This issue of PEDIATRIC ANNALS, a continuation of our symposium on "Pediatrie Neurology" under the Guest Editorship of Dr. Hart deC. Peterson, pediatrie neurologist at New York Hospital-Cornell Medical Center, presents an up-to-date review of two important areas of information. First, there are three articles on conditions commonly met by most practicing pediatricians - meningitis, convulsions, and hypotonia. Then there is a contribution on an area unfamiliar to most of us, genetic-metabolic diseases of the central nervous system.
It is of interest to note that in the past three years we have received a number of requests from practicing pediatricians asking for a discussion of recent genetic-metabolic advances. The article by Dr. Isabelle Rapin, of the Rose F. Kennedy Center for Research in Mental Retardation and Human Development, the Bronx, New York, superbly fulfills this need.
The reader should not be put off by the size of Dr. Rapin's article, for it contains a wealth of information - much of it listed for ease of diagnosis, with references to sections in the article containing further information.
Such lists include geneticmetabolic diseases causing severe or profound dementia, those producing a hearing loss, those associated with organomegaly, those causing changes in the skin and hair, those with ocular abnormalities, those associated with seizures or myoclonus, those with abnormal involuntary movements, those with a neuropathy, and those associated with prominent cerebellar signs.
One cannot expect the reader of this interesting article to retain in his mind all the information it contains unless, of course, his subspecialty includes this area. But we would advise him to file this issue in his library for ready reference should he suspect the possibility of a genetic-metabolic disease in some patient in the future.
In past issues of Pediatric Annals, we have not hesitated to present such newer concepts in pediatrics - and we were rewarded by the many pediatricians and even geneticists who wrote and told us that they were saving the issues for future reference. Two such subjects come to mind at once - the issue on "Genetics in Pediatrics," edited by Drs. Wayne H. Finley and Sara C. Finley, and the two issues on "The Face in Diagnosis," edited by Dr. Robert J. Gorlin.
The other three articles in this issue of the magazine deal with neurologic problems frequently met in the practice of pediatrics.
The first - "Bacterial Meningitis in Childhood," by Drs. Edgar Y. Oppenheimer and N. Paul Rosman - presents some new and provocative aspects concerning the management of this disorder. The authors point out that the modern treatment of these infections by antibiotics has resulted in many recoveries but numerous serious sequelae. Some of these sequelae, they suggest, may be the result of late diagnosis and late treatment; others may be iatrogenic, due to a reaction to the drugs given, a matter still to be decided. In view of these serious problems, the solution emphasized by Drs. Oppenheimer and Rosman will be found in the perfection of a new vaccine against bacterial meningitis, which is at present under active experimentation.
The article "Diagnosis of the Hypotonic Child," by Dr. Peterson, discusses a problem frequently confronted by the practicing pediatrician. Most of us, when we have a child with considerable hypotonia, wonder, at the outset, if we are dealing with a benign condition or whether it reflects a more serious origin, such as cerebral palsy, brain damage, mental retardation, or some muscular disease. Dr. Peterson carefully examines the whole problem and clearly presents a full approach to diagnosing the underlying cause of hypotonia in the individual child.
The article on "Convulsive Seizures in Infancy and Childhood" is by Dr. Barry S. Russman. Most practicing pediatricians are quite familiar with febrile convulsions and occasionally meet cases of petit mal or grand mal. Dr. Russman discusses these but also includes the other, less common causes of seizures, with tables of the types, differential diagnosis, and management. It is interesting to note that he does not recommend a spinal tap as a routine part of the examination - a procedure that I, personally, have always felt was greatly overdone in the early study of convulsions.
The third and final issue of Pediatric Annals on the neurology of infancy and childhood relating to muscle diseases will appear in a few months.