Neurology diagnoses and treats disorders of the nervous system, including the brain, spinal cord, and nerves, as well as thought and memory.
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The management of pediatric neurological disorders has evolved from purely supportive care to active, targeted interventions. The philosophy is “management, not just diagnosis.” Even for conditions that are currently incurable, significant improvements in quality of life can be achieved through symptom management, rehabilitation, and emerging molecular therapies.
Medications are the cornerstone of treating conditions like epilepsy, migraine, and spasticity. Antiepileptic drugs (AEDs) are selected based on the specific seizure syndrome and the child’s age. The goal is “seizure freedom without side effects.” Careful titration is needed as the child grows and metabolizes drugs differently.
For spasticity (muscle tightness), muscle relaxants like Baclofen are used. Injections of Botulinum toxin (Botox) into specific muscles can help relax a tight limb, improving gait or making hygiene easier. This is often used in children with cerebral palsy to prevent permanent contractures.
Rehabilitation is essential for maximizing a child’s functional potential. The developing brain learns through repetition and sensory input. Physical Therapy (PT) focuses on gross motor skills like sitting, standing, and walking. It helps prevent orthopedic deformities caused by muscle imbalance.
Occupational Therapy (OT) focuses on fine motor skills and activities of daily living, such as feeding, dressing, and writing. Sensory integration therapy helps children who have trouble processing textures, sounds, or vestibular input. Speech Therapy addresses communication deficits and swallowing safety (dysphagia).
We are witnessing a revolution with the approval of gene therapies for previously fatal pediatric diseases. For Spinal Muscular Atrophy (SMA), therapies can now replace the missing gene (Zolgensma) or modify the existing gene to function better (Spinraza). These treatments preserve motor neurons and can allow children to walk who otherwise would not.
Early intervention is critical for these therapies. “Time is neurons.” Treating a pre symptomatic baby identified via newborn screening yields far better results than treating a symptomatic child who has already lost motor units. This has emphasized the need for rapid genetic diagnosis.
Diet is a powerful tool in pediatric neurology. The Ketogenic Diet is a high fat, low carbohydrate medical treatment for drug resistant epilepsy. It shifts the brain’s metabolism to burn fat (ketones) instead of sugar, which stabilizes neuronal membranes and reduces seizures.
For metabolic disorders like Phenylketonuria (PKU), diet is the cure. Restricting specific amino acids prevents the toxic buildup that damages the brain. These diets require lifelong adherence and careful monitoring by a metabolic dietician to ensure growth and nutrition are maintained.
Structural problems often require surgical solutions. Hydrocephalus (fluid buildup in the brain) is treated with the placement of a shunt to drain the fluid. Craniosynostosis (premature fusing of skull bones) requires surgery to reshape the skull and allow the brain room to grow.
Epilepsy surgery is an underutilized option for children with focal seizures that do not respond to medication. Removing the “bad” spot of the brain (cortical dysplasia) can be curative. Because of the young brain’s plasticity, children often recover function remarkably well even after removing significant amounts of tissue.
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It is a strictly calculated medical diet high in fat and very low in carbs that forces the brain to use ketones for energy, which can significantly reduce seizures in some children.
For some conditions like SMA, a one time gene replacement is designed to be a long term fix, though we are still studying the lifetime durability; it stops progression but may not reverse all existing damage.
Not necessarily; many children with epilepsy can be weaned off medication after being seizure free for two years. Other conditions may require lifelong treatment.
A VP shunt is a tube surgically placed in the brain to drain excess fluid (hydrocephalus) down to the belly, where it is absorbed, relieving pressure on the brain.
Yes, when used by a specialist for spasticity, Botox is safe. It stays in the muscle where it is injected and helps relax tightness to improve walking or comfort.
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