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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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.
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Semin Pediatr Neurol · Jun 2011
Genetics and child neurology: what every trainee/resident should know.
The training of residents in child neurology varies from one center to another, being influenced to a large extent by the nature and volume of the clinical practice at a specific center and the expertise of the faculty. There is no doubt that there is an undercurrent of genetics in everything we do as child neurologists, sometimes explicit and sometimes implicit. In this article, we highlight a fundamental set of concepts, principles, methodologies, and learning tools/resources of which every child neurology trainee should have some knowledge. We may eventually arrive at a child neurology curriculum that might be continuously revised and maintained (perhaps through the Child Neurology Society) and serve as a template for individual training programs.