Pediatric Annals

A Pediatrician's View

Milton I Levine, MD

Abstract

This is the first of two issues of PEDIATRIC ANNALS devoted to the subject of neurology in infancy and childhood, an area of special interest to the practicing pediatrician.

Hardly a week passes without some patient's exhibiting neurologic or possibly neurologic signs. Among these are children with headaches, slow muscular development, convulsive seizures, meningitis, or mild cerebral dysfunction.

As with so many other special fields of pediatrics, knowledge in the field of neurology has been increasing rapidly. New entities have been discovered and new methods of diagnosis devised. The differential staining of chromosomes and the newer knowledge of inborn metabolic disturbances have added considerably to the number of known neurologic syndromes.

It is evident, therefore, that the practicing pediatrician must have a good basic knowledge of pediatrie neurology and be prepared to conduct an efficient neurologic examination, and make a fairly accurate diagnosis in most cases. This is the aim of the present issue of PEDIATRIC ANNALS, prepared under the Guest Editorship of Dr. Hart deC. Peterson, Director of Pediatrie Neurology at the New York Hospital-Cornell Medical Center.

Dr. Peterson has selected five subjects for this first issue on pediatrie neurology. These include two basic articles on the neurologic examination and modern diagnostic methods and three contributions on subjects of clinical importance - neonatal seizures, headaches in children, and minimal cerebral dysfunction.

A future issue of this magazine, also under the editorship of Dr. Peterson, will continue the subject of neurology and will cover such areas as meningitis, encephalitis, the dystrophies, and degeneration of the nervous system.

It should be obvious that the diagnosis of many of the neurologic problems during the early years of life depends on a careful, well-organized, unhurried examination. In the opening article of the present symposium, Dr. Peterson describes all aspects of a complete neurologic examination, which can be performed in the office of the practicing pediatrician. All physicians who handle children can gain from reading this excellent review, for it presents a well-organized approach to the investigation.

The second article, by Dr. Irving Fish, describes the diagnostic "tools" of value in dealing with the neurologic problems of infancy and childhood. This contribution discusses not only the usual techniques - such as skull x-rays, pneumoencephalograms, electroencephalograms, spinal taps, and angiograms - but also the more recent techniques of brain scans, echo encephalograms, electromyography, and computerized axial tomography (EMI scan).

The contribution "Neonatal Seizures," by Dr. Gail E. Solomon, is of the greatest importance, for recognition of seizures in the newborn, and immediate and adequate treatment, may make the difference between a normal and a mentally retarded child. Dr. Solomon emphasizes the marked difference between the overt signs of convulsions in the neonate and those of the older child and adult. The numerous causes of neonatal seizures are specified and discussed, stressing that the pediatrician should determine as quickly as possible all remediable causes, which, if not treated speedily and adequately, may lead to irreversible brain damage. This article is of such value that it should be carefully read by all practicing pediatricians and all other physicians responsible for the care of the newborn.

The article that follows - "Headaches in Children," by Drs. David Scheff and Robert Vannucci - deals with one of the most frequent and difficult problems faced by all practicing pediatricians. There are so many causes of headaches in children that an organized diagnostic investigation is usually indicated before a specific diagnosis can be made. Using a modification of the headache classification of the National Institute of Neurological Diseases and BKndness, the authors clearly review each of the categories and direct the…

This is the first of two issues of PEDIATRIC ANNALS devoted to the subject of neurology in infancy and childhood, an area of special interest to the practicing pediatrician.

Hardly a week passes without some patient's exhibiting neurologic or possibly neurologic signs. Among these are children with headaches, slow muscular development, convulsive seizures, meningitis, or mild cerebral dysfunction.

As with so many other special fields of pediatrics, knowledge in the field of neurology has been increasing rapidly. New entities have been discovered and new methods of diagnosis devised. The differential staining of chromosomes and the newer knowledge of inborn metabolic disturbances have added considerably to the number of known neurologic syndromes.

It is evident, therefore, that the practicing pediatrician must have a good basic knowledge of pediatrie neurology and be prepared to conduct an efficient neurologic examination, and make a fairly accurate diagnosis in most cases. This is the aim of the present issue of PEDIATRIC ANNALS, prepared under the Guest Editorship of Dr. Hart deC. Peterson, Director of Pediatrie Neurology at the New York Hospital-Cornell Medical Center.

Dr. Peterson has selected five subjects for this first issue on pediatrie neurology. These include two basic articles on the neurologic examination and modern diagnostic methods and three contributions on subjects of clinical importance - neonatal seizures, headaches in children, and minimal cerebral dysfunction.

A future issue of this magazine, also under the editorship of Dr. Peterson, will continue the subject of neurology and will cover such areas as meningitis, encephalitis, the dystrophies, and degeneration of the nervous system.

It should be obvious that the diagnosis of many of the neurologic problems during the early years of life depends on a careful, well-organized, unhurried examination. In the opening article of the present symposium, Dr. Peterson describes all aspects of a complete neurologic examination, which can be performed in the office of the practicing pediatrician. All physicians who handle children can gain from reading this excellent review, for it presents a well-organized approach to the investigation.

The second article, by Dr. Irving Fish, describes the diagnostic "tools" of value in dealing with the neurologic problems of infancy and childhood. This contribution discusses not only the usual techniques - such as skull x-rays, pneumoencephalograms, electroencephalograms, spinal taps, and angiograms - but also the more recent techniques of brain scans, echo encephalograms, electromyography, and computerized axial tomography (EMI scan).

The contribution "Neonatal Seizures," by Dr. Gail E. Solomon, is of the greatest importance, for recognition of seizures in the newborn, and immediate and adequate treatment, may make the difference between a normal and a mentally retarded child. Dr. Solomon emphasizes the marked difference between the overt signs of convulsions in the neonate and those of the older child and adult. The numerous causes of neonatal seizures are specified and discussed, stressing that the pediatrician should determine as quickly as possible all remediable causes, which, if not treated speedily and adequately, may lead to irreversible brain damage. This article is of such value that it should be carefully read by all practicing pediatricians and all other physicians responsible for the care of the newborn.

The article that follows - "Headaches in Children," by Drs. David Scheff and Robert Vannucci - deals with one of the most frequent and difficult problems faced by all practicing pediatricians. There are so many causes of headaches in children that an organized diagnostic investigation is usually indicated before a specific diagnosis can be made. Using a modification of the headache classification of the National Institute of Neurological Diseases and BKndness, the authors clearly review each of the categories and direct the manner of treatment. This is an excellent review and, at the expense of my sounding repetitious, is, once again, an article to be carefully read.

The final article - "Minimal Cerebral Dysfunction/' by Dr. Madelyn E. Olson - r refers essentially to the child who has learning or behavior problems in school. Today more and more parents are bringing their children's learning problems to the attention of the pediatrician. The diagnosis of minimal cerebral dysfunction is not a simple one. Dr. Olson carefully goes through the differential diagnosis, specifying the importance not only of the history and neurologic examination but of the psychologic and educational evaluation as well. Medication is advised as a last resort when other efforts at relief have failed; it should be remembered, however, that medication does not produce learning but acts by decreasing distractibility and increasing the power of concentration. It is further emphasized that a physician treating such cases should keep close contact not only with the parents of the child but also with his educators.

10.3928/0090-4481-19750801-03

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