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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As traumatic brain injury is among the most common causes of pediatric mortality and neurologic morbidity, the well-trained child neurologist should have a solid foundation of the pathogenesis of traumatic brain injury and be competent in the acute and chronic management of children and adolescents who experience a traumatic brain injury. This article outlines the training goals and core knowledge of traumatic brain injury that should be attained by those training in child neurology by the completion of their formal training.
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Neurocritical care (NCC) is now an essential field in child neurology that requires dedicated training. NCC applies the basic principles of neuroresuscitation to all situations, integrates this with modern technology. and emphasizes that brain protection is not limited to the intensive care unit. We outline the essential competencies needed and how to obtain these.