Peds Neuro Flashcards
Common Child Neurology Referrals
- seizures and epilepsy
- developmental delay/cerebral palsy
- ADHD/Behavior/Autism
- Headaches
- Tics/Movements
Developmental Delays
Most important question: Is there anything your child can’t do now that she could do before?
4 domains of Development
- Gross Motor
- Fine Motor
- Speech
- Social
With apparent development delays: ALWAYS measure head circumference (below 2 SD’s for age, almost always has the brain as part of that child’s problem)
Key Terms for Developmental Things
- Developmental Delay: category that means something to parents. Need to be careful with how they interpret this. Delay implies the possibility of catching up. They’re behind but they might catch up. We don’t always know, maybe take a watch and wait approach because they aren’t presenting something that may need an MRI
- *in contrast: kid with a profound neurological impairment and we know they aren’t going to catch up, doing a disservice to the parent by saying they have a developmental delay. Need to level with people about what you do and don’t know
- Static Encephalopathy: some deficits will be permanent. Something happens to the brain that won’t get better
- Intellectual Disability
- Typically Developing
Rett Syndrome (MECP2 mutation)
- systematic, something about social skills in the video, the gait, a movement that she does a lot unnecessarily. Sense of odd language
- stereotype: repetitive hand movement on midline. Wide based gait. No normal cadence or balance when she walks. She doesn’t look at the camera at all, doesn’t seem to notice it. Doesn’t really interact with mom in a typical way either
- can make dx just by saying they’ve seen a patient with this before. Part of dx is frankly going to a good residency, seeing a lot of patients and going out into the world with this experience
“Spells”
- common in child neurology
- you don’t get to see the problem
- emphasis is on the history
- examination, developmental history helpful
Key Spell Questions
- Seizure or not seizure?
- Provoked or unprovoked
- Focal onset or generalized onset? (If starts with staring, almost always focal) (Started in one arm or spread? We know part of brain was seizing before other parts which makes us worried about a possible tumor, abscess)
- Does this child have epilepsy? (2 or more unprovoked seizures)
- Should he be placed on daily anti-seizure meds?
- What dx tests should be performed in the ED?
- What dx tests should be performed as an outpatient?
- Prognosis and precautions?
- Is neurology consultation needed?
Febrile Seizures in Kids (key points)
- common (100,000 kids per year)
- age (6 months to 6 years)
- recurrence risk (1 in 3)
- epilepsy risk (1 in 25 or less)
Management:
- ALWAYS get the H&P
- Sometimes get labs (more geared to ward you have a kid with a fever)
- nearly never get LP, imaging, EEG, daily seizure meds
- ALWAYS educate
- Sometimes you give PRN seizure meds
Evaluation of Non-Febrile Seizures in Kids
- ALWAYS H&P
- LP nearly never
- Sometimes: labs
- Usually: imaging and EEG (esp. focal)
- ALWAYS education
KEY POINTS:
- common
- recurrence risk idiopathic (4 in 5)
- recurrence risk symptomatic (2 in 3)
- treat
- safety
Epilepsy
- dx after 2 unprovoked seizures
- indicates a chronic tendency to have seizures
- categorized based on symptomatic vs. idiopathic, focal vs. generalized, and by special features of syndromes, e.g. Childhood Absence Epilepsy, Benign Rolandic Epilepsy
Childhood Absence Epilepsy
- idiopathic, generalized
- semiology
- post-ictal?
- duration
- frequency
- time course
What helps differentiates kids staring off that are bored vs. kids with childhood absence epilepsy? If it’s referred by the 2nd grade teacher it’s boredom. It’s interruptibility. Parents can touch them, kiss them, shake them and they stare off for a few more seconds, uninterruptible it’s a seizure. Can be hard because these can be short.
-Staring that interrupts child’s behavior and cannot be interrupted by others
Tx:
- ethosuximide: 20 mg/kg/day (standard)
- valproic acid: 20 mg/kg/day if atypical
Absence Epilepsy Features
Onset: unpredictable Appearance: staring with glassy eyes Interruptible: No Automatic Behaviors such as chewing or lip smacking: sometimes Duration: seconds Consistency: highly Offset: abrupt-child returns to normal awareness and activity Frequency: many episodes daily
Partial Epilepsy with Complex Partial Seizures
Onset: unpredictable Appearance: staring with glassy eyes Interruptible: No Automatic Behaviors such as lip smacking or chewing: often Duration: seconds to minutes Consistency: highly Offset: gradual (child has post ictal confusion and/or sleepiness) Frequency: variable
Behavioral Staring: dissociation from the ENV (bored)
Onset: predictable Appearance: staring Interruptible: Yes, may require touch or loud voice Automatic behaviors: rarely. However child with stereotypies may stare off Duration: variable Consistency: variable Offset: immediate Frequency: variable
Tool Kit for Peds Neuro
- play-by-play Hx
- developmental Hx
- 3 generation family Hx/pedigree
- hypothesis: driven exam with careful observation
- medical knowledge and resources
- thinking
