Pediatric Neurology

Pediatric Neurology

Overview

Pediatric Neurology and Treatment Areas

Pediatric Neurology is a multi-disciplinary division, which aims to diagnose and treat nervous system diseases in children aged 0 to 18 years in a timely manner and to provide the children with a life at better conditions in the general population.

Growth and development continues in childhood, while the nervous system is the last one to complete development. Neurologic diseases not only affect children, but also their families and close social circle due to long-lasting treatment and rehabilitation process.

Which Conditions are assessed in a Pediatric Neurologic Examination?

  • Overall health, behaviors and development according to age of patient
  • Orientation and learnedness
  • Head circumference
  • Speech and movement
  • Coordination, access and balance
  • Strength, ability to walk
  • Reflexes

Major Diseases of Central and Peripheral Nervous Systems

A very wide range of disease begin in central and peripheral nervous systems and the major ones are delayed walking, floppy baby syndrome (hypotonia) (SMA), delayed speech, behavioral disorders and autism, attention deficit and seizures (epilepsy) as well as febrile convulsions.

Congenital Damages

Patients are brought to pediatric neurology due to brain damage (cerebral palsy, spasticity, diparesis, tetraparesis), damage to nerves of arm at birth (brachial plexus damage), and small (microcephaly) or large head circumference.

Intracranial Diseases

Patients are followed up and treated with multidisciplinary approach in cooperation with neurosurgery department when presented with intracranial lesions (fluid accumulation in brain (hydrocephalus), brain cysts, infarction, tumor, hemorrhage and aneurysm).

Headache in Children

Headache is the most common reason of admission to pediatric neurology, seen in 40% of children aged 7 and 75% of children aged 15. Among headaches, prevalence of migraine is 3 to 10%. Severe headaches that are associated with vomiting may develop due to other causes (hormonal, blood pressure, tumor, bleeding) and therefore, they should be urgently examined and tested.

Other Neurologic Groups

Other group of pediatric neurology patients consists of musculoskeletal diseases associated with progressive muscle weakness and deformities, gait disorder and poor exercise capacity. The most common ones are SMA (hypotonia in babies) and Duchenne Muscular Dystrophy.

What are Potential Genetic and Metabolic Disorders in Children?

  • Thyroid gland disorders
  • Disorders of amino acid metabolism
  • Disorders of organic acid metabolism
  • Mitochondrial diseases
  • Chromosome abnormalities (Down Syndrome)
  • Genetic syndromes manifested by facial or other deformities

PEDIATRIC NEUROLOGY

DIAGNOSIS AND TREATMENT MEANS

Diseases of Central and Peripheral Nervous Systems

  • Attention deficit, seizures (epilepsy), febrile convulsions
  • Floppy baby (hypotonia)
  • Behavioral disorders and autism

Congenital Damages

  • Brain injuries at birth (cerebral palsy, spastic diparesis, tetraparesis)

Intracranial Diseases

  • Fluid accumulation in brain (hydrocephalus)
  • Cysts, tumors, hemorrhage, infarction

Migraine

Other Neurologic Groups

  • Duchenne Mascular Dystrophy and other muscular disorders

Genetic and Metabolic Diseases

  • Thyroid gland disorders
  • Disorders of amino acid metabolism
  • Chromosome abnormalities (Down Syndrome)


GUIDE FOR PARENTS (Ages 0 to 6)

PEDIATRIC NEUROLOGY

0 to 3 Months of Age

  • There is eye – facial contact.
  • Recognizes the speech and laughs.
  • Shows interest in objects by rising the head while lying down
  • There is babbling
  • Reacts to sounds
  • Arms and legs move simultaneously.
  • Lifts head in supine position.

4 to 6 Months of Age

  • Grasps with hands.
  • Notices small objects.
  • Clenches hands for shorter duration.
  • Grasps when objects are offered.
  • Laughs loudly.
  • Watches his/her hands.
  • Holds the head high.
  • Starts sitting up when supported.

7 to 12 Months of Age

  • Looks at the pointed direction.
  • Can clap hands, wave goodbye, etc.
  • Points at desired objects or expresses self with voice.
  • Switches objects between hands.
  • Says mama, dada.
  • Stands up for several seconds.
  • Stands up and sits down without aid.

1 TO 3 YEARS OF AGE (TODDLER STAGE)

  • Puts toys in the box and takes them out.
  • Makes columns of 5 to 6 cubes.
  • Plays ball with others.
  • Helps with housework.
  • Eats food without aid.
  • Speaks in single words.
  • Uses combination of 2 words at age 2.
  • Walks smoothly and without aid at maximum 15 months of age.
  • Picks up objects from ground without using support for balance.
  • Kicks ball at 2 yearS of age.
  • Climbs stairs.
  • Hops and jumps.

4 to 6 YEARS OF AGE (PRE-SCHOOL PERIOD)

  • Says names of the objects.
  • Draws vertical lines.
  • Makes towers of 8 cubes.
  • Forms articulate sentences.
  • Dresses, undresses and eats food without aid.
  • They are toilet trained by the age of 4.
  • Can button clothes.
  •  Knows about antonyms and synonyms.
  • Can identify several colors and numbers.
  • Can draw pictures without aid.
  • Can tell imaginary stories.
  • Speaks in tenses, such as past and future.
  • Jumps using both legs.
  • Can stand 8 to 10 seconds on single leg.
  • Can catch ball with hands when thrown.

Sleep EEG in Children: What is it? What are indications?

EEG is a test performed to assess electrical waves in the brain. Data is recorded from various points of head using cables (called electrodes, similar to ones used for cardiac electrogram). However, signals are recorded at a significantly lower voltage in EEG that requires higher technical diligence and takes a longer time. The test should be performed by an EEG technician, who has experience in working with children, under supervision of a pediatric neurologist.

EEG is used for;

  • Assessing development of human brain by age
  • Choosing medication treatment for a series of psychiatric diseases
  • Diagnosis and follow-up of epilepsy
  • Follow-up of metabolic disorders, comas and brain infections such as encephalitis.

How is Pediatric EEG Different than Normal EEG?

Pediatric EEG is recorded in two stages, requiring a more diligent and detailed work. The test may be difficult to perform, since children do not cooperate well. It is important to recognize signs of development and artefacts in childhood when the test data is assessed.

What Should Be Taken Into Consideration Before the Test?

The child is expected to present for the test after sleep deprivation. This will not only facilitate the test, but it will also reveal out the findings more clearly.

The child’s hair should be clean. Elements such as hair gels and dirt will affect the test’s quality. It is better to perform the test with a full stomach.

Electrodes are placed according to internationally acknowledged 10-20 EEG system. Centers have to use this system when a pediatric EEG is tested. The patient should be in a calm state during recording, while sleep and wake periods should be observed depending on the patient’s condition. A regular sleep-awake EEG takes approximately 1 to 2 hours, including preparation and recording time. The procedure is absolutely pain-free; however, children may cry due to being restless. Children may face problem falling asleep if not sufficiently deprived of sleep. Technician may administer certain medication in such cases, such that EEG results are not affected.

Our Hospital admits patients at 0 to 19 years of age for wake + night-sleep EEG.

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