Loma Linda University

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David Michelson, MD
Assistant Professor, Pediatrics
School of Medicine
Assistant Professor, Neurology
School of Medicine
Publications    Scholarly Journals--Published
  • Ho A, Michelson D, Aaen G, Ashwal S. Cerebral folate deficiency presenting as adolescent catatonic schizophrenia: a case report. J Child Neurol. 2010 Jul;25(7):898-900. ( 7/2010 - 6/2010 )
  • Ashwal S, Michelson D, Plawner L, Dobyns WB; Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Practice parameter: Evaluation of the child with microcephaly (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2009 Sep 15;73(11):887-97. ( 9/2009 )
  • Schuster FL, Yagi S, Gavali S, Michelson D, Raghavan R, Blomquist I, Glastonbury C, Bollen AW, Scharnhorst D, Reed SL, Kuriyama S, Visvesvara GS, Glaser CA. Under the radar: balamuthia amebic encephalitis. Clin Infect Dis. 2009 Apr 1;48(7):879-87. ( 4/2009 )
  • Ray P, Hayward J, Michelson D, et al.. "Encephalopathy after whole-cell pertussis or measles vaccination: lack of." Pediatr Infect Dis J 25.9 (2006): 768-773. ( 9/2006 )
    BACKGROUND: Whole-cell pertussis (wP) and measles vaccines are effective in preventing disease but have also been suspected of increasing the risk of encephalopathy or encephalitis. Although many countries now use acellular pertussis vaccines, wP vaccine is still widely used in the developing world. It is therefore important to evaluate whether wP vaccine increases the risk of neurologic disorders. METHODS: A retrospective case-control study was performed at 4 health maintenance organizations. Records from January 1, 1981, through December 31, 1995, were examined to identify children aged 0 to 6 years old hospitalized with encephalopathy or related conditions. The cause of the encephalopathy was categorized as known, unknown or suspected but unconfirmed. Up to 3 controls were matched to each case. Conditional logistic regression was used to analyze the relative risk of encephalopathy after vaccination with diphtheria-tetanus-pertussis (DTP) or measles-mumps-rubella (MMR) vaccines in the 90 days before disease onset as defined by chart review compared with an equivalent period among controls indexed by matching on case onset date. RESULTS: Four-hundred fifty-two cases were identified. Cases were no more likely than controls to have received either vaccine during the 90 days before disease onset. When encephalopathies of known etiology were excluded, the odds ratio for case children having received DTP within 7 days before onset of disease was 1.22 (95% confidence interval [CI] = 0.45-3.31, P = 0.693) compared with control children. For MMR in the 90 days before onset of encephalopathy, the odds ratio was 1.23 (95% confidence interval = 0.51-2.98, P = 0.647). CONCLUSIONS: In this study of more than 2 million children, DTP and MMR vaccines were not associated with an increased risk of encephalopathy after vaccination.
  • Angeles DM, Wycliffe N, Michelson DJ, et al.. "Use of opioids in asphyxiated term neonates: effects on neuroimaging and clinical outcome.." Pediatric Research 57.6 (2005): 837-838. ( 6/2005 )
    Perinatal asphyxia is a common cause of neurologic morbidity in neonates who are born at term. Asphyxiated neonates are frequently treated with analgesic medications, including opioids, for pain and discomfort associated with their care. On the basis of previous laboratory studies suggesting that opioids may have neuroprotective effects, we conducted a retrospective review of medical records of 52 neonates who were admitted to our neonatal intensive care unit between 1995 and 2002 and had undergone magnetic resonance imaging (MRI) of the brain. Our review revealed that 33% of neonates received morphine or fentanyl. The neonates who received opioids also had experienced hypoxic/ischemic insults of greater magnitude as suggested by higher plasma lactate levels and lower 5-min Apgar scores. It is interesting that the MRI studies of neonates who were treated with opioids during the first week of life demonstrated significantly less brain injury in all regions studied. More important, follow-up studies of a subgroup of opioid-treated neonates whose MRI scans were obtained in the second postnatal week had better long-term neurologic outcomes. Our results suggest that the use of opioids in the first week of life after perinatal asphyxia have no significant long-term detrimental effects and may increase the brain's resistance to hypoxic-ischemic insults.
  • Miller SM, Rangaswami, Michelson DJ, et al.. "Patterns of brain injury in term neonatal encephalopathy.." Journal of Pediatrics 146.4 (2005): 453-460. ( 4/2005 )
    OBJECTIVES: To determine whether the pattern of brain injury in term neonatal encephalopathy is associated with distinct prenatal and perinatal factors and to determine whether the pattern of injury is associated with 30-month neurodevelopmental outcome. STUDY DESIGN: A total of 173 term newborns with neonatal encephalopathy from 2 centers underwent magnetic resonance imaging (MRI) at a median of 6 days of age (range, 1-24 days). Patterns of injury on MRI were defined on the basis of the predominant site of injury: watershed predominant, basal ganglia/thalamus predominant, and normal. RESULTS: The watershed pattern of injury was seen in 78 newborns (45%), the basal ganglia/thalamus pattern was seen in 44 newborns (25%), and normal MRI studies were seen in 51 newborns (30%). Antenatal conditions such as maternal substance use, gestational diabetes, premature rupture of membranes, pre-eclampsia, and intra-uterine growth restriction did not differ across patterns. The basal ganglia/thalamus pattern was associated with more severe neonatal signs, including more intensive resuscitation at birth ( P = .001), more severe encephalopathy ( P = .0001), and more severe seizures ( P = .0001). The basal ganglia/thalamus pattern was associated with the most impaired motor and cognitive outcome at 30 months. CONCLUSION: The patterns of brain injury in term neonatal encephalopathy are associated with different clinical presentations and neurodevelopmental outcomes. Measured prenatal risk factors did not predict the pattern of brain injury.
  • Michelson DJ, Ashwal S. "Tethered cord syndrome in childhood: diagnostic features and relationship to congenital anomalies." Neurological Research 26.7 (2004): 745-753. ( 10/2004 )
    Tethered Cord Syndrome (TCS) is a stretch-induced functional disorder of the spinal cord that often develops and presents in childhood in association with spinal dysraphism. While the subtlety with which TCS can present makes it challenging to diagnose, awareness of the common neurological, musculoskeletal and urologic symptoms are of great value to the clinician, and can aid timely referral for neurosurgical evaluation. This article reviews these symptoms, as well as the clinical and radiological findings of the most common dysraphic conditions associated with TCS.
  • Michelson DJ, Ashwal S. "The pathophysiology of stroke in mitochondrial disorders.." Mitochondrion 4.5-6 (2004): 665-671. ( 9/2004 )
    Stroke occurs with an increased frequency in patients with mitochondrial disorders and is a characteristic feature of the MELAS phenotype. This article explores the proposed mechanisms by which mitochondrial dysfunction may contribute to both vascular and non-vascular strokes and stroke-like episodes. The clinical features, neuroimaging, and pathologic findings of MELAS are reviewed as evidence for a cytopathologic basis for stroke in mitochondrial disorders.
  • Michelson DJ and Ashwal S. "Evaluation of coma and brain death." Seminars in Pediatric Neurology 11.2 (2004): 105-108. ( 6/2004 )
    Coma is a nonspecific sign of widespread central nervous system impairment resulting from various metabolic and structural etiologies. The rapid recognition of this neurologic emergency and results from the history, physical examination, and early investigative studies are key to the identification and treatment of its underlying cause. The prognosis for recovery depends greatly on the underlying etiology as well as on its optimal treatment, which seeks to preserve neurologic function and maximize the potential for recovery by reversing the primary cause of brain injury, if known, and preventing secondary brain injury from anoxia, ischemia, hypoglycemia, cerebral edema, seizures, infections, and electrolyte and temperature disturbances. Brain death must be diagnosed with similar care and precision, and families approached compassionately about the diagnosis and their decisions regarding organ donation.
  • Clark AE, Goldstein MK, Michelson DJ, et al.. "The effect of assessment method and respondent population on utilities elicited for Gaucher disease." Quality of Life Research 6.2 (1997): 169-184. ( 3/1997 )
    Measured preferences have been reported to vary with the method of elicitation and respondent population surveyed. We elicited utilities for Gaucher disease using a multimedia implementation of the time trade-off, standard gamble, and a conceptually different, largely untested approach, the risk-risk trade-off, from those who are healthy, those with a chronic illness and those with Gaucher disease. The risk-risk trade-off produced significantly lower utilities than the other two preference assessment methods and had the poorest test-retest reliability. The respondent's self-rated current health state utility was the most important determinant of utility values elicited by the time trade-off and standard gamble for the hypothetical health states. Our results do not support the use of our implementation of the risk-risk trade-off method. In eliciting preferences for hypothetical health states from the general population, the subjective rating of a respondent's own health state should be considered in determining representative population groups.
  • Lenert LA, Michelson DJ, Flowers C, et al.. "IMPACT: an object-oriented graphical environment for construction of multimedia patient interviewing software." Proc Annu Symp Comput Appl Med Care . (1995): 319-323. ( 1/1995 )
    This paper describes our software for rapid construction of multimedia computer interviews. The program, which we call IMPACT, was designed to measure preferences for health outcomes using the standard gamble and other decision analytic techniques. IMPACT is also a multimedia shell program that allows researchers to interactively construct patient interviewing instruments without programming or scripting. It supports the integration of text, graphics, synthesized speech, digital sound and QuickTime movies into interviewing instruments through a point-and-click interface. IMPACT also supports branching logic and randomizing the presentation order of materials within an instrument. This allows customization of the presentation based on patient responses and facilitates experimental designs. Validation studies show that preference assessments performed using IMPACT have high test-retest reliability (r = 0.83, n = 96). Post-test surveys (n = 52) show that most subjects understand valuation methods (86%) and believe that the explanations provided were clear (96%) and that methods were reasonable (80%). The majority of subjects thought the preference assessment methods were not difficult to use (53%) and would have been comfortable using such methods for medical decisions (53%).
  • Goldstein MK, Clark AE, Michelson DJ, et al.. "Developing and testing a multimedia presentation of a health-state description." Medical Decision Making 14.4 (1994): 336-344. ( 10/1994 )
    Quality-adjustment weights for health states are an essential component of cost-utility analysis (CUA). Quality-adjustment weights are obtained by presenting large numbers of subjects with multiattribute descriptions of health states for rating. Comprehending multiattribute health states is a difficult task for most respondents. The authors hypothesized that multimedia (MM) presentation using computers might facilitate this task better than would a paper-based text (Text). To test this hypothesis, they developed closely matched MM and Text descriptions of health states in the first-person narrative style, and developed a method of testing the presentation of a health state. Subjects were randomized to exposure to either MM or Text and subject recall of the health state and recognition of features of the health state were tested. How well defined the preferences of the subjects were after each presentation method was assessed by having the subjects mark on a double-anchored visual-analog scale the "best" and "worst" they believed the quality of life in the health state might be. MM subjects had better recall (11.85 vs 9.44 of a total of 24 meaning units, p = 0.098) and better recognition (4.71 vs 4.22, p = 0.08). The average interval between the "best" and "worst" ratings was shorter for the MM subjects (2.19 cm vs 3.26 cm, p = 0.12).
  • Timko C, Moos RH, Michelson DJ. "The contexts of adolescents' chronic life stressors." American Journal of Community Psychology 21.4 (1993): 397-420. ( 8/1993 )
    Proposed and tested a model of the determinants of adolescents' chronic life stressors, consisting of sociodemographic, personal, and contextual stress and coping factors, using baseline and 1-year follow-up data from 259 adolescents who varied in their psychological and physical health. Concurrent regression analyses at Time 1 and at Time 2, and longitudinal regressions that controlled for the levels of chronic stressors 1 year earlier, showed that sociodemographic, personal, and contextual factors each made a significant contribution to predicting adolescents' ongoing stressors with their mother, father, siblings friends and classmates and teachers at school. Personal factors of an emotional temperament and low perceived self-worth, and contextual factors of more negative life events and fewer social resources, were related to more chronic stressors. Suggestions for further development of the model are discussed.
  • Goldstein MK, Michelson DJ, Clark AE, et al.. "A multimedia preference-assessment tool for functional outcomes." Proc Annu Symp Comput Appl Med Care . (1993): 844-848. ( 1/1993 )
    Functional outcomes of clinical trials are often reported as number of dependencies in activities of daily living (ADLs). Quality-weighting for the ADLs has not been reported. We designed and pilot-tested ADLIB (ADL Index Builder), a multimedia computer program, that presents ADL health states to subjects and elicits from subjects a rating for the quality of life of each health state. Subjects, who were patients over age 50 without previous computer experience, found the program easy to use. Health care professionals specializing in geriatrics confirmed that the ADL presentations used in the program are in accord with typical practice in scoring ADLs. We plan to use the program to obtain population-based preference ratings that can be used to assess efficacy of clinical trials and to provide quality-weights for cost-effectiveness analysis.
  Scholarly Journals--Accepted
  • Michelson DJ, Shevell MI, Sherr EH, Moeschler JB, Gropman AL, and Ashwal S. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society: Evidence-Based Guideline: Genetic and Metabolic Testing in Children with Global Developmental Delay. Neurology. Nov 2011 ( 11/2011 )
  Books and Chapters
  • Michelson DJ and Ashwal S, Neuroimaging. Textbook of Critical Care, 6th Edition: Elsevier, 2011. ( 12/2011 )
  • Michelson DJ. Spinal Fluid Examination. Pediatric Neurology: Principles and Practice, 5th Edition: Elsevier, 2011. ( 11/2011 )
  • Michelson DJ, Shu SK. Cognitive and Motor Regression. Pediatric Neurology: Principles and Practice, 5th Edition: Elsevier, 2011. ( 11/2011 )
  • Michelson DJ and Ashwal S. Coma. Textbook of Pediatrics, 2nd Edition, Elzouki ed., Springer-Verlag, 2011. ( 9/2011 )
  • Michelson DJ and Ashwal S. Non-perinatal Acquired Brain Injury. Clinical and Scientific Aspects of Neurodevelopmental Disabilities, IRCN, 2009. ( 9/2009 )
  • Michelson DJ and Ashwal S. Neurologic Imaging. Rogers Textbook of Pediatric Intensive Care, 4th Edition: Lippincott, Williams and Wilkins, 2008. ( 9/2008 )
  • Michelson DJ and Ashwal S. Evaluation of Coma. Pediatric Critical Care Medicine: Basic Science and Clinical Evidence: Springer-Verlag, 2007. ( 1/2007 )
  • Michelson DJ and Ashwal S. Global Developmental Delay and Developmental Regression. Neurology in Clinical Practice, 5th Edition: Elsevier, 2007. ( 1/2007 )
  • Michelson DJ and Ashwal S. Neuroimaging. Textbook of Pediatric Critical Care, 4th Edition: Williams & Wilkins, 2007. ( 1/2007 )
  • Michelson DJ, Shu SK, McClure C. Cognitive and Motor Regression. Pediatric Neurology: Principles and Practice, 4th Edition: Elsevier, 2006. ( 1/2006 )
  • Michelson DJ. Spinal Fluid Examination. Pediatric Neurology: Principles and Practice, 4th Edition: Elsevier, 2006. ( 1/2006 )
  • Michelson DJ. Inflammatory Neuropathies: Guillain Barre Syndrome, Acute Disseminated Encephalomyelopathy, Transverse Myelitis. Pediatric Hospital Medicine, 2nd Edition: Lippincott Williams & Wilkins, 2006. ( 1/2006 )
  • Michelson DJ and Ashwal S. Global Developmental Delay and Developmental Regression. Neurology in Clinical Practice, 4th Edition: Elsevier, 2004. ( 1/2004 )