Paediatric Neurology

Question 1

What are the common neurology presentations in paediatrics?

Answer 1

Headaches
Seizures (epilepsy or otherwise)
Abnormally sized heads
“Floppy” child - neuromuscular

Less common:
Brain tumours
Traumatic brain injury
Tourette syndrome

Question 2

What is the aetiology of, clinical features and management of childhood headaches, including migraine?

Answer 2

Childhood headaches may be caused by: migraine, tension type headache (primary) or raised intracranial pressure, analgesic overuse (secondary).

Migraine
Features - hemicranial pain, throbbing, abdo pain, N&V, photo/phonophobia, aura, positive FH
Management - acute: effective pain relief, triptans. Preventative: pizotifen, propranolol, amitryptyline, topiramate, valproate

Tension
Features - diffuse, symmetrical, band like, present most of the time, constant ache
Management - reassure, multidisciplinary, attend to underlying problems, acute: analgesia, prevent: amitryptilin

Question 3

What is the range of epileptic and non epileptic acute event which occur in children, and what terminologies and definitions are used when referring to them?

Answer 3

Seizure/fit: any sudden attack from whatever cause
Convulsion: seizure where there is prominent motor activity
Epileptic seizure: an electrical phenomenon- abnormal excessive hypersynchronous discharge from a group of neurons

Range

• epileptic (generalised and focal)
• acute symptomatic seizures eg hypoglycaemic seizures, trauma, febrile convulsions
• reflex anoxic seizure
• syncope
• parasomnia eg night terrors
• behavioural stereotypies
• psychogenic non epileptic seizures

Seizure types

• jerk/shake: clonic, myoclonic, spasms
• stiff: tonic
• fall: atonic/tonic/myoclonic
• vacant attack: absence, complex partial seizure

Question 4

What is the differential diagnosis for generalised and focal epileptics and what is the approach to managing them?

Answer 4

Differential diagnosis

• syncope
• migraine
• brain tumour
• acute symptomatic seizure
• reflex anoxic seizure
• psychogenic
• Parasomnias
• behavioural stereotypies

Management:

• anti epileptic drugs (only if diagnosis is clear) to control seizures eg sodium valproate, levetriacetam, carbamazepine
• Other therapies including steroids, immunoglobulins and ketogenic diet
• vagus nerve stimulation
• surgery

Question 5

What are the potential causes of weakness in children and how may this be investigated?

Answer 5

Possible causes: electrolyte disturbance, infections, thyroid dysfunction, muscle dystrophy, neuropathies. Usually Lower motor neurone but can be upper motor neurone

Test for creatinine kinase (usually raised)

Features: ‘floppy’, slips from hands, paucity of limb movement, alert but less motor activity, delayed motor milestones, able to walk but frequent falls, lordosis, foot drop

Question 6

What is the range of neuromuscular disorders in childhood?

Answer 6

Muscular: muscular dystrophies, myopathies (congenital and inflammatory), myotonic syndromes

NMJ: myasthenic syndromes

Nerve: hereditary or acquired neuropathies

Anterior horn cell: spinal muscular atrophy

> > Most common is duchenne muscular mystrophy