Seminars in pediatric neurology
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The training of the child neurologist in the fundamentals of neurology is discussed. Although the fundamentals of neurology are clearly necessary for the practice of child neurology, the breadth of the background necessary for the practice of child neurology depend on the interest, enthusiasm, and goals of the resident in question. Some of the issues involved in the design and implementation of the training curriculum will be considered.
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The discipline of childhood movement disorders is an exciting new area of specialization within the field of pediatric neurology. Establishing a formal educational system is an ongoing challenge that should include the standardization of movement definitions, the development of a formal classification system for existing disorders, the adequate exposure of trainees to both common and rare disorders, and the ongoing formulation of topic guidelines and consensus papers. Specific suggestions and recommendations are provided for further discussion.
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Pediatric neurologists frequently treat acute pain in children. A broad range of medication options is available including nonsteroidal anti-inflammatory drugs, opioids, and other analgesic adjuvants, such as antidepressants and antiepileptics. This article reviews the physiology underlying the experience of pain and compares the pharmacologic mechanisms and properties of these medications, providing a framework for developing effective multimodal medical treatment approaches to pain in children.
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Semin Pediatr Neurol · Sep 2010
ReviewSurgical treatment of refractory status epilepticus in children: candidate selection and outcome.
Surgical treatment emerges as a therapeutic option for refractory status epilepticus (RSE) in children. Surgical approaches for RSE include focal cortical resections, hemispherectomies, multiple subpial transections, and rarely corpus callosotomy and vagal nerve stimulator implantation. Resective surgery has shown immediate- and long-term benefits in cases of definite localization of the epileptogenic focus by elecrographic and imaging data. ⋯ The optimal timing of surgery in eligible patients has been determined by concerns about medical intractability weighed against accumulating risks of RSE and the possible appearance of secondary epileptogenic zones caused by ongoing seizures. Overall, preliminary case series suggest that epilepsy surgery may be an alternative treatment option for selected children with RSE. Additional studies are needed to delineate timing and criteria for intervention as well as prognostic factors.