Pediatric Neurology: What is Pediatric Neurology?
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
Institute. Dr. Maria is a pediatric
neurologist. To be helpful to our
listeners, let’s define pediatric neurology.
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?
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?
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.
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
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?
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
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.
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.