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2023 | OriginalPaper | Hoofdstuk

29. Neurological disorders in children

Auteurs : J. B. M. Kuks, J. W. Snoek, B. Jacobs, C. O. Martins Jarnalo

Gepubliceerd in: Textbook of Clinical Neurology

Uitgeverij: Bohn Stafleu van Loghum

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Abstract

Although many neurological disorders can affect children as well as adults, many are specific to childhood, such as congenital abnormalities of the nervous system and perinatal brain damage. The severity and nature of congenital disorders depend on the cause and when it occurred. Impaired proliferation and migration of neurons can cause learning disabilities, motor problems and epilepsy. Congenital disorders due to chromosomal aberrations often cause learning disabilities. Intrauterine infections can cause severe abnormalities. Hereditary metabolic diseases can give rise to developmental disorders but may not manifest themselves until later in life. Neurocutaneous diseases are disorders involving the ectodermal structures of the nervous system and skin. Childhood ataxia can be a manifestation of very different disorders. Paediatric neurology is concerned with disorders of the central and peripheral nervous system and the muscles, in children from the prenatal period up to 16 to 18 years of age. Although not a recognized separate medical specialism in most European countries, it is an area for which additional training is required. About half of specialists dealing with paediatric neurology have a background as neurologists, the other half as paediatricians. A full understanding of neurological deficits in children requires a sound grasp of normal CNS development. Therefore, this chapter’s opening sections are essential. Many symptoms and disorders are also dealt with elsewhere in this book. These include the various forms of epilepsy (sect. 18.2.1) as well as neuromuscular and anterior horn diseases that manifest themselves in childhood (sect. 12.4 and 13.2.2). Paediatric neurology differs from ‘ordinary’ neurology in several respects. First, there are specific disorders that occur in childhood, such as congenital abnormalities of the nervous system (sect. 29.3) and brain damage due to perinatal problems (sect. 29.3.9). Other examples are various neurometabolic and neurodegenerative diseases, some of which even cause affected children to die before they reach adulthood (sect. 29.4). Secondly, every disorder develops against the background of the developing nervous system. The clinical presentation is determined by the sum of the positive effects of the maturing nervous system on the one hand and the negative effects of the disorder on the other. A good example is a perinatal cerebral infarction, which will not cause clear symptoms of hemiparesis until the child reaches one year of age. This phenomenon is known as growing into deficit. A certain degree of cerebral development is needed before any functional disorder manifests itself. Then there are disorders that occur at all ages, such as traumatic brain injury and infections, which have a different impact on the young nervous system than on that of an adult. Children are more vulnerable, but on the other hand they have greater plasticity and ability to recover. Lastly, neurological examinations in children are very different from those in adults, and each age has its own requirements. This chapter discusses some disorders specific to childhood that are fairly common (cerebral palsy or infantile encephalopathy), as well as diseases that are fairly rare (many metabolic disorders). These rare diseases are nevertheless discussed in order to provide some understanding of mechanisms that can cause neurological problems (which are often severe) at a young age. On the other hand, many neurological disorders that can affect adults can also occur in children. These are mainly discussed elsewhere in this book, stressing the paediatric neurology aspects where necessary.
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Metagegevens
Titel
Neurological disorders in children
Auteurs
J. B. M. Kuks
J. W. Snoek
B. Jacobs
C. O. Martins Jarnalo
Copyright
2023
Uitgeverij
Bohn Stafleu van Loghum
DOI
https://doi.org/10.1007/978-90-368-2898-7_29