Pediatric Neurology: What is Pediatric Neurology?

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Pediatric Neurology:  What is Pediatric Neurology?




Guest:  Dr. Bernie Maria - Pediatrics

Host:  Dr. Pam Morris - Cardiology


Dr. Pam Morris:  Hi.  I’m Dr. Pam Morris and I’m here, today, with Dr. Bernie Maria who is Professor of Pediatrics and Neurosciences at the Medical University of South Carolina.  He’s also Executive Director of the Charles P. Darby Children’s Research Institute.  Dr. Maria is a pediatric neurologist.  To be helpful to our listeners, let’s define pediatric neurology.


Dr. Bernie Maria:  Pediatric neurology is a medical discipline that involves the care of children with various kinds of neurological problems.  So, they can have something going on in the brain, spinal cord, nerves and muscles.  The pediatric neurologist is the pediatrician who has trained in neurology and can care for children with many different kinds of neurological diseases.


Dr. Pam Morris:  So, what are some of the types of problems that a child might have that would cause a parent to bring them to your attention, for your care?


Dr. Bernie Maria:  Some of the more common things that we see in our outpatient clinic involve headaches and migraines, which is a very common cause of school absence.  And though adults with migraines are frequently diagnosed with the problem, children are often undiagnosed and go on suffering with their headaches, which can be readily addressed and managed today. 


We also see children with seizures and epilepsy, different kinds of developmental problems.  If they were born prematurely, as they often are in our state, they’re born with problems in the brain that lead to issues like cerebral palsy or problems with learning.  We see children with autism and other kinds of neurobehavioral disorders, including attention deficit hyperactivity disorder (ADHD).  Then, the hospital will see children who have been in an accident or near drowning, in some of our waters, whose brain has been injured as a result.  We’ll see children with seizures and epilepsy in the hospital as well.


Dr. Pam Morris:  What are some of the tools that a neurologist uses to diagnose the illnesses that involve the nervous system?


Dr. Bernie Maria:  Because the nervous system involves many different parts of our body, it’s good to think of neurology like you would a realtor, meaning, location, location, location.  So, our first job is to take a history, examine the child, find out if the problems that the child is having have been present in the family or extended family and then try to locate the problem in the nervous system:  Is this coming out of the brain, and, if so, where in the brain?  By defining where the problem is, we can, then, narrow the scope of what the problem is.  Because well over 3,500 types of diseases can affect the developing nervous system, we need to be a realtor before we can figure out what to do for the problem.


Dr. Pam Morris:  Bernie, when many of us take our children in for their annual physical, they have many parts of their body evaluated, but I venture to say that a good neurologic exam is not really part of a routine annual pediatric physical.

Dr. Bernie Marie:  That’s true.  When we see children who come to us with problems and look at what kind of previous neurologic exams may have been done by their pediatrician or family physician, we often have difficulty finding details.  Part of the problem is that if one conducted a neurologic exam that really examined all of the things that can be examined, that’s an exam that would easily take several hours to do.  It wouldn’t be all that practical and it wouldn’t tell you that much more than what you sort out in 15 or 20 minutes. 


So, the art of conducting a neurologic exam is to have an idea of what the problem is and then test out some theories while examining the child.  So, if I, for example, think that the child has headaches but that those headaches might be caused by a brain tumor, rather than a migraine, and I examine the back of the eye with my ophthalmoscope and see swelling in the nerve, that would tell me that there’s pressure in the brain.  So, my neurologic examination is really targeted to the problem that’s presenting to me.


Dr. Pam Morris:  What are some of the diagnostic tests that a neurologist uses to diagnose illness?


Dr. Bernie Maria:  Well, we like to see what the brain and spinal cord look like when we think there are problems there.  The best way to look at the structure of the brain is with a magnetic resonance imaging (MRI), where you lie in a tube and they take some pictures of your brain, then we can determine whether what’s going on in the brain has a structural cause.  In addition to that, we look at the physiology.  The brain functions on about as much electricity as a 10-watt light bulb.  But when you measure the electricity of the brain with an EEG, on the surface of the brain, you can tell whether that child is more or less at risk for seizures. 


Then, when studying the muscles and nerves, we look at the speed of conduction through the nerves.  We look at how well the muscles are working.  Those are nerve conduction velocities and EMGs.  Those are some of the tests that are used and are part of our toolbox. 


Dr. Pam Morris:  Thank you so much for joining us here today.  I’d like to come back, in another podcast, and talk about some of the specific pediatric neurological illnesses.


Dr. Bernie Maria:  My pleasure.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.


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