Seminars in pediatric neurology
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Pediatric syncope is one of the most common neurological problems in the pediatric population in both the office setting and in the emergency department. The abrupt brief loss of consciousness is usually dramatic and alarming to patients, family, onlookers, and providers. ⋯ It should be noted that the evaluation of syncope in children is costly and testing provides a low diagnostic yield. This chapter reviews the various types of syncope and provides a succinct clinical approach to the diagnosis, investigation, and management of syncope in children.
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Patients with medically intractable epilepsy who are not candidates for epilepsy surgery could benefit from neurostimulation. At this time, vagus nerve stimulation (VNS) therapy is the only Food and Drug Administation-approved neurostimulation modality; it has been shown to be efficacious and just as well tolerated in children and adolescents as in adults. ⋯ Deep brain stimulation of various brain regions, especially the anterior nucleus of the thalamus and responsive neurostimulation, also appear effective but are not yet approved for clinical use. Repetitive transcranial magnetic stimulation, which is also in early clinical development, is promising and could become available in the not too distant future.
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The curriculum for child neurology trainees should include information regarding the many infectious and post-infectious disorders that affect the developing nervous system. This article provides recommendations regarding the nature of the educational content and suggestions how this content can be provided to trainees.
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Co-morbid sleep disorders are quite common in Child Neurology. Formal training in the field of sleep medicine and routine attention to sleep-wake function in clinical practice enhances the ability of the child neurologist to deliver comprehensive care.
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The newborn infant and the neonatal intensive care unit are areas in which there is great variability in the involvement of child neurology. As preterm birth rates continues to rise, with the associated long-term neurologic morbidities, and neuroprotective interventions become available for the newborn infant, a critical knowledge of neurology in the newborn is required for a well-trained child neurologist.