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30
Mar

Common problems in Pediatric Neurology

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Pediatric neurology

Pediatric neurology or child neurology is a specialized branch of medicine that deals with the diagnosis and management of neurological conditions in neonates (newborns), infants, children and adolescents. The child neurology field encompasses diseases and disorders of the spinal cord, brain, peripheral nervous system, autonomic nervous system, muscles and blood vessels that affect individuals in these age groups.

If a child has problems that involve the nervous system, a child neurologist has the specialist training and knowledge to assess, diagnose and treat the child. The conditions dealt with by pediatric neurologists vary considerably, from relatively simple disorders such as migraine or cerebral palsy through to more complex and rare conditions such as metabolic disease or neurodegenerative disorders.

Pediatric neurologists act as consultants to primary care physicians, who may refer children to the neurologists for specialist care. For children with long-term neurological ailments, the pediatric neurologist provides regular care and consultation.

Child neurologists are found in a variety of medical environments ranging from children’s hospitals through to outpatient practices, university medical centers and private clinics. They combine their understanding of diagnosis and treatment of the nervous system with expertise in childhood disorders and children’s special needs.
Overall, about 40% to 50% of the patients treated in a typical pediatric neurology practice have epilepsy, while 20% have learning difficulties or developmental problems and 20% are suffering from headaches. The remainder are treated for rare or unusual conditions such as metabolic or genetic disease. Many centers are equipped with the specialized facilities and knowledge needed to treat very specific disorders such as rare neurodegenerative conditions, intractable epilepsy or pediatric stroke.

A number of pediatric neurologists choose careers in laboratory-based, clinical or translational research meaning the subspecialties of this field can attract individuals with PhD degrees, MD degrees or other forms of advanced training related to research. Advances in neurogenetics have meant this field has moved on from identifying single gene disorders to research into complex conditions such as Tourette’s syndrome or autism spectrum disorders. The opportunities available to both clinical and basic researchers in this field are continuing to expand.

In the USA, the training to become a pediatric neurologist involves four years of medical school, followed by 1 to 2 years of pediatric residency and at least three more years of residency training in adult and child neurology. Physicians then require certification from the American Board of Pediatrics and the American Board of Psychiatry and Neurology.

Condition that are treated by pediatric/ child neurologist are :

Cerebral palsy

• Clinical features and classification of cerebral palsy
• Epidemiology, etiology, and prevention of cerebral palsy
• Evaluation and diagnosis of cerebral palsy
• Management and prognosis of cerebral palsy

Cerebrovascular disease

• Acute stroke in sickle cell disease
• Clinical manifestations and diagnosis of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
• Etiology, clinical features, and diagnosis of cerebral venous thrombosis
• Hemorrhagic stroke in children
• Ischemic stroke in children and young adults: Etiology and clinical features
• Ischemic stroke in children: Evaluation, initial management, and prognosis
• Ischemic stroke in children: Secondary prevention
• Management of hereditary hemorrhagic telangiectasia
• Moyamoya disease: Etiology, clinical features, and diagnosis
• Moyamoya disease: Treatment and prognosis
• Stroke in the newborn
• Treatment and prognosis of cerebral venous thrombosis
• Vascular malformations of the central nervous system

Demyelinating disease

• Acute disseminated encephalomyelitis in children: Pathogenesis, clinical features, and diagnosis
• Acute disseminated encephalomyelitis in children: Treatment and prognosis
• Alexander disease
• Cerebrotendinous xanthomatosis
• Clinical course and classification of multiple sclerosis
• Differential diagnosis of acute central nervous system demyelination in children
• Neuromyelitis optica spectrum disorders
• Optic neuritis: Pathophysiology, clinical features, and diagnosis
• Optic neuritis: Prognosis and treatment
• Pathogenesis, clinical features, and diagnosis of pediatric multiple sclerosis
• Pelizaeus-Merzbacher disease
• Sjögren-Larsson syndrome
• Treatment and prognosis of pediatric multiple sclerosis
• Vanishing white matter disease

Developmental and behavioral problems

• Asperger syndrome (a specific autism spectrum disorder): Clinical features and diagnosis in children and adolescents
• Asperger syndrome (a specific autism spectrum disorder): Management and prognosis in children and adolescents
• Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis
• Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis
• Autism spectrum disorder in children and adolescents: Behavioral and educational interventions
• Autism spectrum disorder in children and adolescents: Complementary and alternative therapies
• Autism spectrum disorder in children and adolescents: Overview of management
• Autism spectrum disorder in children and adolescents: Pharmacologic interventions
• Autism spectrum disorder: Clinical features
• Autism spectrum disorder: Diagnosis
• Clinical features and classification of cerebral palsy
• Intellectual disability in children: Definition, diagnosis, and assessment of needs
• Intellectual disability in children: Evaluation for a cause
• Intellectual disability in children: Management, outcomes, and prevention
• Specific learning disabilities in children: Clinical features
• Specific learning disabilities in children: Educational management
• Specific learning disabilities in children: Evaluation
• Specific learning disabilities in children: Role of the primary care provider

Encephalopathy

• Acute disseminated encephalomyelitis in children: Pathogenesis, clinical features, and diagnosis
• Acute toxic-metabolic encephalopathy in children
• Clinical features, diagnosis, and treatment of neonatal encephalopathy
• Etiology and pathogenesis of neonatal encephalopathy

Evaluation

• Approach to neuroimaging in children
• Approach to the infant with hypotonia and weakness
• Detailed neurologic assessment of infants and children
• Diagnosis of brain death
• Evaluation of stupor and coma in children
• Lumbar puncture: Indications, contraindications, technique, and complications in children
• Macrocephaly in infants and children: Etiology and evaluation
• Treatment and prognosis of coma in children

Feeding the child

• The ketogenic diet and other dietary therapies for the treatment of epilepsy

Genetic disorders

• Adrenoleukodystrophy
• Clinical manifestations and diagnosis of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
• Huntington disease: Genetics and pathogenesis
• Krabbe disease
• Management of hereditary hemorrhagic telangiectasia
• Metachromatic leukodystrophy
• Mitochondrial myopathies: Clinical features and diagnosis
• Mitochondrial myopathies: Treatment
• Mitochondrial structure, function, and genetics
• Mucopolysaccharidoses: Clinical features and diagnosis
• Mucopolysaccharidoses: Complications and management
• Neurologic manifestations of Fabry disease
• Organic acidemias
• Overview of Niemann-Pick disease
• Peroxisomal disorders
• Rett syndrome: Genetics, clinical features, and diagnosis
• Rett syndrome: Treatment and prognosis
• Spinal muscular atrophy
• Sturge-Weber syndrome
• The genodermatoses
• Tuberous sclerosis complex: Genetics, clinical features, and diagnosis
• Tuberous sclerosis complex: Management
• Vascular malformations of the central nervous system
• Wilson disease: Diagnostic tests
• Wilson disease: Treatment and prognosis

Headache

• Acute treatment of migraine in children
• Classification of migraine in children
• Cold stimulus headache
• Cyclic vomiting syndrome
• Elevated intracranial pressure (ICP) in children: Clinical manifestations and diagnosis
• Headache in children: Approach to evaluation and general management strategies
• Migraine with brainstem aura (basilar-type migraine)
• Pathophysiology, clinical features, and diagnosis of migraine in children
• Preventive treatment of migraine in children
• Tension-type headache in children
• Vestibular migraine

Infections

• Acute viral encephalitis in children: Clinical manifestations and diagnosis
• Acute viral encephalitis in children: Treatment and prevention
• Clinical manifestations and diagnosis of Rocky Mountain spotted fever
• Viral meningitis: Clinical features and diagnosis in children

Malformations

• Anencephaly
• Chiari malformations
• Closed spinal dysraphism: Clinical manifestations, diagnosis, and management
• Closed spinal dysraphism: Pathogenesis and types
• Hydrocephalus in children: Clinical features and diagnosis
• Hydrocephalus in children: Management and prognosis
• Hydrocephalus in children: Physiology, pathogenesis, and etiology
• Orthopedic issues in myelomeningocele (spina bifida)
• Overview of the management of myelomeningocele (spina bifida)
• Pathophysiology and clinical manifestations of myelomeningocele (spina bifida)
• Primary (congenital) encephalocele
• Urinary tract complications of myelomeningocele (spina bifida)

Miscellaneous

• Cyclic vomiting syndrome
• Idiopathic intracranial hypertension (pseudotumor cerebri): Clinical features and diagnosis
• Idiopathic intracranial hypertension (pseudotumor cerebri): Epidemiology and pathogenesis
• Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment
• Pathogenesis, clinical features, and diagnosis of pediatric multiple sclerosis

Movement disorders

• Acquired torticollis in children
• Acute cerebellar ataxia in children
• Ataxia-telangiectasia
• Bradykinetic movement disorders in children
• Congenital muscular torticollis: Clinical features and diagnosis
• Congenital muscular torticollis: Management and prognosis
• Friedreich ataxia
• Hyperkinetic movement disorders in children
• Overview of the hereditary ataxias
• Sydenham chorea
• The spinocerebellar ataxias
• Tourette syndrome
• Wilson disease: Clinical manifestations, diagnosis, and natural history
• Wilson disease: Epidemiology and pathogenesis

Neonatal neurology

• Brachial plexus syndromes
• Clinical features, evaluation, and diagnosis of neonatal seizures
• Clinical manifestations and diagnosis of intraventricular hemorrhage in the newborn
• Congenital myopathies
• Etiology and pathogenesis of neonatal encephalopathy
• Etiology and prognosis of neonatal seizures
• Management and complications of intraventricular hemorrhage in the newborn
• Neonatal brachial plexus palsy
• Neonatal epilepsy syndromes
• Neuromuscular junction disorders in newborns and infants
• Overview of peripheral nerve and muscle disorders causing hypotonia in the newborn
• Periventricular leukomalacia
• Pneumococcal meningitis in children
• Stroke in the newborn
• Treatment of neonatal seizures

Neurocutaneous disorders

• Neurofibromatosis type 1 (NF1): Management and prognosis
• Neurofibromatosis type 1 (NF1): Pathogenesis, clinical features, and diagnosis
• Sturge-Weber syndrome
• Tuberous sclerosis complex: Genetics, clinical features, and diagnosis
• Tuberous sclerosis complex: Management

Neuromuscular disorders
• Approach to the metabolic myopathies
• Clinical features and diagnosis of Duchenne and Becker muscular dystrophy
• Emery-Dreifuss muscular dystrophy
• Energy metabolism in muscle
• Facioscapulohumeral muscular dystrophy
• Guillain-Barré syndrome in children: Epidemiology, clinical features, and diagnosis
• Guillain-Barré syndrome in children: Treatment and prognosis
• Hereditary spastic paraplegia
• Juvenile dermatomyositis and polymyositis: Epidemiology, pathogenesis, and clinical manifestations
• Juvenile dermatomyositis and polymyositis: Treatment, complications, and prognosis
• Limb-girdle muscular dystrophy
• Metabolic myopathies caused by disorders of lipid and purine metabolism
• Myotonic dystrophy: Etiology, clinical features, and diagnosis
• Myotonic dystrophy: Treatment and prognosis
• Neonatal brachial plexus palsy
• Neuromuscular junction disorders in newborns and infants
• Oculopharyngeal, distal, and congenital muscular dystrophies
• Pathogenesis of myasthenia gravis
• Patient education: Overview of muscular dystrophies (Beyond the Basics)
• Spinal muscular atrophy
• Treatment of Duchenne and Becker muscular dystrophy

Neuropathy

• Facial nerve palsy in children
• Guillain-Barré syndrome: Pathogenesis
• Hereditary primary motor sensory neuropathies, including Charcot-Marie-Tooth disease
• Hereditary sensory and autonomic neuropathies
• Krabbe disease
• Metachromatic leukodystrophy
• Neurologic manifestations of Fabry disease
• Neuropathies associated with hereditary disorders
• Overview of Niemann-Pick disease
• Overview of acquired peripheral neuropathies in children
• Overview of hereditary neuropathies

Ophthalmology

• Fourth cranial nerve (trochlear nerve) palsy in children
• Horner syndrome
• Myopathies affecting the extraocular muscles in children
• Optic neuritis: Pathophysiology, clinical features, and diagnosis
• Optic neuritis: Prognosis and treatment
• Pendular nystagmus
• Sixth cranial nerve (abducens nerve) palsy in children
• Supranuclear disorders of gaze in children
• Third cranial nerve (oculomotor nerve) palsy in children

Seizures

• Antiseizure drugs: Mechanism of action, pharmacology, and adverse effects
• Benign focal epilepsies of childhood
• Childhood absence epilepsy
• Clinical and laboratory diagnosis of seizures in infants and children
• Clinical features and complications of status epilepticus in children
• Clinical features and diagnosis of infantile spasms
• Clinical features and evaluation of febrile seizures
• Clinical features, evaluation, and diagnosis of neonatal seizures
• Dravet syndrome: Management and prognosis
• Epilepsy syndromes in children
• Etiology and pathogenesis of infantile spasms
• Etiology and prognosis of neonatal seizures
• Juvenile myoclonic epilepsy
• Localization-related (focal) epilepsy: Causes and clinical features
• Management and prognosis of infantile spasms
• Management of convulsive status epilepticus in children
• Neonatal epilepsy syndromes
• Nonepileptic paroxysmal disorders in children
• Nonepileptic paroxysmal disorders in infancy
• Pathophysiology of seizures and epilepsy
• Seizures and epilepsy in children: Classification, etiology, and clinical features
• Seizures and epilepsy in children: Initial treatment and monitoring
• Seizures and epilepsy in children: Refractory seizures and prognosis
• Treatment and prognosis of febrile seizures
• Treatment of neonatal seizures
• Vagus nerve stimulation therapy for the treatment of epilepsy

Trauma

• Child abuse: Epidemiology, mechanisms, and types of abusive head trauma in infants and children
• Child abuse: Evaluation and diagnosis of abusive head trauma in infants and children
• Intracranial epidural hematoma in children: Clinical features, diagnosis, and management
• Intracranial epidural hematoma in children: Epidemiology, anatomy and pathophysiology
• Intracranial subdural hematoma in children: Clinical features, evaluation, and management
• Intracranial subdural hematoma in children: Epidemiology, anatomy, and pathophysiology
• Minor head trauma in infants and children: Evaluation

So child neurologist, also known as pediatric neurologist, specializes in the diagnosis and management of neurologic conditions in infants, children, and adolescents. Child neurologists have special competence in the genetic and metabolic problems, malformations, and developmental problems of childhood, including epilepsy, cerebral palsy, muscular dystrophy, mental retardation, autism, Tourette’s syndrome, Batten’s disease, neurofibromatosis, learning disabilities, complex metabolic disorders, and a host nerve and muscle diseases.

In 1968, the American Board of Psychiatry and Neurology awarded the first board certificate in Neurology “with Special Qualifications in Child Neurology.” Three years later, in 1972, the Child Neurology Society was founded with an initial enrollment of 223 members. There are, at present, over 70 university-based training programs in child neurology in the United States and Canada, and over 2000 child neurologists in the CNS

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