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Pediatric NeurologyBarbara Kolk-Seda MS PA-C

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Neurological Evaluation

Pediatricians & Pediatric Practitioners may be the first to discover

abnormal neurological findings e!borns Adolescents on routine PE Consults for behavior problems or poor school performance Sick visits due to C/O

Headaches

Dizziness Head n!uries "isual Disturbances

"ork u# should begin !ith a detailed history Physical $%am

Pertinent abs 'eferrals !hen a##ro#riate

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Screening Tools (enver (evelo#mental Screen

AS) Pediatric Sym#tom Check ist Modified Checklist for Autism in *oddlers

+oals of Screening tools *o give the #ractitioner an idea of any s#ecific #roblems

Point the #ractitioner in the direction of further ,uestioning and e%aminationTHESE SCREENING TOOLS ARE NOT A SUPPLEMENT

FOR CAREFUL CLINICAL EVALUATION

ther ty#es of evaluations available $$+ $voked Potentials umbar Puncture C*.M'/ P$* Scan 0ltra Sound Cerebral Angiogra#hy

Myelogra#hy. $M+

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Seizure Disorders Sei1ure Classification

Partial vs +enerali1ed

$#ile#sy Syndromes are defined by

ature of the sei1ure Age of nset $$+ 2indings

$#ile#sy Classification Sym#tomatic Cry#togenic /dio#athic

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Neonatal Seizures nset

Birth to 3 !eeks Cause

4y#o%ia /schemia /ntracranial 4emorrhage Metabolic disturbances

/nfections

Clinical 2indings Sudden lim#ness. tonic #osturing. t!itching. clonic movements Brief a#nea Cyanosis

dd cry. li# smacking $yes rolling

$$+ 2ocal S#ikes Slo! 'hythms

Multifocal (ischarges $lectrical (issociation

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Neonatal Seizures

*reatment

Correct underlying abnormalities Phenobarbital /5 or /M Phenytoin /5 (ia1e#am Sto# #rotein feedings

abs . (iagnostic Studies

P for CS2 PC' Metabolic Panel6 calcium6 Phos#horus6 Magnesium6 ammonia6 *'C4 /gM 0ltra Sound C* . M'/

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Infantile Spasms

nset 7-89 months

Cause CS /n:ury Biochemical /nfections Pyrido%ine (e#endency

/nherited Metabolic (isorder *uberous Sclerosis *'C4 /nfections +enetic

Clinical 2indings Sudden6 symmetrical adduction or fle%ion

of limbs !ith fle%ion of head and trunk ccur in clusters *y#ically u#on a!akening Associated irritability (evelo#mental 'egression

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Infantile Spasm

$$+ 4y#sarrhythmia

abs & (iagnostic *ests 2undisco#ic and skin e%am *rial of Pyrido%ine

Amino acid & rganic acid screen Chromosome Analysis *'C4 Screen C*.M'/

*reatment

AC*4 gel ;= /0.m#/d$ % &D "i'abatrin (opiramate )onisamide "alproic Acid

*amotri'ine (rial of +,/ -eto'enic Diet

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Febrile Seizurenset

7mo ? > years

Cause 4o! ,uickly a fever rises or falls 2amily 4istory (ay Care Slo! (evelo#ment Prolonged eonatal 4os#itali1ation

Clinical 2indings +enerali1ed Sei1ures ;@8> min 7= risk of second sei1ure

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Febrile Seizures$$+

ormal

abs & (iagnostic Studies Consider P if sus#icion of meningitis

*reatment 2ever Stability

(ia1e#am ;=7-=> mg.kg6 P divided */( during illness (iastat ;Prolonged Sei1ures Pro#hyla%is

Phenobarbital 5al#roic Acid

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Childhood bsence Seizures

nset 7 ? 83 years

Causes 0nkno!n Sus#ected

+enetic Abnormal *halmocortical circuitry

Clinical 2indings a#ses of Consciousness

5acant Stares ;7 ? 8= sec Automatisms o Aura o Postictal Confusion

$$+ 7.s bilaterally synchronous6

symmetrical6 high voltage s#ikes

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Childhood bsence Seizuresabs & (iagnostic *esting

'arely of value

*reatment $thosu%imide 5al#roic Acid

amictal Donisamide *o#iramate evetiracetam Aceta1olamide Ketogenic (iet

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!uvenile bsence Seizures

nset

8= ? 8> years

Cause 0nkno!n

Clinical 2indings Similar to Childhood onset but higher risk of convulsive sei1ures

7-41 s#ike !ave

Aty#ical +enerali1ed (ischarges

$$+

abs & ther (iagnostic *ests 'arely of 5alue

*reatment

Same as Childhood onset

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Simple Partial Seizures

AKA- 2ocal Sei1uresAffects All Age +rou#s

Cause ften unkno!n Birth trauma /nflammatory #rocess

5ascular accident Meningo-ence#halitis Structural lesions

Clinical 2indings

May involve any #art of the body May s#read in fi%ed #attern ;Eacksonian March

becoming generali1ed

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Simple Partial Seizures$$+

ormal

2ocal s#ikes Slo! !aves in cortical region 'olandic S#ikesF centrotem#oral s#ikes

ther (iagnostic Studies M'/

*reatment Carbama1e#ine %ycarbama1e#ine Phenytoin amotrigine +aba#entin *o#iramate evetiractam Donisamide

5al#roic Acid ;ad:unct

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"eneralized Tonic#Clonic SeizuresAKA +rand Mal Sei1ures

Any Age +rou#Cause

Ma:ority unkno!n +enetic Metabolic disturbances

*rauma /nfection /nto%ication Brain tumors

Clinical 2indings

C *onic Clonic Movements 5ague Aura or Cry /ncontinence 8> Postictal #hase

Can be mi%ed !ith or masking othersei1ure #atterns

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"eneralized Tonic#Clonic Seizures

$$+

Bilateral6 synchronous6 symmetrical high-voltage s#ikes Gounger than < years often normal 2ocal s#ikes may become Secondarily +enerali1ed

ther (iagnostic *ests Most likely not needed

consider C* or M'/6 electrolytes

*reatment Phenobarbital ;infants Carbama1e#ine 5al#roic Acid

Phenytoin *o#iramate amotrigine