There are a myriad of Paediatric Neurological Conditions, with varying degree of severity and scope of treatment, that range from common and relatively benign febrile seizures to uncommon yet complex neurometabolic disorders. Affected children may have multiple disabilities and complex medical needs. They are best looked after by a multidisciplinary team that provides comprehensive medical care.
Even in urban India there are very few comprehensive Paediatric Neurology centres. In rural areas the scarcity is predictably worse. This leads to huge treatment gaps. Parents and families struggle to get a diagnosis let alone appropriate treatment. Children with disabilities can prove to be a huge burden, financially and socially, to the affected families.
The commonest cause of seizures in childhood is febrile seizures - an incidence of 2-5% is seen between six months to two years. This is a relatively benign condition with a low risk of developing epilepsy in the long term. However, 1% of children will experience an afebrile seizure by 14 years of age.
Paediatric epilepsy syndromes are well-defined with indeed a few unique syndromes restricted to infancy and childhood. Management includes investigations, such as EEG, MRI, blood tests and medications. There are newer treatment modalities available for treatment of difficult to control epilepsies. These include epilepsy surgery for the surgically remediable epilepsies, ketogenic diet and vagal nerve stimulation.
Cerebral palsy affects 1.5-3.0 children per 1000 live births. Prematurity is the single most important factor in developed countries. However, we still continue to see babies affected because of several factors related to poor antenatal care and maternal health issues. Developmental delay with abnormalities of tone, posture and/or movement is the most common presenting complaint in children with cerebral palsy.
Apart from motor difficulties, they also have associated morbidities, such as problems with feeding and swallowing/speech and language, visual impairment, epilepsy and learning difficulties. These children are best looked after by a paediatric rehabilitation team. Medically refractory spasticity and dystonia requires special treatments, such as intrathecal baclofen pump and botulinum injections. The goal of treatment is functional independence.
Headache ranks amongst the top five health problems in childhood. The prevalence rates range from 14% at age 7 to 75% by age 15. The commonest cause of headaches is migraine. Incidence of definite childhood migraine is about 1% at 15 years of age! It can be a very worrying situation for the family to have a child with recurrent headaches. Appropriate medications and lifestyle changes are the key treatments.
Several acute neurological conditions and emergencies are frequently encountered by those involved in paediatric medicine. These include meningitis, encephalitis, acute flaccid paralysis, status epilepticus, childhood stroke, Bell’s palsy, acute demyelinating disorders, etc. They often require immediate expert neurological consult and intensive care treatment.
The incidence of neurobehavioural conditions, such as Autistic Spectrum Disorder, Attention Deficit Hyperactive Disorder, Asperger’s disorder and Childhood Disintegrative Disorder is steadily increasing, especially, in the urban areas. Early diagnosis is the key to the management, which is mainly therapy based.
Patients may become symptomatic at various ages - right from birth to late childhood and adolescence. The common symptoms are seizures, delayed sitting or walking, delayed speech, behavioural issues and academic difficulties. The acute conditions present sudden symptoms like fever, loss of consciousness/drowsiness, sudden loss of function such as movement in a limb/speech/vision, and seizures.
Often multi-modality assessment is required to arrive at a diagnosis. The various modalities which maybe helpful are
Depending on the underlying cause children may need EEG, video-EEG, Video Telemetry; assessment of hearing and vision (BERA/VEP); checking nerve and muscle function (EMG/NCS)
Various modalities may be required, such as CT scan, MRI, MR spectroscopy, MR tractography apart from interventional radiology and nuclear scans (SPECT/PET)
Blood, urine and CSF can be checked for various metabolic and genetic disorders. Examples include plasma amino acids, urine organic acids, karyotype, CGH microarray, etc.
Treatment of childhood neurological problems varies according to the underlying cause. Medications usually include those for seizure control, tone control and behavioural modulation. Therapy forms the backbone of majority of chronic disorders. Modalities include
Supportive treatments include botulinum toxin injections, intrathecal baclofen pumps, orthopaedic surgery, etc., especially for patients with medically refractory spasticity, dystonia and other movement disorders.
Besides state-of-the-art infrastructure and advanced technology, we at Kokilaben Hospital have a comprehensive team that comprises of a Paediatric Neurologist, Epileptologist, Neurosurgeon, Orthopaedic Surgeon, Child Psychiatrist, Geneticist, Neurophysiologist, Therapists, Clinical Psychologist and Child Counsellors. This multidisciplinary team works in tandem with the patient and the family to ensure an optimum long term outcome for the child.
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