A few days ago, a women lost her fifth child outside a hospital in the Capital. The reasons of all the five deaths were the same: fits and seizures. And in all probability, her next child won't survive either. But who would tell her that? She has consulted many doctors, but none of them referred her to a neurologist, who could have identified the symptoms and traced the history of the earlier deaths. He would have warned her against conceiving again, for all her children had died of progressive neurological disease, which are fatal.Neurological disorders are mostly related to the malfunctioning of a part of the nervous system, be it the brain or the spinal cord. Handling neurological diseases in children is the most daunting task faced by doctors and surgeons alike, one of the main reasons being that children cannot explain their symptoms accurately. As a result, congenial neurological disorders often go unnoticed and, therefore, untreated. ``As far as neurological disorders in children are concerned, the most important part of the diagnosis is tracing the history of the disease. That way there is very little chance of our missing a treatable form of the disease,'' says Pushpendra N. Renjen, Senior Consultant Neurology, Indraprastha Apollo Hospital.Not that keeping tabs on a child's development is easy. In the case of very young children, who cannot express themselves, the only way to keep a record is to observe their growth carefully. The observation has to begin right at the time of the child's birth. parent's should consult a neurologist if there is a delay in the child's crying, or the child is born with jaundice or remains blue for a long time.``If the child is normal at birth but shows a delay in reaching the landmarks, it should be enough to ring alarm bells in the parents' minds. For example, if the child does not become active with age and is unable to react to toys, sounds or the mother's presence, it is time to get him examined. You also need to watch out for recurrent fever and infection in the child. In many cases, as the child develops, the circumference of the head starts becoming abnormal,'' advises Renjen.Neurological disorders can be categorised according to the onset, episodic, duration, and rate of progression of the illness. In the case of an acute neurological disorder, the illnesses are rapidly progressing emergencies which need immediate therapy. However, once the patient stabilises, a detailed history of the events which led to the illness has to be obtained. Some examples of relevant associations are stroke, sickle-cells disease, cerebral abscess and cyanotic congential heart disease, and status epilepticus in the patients with epilepsy. History of ingestions and a list of all possible intoxication should also be obtained.Another type of neurological disorder in children is of the episodic type, with a majority of its sufferers complaining of seizures. It can also manifest in the form of breath-holding spells, vascular headaches, intoxications, and some of the rare metabolic and neuro-muscular diseases. The patient is mostly amnesic during such spells. ``In case of patients suffering from episodic disorders over many years, there may not be a serious underlying disease. In cases which have a more recent onset, however, particularly those showing a crescendo progression, there is cause of more concern. Most children suffering from episodic disorders are likely to behave normally between the attacks,'' says Renjen.There are times, however, when a child fails to regain normal functions after an episodic attack. There is a chance of such a child suffering from a metabolic or degenerative disease, which is the most serious neurological dsorder, where treatment is almost impossible. In other cases, a child may have congenial neurological problems or may acquire the same from a specific illness or injury. Here, the neurologica and intellectual functions may have been normal before the injury. The most worrisome neurological disorders, however, are the progressive ones. The slower the progression of the disease, the more the chances of the child suffering from a degenerative disease. This disease has a lot to do with the child's early development, which makes it essential for the parents to observe when a child stops performing at the levels of his peers.In many cases, neurological diseases may be manifested in the form of behavioural disorders like hysteria, sleep disorders, mental retardation, cerebral palsy, learning disabilities and psychiatric disorders.Finally a word of caution. ``Though a maximum number of patients come in with symptoms of epilepsy, it does not mean they are suffering from the disease. Having a couple of attacks spread over long periods of time do not suggest that a patient is epileptic.'' Though most doctors suggest anti-epileptic drugs at the mere suspicion of the disease, it is prudent to watch the symptoms for some time and wait for a specialist to trace the history. ``Unless a patient has a history of two to three attacks within a week's time, there is no need to panic,'' says Renjen. Anti-epileptic drugs have side effects and therefore should be prescribed only if their use is essential.
