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Diagnoses Treated by Pediatric Neurology/Neurosurgery

Epilepsy
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 medication).

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/Migraines
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
Neuromuscular diseases are progressive disorders caused by the improper functioning of muscles and nerves. They include muscular dystrophies and spinal muscular atrophy.

Attentional Issues - ADD/ADHD
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:

  1. Have occurred before the age of seven
  2. Been present for more than six months
  3. Be present in two out of three settings (home, school, in public)
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.

Autism
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.

Hydrocephalus/Macrocepahly
Children with abnormal head size may be referred to neurologists. Abnormal head size includes microcephaly (small head size) and macrocephaly (large head size).

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
Brain tumors may vary from benign to malignant. The child may have symptoms of headache, vomiting, change in consciousness, change in vision, and stiff neck.

Craniosynostosis/Plagiocephaly
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.

Strokes
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
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:

  1. Diplegia - the legs are more involved than the arms (most common)
  2. Quadriplegia - the legs and arms are equally involved
  3. Hemiplegia - one side of the body is involved, with the arm often more involved than the legs (least common.)
  4. Athetoid - involves writhing-like movements

Movement Disorders
Ataxia - the inability to make smooth, accurate, coordinated movements

Chorea - continuous random movements

Dystonia - abnormal muscle contractions that lead to jerking, twisting, spasms and stiffening at rest or during attempts at movement

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 cerebral palsy.

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.

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