Epilepsy, or recurrent afebrile seizures, is a pediatric disorder occurring
in 5.2 to 7.3 per 1,000 school-age children. Fortunately, most children
who have a single seizure will not go on to develop epilepsy. Even when
they do, the majority will have a relatively benign disorder that can
be effectively controlled with a single antiepileptic drug and, over time,
the disorder often resolves itself, allowing the discontinuation of treatment.
Proper selection of medication is critical, since all antiepileptic drugs
have a potential for significant side effects that may become more severe
with higher doses and with polydrug therapy (taking more than one anti-epileptic
Despite proper selection of medication and satisfactory compliance,
some patients continue to suffer from epileptic seizures. In these children,
drug dosages are gradually increased and sometimes more than one medication
is used at a time to try to achieve seizure control.
Children with epilepsy are at risk for associated problems like learning
disabilities, attention deficit disorder and depression. Pediatric neurologists
work with the parents to try and ensure that children with epilepsy are
treated like ordinary kids. In addition to treatment with medications,
some novel therapies like pacemakers (vagal nerve stimulator) and, in
some cases, epilepsy surgery, or diet control, are being used. All of
these treatments are offered at our Comprehensive Epilepsy Center.
Headaches are more common in children than most people think. It is estimated
that half of all adult migraine patients experience migraines before age
15 -- with some occurring as young as two to three years of age. Studies
indicate that approximately five to eight percent of children have migraine
headaches. The peak age of onset for migraine with aura (temporary visual
disturbances, such as flashes of light) is age 5 to 10 for boys and age
12 to 13 for girls. For migraine without aura, the peak age of onset is
age 10 to 11 for boys and age 14 to 17 for girls. Prior to puberty, the
prevalence of migraine appears to be equal to or slightly higher in boys
than girls. After puberty, however, nearly three times as many females
as males suffer from migraines.
Migraines are episodic disorders that may occur as often as 10 to 15
times a month or as rarely as once a year. Onset may be at any time of
day, including first thing in the morning; migraine seldom awakens the
patient at night. The headache typically lasts from 4 to 72 hours in the
adult population. In children, however, the duration might be much shorter,
lasting only 2 to 4 hours. After the pain subsides, the patient may feel
"normal" or may be fatigued, have a poor appetite, and feel achy. This
is known as the postdrome. Migraine headache is thought of as the "sick
headache" because it is often accompanied by nausea and/or vomiting. Children
may be especially sensitive to light or sound, not always both, and their
stomach problems may be worse than those of adults who have migraine.
Even with these severely debilitating symptoms, the child will seldom
scream with pain. More often, he or she will insist on lying down in a
dark, quiet room. If sleep ensues, the pain will often (though not always)
subside prior to awakening.
Children and teenagers can also suffer from chronic daily headaches,
cluster headaches and tension headaches. Headaches may also be the symptom
of an underlying problem (virus, meningitis, brain tumor).
Neuromuscular diseases are progressive disorders caused by the improper
functioning of muscles and nerves. They include muscular dystrophies and
spinal muscular atrophy.
Attention deficit disorder, with or without hyperactivity, means that
the child (or adult) has difficulty paying attention in situations where
attention and focusing is needed. It is diagnosed by using rating scales,
which are completed by the teacher and the parents and the child if the
child is old enough to do so. Symptoms must:
ADD is not diagnosed by medical tests, although tests may be used if other conditions are expected.
ADD is treated with therapy, behavioral modification and, in some cases,
medication. Some families believe that alternative therapies are useful,
although these are not proven.
- Have occurred before the age of seven
- Been present for more than six months
- Be present in two out of three settings (home, school, in public)
Autism and pervasive developmental disorder (PDD) are disorders characterized
by impairments in socialization and communication. They are associated
with restricted patterns of interest and usually are first noted around
the age of two. The child exhibits a lack of social and language development
and limited interpersonal interaction. Children with autism and PDD may
be easily disturbed by the slightest change in environment and have repetitive
self-stimulatory behaviors such as rocking, head banging or flapping of
hands. They also have a limited repertoire of interests and activities.
Autism and pervasive developmental disorder are on the same continuum,
but PDD has less severe symptoms. The language of children with PDD and
autism may range from none (non-verbal) to difficulties with pragmatic
language (carrying on a conversation). Language problems may include use
of jargoning (gibberish,) repetitive language, and echolalia (repeating
words or phrases.) It is very important that any child with speech delays
be evaluated to determine whether other autistic characteristics are present.
Diagnosis is made by using standardized scales, such as the CARS (Childhood
Autism Rating Scales). Neither autism nor PDD are diagnosed by using MRIs
or any other medical tests.
Children with abnormal head size may be referred to neurologists. Abnormal
head size includes microcephaly (small head size) and macrocephaly (large
One cause of macrocephaly is hydrocephalus. Hydrocephalus is caused by
a problem with the cerebrospinal fluid, either the abnormal production
of fluid; blocked flow of fluid; or impaired production of cerebrospinal
fluid. If there are symptoms of increased intercranial pressure, surgical
treatment is sometimes necessary.
Brain tumors may vary from benign to malignant. The child may have symptoms
of headache, vomiting, change in consciousness, change in vision, and
Children may be referred because of "cranial vault abnormalities." These includes craniosynostosis, meaning that one or more of the sutures
(places where the bones of the skull meet and fuse) have fused prematurely. This is diagnosed by physical examination and CT scan and, if warranted, is corrected surgically.
Plagiocephaly is flattening of the skull, usually in the back, and usually requires only positioning to improve the appearance.
The obstruction of blood flow may occur in arteries or veins and may be
caused by blood clots or bleeds. Common symptoms are focal seizures and headache.
Most common causes are congenital heart disease, sickle cell anemia, meningitis,
infections, lupus or metabolic disorders.
Cerebral palsy is a non-specific term used to describe a disorder in muscle
function that is characterized by changes in muscle tone (hypertonia or
hypotonia) as a result of brain dysfunction. It is present at birth and
does not worsen with time. Symptoms may include spasticity (stiffness),
involuntary movements (chorea, athetosis), ataxia (balance/coordination
difficulties) or a combination of the above. Descriptions of these symptom
can be found below.
Spastic Cerebral Palsy: There are different categories of spastic
cerebral palsy. Sometimes the medical team uses these terms:
- Diplegia - the legs are more involved than the arms (most common)
- Quadriplegia - the legs and arms are equally involved
- Hemiplegia - one side of the body is involved, with the arm often
more involved than the legs (least common.)
- Athetoid - involves writhing-like movements
Ataxia - the inability to make smooth, accurate,
Chorea - continuous random movements
Dystonia - abnormal muscle contractions that
lead to jerking, twisting, spasms and stiffening at rest or during attempts
Spasticity (hypertonia) - increased muscle
stiffness that worsens with rapid movement and may be associated with
increased reflexes and stiffness
Hypotonia - low muscle tone. These children
appear a little "floppier" or "looser" than usual and may drool, be late
walkers, speak late or articulate poorly
Mild hypertonia and hypotonia may be present without a diagnosis of
Tics/Tourette's Syndrome - involuntary production
of movements or sounds that are sudden, stereotyped, non-rhythmic and
repetitive. They may be simple motor, which are fast brief movements involving
one motor group (sniffing, shrugging, eye blinks, etc.) or complex motor,
which are relatively coordinated movements that seem purposeful (skipping,
twirling) or simple or complex motor tics. A child is diagnosed with Tourette's
syndrome when both vocal and motor tics are present for more than one
year. One subtype of tics is Pandas - tics and obsessive behavior associated
with strep infections.