Sat - Thurs 08:00-19:00Friday - CLOSED+971 4 557 0326info@kidsneuroandrehab.comDubai Healthcare City, Building 64Block A, 6th Floor, Unit 6004 , Dubai, UAE

August 7, 2017 adminblog

Evidence-based guidelines, or recommendations, for the management of infants with seizures are lacking. A Task Force of the Commission of Pediatrics developed a consensus document addressing diagnostic markers, management interventions, and outcome measures for infants with seizures. Levels of evidence to support recommendations and statements were assessed using the American Academy of Neurology Guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The report contains recommendations for different levels of care, noting which would be regarded as standard care, compared to optimal care, or “state of the art” interventions. The incidence of epilepsy in the infantile period is the highest of all age groups (strong evidence), with epileptic spasms the largest single subgroup and, in the first 2 years of life, febrile seizures are the most commonly occurring seizures. Acute intervention at the time of a febrile seizure does not alter the risk for subsequent epilepsy (class 1 evidence). The use of antipyretic agents does not alter the recurrence rate (class 1 evidence), and there is no evidence to support initiation of regular antiepileptic drugs for simple febrile seizures (class 1 evidence). Infants with abnormal movements whose routine electroencephalography (EEG) study is not diagnostic, would benefit from video-EEG analysis, or home video to capture events (expert opinion, level U recommendation). Neuroimaging is recommended at all levels of care for infants presenting with epilepsy, with magnetic resonance imaging (MRI) recommended as the standard investigation at tertiary level (level A recommendation). Genetic screening should not be undertaken at primary or secondary level care (expert opinion). Standard care should permit genetic counseling by trained personal at all levels of care (expert opinion). Genetic evaluation for Dravet syndrome, and other infantile-onset epileptic encephalopathies, should be available in tertiary care (weak evidence, level C recommendation). Patients should be referred from primary or secondary to tertiary level care after failure of one antiepileptic drug (standard care) and optimal care equates to referral of all infants after presentation with a seizure (expert opinion, level U evidence). Infants with recurrent seizures warrant urgent assessment for initiation of antiepileptic drugs (expert opinion, level U recommendation). Infantile encephalopathies should have rapid introduction and increment of antiepileptic drug dosage (expert opinion, level U recommendation). There is no high level evidence to support any particular current agents for use in infants with seizures. For focal seizures, levetiracetam is effective (strong evidence); for generalized seizures, weak evidence supports levetiracetam, valproate, lamotrigine, topiramate, and clobazam; for Dravet syndrome, strong evidence supports that stiripentol is effective (in combination with valproate and clobazam), whereas weak evidence supports that topiramate, zonisamide, valproate, bromide, and the ketogenic diet are possibly effective; and for Ohtahara syndrome, there is weak evidence that most antiepileptic drugs are poorly effective. For epileptic spasms, clinical suspicion remains central to the diagnosis and is supported by EEG, which ideally is prolonged (level C recommendation). Adrenocorticotropic hormone (ACTH) is preferred for short-term control of epileptic spasms (level B recommendation), oral steroids are probably effective in short-term control of spasms (level C recommendation), and a shorter interval from the onset of spasms to treatment initiation may improve long-term neurodevelopmental outcome (level C recommendation). The ketogenic diet is the treatment of choice for epilepsy related to glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency (expert opinion, level U recommendation). The identification of patients as potential candidates for epilepsy surgery should be part of standard practice at primary and secondary level care. Tertiary care facilities with experience in epilepsy surgery should undertake the screening for epilepsy surgical candidates (level U recommendation). There is insufficient evidence to conclude if there is benefit from vagus nerve stimulation (level U recommendation). The key recommendations are summarized into an executive summary. The full report is available as Supporting Information. This report provides a comprehensive foundation of an approach to infants with seizures, while identifying where there are inadequate data to support recommended practice, and where further data collection is needed to address these deficits. Pediatric neurologist /Child neurologist should be familial with these recommendations.

July 14, 2017 adminblog

Pediatric neurologist or child neurologist usually deals with Positional skull deformity (PSD) that is a common problem of infancy. Approximately 45% of infants ages 7 to 12 weeks are estimated to have PSD, although three-quarters of them have mild cases.The incidence of PSD began to increase in 1992 after the American Academy of Pediatrics (AAP) introduced its “Back to Sleep” campaign, which encouraged parents to place their infants on their back at bedtime to reduce sudden infant death syndrome. PSD is a common problem in the field of child neurology or pediatric neurology. Dr Hamza Alsayouf used to run a clinic called plagiocephaly and craniosynostosis clinic.

There are 2 common forms of PSD: plagiocephaly, and brachycephaly. Plagiocephaly is unilateral occipital flattening, which may be accompanied by ipsilateral forehead prominence and asymmetrical ears. Brachycephaly is symmetric flattening of the back of the head, which can lead to prominence of the temporal areas, making the head appear wide. Children with severe plagiocephaly have a misshapen, asymmetric skull, while children with brachycephaly have a flattened skull. The cranial sutures remain open in both kinds of PSD.

Evaluating infants for PSD is part of the routine physical exam, and when the condition is noted, the exam should also differentiate PSD from other causes of skull deformity, such as craniosynostosis. Infants and preschool-aged children with PSD may score lower on developmental testing than children without skull deformity. However, these differences are small and inconsistent (2-3 points on a 100-point scale). Skull deformity persists into adolescence in only 1% to 2% of patients.

Neither the AAP nor the American Academy of Family Physicians has a guideline or consensus statement on PSD. Helmets are intended to correct PSD by fitting closely to an infant’s head but allowing room for the skill to grow at the flattened area. A 2011 clinical report by Laughlin et al recommended against using helmets for infants with mild to moderate deformities, but stated that there was little evidence of harm. Earlier studies have suggested that physical therapy might be effective for plagiocephaly caught early (7 and 8 weeks of age). Biggs suggested considering helmet therapy for infants whose cranial sutures remain open and who do not respond to 4 to 8 weeks of physical therapy for PSD. van Wijk et al conducted an RCT to explore the risks and benefits of helmet therapy for children with PSD. Plagiocephaly is seen commonly in the field of pediatric neurology or child neurology. It is better managed by a pediatric neurologist or child neurologist who has experience in treating such cases.

July 5, 2017 adminblog

Autism spectrum disorder (ASD) is characterized by deficits in social communication and interactions, as well as restricted and stereotypic behaviors. In addition to these core symptoms, children and adolescents with ASD often suffer from problem behaviors, such as symptoms of irritability and aggression (IA), which may manifest as tantrums, self-injury, and aggressive behaviors toward others. Child neurologists /pediatric neurologists are a first liners in treatment of autism.

Formal definition of irritability is scarce in the literature. Irritability is defined as a “feeling state characterized by reduced control over temper which usually results in irascible verbal or behavioral outbursts,” although this mood state may be present without observed manifestation. The developmental literature and studies suggest that irritability can be defined as “an excessive response to stimuli.”Irritability is also a consequence of emotion dysregulation (a dysfunction of evidenced neurobiologic processes), which can lead to change in mood state and aggression (a behavior).Emotion regulation may be defined as “the process of initiating, avoiding, inhibiting, maintaining, or modulating the occurrence, form, intensity, or duration of internal feeling states, emotion-related physiological, attentional processes, motivational states, and/or the behavioral concomitants of emotion in the service of accomplishing affect-related biological or social adaptation or achieving individual goals.”Emotion dysregulation, therefore, is the inability to regulate such process effectively.Aggression is defined as hostile, injurious, or destructive behavior often caused by frustration. Aggression may be divided into 2 categories: impulsive and premeditated. Impulsive aggression has been shown as a possible consequence of emotion dysregulation. Impulsive aggression and its domains have been described by other terms in the literature. For example, “agitation” has been used to describe impulsive aggression, “self-injurious behaviors” describes inwardly driven aggression, and “temper outbursts/tantrums” is used to describe outwardly driven aggression that may be disruptive to the environment or may involve destruction of property. Neurobiologically, emotion dysregulation may be considered as a common pathologic process underlying IA. The 2 major components of emotion regulation are top-down inhibition and bottom-up drive. Generally, the prefrontal cortex (PFC) and anterior cingulate cortex are thought to be the neural substrate for top-down inhibition, whereas the amygdala and insula are often associated with bottom-up drive. When these regions are dysfunctional, affected people may exhibit more severe irritability and impulsivity. In typically developing people, cognitive control has been shown to be associated with optimal functional connectivity between dorsolateral PFC and parietal cortex. In contrast, in ASD cognitive control has been shown to be controlled by the ventrolateral PFC and anterior cingulate cortex. Furthermore, recent evidence has shown that alterations of the GABAergic system in ASD were also present in some of the same areas responsible for top-down inhibition and bottom-up drive. Although evidence is emerging, additional research is needed to increase our understanding of the neurobiology of IA to allow the development of more effective interventions.

Approximately 20% of people with ASD exhibit IA at moderate to severe levels,with >50% exhibiting significant emotion dysregulation.These symptoms often cause significant challenges to people with ASD and their families and affect treatment implementation and long-term outcomes.In an ideal setting, medications for IA in ASD are typically considered after medical problems and comorbid psychiatric disorders have been addressed and behavioral interventions have been unsuccessful or only partially effective. Clinical judgment may override these conditions in the event of emergencies involving severe agitation or aggression to self or others. Once the clinical situation is more stable, however, the clinician may revisit these conditions before committing to longer-term treatment with medication. Clinicians have used a wide variety of medications to treat IA, mostly on an off-label basis. In 2006, the US Food and Drug Administration (FDA) approved risperidone to treat irritability associated with ASD. The agency included the target behaviors (ie, aggression, deliberate self-injury, and temper tantrums) under the general heading of “irritability” based on 28-week, placebo-controlled trials of risperidone in 156 patients aged 5 to 16 years. Subsequently, aripiprazole was also approved for this purpose, with evidence from 2 randomized controlled trials (RCTs) supporting its efficacy and safety in the treatment of IA. Currently, risperidone and aripiprazole are the only medications approved by the FDA for the treatment of IA in people with ASD. Various RCTs of other pharmacologic agents have also been conducted for IA symptoms in ASD.

July 4, 2017 adminblog

Child  neurologist frequently see patients with headaches.It is well documented that headache is a multifactorial disorder which includes not only genetic, biological, medical and neuropsychological factor but also psychological and personality traits.  The close relationship between stress and migraine attacks and the significant psychiatric comorbidities in migraine provide evidence of a “paradigm” of tight interaction between somatic and psychological aspects in paediatric migraine. In particular in younger children, an uncomfortable situation, a psychological problem or an emotional distress is rarely expressed directly but usually through physical symptoms. So migraine may be considered as a disorder of psychobiological adaptation in which genetic predisposition interplays with internal and/or external environmental influences such as psycho-emotional, climatic, hormonal, dietary or other factors. Pediatric neurologists need always to take in consideration the prevalence of psychological factors in pediatric migraine.

July 3, 2017 adminblog

Whole exome sequencing (WES) represents a significant breakthrough in clinical genetics as a powerful tool for etiological discovery in neurodevelopmental disorders. The high diagnostic yield of WES supports its use in pediatric neurology practices. It may also lead to earlier diagnosis, impacting medical management, prognostication, and family planning. WES therefore serves as a critical tool for the childneurologist. Having said that a number of challenges need to be resolved before whole exome sequencing can be implemented as a standard of care in the clinical setting. The three challenges that were most consistently reported by technology users were that of incidental findings, variants of unknown significance, and the cost of the technology. Although a small number of challenges, notably communication with patients, education of clinicians, and patients’ turnaround time, were reported differently in articles focusing on cancer, rare diseases or all diseases, and in articles from different countries, most challenges were discussed similarly across diseases and countries (data not shown). WES is already used in the clinical setting, and may soon be considered the standard of care for specific medical conditions, most notably for the identification of mutations contributing to rare genetic diseases. Clinics in the USA, France and the Netherlands already report promising results from the systematic use of NGS in hundreds of patients. Yet, technology users are calling for certain standards and guidelines to be published before this technology replaces more focused approaches such as gene panels sequencing. In addition, it is clear that a number of infrastructural adjustments will have to be made for clinics to store, process and analyze the amounts of data produced by WES. The interpretation of this data requires specially trained staff, and patients and families must also be adequately prepared to deal with WES test results. Some intermediary solutions may be found, such as the one suggested by Topper et al.: “In the near term, we suggest that many of these technical and ethical challenges may be alleviated by a targeted analysis approach, in which the full exome sequence is generated in patients, but analysis is initially limited to those genes already known to play a role in the presenting disorder”. At Kids Neuro Clinic and Rehab Center we do refer patients for whole exome sequencing for evaluation of unexplained delayed milestones ,epilepsies, metabolic diseases and many more.

June 21, 2017 adminblog

PAEDIATRIC NEUROLOGY The best emerging resource for child neurology is Child Neurology in the United Kingdom, which despite its emphasis is an up to date source of links, news, discussion, and practice resources for pediatric neurologists worldwide. The Child Neurology website had been the leading pediatric neurology portal for some time,although the website’s design is rudimentary and brief, but clear. Child Neurology also runs the Child-Neuro email discussion list (www., which can be joined by emailing Pediatric neurologists will also find the Neuromuscular Disease Center and Online Mendelian Inheritance in Man (OMIM) particularly valuable resources for up to date information about neuromuscular and genetic diseases respectively.Tables of contents and email alerts are available— sometimes requiring registration—for the main journals, Developmental Medicine and Child Neurology (www.journals. journalofdevelopmentalmedicineandchildneurology), Neuropediatrics (, and Journal of Child Neurology (, but free access is not provided to the full text of the online journals.

Dr. Hamza Alsayouf ,MD.
Consultant Child Neurologist and Epileptiologist
American Board.
Kids Neuro Clinic and Rehab Center

Dubai Healthcare City, Building 64, Block C, Unit 6004
Tel #: 04 557 0326    Fax #: 04 557 0384

June 14, 2017 adminblog
History:  As with adults, careful and accurate neurologic history is the most important part -Discussing onset of symptoms in chronological order is often helpful -Other characteristics: – Frequency – Duration  – Static, progressing, or improving – Acute, subacute, or chronic -ROS -Birth history Gestational age, complications during pregnancy (including infections), maternal drug and alcohol use, APGAR scores, problems during delivery e.g. meconium, and feeding difficulties.

PMH: immunization status, accidents, chronic medical problems;  Espec pertinent to szs—head trauma, febrile szs, status epilepticus, meningitis Medications (when discussing szs, include previous AEDs and response) Developmental milestones (may use the Denver II) Family history: epilepsy, neurocutaneous syndromes, migraines, neurodegenerative disorders, etc

General Physical :

1. Height, weight, blood pressure, and head circumference.  -Rule of thumb for head circumference is the 3 & 9 rule.  AGE  head circumference newborn  35 cm 3 month   40 cm 9 month    45 cm 3 yo  50 cm 9 yo  55 cm
2. General appearance, including dysmorphology.
3. Skin exam: neurocutaneous lesions (ash leaf spots (TS), cafe au lait spots (NF), angiomas (SW), axillary freckling (?), adenoma sebaceum (?), or shagreen patches (?).
4. Location of the hair whorl (can signify presence of cerebral malformations) and appearance of palmar creases (which genetic syndrome?)
5. Quality of scalp hair, eyebrows, and nails. Friable, kinky hair may signify Menkes kinky hair disease that is associated with mental retardation and optic atrophy.
6. Exam of the midline of the back and neck for sacral dimples, tufts of hair, or other signs of spinal dysraphism.
7. Comparison of thumbnail sizes and their convexity. Abnormalities may signify a growth disturbance, which may be a sign of hemiparesis.
8. Presence of unusual body odor, which is present in some inborn errors of metabolism.
9. Hepatosplenomegaly .
 Neurologic Examination of the Child:
General tips :
1. Use items such as a tennis ball, small toys (including a toy car), bell, and an object that will attract the child’s attention (like a pinwheel).
2. Do not wear a white coat.
3. Postpone uncomfortable tasks until the end, such as head circumference, funduscopy, corneal and gag reflexes, and sensory testing.
4. Make the most of every opportunity to examine the child. See how he or she plays, taking into account handedness and motor deficits.
5. Examine the younger child in the parent’s lap. Be patient and wait for the child the make the first move before touching him or her. Give the child a toy to establish rapport.
1) The Skull – microcephaly, macrocephaly, craniosynostosis (or premature closure of the cranial sutures) – Prominence of scalp veins :increased ICP. – Flattening of the occiput = hypotonia – Prominence of the occiput may signify Dandy-Walker syndrome – Ridging of the cranial sutures–sign of craniosynostosis – Percussion of the skull showing areas of tenderness—osteomyelitis – Macewen (cracked pot) sign = sutures are separated, may indicate increased ICP – Anterior fontanelle is bulging (see how it changes based on infant’s position while sitting up or laying down, and while crying or content) = increased ICP – Auscultate the skull using the bell of the stethoscope in six locations for bruits: globes, the temporal fossae, and retroauricular or mastoid areas o Intracranial bruits are heard in many cases of angiomas, often accompanied by a palpable thrill. They can also be heard in anemia, thyrotoxicosis, and meningitis.
2) Cranial nerves  CN I (olfactory) appears at 5 to 7 months of age.  CN II (optic) can be tested through various means  -Funduscopic exam for appearance of the optic disk, macula, and retina   -Visual acuity – Vision chart – In a younger child, offer toys of various sizes – Optokinetic nystagmus o Rotate a striped drum or draw a strip of cloth with black and white squares in front of the eyes o Optokinetic nystagmus can be elicited starting 4 to 6 months of age o Confirms cortical vision o Supports the integrity of the frontal/parietal lobes and visual fields.   -Visual fields in children less than a year of age o Have one examiner attract the attention of the child to a toy/shiny metal object after which another examiner in back of the child brings another toy into the
field of vision, noting the location at which the child turns his or her head towards this second toy   -The blink reflex appears at about 3 to 4 months. Present in about 50% at 5 months and 100% of children at 12 months.

CN III, IV, and VI (oculomotor, trochlear, abducens) (LR6SO4).  -extraocular movements   -pupillary size and reaction to light.   Pupils may be large and not responsive to light in babies earlier than 30 weeks   -The Doll’s eyes phenomenon can also be used to assess extraocular movements in a comatose patient with an intact brainstem.   -In conscious patients, the cortical input “overrides” the Doll’s eyes phenomenon.   -cold calorics. In order to do this test, 5 mL of ice water is squirted into the  external ear canal in comatose patients or 0.5 mL in alert, awake patients, and the  action of the eyes are noted.    -There are three possible responses to this test.    1) comatose patient with an intact brainstem, the eyes move in the direction   of the stimulus.    2) alert, awake patients, there is nystagmus with the quick component in the  opposite direction of the stimulus.    3) without a functioning brainstem, there is no movement of the eyes when cold  calorics are performed.   ***One needs to remember that cold calorics test vestibular function (CN VIII).   CN V (trigeminal)   -sensation of the face.   -temporalis and masseter muscles can test the motor roots of this cranial nerve. –corneal reflex also checks the ophthalmic branch of CN V.

CN VII (facial nerve)  -facial asymmetry.  -Taste in the anterior two-thirds of the tongue is innervated by the chorda tympani branch of VII, and can be checked by applying salt or sugar solutions by cotton-stick applicators.

CN VIII (auditory) cochlear and vestibular function can be tested by the child’s response to a bell or by recalling a whispered word or number. Noting the eye movements after turning the infant several times in a clockwise and counterclockwise direction can check vestibular function.  CN IX, X (glossopharyngeal, vagus)   -uvula and palate.   -If there is a vagal nerve problem, the uvula will deviate toward the unaffected  side, and the palate will move away from the affected side.     -The gag reflex actually tests parts of IX and X   –IX is the afferent sensory limb (sensory to the back of the pharynx)   –X controls the muscles of the pharynx and elevation of the palate.

CN XI (spinal accessory)   -turn his/her head against resistance, sternocleidomastoid muscle.

CN XII (hypoglossal)   -tongue deviates toward the affected side.

3. Motor System

Observing the child’s posture and simple maneuvers such as retrieving a ball or running outside the examination room can check motor integrity. The following grading system can be used for assessing muscle strength:  0 – No muscle contraction  1 – Flicker or trace of contraction  2 – Active movement without gravity  3 – Active movement against gravity  4 – Active movement against gravity and resistance  5 – Normal strength (for age, keeping in mind that you as the examiner may be stronger) pronator sign – sensitive test to assess the strength for the upper Barré sign. having the child keep both knees at right angles while lying prone. Strength of the flexors of the knee

4. Cerebellar function   how a child reaches for and manipulates toys can check for coordination.  FFM, FTN, RAM, or rapid tapping of the foot can assess for dysdiadochokinesia

5. Sensory –   -pinprick, light touch, position, and vibration sense  -Object discrimination, which tests for higher cortical functions, can be done using coins, paper clips, or rubber bands.

Romberg test –  test of proprioception (dorsal columns).

6. Reflexes.  Jaw jerk (CN V) biceps (C5-6) triceps (C6-8) brachioradialis (C5-6), patellar (L2-4) ankle (S1-2).  Babinski’s sign – pyramidal tract dysfunction    + Babinski’s sign = dorsiflexion of the great toe and fanning of the toes.  Can be normal up to 1 year of age so symmetry is the important feature to look at below 1 year. May be seen after a seizure.  Clonus – maintaining dorsiflexion of the foot. Sustained clonus is abnormal at all ages
Neurological examination of the infant.  1) Posture and muscle tone 2) Primitive reflexes 3) Age invariable items.

7. Posture and muscle tone.  1) resting posture -observing the infant undressed. The infant should have flexion of the elbows, hips, and knees (varying with age). Hypertonia in the extremities decreases after 3 months of age, with the upper extremities then the lower extremities. At the same time, tone in the trunk and neck increases. 2) passive tone – determining resistance of passive movements of the joints while the infant is awake and not crying. One can do this by flapping the hands and feet, and by other maneuvers. The scarf sign is where the arm is pulled across the chest and if the elbow passes the midline, then hypotonia is present. 3) active tone – traction response up to 3 months of age. The infant’s hands are held with the examiner’s thumbs in the infant’s palms, and the fingers around the wrists. The infant is slowly pulled to a sitting position. Normally the elbows flex and the neck raises the head. If hypotonia is present, then the head lags backward, then as the erect position is assumed, the head then drops forward. If hypertonia is present, the head is maintained backwards.

Primitive reflexes.  -present from the time of birth  -represents spinal reflexes until the infant becomes older and higher cortical functions suppress them.

Vertical suspension. The infant is suspended by holding the chest with both hands and lifting the patient in an upright position, with the legs dangling. Scissoring or hyperextension of the legs is seen= spasticity is present; consider cerebral palsy

Horizontal (ventral) suspension (Landau reflex) –  Infant is held prone with the examiner’s hand under the trunk, is gently lifted upwards. Normally, the spine extends a little so that the eyes are looking just below the horizontal. If the body collapses into an upside down “U” shape, then hypotonia is present.

Segmental medullary reflexes.  sucking reflex -afferent fibers of CN V and IX  -efferent fibers of CN VII, IX, and XII.

Moro reflex.  -head hyperextended, falling back about 3 centimeters in relation to the trunk.  A normal response is seen when the infant opens his hands, extends and abducts the arms, and then brings them together, followed by a cry. It is present in all newborns and disappears before the age of 6 months.

Tonic neck response. (AKA fencer’s stance)   -this reflex can be elicited when the head is turned to the side while the rest of the body lies flat on the table. A normal response is extension of the arm and leg on the side that the head is turned, and flexion of the arm and leg on the opposite side (similar to a fencing stance). Abnormal responses occur when this response is sustained or if it occurs differently when the head is turned to the right or left (i.e., the response is not the same when tested on both sides). It usually disappears about 6 to 7 months of age.

Palmar and plantar grasp reflexes.  They are performed by applying gentle pressure to the palm or sole. An abnormal response occurs when this response is absent before 2 to 3 months of age  or asymmetric. The palmar grasp reflex should disappear by 6 months; the plantar by 9 to 10 months.

Parachute response.  The infant is suspended horizontally with the face down, and is brought quickly down toward the floor, making sure that the infant is firmly held. A normal response should be seen at 8 to 9 months and consists of  arms  extended and hands open.    Reflex placing and stepping responses.  Reflex placing is seen when the dorsum of the foot is placed against the edge of the examination table. Reflex stepping is seen when the sole of the foot is placed on the table, and the infant appears to be walking. This reflex disappears at about 4 to 5 months of age.

References  :
1. Haslam RHA. Chapter 600 – Neurologic Evaluation. In: Behrman RE, et al (eds). Nelson Textbook of Pediatrics, 16th edition. 2000, Philadelphia: W.B. Saunders Company, pp. 17931802.
2. Menkes JH, Sarnat HB, and Moser FG. Introduction – Neurologic Examination of the Child and Infant. In: Menkes JH, Sarnat HB (eds). Child Neurology, sixth edition. 2000, Philadelphia: Lippincott Williams & Wilkins, pp. 1-32.
3. Inaba AS. Personal communication, 1999.
4. Tottori M. Personal communication, 2001.

June 14, 2017 adminblog

A child neurologist, or pediatric neurologist, is a doctor that deals with diseases and conditions that affect the nervous system in children less than 18 year old. For example, if your child has seizures, delayed speech, poor muscle tone,frequent headaches ,ADHD, or Autism, your pediatrician may ask a neurologist for an evaluation. This branch of medicine is called child neurology or pediatric neurology field. A pediatric or child neurologist is a neurologist that treats children. This type of neurologist has specialty in dealing with children from birth to young adulthood (less than 18 year). In addition to a four-year medical degree, a pediatric neurologist or child neurologist usually does minimum of 2 year pediatric training plus three or more years of training in child neurology. The American Board of Pediatrics certifies child neurologists. In some cases, child neurologists may work as part of a team with your child’s primary care doctor and a developmental pediatrician to develop a treatment plan for your child if he has some difficult or serious medical concerns. Children with autism spectrum disorder (ASD or autism) may see a child neurologist, in order to deal with sensory issues or behavioral issues associated with autism.

What Do Neurologists Do?

Child neurologist or pediatric neurologist diagnoses and treat a variety of conditions. Neurologists deal with children who have seizures, head injuries, or muscle weakness. They also develop treatment plans and help manage the care of children that have disorders such as attention deficit hyperactivity disorder(ADHD) and autism. Children that have developmental disorders, such as speech delays, fine and gross motor delays, and coordination issues, may also see a neurologist. A neurologist may also treat children who have learning disabilities or learning delays.

Sometimes, a developmental doctor may ask you to take your child to see a neurologist to rule out any serious issues.

June 10, 2017 adminblog

Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral disorder of childhood, adolescence and adulthood with an estimated prevalence in children from 3% to 6%. The worldwide prevalence of ADHD is about 5.2% including UAE.

A diagnosis of ADHD is fundamentally clinical, based on clear and well-defined operational criteria, derived from classification systems such as the Diagnostic and Statistical Manual of Mental Health Disorders,2013. TOVA test has been used at Kids Neuro Clinic as initial and objective test for ADHD.

Executive functions (EFs) represent major functions that allow anticipation and the establishment of objectives, as well as the monitoring of results, by comparing them to the initial objective and reaching a final result. These abilities enable a human being to perceive stimuli in their environment, respond adequately, change direction in a flexible way, anticipate future objectives, consider the consequences and respond in an integrated way, using all these abilities to reach a final objective.

Attention-deficit/hyperactivity disorder can be considered a neurobiological condition that presents with changes in some brain areas and their associated circuits, mainly the prefrontal and parietal cortex, cerebellum, and basal ganglia, which may imply problems in EF, such as working memory (WM), inhibition capacity (IC) and mental flexibility.

Working memory is an EF that is characterized as a complex cognitive mechanism to maintain, control and manipulate relevant information. It is considered the “online memory” that allows a person to understand what is happening at the moment. It is retained just for a few seconds, to enable understanding of the rest of the story or context. Deficits related to WM affect the ability to maintain control, and manipulate goal-related information.

Another important characteristic of ADHD from a neuropsychological point of view has been widely debated. Barkley’s theory proposes a deficit specifically in behavior inhibition. This view considers inhibitory processes as a core deficit in ADHD that secondarily disrupts other EF processes. Adaptive inhibition requires a multitude of interrelated processes, such as the monitoring of behavior, sustained attention, conflict detection and others, before the inhibition of the planned course of action and the behavior can be adjusted according to the moment.. A wide variety of neuropsychological tests indicate that ADHD children exhibit relatively weak, or sub-average, performances on various EFs.

Stimulants are the most commonly-used medications in the treatment of ADHD and their clinical efficacy is well established.

May 21, 2017 adminblog

Approximately 60% of all patients with epilepsy suffer from focal epilepsy syndromes. In approximately 15% of these patients, the seizures are not adequately controlled with anticonvulsive drugs, and such poorly controlled patients are potential candidates for surgical treatment and majority are children. Epilepsy surgery in children, who have been carefully chosen, can result in either seizure freedom or a marked (>90%) reduction in seizures in approximately two-third of children with intractable seizures. In the presurgical evaluation approach identifying the location and extent of the epileptogenic zone with a high degree of confidence is critical for successful surgery.. Early surgery improves the quality of life and cognitive and developmental outcome of the child. Surgically treatable epilepsies in children should be identified early and include temporal lobe epilepsy with focal lesions, lesional extratemporal epilepsies, hemispherical epilepsies, and gelastic epilepsy with hypothalamic hamartoma, and can be treated by resective or disconnection surgery. Palliative procedures include corpus callosotomy and vagal nerve stimulation for children with diffuse and multifocal epilepsies, who are not candidates for resective surgery. For children with “surgically remedial epilepsy,” surgery should be offered as a procedure of choice rather than as a treatment of last resort whenever is available.In The middleeast the biggest challenge is to have a well trained team of pediatric neurologist, pediatric epileptiologist with adequate training in epilepsy surgery along with highly qualified and trained epilepsy surgeon.

Amazing Speech Therapy Physical Therapy Offer:

  • Session per hour is AED 300 (280 after parking reimbursement) when paid in 5 sessions or 350 AED per hour when paid one per session.
  • Session per 45 minutes is AED 240 AED (220 after parking reimbursement) when paid in 5 sessions or 300 AED per hour when paid one per session
  • Parking Fee reimbursement per visit up to 2 hours at the parking including the parking in the basement.
  • FREE Initial Consultation by Consultant Child Neurologist and FREE Follow Up Consultation every 3 months (given as credit toward therapy).
  • FREE Evaluation for patient (Excluding the Medications cost).
  • FREE On spot Orthosis Evaluation.
  • FREE Pick up and drop off can be arranged as per availability of the driver within Dubai Area.
  • One Patient only per physical therapy gym. Spider Cage and Therasuit therapy.

Kids Neuro Clinic and Rehab Center

We make sure to provide a focused and individualised service to all our patients, as we understand that each case is unique from others, and each child has different needs. We want all kids who visit our center to feel safe and relaxed, and have fun throughout the consultation and activities. Through our center, children of all ages stand to benefit from the expertise of an American Board Child Neurologist. Our services are available in reasonable packages and cover speech therapy, physical therapy, and pediatric neuro consultation.