Faculty Members

Dr. Lawrence Richer

Assoc Dean, Clinical & Translational Research / Assoc Professor & Div. Director of Ped. Neurology

Department of Pediatrics

Division of Pediatric Neurology
    Contact details are for academic matters only.

About Me

Summary

My research focusses on three interrelated areas: (1) evaluation of functional changes in the autonomic nervous system (ANS) in children with migraine, brain injury, and pediatric autonomic disorders in relation to clinical outcomes and novel therapeutic targets; (2) development or evaluation of therapeutic strategies for children in the above disorders; and (3) the integration of clinical and research informatics to support translational science, clinical trials, and health outcomes research. The ANS is a dynamic system responsible for the maintenance of a stable internal environment and to respond rapidly to external challenges or threats. Functional changes in the ANS are observed in disorders like migraine, brain injury, and other pediatric autonomic disorders. While initially adaptive, these changes over time may become maladaptive -  often as the disorder becomes more chronic or with severe injury. Changes in the ANS may be predictive of undesirable clinical outcomes providing an early warning sign. A better understanding of these changes may also provide insight on the pathophysiologic mechanisms of the disorder and present novel therapeutic targets. However many of the medications frequently used in children to treat migraine or autonomic disorders for example, have not been tested in children - a problem that can no longer be tolerated. Children may metabolize medication differently or they may have side effects that are not observed in adults. In my research, I also aim to study therapeutic strategies commonly used in children or novel ones for their safety and efficacy in treating migraine, brain injury, and pediatric autonomic disorders. Assessing the safety and effectiveness of medications in the real world, however, can be challenging and sometimes cost prohibitive. The use of innovative clinical trial designs, pragmatic clinical trials, and informatics can overcome some of these challenges forming a third focus of my research and research administration interests. The integration of clinical and research informatics promises to bring efficiencies to the research enterprise and lead to improvements in patient care. Many obstacles in technology, policy, and process need to be addressed to realize this promise.

Autonomic Neuroscience

The autonomic nervous system is responsible for monitoring and maintaining balance in numerous body systems. Nerves in the peripheral and central nervous systems help coordinate the fine balance within and between systems. My research interests are focussed on the examining the function or dysfunction of the autonomic nervous in various disorders. The three conditions we are currently investigating include the following:

  1. Prader-Willi Syndrome
  2. Pediatric concussion
  3. Chronic migraine

Emergency Department Management of Pediatric Migraine

Migraine is a common and often debilitating disorder. Many children present to the Emergency Department for migraine treatment when their usual medications have failed. However many of these medications have not been studied in children. We are conducting a series of clinical trials to assess the safety and efficacy of commonly used medications for treating migraine in the pediatric age group. These include:

  1. Intravenous fluid alone
  2. Ketorolac as an add-on treatment to metoclopramide

Research Keywords

acute paediatric neurology, albumin, autonomic, autonomic nervous system, clinical decision rule, concussion, diagnostic tests, electrical stimulation, emergency department, headache, health services, migraine, migraine, randomized clinical trial, ketorolac, orthostatic intolerance, postural orthostatic tachycardia syndrome, postural tachycardia syndrome, POTS, prader-willi syndrome, autonomic nervous system, real-world evidence, registry, schizophrenia