Improving on the Entire Spectrum of Care
By BECKY GILLETTE
New Chief of Pediatric Neurology at UAMS/Arkansas Children's looking to continue refining and improving access to care and services
Freedom F. "Fred" Perkins, Jr., MD, has a background uniquely suited being the new chief of pediatric neurology of both Arkansas Children's system and the University of Arkansas for Medical Sciences (UAMS). In addition to being a physician and researcher with an international reputation, he grew up helping care for a younger brother, Mikie, who developed significant permanent cognitive/intellectual delays, as well as epilepsy, as a result of a respiratory infection at age nine months.
"Functionally, Mikie was autistic," said Perkins, who shared a bedroom with Mikie for 20 years until Perkins entered medical school. "He was cognitively, speech and socially delayed. He had fixed-repetitive behaviors and a keen memory for details. He did not do well with changes in his routines. He has never been formally diagnosed with autism and his hypoxic brain injury is the main source of his difficulties. But this profoundly shaped my perceptions and empirical understanding of what children and families with developmental disabilities (however they are acquired) go through."
Perkins grew up in a military family that moved often. He had a natural affinity for drawing, an interest in design and a fascination with science. If not for having a brother so gravely ill, he might have been a designer, architect or engineer. As he grew up, encouraged by his family, he felt drawn to become a doctor.
"I was the first one in my family to go to college, so none of us were totally clear on what we were in for," Perkins said. "After high school, I entered St. Mary's University in San Antonio. I spent my weekends working, the last couple of years in the physiology department at the University of Texas Health Science Center, San Antonio. From there I was fortunate to go to medical school at the University of Texas Medical Branch, Galveston, where I initially thought I would do adult neurology."
During his training, he found he was much happier in pediatrics and came to the conclusion that pediatric neurology was a better fit. He had a four-year military commitment to the Air Force which, at the time, had all the pediatric neurologists needed. So, after his intern year, he went on active duty as an aerospace medicine specialist, the primary care provider for the flight crew.
Perkins completed his fellowship in clinical neurophysiology/epilepsy at the University of Texas at Houston and went on to be program director at the University of Tennessee Health Science Center at Memphis Pediatric Neurology Residency Program. He joined Dell Children's Medical Center in Austin, Texas, in 2012 and most recently was interim leader of the epilepsy program.
His new job involves overseeing the child neurology section at UAMS/Arkansas Children's system, which has neurodevelopmental specialists whose work includes evaluating and treating children with autism spectrum disorders (ASD). They also coordinate care with other medical and developmental specialists.
"We intend to continue refining and improving access to care and services in any way we can," Perkins said. "A comprehensive approach works best. That means confirming or reaffirming the diagnosis of autism, performing appropriate diagnostic studies (i.e. genetic screening, EEG, etc.) and addressing some of the major co-morbidities that are observed in autism. These include sleep disorders, irritability, epilepsy, etc. We also wish to be strong advocates for speech, occupational and behavioral therapies-within the child's local community, if possible. This can be very challenging."
Over the past 15 years, autism rates have increased. There is a lot of speculation as to the cause, but Perkins believes awareness and testing do play a role.
"Some evidence suggests environmental causes, epigenetics, etc.," he said. "While very interesting, I don't think there is a single cause that explains the numbers. Early intervention is crucial. Autism is broken down into different levels (I-III) from mild to severe. At its core, the main issues in autism spectrum disorders are the development of appropriate communication and social skills. Early recognition and subsequent deployment of therapy has been shown to have a profound positive impact of the child."
If a child isn't speaking/communicating, they want to help the child develop that skill. If the child is speaking, is it at the appropriate level? Is the communication effective? If they aren't interacting with peers very much, can they change that? If they are interacting, is it reciprocal, etc.?
GI problems are very common in the ASD population. Some causes are not clear, but Perkins suspects a poor diet (i.e. starchy foods) and sensory processing issues (i.e. fear of the toilet; discomfort during a bowel movement) are contributing factors. Behavioral therapy can help most cases.
"The brain-gut connection is not too well understood, but there seems to be growing evidence, not just in autism, that it is more complex than previously thought," Perkins said. "This is an area for further research. Probiotics and fiber supplements can be helpful for some patients."
One reason Perkins was selected for the job was his clinical experience, particularly with surgical epilepsy and magnetoencephalography. Arkansas Children's recently installed a magnetoencephalography system.
"I visited, loved the hospital and met with an awesome team," he said. "I thought, 'What a great opportunity to work with a smart and enthusiastic faculty and staff! We could really do something special!'"
There is also a lot going on with epilepsy care at UAMS/Arkansas Children's. There are five pediatric epileptologists and a sixth person coming early in 2021. They have a National Association of Epilepsy Centers Level IV (highest acuity) epilepsy program at Arkansas Children's.
"We see and treat children, predominantly from Arkansas, but beyond state borders as well, with all forms of epilepsy," Perkins said. "They have the most advanced diagnostic technology including video EEG, neuropsychological assessment, brain imaging, magnetoencephalography, functional MRI, neuro-navigated transcranial magnetic stimulation, diet therapy and all forms of epilepsy surgery (including stereotactic EEG, focal thermal laser ablation therapy, and neuromodulation)."
ACH has recently been admitted to the Pediatric Epilepsy Research Consortium joining many colleagues in collaboration around the country. They also have a number of ongoing investigational drug trials.
"These things are intended to improve the diagnosis and treatment options of patients with epilepsy and most of all, improve their quality of life," Perkins said.
Perkins wants other healthcare providers in the state to know that their goal is to be the best care partners and advocates for patients and families.
Perkins said UAMS and Arkansas Children's share many of the same goals including patient care, community advocacy, training the next generation of medical providers, and pushing the research envelope.
"Arkansas Children's system provides the clinical venue and tons of support for faculty and staff," Perkins said. "Without that, there is no program. UAMS provides critical academic structure, scientific support and collaboration. For me, they are really two halves of the same coin. Both are paramount in their own respect and each makes the other stronger."
In his free time, Perkins loves yard work, even mowing the grass, and growing native plants and vegetables. Perkins has been married to pediatrician Silvia Flores-Perkins, MD, for 24 years, and they have an 18-year-old, Jamie Perkins.
For more information, go online to: