the intestine and have implications for other organs.

This grant from the NIH will provide the necessary resources for our research team to use this information to study how repair programs work in a mouse model and to find new ways to help the body heal. The data from our research will be shared online in a way that is easy to use, so the research community at large can explore it and come up with new ideas and treatments in the future. The insights we stand to gain could pave the way to a paradigm shift in our understanding of gut repair.

What is fetal reversion, and how will this grant help advance the understanding of injury and repair?

Fetal reversion is a regenerative response in which adult tissues reactivate behaviors from their developmental stage to heal from damage or injury, including those induced by infection, radiation treatment or inflammation.

Sometimes, the body heals perfectly well, while other times it doesn't heal at all. With the support of the NIH grant, we aim to understand how the healing process occurs and whether it involves processes used by the normally developing embryo. This understanding is important to lay a foundation for potential new treatments and drugs for wound healing.

How will the findings from this research potentially impact the development of new treatments for intestinal injuries and gut repair?

The fetal reversion process involves turning off aspects of normal gene expression programs and switching to a more fetal-like state. We don’t yet know if fetal reversion happens in all types of intestinal healing or if it occurs only during certain types of repairs.

It’s still a little bit of a mystery how the gut is able to repair itself after various injuries. One interesting approach is to compare intestinal regeneration across different organisms, and this hasn't been systematically studied. Our aim is to map intestinal injury and repair in mouse and human models, study repair programs and find new therapeutic targets using drug screening. A standardized approach to this study with the latest technologies will hopefully provide further insight into wound healing and fill gaps in our understanding of intestinal regeneration.

This is a historic grant for Cedars-Sinai Guerin Children’s. How will these funds advance the work being done in your laboratory and further advance Guerin Children’s commitment to bench-to-bedside care?

Receiving an NIH grant of this scope allows Guerin Children's to continue conducting leading-edge research, advancing the work of our physician-scientists who merge top-notch clinical care with translational and foundational research. At Guerin Children's, we focus on the entire health span and how pediatric medicine influences health beyond childhood. By learning from children’s health, we aim to improve health outcomes for adults. We are grateful to the NIH and our collaborators for helping us advance this science.

Read more on the Cedars-Sinai Blog: Six Questions With Ophir Klein, MD, PhD

The CurePSP designation means a medical center offers multidisciplinary clinics and movement disorder expertise for patients with progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) and multiple system atrophy (MSA).

“These disorders are similar to Parkinson’s disease, but are more rare,” said Yvette Bordelon, MD, PhD, who is part of the Movement Disorders Division in the Department of Neurology at Cedars-Sinai, and is director of the new Cedars-Sinai CurePSP Center of Care. “This designation will help consolidate our resources and outreach for patients with these disorders, generate additional interest in research and fuel community education.”

Movement disorders affect parts of the brain that control the body’s ability to walk and coordinate movements. Among other symptoms, these disorders can also cause tremors, slowness, rigidity, difficulty with speaking, swallowing, balance and, in some patients, problems with cognition.

“People with PSP, CBD or MSA often confront diagnostic delays, barriers to participating in clinical trials, and lack of familiarity with their disease among healthcare professionals,” said Jessica Shurer, director of clinical affairs and advocacy at CurePSP. “With its long history of comprehensive care and the strong collaboration between the movement and cognitive teams, Cedars-Sinai is well positioned to serve the large and diverse Los Angeles community with these diseases and will help to advance the thought leadership of the CurePSP network.”

Bordelon said each of these neurodegenerative disorders is defined by specific prominent symptoms:  

• Progressive supranuclear palsy often manifests in eye movement difficulties caused by abnormal clumps of tau protein, which have also been implicated in Alzheimer’s disease. It also often involves unexplained falls and difficulty with impulsivity and decision-making.
• Corticobasal degeneration also is associated with abnormal tau protein accumulation and causes challenges with word-finding and the loss of the ability to perform complex movements, such as using eating utensils or buttoning clothes.
• Multiple system atrophy is caused by abnormal clumps of the alpha-synuclein protein, similar to Parkinson’s disease. MSA disrupts involuntary bodily processes, such as heart rate and blood pressure, and leads to clumsy walking and slurred speech.

“There is perfect synergy between being a CurePSP Center of Care and our existing Neurobehavior and Movement Disorders programs,” said Sarah Kremen, MD, director of the Neurobehavior Program at Cedars-Sinai, and co-director of the Center of Care. “We have a full complement of specialists to help patients manage cognitive and behavioral symptoms of these rare conditions, as well as access to leading-edge translational research for those with neurodegenerative illnesses.”

The new center will take advantage of the robust pipeline of clinical trials at Cedars-Sinai, as well as a monthly multidisciplinary movement disorders clinic that brings together patients and neurologists, neuropsychologists, social workers, and specialists in physical therapy, occupational therapy and speech therapy.  

“Cedars-Sinai Neurology embraces a holistic approach to patient-centered, multidisciplinary care coupled with access to novel, cutting-edge research opportunities,” said Nancy L. Sicotte, MD, chair of the Department of Neurology and the Women’s Guild Distinguished Chair in Neurology at Cedars-Sinai. “Our department has grown tremendously in recent years with this focus in mind, and with our current team of providers, it is well positioned to serve patients as a CurePSP Center of Care.”

Cedars-Sinai is one of just four Centers of Care in California; the other three are in Palo Alto, San Francisco and San Diego.

“Incredible advances in our understanding of these disorders in recent years have put us on the cusp of identifying meaningful and effective therapies to integrate into our care of patients,” Bordelon said. “This designation will fuel additional research opportunities and brings a level of distinction we're very proud of.”

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“In older adults, higher levels of amyloid beta and tau have been associated with poorer memory and cognition," said Mitzi Gonzales, PhD, director of Translational Research in the Jona Goldrich Center for Alzheimer’s and Memory Disorders at Cedars-Sinai and lead author of the study. “Our study found that this was also true in adults age 55 and younger—a period thought to be important for prevention. We also found higher levels in individuals with a higher genetic risk for Alzheimer's disease. Future studies should examine memory and cognitive changes over time and look at why some individuals remain mentally sharp despite having high levels of these proteins, to provide important clues about maintaining cognitive health over the lifespan.”

The findings highlight the importance of understanding the effects of amyloid beta and tau proteins on memory and thinking abilities at earlier ages. The work could also help focus dementia-prevention efforts in younger at-risk populations.

Additional authors: Adrienne O’Donnell, Saptaparni Ghosh, Emma Thibault, Georges El Fakhri, Sudha Seshadri, Jeremy Tanner, Claudia L. Satizabal, Charles S. Decarli, Keith A. Johnson, Alexa S. Beiser, Matthew Pase.

Funding: National Institutes of Health, Grant/Award Numbers: N01-HC-25195, HHSN268201500001I, 75N92019D00031; National Institute on Aging, Grant/Award Numbers: RF1AG059421, R01AG054076, R01AG049607, R01AG033090, R01AG066524, R01NS017950, R01AG077472, P30AG066546; National Health and Medical Research Council of Australia Investigator, Grant/Award Number: GTN2009264. 

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“The retina, a layer of tissue at the back of the eye, is part of the central nervous system and is directly connected with the brain,” said Maya Koronyo-Hamaoui, PhD, professor of Neurosurgery, Neurology and Biomedical Sciences at Cedars-Sinai and senior author all three studies. “It has similar cell types and vascular structures to the brain, but is not shielded by bone, so it is more accessible to noninvasive imaging. Our latest research unearths new details about the eye-brain connection.”

Tau

Tau is a protein that helps stabilize the structure of nerve cells in the brain and the retina and is one of the key markers of Alzheimer’s disease. When tau disengages from nerve cells it can form tangles that interfere with cellular function and contribute to cognitive decline.

In a study published in the peer-reviewed journal Acta Neuropathologica, Koronyo-Hamaoui and fellow investigators compared retinal tissue from 45 patients diagnosed with Alzheimer’s-related cognitive impairment or dementia with tissue from 34 individuals with normal cognition or non-Alzheimer’s forms of dementia.

Investigators found that higher levels of abnormal tau in the retina corresponded to levels of tau in the brain, other brain changes related to Alzheimer’s disease, and cognitive decline.

Vessels and amyloid plaques

Clumps of a protein called beta-amyloid, also known as amyloid plaques, are another hallmark of Alzheimer’s disease.

In a study published in the peer-reviewed journal Acta Neuropathologica Communications, Koronyo-Hamaoui and co-investigators used leading-edge imaging and image-processing technology to compare amyloid plaques in the retinas of living patients who had early-stage cognitive impairment with those in individuals who had normal cognition.

Thirty-four patients underwent retinal and brain imaging, and cognitive testing. Analysis in 28 patients revealed two to three times as many plaques clustered near blood vessels in the retinas of patients with mild cognitive impairment or Alzheimer’s disease when compared with individuals with normal cognition. The numbers and position of the plaques correlated with cognitive decline and physical changes in the brain.

Diagnosis in development

Koronyo-Hamaoui’s team also published a review article in the peer-reviewed journal Progress in Retinal and Eye Research that detailed additional Alzheimer’s disease biomarkers that have been identified in the retina.

These include reduced blood flow, deposits of amyloid-beta proteins inside blood vessel walls, damage to the barrier that prevents harmful substances from entering retinal tissue, inflammation, and damage to nerve cells.

“Imaging technology now being developed will allow us to see these changes in patients in clinical settings,” said Keith L. Black, MD, chair of the Department of Neurosurgery and the Ruth and Lawrence Harvey Chair in Neuroscience at Cedars-Sinai and co-author of these studies. “This technology, which is noninvasive and affordable, allows us to see changes in the cells and blood vessels in tremendous detail.”

Black and Koronyo-Hamaoui envision this technology as a tool to screen patients in primary care settings, with those who show features suggestive of Alzheimer’s disease referred for additional testing, such as a PET brain scan or cerebrospinal fluid or blood test. The technology could also assess disease progression and the effectiveness and safety of new treatments.

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Safaa, weighing just 1.1 pounds, was in the Neonatal Intensive Care Unit (NICU) at Cedars-Sinai Guerin Children’s.

“Shortly after Safaa was born, pandemic lockdowns were implemented and only one visitor was allowed in the hospital at a time, so we had to take turns visiting her in the NICU,” Cardello said. “We were not only scared of getting germs at the hospital, but we were scared of bringing germs into the hospital and harming Safaa.”

Safaa experienced a number of health challenges in those early days, including bronchopulmonary dysplasia, or premature lung disease, because her lungs were not fully developed. Additionally, her physicians discovered Safaa had an extremely narrow upper airway, making it difficult for her to breathe without medical intervention.

“I would honestly say Safaa had the smallest windpipe I’ve ever seen,” said Irina Dralyuk, MD, a pediatric pulmonologist at Cedars-Sinai Guerin Children’s and one of Safaa’s consistent care providers.

To bypass her narrow airway, Safaa’s doctors performed a tracheostomy, a procedure to create an opening in the neck that extends to the trachea, allowing easier breathing and enabling oxygen to reach the lungs.

Safaa graduated from the Cedars-Sinai Guerin Children’s NICU four months later, in July 2020, but her airway issues were not solved, so she went home with the tracheostomy tube in her neck.

Fixing Safaa’s Airway

“When I first met Safaa, her airway opening was only a couple of millimeters wide,” said Gene Liu, MD, director of Academic Otolaryngology for Cedars-Sinai Medical Center and a pediatric ear, nose and throat specialist for Cedars-Sinai Guerin Children’s. “And even though she was growing, her windpipe needed help to expand.”

Hoping to avoid a major surgical procedure on her neck that would come with additional risks, Safaa’s family and their care team opted for a less invasive approach using a balloon dilation to gradually widen her airway over time.

“Every few months, we would look at Safaa’s airway with a fiberoptic camera, and the balloon dilation procedure would gently push open the airway little by little until it became a very nice, normal-looking airway,” Liu said.

In March 2024, shortly after Safaa’s 4^th birthday, her tracheostomy tube was removed.

Becoming Like Family

Through four years of appointments and procedures, the Cardello family and Safaa’s Cedars-Sinai care team became quite close.

“Safaa got to know us really well and I think that helped when she would come in for her balloon dilation,” Dralyuk said. “I would always meet her and her family in pre-op and either Dr. Liu or I would carry her back to the procedure area. She’s a tough cookie. She and her parents have done an amazing job.”

Dralyuk said she especially loves to hear Safaa say her name. “Early on, we didn’t know what Safaa’s voice might sound like due to her narrow airway and whether there may be any residual damage to her vocal cords. Now when I see her, and I hear, ‘Hi Dr. Dralyuk,’ it is really special.”

Ahmadi Cardello said she and her family are thankful for the care and attention they received.

“The advice Drs. Liu, Dralyuk and all of Safaa’s other doctors gave us always felt like it was something they would recommend for their own child,” Ahmadi Cardello said. “We didn’t feel alone.”

What’s Next for Safaa

Now that her tracheostomy tube has been removed, Safaa and her parents are waiting patiently for the stoma, or the hole where the tube was previously located, to close. That typically happens on its own in a few months.

Prior to the removal, many things that would be normal for a toddler were risky for Safaa as they could cause infection of the stoma.

“I can’t wait to teach her how to swim,” Cardello said, “It’ll be fun to finally take her to the park and let her play in the sand. We haven’t been able to do that until now.”

Ahmadi Cardello is relieved. “Now that Safaa’s tracheostomy has been removed, I feel like we can all breathe a little easier,” she said.

Read more from the Cedars-Sinai Blog: Common Breathing Problems in Kids and How to Treat Them

“Abstraction allows us to ignore irrelevant details and focus on the information we need in order to act, and inference is the use of knowledge to make educated guesses about the world around us,” said Ueli Rutishauser, PhD, professor and Board of Governors Chair in Neurosciences at Cedars-Sinai and co-corresponding author of the study. “Both are important parts of cognition and learning.”

Humans often use these two cognitive processes together to rapidly learn about and act appropriately in new environments. One example of this is an American driver who rents a car in London for the first time.

“The English drive on the right-hand side of the car and on the left-hand side of the road, the opposite of the way we do in the U.S.,” Rutishauser said. “For someone from the U.S., driving in London means reversing many of the rules they have learned, and making that mental shift requires abstraction to focus on driving-sidedness, and making inferences to avoid pulling directly into oncoming traffic.”

In the study, investigators worked with 17 hospitalized patients who had electrodes surgically implanted in their brains as part of a procedure to diagnose epilepsy. In total, the researchers recorded the firing of thousands of brain cells as participants performed an inference task on a computer.

Looking at the activity of so many brain cells required the use of artificial intelligence to extract the responses that were relevant, allowing investigators to see the coordination between the neurons during successful inference.

“These are high-dimensional geometrical shapes that we cannot imagine or visualize on a computer monitor,” said Stefano Fusi, PhD, a principal investigator at Columbia University’s Zuckerman Mind Brain Behavior Institute and co-corresponding author of the study. “But we can use mathematical techniques to visualize simplified renditions of them in 3D.”

During the recordings, participants were repeatedly shown four pictures—a person, a monkey, a car and a watermelon. In response to each picture, they were asked to press a left-hand or right-hand button. Individuals then received a “correct” or “incorrect” message.

Through repetition, participants eventually learned the correct response for each of the four pictures. At that point, the rules of the game were reversed without the participants being informed, and the opposite response for each picture was counted as correct.

After the switch, some participants were able to quickly figure out the rule change and infer the correct responses without relearning them, meaning they performed inference.

Investigators saw striking geometric patterns in the brains of those participants. Groups of neurons were firing together, much like birds flying in formation or a crowd of people spontaneously taking up a chant at a sporting event. The way the neurons coordinated their activity and encoded the relevant information indicated that the subjects had gained the conceptual knowledge needed to perform the task. Investigators saw no such patterns in the brains of participants who were not successful in using inference.

“Building conceptual knowledge is an important aspect of learning,” said Hristos Courellis, PhD, a researcher at Cedars-Sinai and first author of the study. “In our study, we identified a neural basis for this process, which in cognitive psychology is referred to as abstraction.”

Some subjects were initially not able to perform inference from experience with the task alone. For these subjects, investigators provided verbal instructions that allowed the subjects to then infer the correct answers.

“A remarkable discovery was that the same neural geometries emerged in participants who received verbal instructions as in those whose ability to infer was based on experiential learning,” said Adam Mamelak, MD, director of the Functional Neurosurgery Program and professor of Neurosurgery at Cedars-Sinai and co-author of the study. “This crucial discovery shows that verbal input can result in neural representations that otherwise might take a long time to learn through experience.”

The study, which relied on data from Cedars-Sinai and the University of Toronto, was led by Cedars-Sinai and conducted as part of a multi-institutional consortium funded by the National Institutes of Health’s The Brain Research Through Advancing Innovative Neurotechnologies Initiative, or The BRAIN Initiative.

“This study provides new insights into how our brains allow us to learn and carry out tasks flexibly and in response to changing conditions and experiences,” said Merav Sabri, PhD, program director for The BRAIN Initiative. “These insights build on the body of knowledge that could one day lead us toward interventions for neurologic and psychiatric conditions that involve deficits in memory and decision-making.”

A surprise to investigators was the discovery that these particular patterns of brain activity emerged only in the hippocampus, a region deep in the center of the brain that is known to be crucial for the formation of new long-term memories.

“Our finding expands our knowledge of the role of the hippocampus in learning,” Rutishauser said. “This is the first direct demonstration of the involvement of the human hippocampus in the learning of abstract knowledge and inference behavior. Many neurological conditions, including Alzheimer’s disease, obsessive-compulsive disorder and schizophrenia, affect this brain region, and our finding could help explain the impaired decision-making we see in these patients.”

Additional Cedars-Sinai authors include Juri Minxha, and Chrystal M. Reed.

Other study authors include Araceli R. Cardenas, Daniel Kimmel, Taufik A. Valiante, and C. Daniel Salzman.

Funding: This work was supported by The BRAIN Initiative through the NIH Office of the Director (U01NS117839 to U.R.) and the Simons Foundation Collaboration on the Global Brain (to S.F., and U.R.).

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“I am excited to have Dr. Tuchman as a partner in elevating and building the Cedars-Sinai Spine Center,” Skaggs said. “I have enjoyed partnering with Dr. Tuchman in research, educating the next generation of spine surgeons, and in the operating room. It takes a comprehensive team including both neurosurgical and orthopedic spine expertise to build on our foundation of leading-edge research while at the same time providing the highest-quality clinical care.” 

Tuchman, an assistant professor of Neurosurgery at Cedars-Sinai, attended medical school at the University of Miami Miller School of Medicine and completed his neurosurgery fellowship at the University of Southern California. Before joining Cedars-Sinai in 2018, Tuchman also completed a spine deformity fellowship at Columbia University Medical Center in New York.

It was during his residency that Tuchman discovered the complexity, challenges and rewards of providing adult spinal care, and he did extra training in treatment of spinal malalignments and deformities such as scoliosis, sagittal plane deformities and flat back syndrome.

“These surgeries have impressive impacts on people’s quality of life,” Tuchman said. “The spine is the center connection point for your extremities and brain, and anytime there's a structural issue, it can cause devastating consequences. With reconstructive spine surgery, we can often restore function and relieve pain, taking someone who is basically homebound, or even bedridden, and getting them back out into the world.”

Tuchman also conducts research focused on outcomes for spine surgery patients, and treats adult patients with rare spinal conditions such as achondroplasia, a genetic condition that truncates the growth of the arms and legs and is the most common form of short-limbed dwarfism.

He said proper selection of spine patients—and treatments—is paramount. An open dialog between the patient and the surgeon is essential so that the patient feels comfortable expressing their wants and needs and the surgeon can adapt a treatment plan to address those things.

“One of the biggest challenges for a spine surgeon is determining whether we can genuinely help,” Tuchman said. “If a patient’s spine problem is not going to respond well to spine surgery, then that person shouldn't have spine surgery, and if a spinal malalignment isn’t affecting the patient’s quality of life, perhaps it does not need to be treated.”

Keith L. Black, MD, chair of the Department of Neurosurgery and the Ruth and Lawrence Harvey Chair in Neuroscience at Cedars-Sinai, said that the robust resources of Cedars-Sinai and Cedars-Sinai Spine Center also are key factors in quality care.

“Spine surgery is a team sport and we have internists, cardiologists, physical and occupational therapists, anesthesiologists, surgical technicians, pain specialists, hospitalists, and top-notch nurses working with our surgeons to care for hundreds of spine surgery patients each month,” Black said. “Dr. Tuchman taking the reins as co-leader means continued excellence for the team and the best possible outcomes for our spine patients.”

Read more on the Cedars-Sinai Blog: Seeking a Second Opinion for a Spine Condition

“Donor milk plays a crucial role in improving the outcomes for our most vulnerable premature infants,” said Bevin Merideth, MSN, RN, associate director of the Neonatal Intensive Care Unit at Cedars-Sinai Guerin Children’s. “A diet comprised of human milk—whether maternal, donor, or a combination of both—has been shown to significantly decrease the incidence of necrotizing enterocolitis [NEC], an inflammation of the intestinal tract, which is the leading cause of death in premature infants,” Merideth said.

To participate in the breast milk drive, donors first register with the milk bank, share their health history and undergo a blood test.  

Wendy De Leon, Cedars-Sinai’s lead lactation consultant, said donors are helping the smallest patients.

“Babies digest human milk better than bovine protein and the antibodies from breast milk are greater than what babies would receive from formula,” De Leon said. “The availability of donor breast milk in our Neonatal Intensive Care Unit [NICU] is made possible through these generous donations of surplus breast milk to milk banks.”

Those who wish to participate in the upcoming milk drive should preregister and bring their frozen milk in a cooler to the drop-off. Frozen breast milk is good for approximately six months.

Mothers Milk Drive
When:       Sunday, Aug. 4, 11 a.m.-2 p.m.
Where:      Cedars-Sinai
Thalians Health Center 
8730 Alden Drive
Los Angeles, California 90048

Read more on the Cedars-Sinai Blog: Support for Nursing Parents 

But parents of premature babies often wait weeks or even months before they can do so. This is especially true if infants need a ventilator to help them breathe, a common issue for preemies, because lifesaving ventilator tubes and cords make it difficult to safely move a baby.

Cedars-Sinai joined with other hospitals across the state to find a solution and facilitate earlier skin-to-skin bonding for the tiniest babies and their parents. The project involves neonatal intensive care unit (NICU) specialists, including respiratory therapists, nurses and doctors. They figured out how to carefully move premature babies and respiratory equipment safely out of incubators and into parents’ arms.

“It is a three- to four-person job, and because the baby is so fragile, once the infant is moved, they remain in their parent’s arms for about two hours,” said clinical nurse specialist Amanda Williams, MSN, who led the Cedars-Sinai Guerin Children’s effort.

Emma and Tyler Beckett’s son, Owen, was born the first week of June at Cedars-Sinai at 24 weeks’ gestation, weighing just 1.7 pounds, and he was started on a jet ventilator in the Neonatal Intensive Care Unit at Cedars-Sinai Guerin Children’s.

“It’s so special,” Emma Beckett said. “The day that they told us we could start doing skin-to-skin, it was a surprise for us, and I just started crying immediately because I thought we were going to have to wait a long time—and to be able to do this now, it’s just amazing. Like we feel so much more connected to him.”

Courtney and Steven Fine also are getting an unexpected opportunity to bond with their daughter, Alia, who was born at 26 weeks’ gestation in mid-May and weighed 1.11 pounds.

“It's just nice to have her close to me,” Courtney Fine said. “I just really feel like I'm getting to bond with her more. It really does change my entire day and week.”

The reaction from parents has been universally positive, Williams said.

“We know how important skin-to-skin is for the babies and the parents, both emotionally and physically,” Williams said. “It’s so good for the baby. When they are skin-to-skin, we see their vital signs improving, including their respiratory and heart rates. It also helps mom with producing breast milk, and for both moms and dads, the bonding opportunity is key.”

Rangasamy Ramanathan, MD, MBBS, director of Neonatology and an innovator in neonatal and pediatric respiratory care, pioneered the new technique of nasal high frequency jet ventilation. That technique uses a nose tube called a RAM Cannula that was named for Ramanathan.

“There is so much benefit for the baby and the parents with skin-to-skin care that our approach is to make it possible with the use of jet ventilators as soon as possible in babies with breathing problems,” Ramanathan said.  

Tyler Beckett alternates with his wife, doing skin-to-skin with newborn Owen every other day. “I see his improving health and his improving strength,” Beckett said. “I am happy to think that I might be contributing in a small way, and it makes us feel better too. I am happier and calmer from the contact.”

The same is true for Steven Fine and his baby, Alia. “Skin-to-skin is our happy place,” Fine said. “It lets us not focus on any of the medical issues going on and just be with her and be present.”

Read more from the Cedars-Sinai Blog: Anxious About Breastfeeding? You're Not Alone

The 17-year-old actor, who has starred in popular shows and movies like Ghostbusters: Frozen Empire, The Handmaid’s Tale and Young Sheldon, brought specially designed movie-themed hospital gowns, coloring books and toys for the patients.

“It’s fun for me to be able to bring things and just talk to people and talk to kids and teens,” Grace said.

For the visit, Grace teamed up with nonprofit Starlight Children’s Foundation, a longtime partner of Cedars-Sinai that distributes hospital wear, games and supplies to make the inpatient experience more positive for children and their families.

“Hospitalization can be a scary and lonely experience,” said Richard Jardiolin, the foundation’s spokesperson. “Our goal is to transform hospital experiences so kids can enjoy the best parts of being a kid, no matter what they're going through.”

Grace has been through it herself. She had spine surgery performed by David L. Skaggs, MD, director of Pediatric Orthopaedics at Guerin Children's, to fix severe scoliosis. Now, fully recovered and back in action, she is able to bring joy to other patients still on their healthcare journey.

“Through visits from celebrities like Mckenna, whose sincerity and kindness were apparent throughout her visit, patients and families feel a personal connection with someone they may never have had the opportunity to meet,” said Sandie Sternberg, a certified child life specialist at Guerin Children’s.

During her visit, Grace gleefully swapped pet photos with one of the hospitalized teens and connected with another patient over their mutual love of video games.

“My visit today was great. I got to talk to a lot of kids. I got a new Roblox friend, and I also got invited to a senior prom,” Grace said. “So, I'd say overall, a very successful day.”

Read more on the Cedars-Sinai Blog: Five Deep Breathing Exercises for Kids and Teens

“After several decades of research, we understand that Alzheimer’s disease is not going to be easy to conquer,” said Zaldy Tan, MD, MPH, director of The Maxine and Bernard Platzer Lynn Family Memory and Healthy Aging Program. “There is no magic infusion, injection or pill that will cure it, but there are tactics to prevent or reduce one’s risk for it. While we continue to search for a viable path for stopping this disease in its entirety, prevention is of the utmost importance.”

An estimated 6.7 million Americans are living with Alzheimer’s disease, according to the National Institutes of Health. As advances in medicine and disease prevention are helping more people live longer and reach the age—65 and older—at risk for developing Alzheimer’s disease and dementia, Cedars-Sinai’s healthy aging program focuses on personalized risk profiling using clinically validated tools.

Risk factors for developing Alzheimer’s disease or dementia include family history of the disease, a gene called APOE4, diabetes, high blood pressure, sleep apnea, unhealthy weight, history of traumatic brain injury or head trauma, and social isolation.

The Cedars-Sinai program is open to anyone 40 to 60 years old with at least two of these risk factors, and anyone 60 or older who doesn’t have signs of Alzheimer’s disease or dementia but wants to protect their brain health.

Prior to their first clinic visit, patients complete a questionnaire that delves into their physical activity, diet, social networking, history of physical and emotional trauma, and level of education, among other things.

During the clinic visit, Tan and colleagues perform a detailed physical and neurological exam and cognitive tests. They also assess each patient’s grip strength, how many times they can sit in a chair and stand up again unsupported in 30 seconds, their level of frailty and risk of falling. Some patients are sent home with digital devices to continuously measure blood pressure, sleep patterns and oxygenation during sleep.

“These are things that are not necessarily asked about in primary care, or even in general neurology clinics,” said Tan, who is also medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders and the Carmen and Louis Warschaw Endowed Chair in Neurology at Cedars-Sinai. “We use clinically validated tools to evaluate each individual’s risk and resilience factors. And based on that information, we teach them strategies to reduce their risk and maintain brain health.”

The team includes a dietitian to help participants improve their eating habits, a health psychologist who assists with behavior change issues such as smoking cessation, sleep specialists, and an occupational therapist who helps participants understand how their brains work and offers cognitive training to improve memory habits. Patients also can be referred to other specialists, including those from the Smidt Heart Institute at Cedars-Sinai, as brain and heart health are closely linked, Tan said.

“Studies show that as many as 40% of cases of Alzheimer’s disease and related dementias can be prevented or delayed with the right clinical guidance,” said Nancy L. Sicotte, MD, chair of the Department of Neurology and the Women’s Guild Distinguished Chair in Neurology at Cedars-Sinai. “We launched this program to help our patients optimize their brain health throughout life, and also to push the science forward through continued translational research.”  

Tan noted that recommendations and referrals are personalized and specific to each patient. He said that everyone is different, and while some people have more areas to improve on and others have fewer, everyone has something.

“We want to help people take preventive action as early as possible,” Tan said. “Delaying the onset of Alzheimer’s disease for even five to eight years is tantamount to a cure for many people, because the greatest risk is in those ages 80 and up. Those who delay onset until their late 80s might avoid it altogether.”

Read more on the Cedars-Sinai Blog: When Should I Be Concerned About Memory Loss?

This could lead to new applications for the therapy, allowing it to influence higher-level functions such as learning and memory.

“Deep brain stimulation has typically been used to overexcite or shut down all neurons in a target area,” said Costas Anastassiou, PhD, associate professor of Neurology, Neurosurgery and Biomedical Sciences at Cedars-Sinai and senior author of the study. “We found that by varying the shape of the electrical pulse waves we apply, we can selectively influence specific neuron types while leaving others unaffected.”

In the study, investigators applied electrical fields to individual cells in tissue samples from the visual cortex and the hippocampal regions of the brains of patients and laboratory mice. The investigators recorded the activity of excitatory and inhibitory neurons, which act as the gas pedal and brakes, respectively, in brain circuits.

Results showed that different electrical wave frequencies influenced the timing of spikes, which are changes in electrical voltage that travel down neuron fibers and are transmitted to other neurons. Anastassiou called spikes “the coin of communication between neurons.”

“We found that electrical frequencies that influenced one cell type did not necessarily influence another, and vice versa,” Anastassiou said. “Surprisingly, the effects on each cell type were the same in both brain areas we examined, and in both species—though more pronounced in humans than in mice.”

Given that previous research has found that higher-level functions in the brain require coordination and communication between different cell types, the ability to manipulate this communication could be of great importance, Anastassiou said.

“This study offers new understanding of how to stimulate the human brain to promote or suppress specific activity patterns, and could pave the way for new directions in basic research and clinical applications,” said Keith L. Black, MD, chair of the Department of Neurosurgery and the Ruth and Lawrence Harvey Chair in Neuroscience at Cedars-Sinai. “These results offer the possibility for electrical protocols that are more selective, more controlled, and allow for different parts of the brain neural network to be manipulated in different ways.”

Investigators are now working to determine the exact mechanisms required to produce various results in the brain, and to replicate their brain tissue experiments in living patients.

“This data supports the idea that electrical brain stimulation could be used in new ways that target specific groups of brain cells,” said Adam Mamelak, MD, director of the Functional Neurosurgery Program at Cedars-Sinai. “This gives us an exciting opportunity to imagine new uses for this therapy and the chance to address disorders involving learning and memory.” 

Other Cedars-Sinai authors involved in the study include Konstantinos Kozalakis, PhD.

Funding: This work was supported by National Institutes of Health grants R01 NS120300 and RO1 NS130126.

Conflict of interest: Anastassiou is listed as an inventor on a patent application related to this work.

Learn more on the Cedars-Sinai Blog: A Patient’s Journey With Deep Brain Stimulation