Neurological conditions are conditions that affect the brain, nerves and muscles. In children, they cover a wide range of diseases and disorders affecting the developing brain of the unborn or newborn child, traumatic and acquired brain injury in children and adolescents, and degenerative disorders that become apparent in childhood when gross motor milestones are not met or there is regression in already developed skills. Some of these conditions are relatively common, others are very rare. Some more commonly known conditions include cerebral palsy (CP); neuromuscular conditions, such as Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA); developmental coordination disorder (DCD), and acquired brain injury (ABI).
A diagnosis of DCD can be made if performance in everyday activities that require motor coordination is significantly below what would be expected from that child’s age and intelligence level. DCD is prevalent in 5–6 per cent of school aged children who display difficulties which may include being unable to master age-appropriate tasks (eg, tying shoe laces, poor handwriting, poor performance in sport and clumsiness). Difficulties can occur in fine and gross motor development, speech and language development, body awareness and coordination of movement; some or all of which are below expected level for their age and are not due to any other neurological condition.
Motor coordination difficulties may impact on academic skills, and social and emotional development. Children with DCD will often have normal intelligence and may not have experienced a delay in their early motor milestones. DCD is commonly, but not always, associated with other developmental disorders, such as ADHD, learning difficulties and speech and language disorders. The cause is unknown but may be linked to the part of the brain that coordinates movement (the cerebellum).
WHAT IS A NEUROLOGIC DISORDER?
A neurologic disorder is caused by a dysfunction in the brain or nervous system (i.e. spinal cord and nerves). This dysfunction can result in physical and psychological symptoms.
The brain begins developing before birth. It continues developing throughout infancy, childhood, and adolescence. Most brain cells form before birth. One type of cell is the neuron, or nerve cell. Trillions of connections exist between neurons. These do not develop until infancy.
The brain is composed of:
- Gray matter. Neurons and the connections between them make up gray matter.
- White matter. Long fibers called axons make up white matter. An outer layer called the myelin sheath protects them.
A motor neuron carries impulses away from the brain.
The brain is self-organizing. It selects information to forward its growth. It also adapts to the environment. An individual experiences their environment through:
- Touch
- Smell
- Sight
- Taste
- Hearing
These senses produce connections in the brain.
Neurologic disorders involve the brain, spinal column, and nerves. Symptoms depend on where damage occurs. Affected areas may control:
- Movement
- Sensation
- Communication
- Vision
- Hearing
- Thinking
- Emotion
Neurologic disorders are wide ranging. They have various causes, complications, and outcomes. Many require life-long management.
Symptoms vary as well. Types of symptoms include:
- Physical
- Cognitive (or thinking)
- Emotional
- Behavioral
Specific disorders have combinations or clusters of these symptoms. For example, cerebral palsy tends to have more physical symptoms. ADHD tends to affect behavior more.
Many neurologic disorders emerge during the early years of development. They may be diagnosed at birth. Some are diagnosed later. Symptoms may only appear when:
- A child misses developmental milestones or has developmental difficulties (such as with autism)
- A damaging infection occurs (such as with meningitis)
- An accident causes brain injury (such as with a stroke, trauma)
CAUSES OF NEUROLOGIC DISORDERS
Many neurologic disorders are congenital. This means they are present at birth. Some disorders are acquired. This means they develop after birth. Those with an unknown cause are called idiopathic.
Congenital Causes
Genetic factors can influence the development of some neurologic disorders. A child typically inherits them through genes and chromosomes, but these genetic changes are not always inherited from the parents – this is called de novo.
Chromosomes are long strands of DNA supported by protein. They exist in the center of cells. Genes are sections of DNA. They carry the chemical code that makes us who we are. Chromosomes are composed of thousands of genes.
A human cell normally contains 46 chromosomes (23 pairs). A child inherits half from their mother and half from their father.
Congenital causes of neurologic disorders include:
Gene abnormalities
Chromosome abnormalities
Metabolic disorders
Congenital malformation
Pediatric neurological conditions
The discipline of child neurology encompasses diseases and disorders of the spinal cord, brain, peripheral nervous system (PNS), autonomic nervous system (ANS), muscles, and blood vessels that affect individuals in these age groups.
If a child has problems that involve the nervous system, a pediatric neurologist has the specialized training and knowledge to assess, diagnose, and treat the child. The conditions dealt with by pediatric neurologists vary considerably, from relatively simple disorders such as migraines or cerebral palsy to more complex and rare conditions such as metabolic diseases or neurodegenerative disorders.
Some examples of the types of conditions that can be encountered by specialists in this field include:
- Genetic diseases of the nervous system
- Congenital metabolic abnormalities that affect the nervous system
- Congenital birth defects affecting the brain and spinal cord, such as spina bifida
- Neurological developmental problems during childhood
- Childhood epilepsy
- Febrile seizures
- Movement disorders such as cerebral palsy
- Progressive neuromuscular conditions such as muscular dystrophy
- Abnormal mental development, speech disabilities, and learning disabilities
- Autism spectrum disorders
- Behavioral disorders such as attention deficit hyperactivity disorder
- Headaches and migraine
- Hydrocephalus or excess fluid build-up in the brain
- Head injuries and their complications
- Brain tumors
- Hospice and palliative medicine
- Neuromuscular medicine
- Sleep disorders
- Vascular neurology
- Intellectual disabilities
Pediatric neurologists act as consultants to primary care physicians, who may refer children to the neurologists for specialist care. For children with long-term neurological ailments, the pediatric neurologist provides regular care and consultation.
Child neurologists are found in a variety of medical environments ranging from children’s hospitals to outpatient practices, university medical centers, and private clinics. These physicians combine their understanding of diagnosis and treatment of the nervous system with expertise in childhood disorders and children’s special needs.
Overall, about 40% to 50% of the patients treated in a typical pediatric neurology practice have epilepsy, while 20% have learning difficulties or developmental problems and 20% are suffering from headaches. The remainder of patients being treated by pediatric neurologists will typically have rare or unusual conditions such as metabolic or genetic diseases.
Many centers are equipped with the specialized facilities and knowledge needed to treat very specific disorders such as rare neurodegenerative conditions, intractable epilepsy, or pediatric strokes.
6 Common Pediatric Neurological Conditions
- Epilepsy
Epilepsy is one of the most well-known pediatric neurological disorders, affecting nearly 1% of children worldwide. It is characterized by recurrent seizures, which are abnormal electrical discharges in the brain. Seizures can manifest in many forms, from staring spells and muscle stiffness to convulsions. The condition can be caused by genetic factors, head injuries, or infections like meningitis.
Treatment: While epilepsy is a lifelong condition, medications like antiepileptic drugs (AEDs) help manage seizures in most children. In severe cases, surgery or a ketogenic diet may be recommended.
- Cerebral Palsy (CP)
Cerebral Palsy is a group of disorders that affect a child’s ability to move and maintain balance. It is caused by brain damage during pregnancy, birth, or shortly after birth. Symptoms of CP vary but often include problems with muscle control, stiffness, or floppy limbs, and difficulty with coordination.
Types of CP: Spastic, Dyskinetic, and Ataxic.
Treatment: Although there is no cure for CP, physical therapy, occupational therapy, medications, and in some cases, surgery can help children manage symptoms and improve mobility.
- Autism Spectrum Disorder (ASD)
Autism Spectrum Disorder is a developmental condition that affects communication, behavior, and social interaction. Children with ASD may show repetitive behaviors, have trouble understanding social cues, or have delayed speech and language skills. The severity of the condition can vary, with some children requiring significant support while others lead relatively independent lives.
Treatment: Early intervention programs, speech therapy, and behavioral therapy (such as Applied Behavior Analysis) can be highly effective in improving communication and social skills in children with ASD.
- Attention Deficit Hyperactivity Disorder (ADHD)
ADHD is a common neurodevelopmental disorder that affects children’s ability to focus and control their impulses. Children with ADHD may struggle with inattention, hyperactivity, and impulsive behavior. These symptoms can affect their academic performance and social interactions.
Treatment: Behavioral therapy, counseling, and medication (like stimulants) are commonly used to manage ADHD. Creating structured routines and offering positive reinforcement can also help improve focus and behavior.
- Hydrocephalus
Hydrocephalus, also known as “water on the brain,” occurs when excess cerebrospinal fluid accumulates in the brain’s ventricles, causing increased pressure. This condition can result from birth defects, infections, or trauma. Common symptoms include a rapidly growing head, irritability, and vomiting.
Treatment: The primary treatment for hydrocephalus is the surgical placement of a shunt, which helps drain the excess fluid to another part of the body.
- Muscular Dystrophy (MD)
Muscular Dystrophy refers to a group of genetic conditions that cause progressive muscle weakness and loss of muscle mass. Duchenne Muscular Dystrophy (DMD) is the most common type affecting children. Symptoms usually start in early childhood and may include difficulty walking, frequent falls, and delayed growth.
Treatment: While there is no cure for MD, physical therapy, corticosteroids, and assistive devices can help improve the quality of life. Research on gene therapy is ongoing, providing hope for future treatment options.
Symptoms to Look Out For
Early detection of pediatric neurological conditions can improve outcomes. Parents should be aware of the following symptoms:
- Developmental delays: Difficulty reaching milestones like walking or talking
- Seizures or staring spells: Sudden, brief periods of confusion or unresponsiveness
- Unusual movements: Tremors, involuntary movements, or stiff muscles
- Frequent headaches or vomiting: Especially if paired with other neurological signs
- Behavioral changes: Extreme mood swings, loss of focus, or trouble interacting with others
Diagnosis and Treatment
Pediatric neurologists use a variety of diagnostic tools to identify neurological conditions. These may include:
- EEG (Electroencephalogram): To monitor electrical activity in the brain, often used in diagnosing epilepsy.
- MRI or CT scans: Imaging tests to detect brain abnormalities or tumors.
- Genetic tests: To identify inherited neurological disorders like Muscular Dystrophy.
Treatment varies depending on the condition but may include:
- Medications: For managing symptoms (e.g., seizures, hyperactivity)
- Therapies: Speech, occupational, and physical therapies to improve function
- Surgery: In some cases, such as with hydrocephalus or epilepsy, surgery may be needed.
Importance of Early Intervention
Early diagnosis and treatment can make a significant difference in a child’s development and quality of life. For many neurological conditions, starting treatment early can help children improve their motor, cognitive, and social skills, giving them the best chance at leading a healthy, independent life.
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