Child Neurology

I am excited to be the Guest Medical Editor of this issue of Practical Neurology. The scope of child neurology is expanding rapidly, with advances in understanding and treatment of common childhood disorders as well as comprehensive descriptions and research into newly recognized or emerging disorders. This issue delves into several “hot topics” in clinical child neurology that will affect how neurologic care is delivered to children.

Hypoxic-ischemic encephalopathy (HIE) in newborns is a cause of neurodevelopmental disability (eg, cerebral palsy or cognitive impairment). Although it has been readily recognized, treatment has been largely supportive. Within the last decade, the use of brain or body cooling in the immediate newborn period in children with suspected HIE has been widely adopted as the new standard. Dr. Worden and Dr. Massey’s article Therapeutic Hypothermia Effects on Brain Development provides the practicing physician with data supporting newborn cooling and factors to consider when outcome prognostication is sought.

Tic disorders, including Tourette syndrome, are common childhood neurodevelopmental disorders that are easily recognized clinically. Tics can result in impairment, including physical pain, decreased self -esteem and anxiety, which prompt parents to seek help for their child’s tics. Historically, treatment for tics has been centered on tic-preventing medicines, which can have many side effects. Dr. Scotti-Degnan and Dr. Ford’s article Comprehensive Behavioral Intervention for Tics provides a current understanding of evidence-based psychologic and behavioral interventions and how they can be effectively used in practice.

Dizziness, headache, and fatigue are common symptoms in adolescents. Postural orthostatic tachycardia syndrome (POTS) is increasingly recognized as a common cause of these symptoms. In Postural Orthostatic Tachycardia Syndrome, the diagnostic criteria, treatment options, and common comorbidities are reviewed for the neurologist who may be the front-line provider for these patients.

The clinical spectrum of neuroinflammatory and demyelinating disease in children is becoming better defined with recognition of identifiable antibody mediated processes. Antibody-Mediated Inflammatory Central Nervous System Disorders of Childhood by Drs. Hardy and Narula review 3 of the most common specific disorders: antiN-methyl D-aspartate receptor (antiNMDAR) encephalitis, neuro-myelitis optica spectrum disorders (NMOSD), and anti-myelin oligodendrocyte glycoprotein (antiMOG) disorders.

What happens when our patients grow up? The process of moving from a child neurologist to an adult neurologist is not as simple as making a new appointment. In his article Medical Transition from Pediatric to Adult Care in Neurology, Dr. Brown discusses the need for a process-based approach to transition and the challenges that occur within it. He provides a structured plan for introducing and implementing the transition process which should reduce stress (for patients, families, and providers) and lead to more satisfactory outcomes for all.

Many adult neurologists take care of children in the scope of their practice. I hope this issue leaves you with new tools to enhance your care of young patients. If you don’t regularly take care of children, I still trust you took away a broader understanding of the advances in the field and some clinical information that may be relevant to adults.