1. Drive through child neurology with special reference to neurobehavioural disorders Dr harshti shah Child neurologist Rajvee hospital Ahmedabad 2. introduction Graduate in child neurology-Telaviv uni, Israel Fellowship in epilepsy-Great Ormond street hospital for children,london Fellowship in electrophysiology-Japan Research in galactosemi- gold prize at world child neurology congress,Taiwan New modality for Opsoclonus myoclonus synrome, Child neurology congress, Australia 3. introduction Post Graduation in child neurology- Tel Aviv university.(2003) Research fellow Great Ormond street hospital for children London(2003) Young investigators award-Japanese society of child neurology(2008) Gold prize World child neurology congress(2010) 4. What is child neurology Diseases of brain of children Developing organ Development continues after the birth It is not the miniature form of adult brain ? 5. Formation of brain Formation begins at 26th day of gestation Migration is complete in 1st trimester Proliferation takes place in subsequent trimester Neural network;axonodendritic connections continues till 1 year 6. Plasticity of brain Damage to brain can occur right from its inception Damage will be of different types which affects the formation, multiplication or maturation of brain . Easy moulding-lots of power of improvement Recovery is good. 7. brain 8. brain 9. brain 10. brain 11. brain 12. brain 13. brain 14. brain 15. brain 16. brain 17. brain 18. brain 19. brain 20. brain 21. brain 22. brain 23. brain 24. brain 25. brain 26. brain 27. Brain function 28. Brain function 29. Brain function 30. Brain function 31. Brain funcion 32. Brain function 33. Brain function 2.mpg 34. cerebellum 35. Peripheral nervous system Anterior horn cells Nerves Neuromuscular junctions Muscles 36. Activity of neurons 37. spasms 38. Myoclonic jerks 39. EEG 40. Course and future Most of them are treatable >80% Course lasts for 2-5 years Future is usually good except in very few. 41. Loss of brain function Disordered motor function Static-non progressive Ned time for improvement Needs good moral and economical support Child can be made functional 42. Why does it occur? Usually ,damage to developing brain Hypoxic ischemic encephalopathy Hypoglycemia Hyperbilirubinemia Intracerebral hemorrages Maternal infections Mental stress to mother antenataly Fall of mother 43. Facts for cerebral palsy Visual field defect-blindness, squinting Deafness Speech problems like apraxia,dyspraxia dysarhtria Mental retardationmay or may not be there Dyslexia-difficulty in learning Behavioral disturbances-ADHD ,Autism ARE NOT INCLUDED IN CP 44. Cerebral palsy 45. cp 46. Choreoathetoid cp 47. Similar delay Chromosomal abnormality Delayed growth Metal retardation Dyslexia 48. future Limited capabilities for development Needs help Moral and economical support 49. Muscle diseases Myopathy Muscular dystrophies Neuropathies Spinal muscular atrophies 50. SMA 51. DMD 52. neuropathy 53. Course and future Usually hypotonic Progressive disease May become handicapped Short life span 54. Neurobehavioral problems ADHD PDDautismautistic spectrum disorders 55. Common features Symptoms Many conditions causes are known Treatable conditions-excellent results with interventions Unknown causesfair improvement 56. Most common causes Epilepsy Deficiency of known and unknown nutrients Neurometabolic disorders 57. What is it? ADHD Hyperactive Short attention span Impulsivity Normal speech Normal to average school Autism 1/88 Hyperactive Poor social communication Eye eye contact Lack of normal speech Repeatoir of activity-stereotypes 58. Course and future Usually guarded for autism Mild cases may go to school Moderate-severe cases-special school Good memory but poor comprehension Meaningless speech Remains in their own world Therefore, stereotypes 59. What best can be done? Earliest possible diagnosis Identify the cause Management of treatment of cause 60. therapy Occupational therapyuse of hands Decrease the hyperactivity Development of sensation of hands Identification of objects Comprehension of routine command Performance of their routine activity 61. Speech therapy Speech is good BUT Does not know what to speak and when. So co relation of name with particular objects Use of maximum words 62. Special educators Teaching of basic alphabet by simplyfying Repeatation of spoken and written educative skills Development of professional skills 63. dyslexia 64. course Needs to be continued for long time Needs lots of social and economical support Needs special set ups Needs the legislation 65. Take home message Disease of developing brain Manifestation depends upon area of involvement of brain Needs early diagnosis and treatment Needs support by law and society Needs lots of awareness in public 66. Thank you 67. Thank you Photo of join hands 68. Central Nervous system Fine cytoarchitectcural network of Neurons Axons Dendrites Synapses neurotransmitters 69. Neuronal dysfunction Prenatal-chromosomal, metabolic Postnatal-perinatal insults- hypoxia, hypoglycemia, hyperbilirubin emia Infections---STATIC DAMAGE CEREBRAL PALSY 70. TRANSMITTER DYSFUNCTION Channelopathies(paroxysmal disorders) EPILEPSY INVOLUNTARY MOVEMENTS ATAXIA Neurobehavioral dysfunction AUTISM ADHD(attention deficit hyperactivity disorder) 71. Neuronal storage/dysfunction Production of essential element i.e. Biotinidase,mitochondrial disease Accumulation of toxins i.e. MPS,sialoidosis,tay sachs ,fabrys Neuronal loss i.e. krabbs, Alexander's disease, ALD,MLDS 72. Video of Child 73. Thoughts Common relative: Not much fruitful, unnecessary to spend Child specialist May or may not improve, needs lot of time for improvement Fact by neurologist: Good part of brain may start taking the function and with therapy u can make functional child 74. MRCP Mental retardation with cerebral palsy Common terminology to be used in the prescription paper It is not always so. Mental retardation may or may not be associated because 75. Cerebral palsy Definition: disordered motor function Delayed Sitting Walking Intelligence and cognition are not included 76. Cp s are mental. Visual field defect-blindness ,squinting Deafness Speech problems like,apraxia,dyspraxia dysarhthria Mental retardation Dyslexia-difficulty in learning Behavioral disturbances-ADHD ,Autism ARE NOT INCLUDED IN CP 77. fact They may or may not be associated BUT It is not included in Cp 78. incidence Not diagnosed so not in the picture Recently increased Due to survival of low birth weight and premature babies 79. Minimization Myth:By elective caesarian section Ideally, Good fetal monitoring is essential Skillful gynecologist, careful fetal monitoring and knowledgeable neonatologist reduce the incidence of Cp 80. Cp means spasticity Not so, Cp means altered tone which may be hypotonic/hypertonic or even normal tone in few with delayed normal development There may be involuntary movements associated with delayed development 81. Classification Cerebracerebral palsy types Spastic quadriplegic Choreochoreoathe toidathetotic Dystonic Mixed hypotonic Ataxic 82. Quadriplegic cp 83. Recovering quadriplegic cp 84. Ataxic cerebral palsy 85. Choreoathetotic cerebral palsy 86. Common labels of cp Any Child is Delayed in development out of the normal range is labeled as cerebral palsy 87. Anything which is slow is not always cerebral palsy