Articles from prior issues of The Advocate

July/August, 1999

Serious Neurological Disorders In Children
by Jacqueline Smith, Oregon DDS

ON WEDNESDAY, APRIL 21, 1999, at the Pacific Regional Training Conference held in Burbank, California, Dr. Perry Lubens gave a presentation on neurological disorders in children. His presentation revolved around what he considers to be the top three most serious neurological disabilities; cerebral palsy (CP), epilepsy, and developmental delay (DD) with a combination of all three being very common. Here are some of the highlights: Cerebral palsy children have three classes: spastic, dyskinetic, and ataxic. Two in 1,000 children are affected and technological advances have not changed that number over the years, meaning we are not preventing CP despite advances in medicine. Etiology is indeterminable, but the current suspicion is that most are caused by problems in the neonatal period or post-natal trauma. Other causes include cerebral malformations, acute metabolic disorders, maternal clotting disorders, and infection of the placental membranes. Approximately 50% of CP children will also be mentally retarded. Other common disabilities associated with CP children include seizures, cataracts, eating problems, drooling, blindness, ear infections, emotional/behavioral difficulties, and skeletal problems. Babies who are spastic and have feeding tubes usually don’t live longer than four years. Those children who are diplegic usually do well as long as there is no seizure involvement. Those with movement disorders will not necessarily progress in severity, but will fail to reach certain milestones due to gross and fine motor difficulties. Pre-term and small for gestational age babies are 27 times at greater risk for CP. Dr. Lubens emphasized the difference between epilepsy and seizures; a seizure is the abnormal discharge of neurons. Epilepsy is a chronic disorder characterized by recurrent, unprovoked seizures. So you can not consider a child epileptic if they have only had a couple of seizures. Again, there are three different types of classes; partial or focal seizures, which are easier to control; complex partial, which are difficult to control; and generalized. Treatments include drugs such as Tegretol and Dilantin, resective surgery (removes large parts of entire hemispheres) which are highly effective in certain epileptics and are being done more often, and vagal nerve stimulation which is a new technique (a pacemaker type device is used to stimulate the vagal nerve) that seems to work. (Does that remind anyone of the Terminal Man?) Most seizure medications are equally effective. The reason there are so many different modifications and they are switched around is because of the side effects. Most children (70-80%) with epilepsy will grow out of it by adulthood. If one can keep a child seizure free for 2-3 years, the chances of them remaining seizure free when the medications stop are very good. However, children who are four years old or younger with seizures have a grimmer prognosis. If the child experiences difficulties reaching the milestone of sitting because of the disorder and reaches the age of two years, it is very likely the child will never ambulate. Developmental delays are probably the most frequent child neurology problems. These are delays in meeting milestones in one or more streams of development and best applied to children under three years of age. Most common cause is static encephalopathy but again no specific etiology is known. Other causes include Down’s syndrome, Fragile X, fetal alcohol syndrome, Rett’s syndrome, and genetic nonchromosomals, like inborn errors of metabolism. Of note, IQs are being used now “prescriptively” and terminology such as “intermediate” and “intensive” are being used to indicate the level of support necessary to achieve a desired outcome. In other words, those terms are used to indicate how much assistance the child will require to function. Common problems include expressive/receptive language problems, visual problem solving difficulties, fine/gross motor skill difficulties, and social/emotional development delays. The expressive/receptive and social/emotional spheres are closely related to speech/language disorders and/or global developmental delays. Children three years or younger with speech/language disorders will, in all likelihood, be diagnosed with autism. And it is statistically shown that a low birth weight child’s environment plays a huge role in its development: level of mom’s education and economics equals their success rate.

Dr. Lubens’ credentials include internship in pediatrics at LAC-USC Medical Center and residency in Pediatrics at Children’s Hospital in Cincinnati, Ohio and Neurology at UCLA. He continued at UCLA doing a Pediatric Neurology Fellowship & Electroencephalography & Epilepsy Fellowship. He has been associate clinical professor in Department of Pediatric Neurology at UCI Irvine, Medical Director at Neurodiagnostic Department at Long Beach Memorial Center and Attending Pediatric Neurologist at Miller Children’s Hospital of Long Beach. Currently, he is in private practice at Long Beach Neurological Medical Group.