IAP Textbook of Pediatric Neurology Anoop Verma, PAM Kunju, Sujata Kanhere, Nitin Maheshwari
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1IAP Textbook of PEDIATRIC NEUROLOGY2
3IAP Textbook of PEDIATRIC NEUROLOGY
Editor-in-Chief Anoop Verma MD FIAP FIAMS FCGP Past National Chairperson, Neurology Chapter Consultant Pediatrician Swapnil Nursing Home Raipur, Chhattisgarh, India Academic Editor PAM Kunju MD DCH DM (Neurol) Professor and Head Department of Pediatric Neurology Chairperson, Neurology Chapter Trivandrum Medical College Thiruvananthapuram, Kerala, India Editors Sujata Kanhere MBBS DCH DNB (Ped) MNAMS FRCPCH Fellowship in Pediatric Neurology (UK) Professor and Head Department of Pediatrics In-Charge, Pediatric Neurology KJ Somaiya Medical College, Hospital and Research Center Mumbai, Maharashtra, India Nitin Maheshwari MD MRCPCH (Lond) CCT (Oxford) FRCPCH (Lond) Senior Consultant Department of Pediatric Neurology Medanta-The Medicity Gurgaon, Haryana, India Forewords CP Bansal National President of IAP 2013 Vijay Yewale National President of IAP 2014 Ashok Banga Convener, IAP National Publication House
IAP National Publication House, Gwalior
4
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© 2014, Editors
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IAP Textbook of Pediatric Neurology
First Edition: 2014
9789351521426
Printed at
5Contributors 9Foreword
In any field of medicine, the best quality of care is proportional to the knowledge of the practitioner. In the case of pediatric neurology, this knowledge is a function of experience, and for most, that the experience is a function of exposure. Therefore, the chapters outlined in this book are provided not as a sole representation, but rather as a supplement to the clinical experience. The contributors have really given their best talent and experience in the given chapters. It was genuinely, a felt need of most of pediatricians, to have a short comprehensive book on pediatric neurology, which covers the topics pertaining to Indian scenario.
We appreciate the work of Dr Anoop Verma and his dynamic academic team for coming out with such a beautiful piece of work in the form of IAP Textbook of Pediatric Neurology. We have gone through the various chapters and found, the text written is worth to retain and apply to the patients.
We are amazed to see that most of the day-to-day neurological problems are covered with great simplicity. We are confident that this book will come out to be the first choice of the practitioners and as tabletop reference for common pediatric neurological disorders. Topics range from neonate to adolescent through childhood and that way almost total pediatric age group has been covered.
The postgraduate students, the clinicians and general pediatricians will find this book more than worth. It is easy to prepare and prevent than to repair and repent. As pediatricians, we are all inclined for preventive measures; hope the knowledge in the contributed chapters will help reducing the neuro-morbidity and mortality.
Once again, we congratulate the whole editorial board and the learned contributors of the chapters in this book for offering their knowledge of science to the readers in an excellent way.
CP Bansal
National President of IAP 2013
Vijay Yewale
National President of IAP 2014
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11Foreword
The book that you are reading is the fulfillment of the long cherished dream of many stalwarts of Indian Academy of Pediatrics (IAP) working in the field of pediatric neurology for decades. This book is the need of seekers of knowledge on various issues in neurology. This is probably the first such book by Indian authors in Indian context. It will benefit not only Indian readers but also all over the globe having similar conditions and will be available throughout the world.
This book covers almost all topics in the specialty and has certain unique features. Many conditions, especially, movement disorders can never be understood and diagnosed by theoretical details unless seen once.
Another concept of giving the names of drugs (and proprietary names of 1–2 preparations) for treatment of every condition is of high practical utility. These names and dosage are as per IAP drug formulary and, therefore, standardized.
Moreover, the authors and editors have dedicated this book to IAP and will be giving all their royalty to IAP National Publication House for IAP activities. This way, your buying this book also contributes to IAP.
You will feel proud to be reading this book written by your colleagues; will see their face through the pages. Communicate directly to them when you find this book filling the void on the subject or if you think of some improvements.
Happy and fulfilling reading.
Ashok Banga
Convener
IAP National Publication House
Gwalior, Madhya Pradesh, India
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13Preface
The history of neurology in India stems from its rich culture and tradition. The first neurosurgical operation in India was trans-sphenoidal hypophysectomy done in 1935 at Chennai, Tamil Nadu, India. At that time, neurosurgeons and neurophysicians were not trained in India; in fact, they went abroad to acquire the specialized knowledge. In around 1948, the first neurosurgical training was established at Christian Medical College and Hospital, Vellore, Tamil Nadu; later on the notion of establishment of neurosciences department was conceptualized. Over the years, similar developments were seen in other parts of the country. In the West, Pediatric Neurology is now a distinct and separate department. In India, the history of Pediatric Neurology emerges from Chennai; subsequently, this subspecialty dominated the medical field in other parts of the country.
The pediatric neurology department serves as a vital link between pediatricians and traditional adult neurologists. The pediatric neurology brings home the expertise in anatomical localization leading to correct diagnosis and management of chronic neurological disorders learned from traditional neurology and combines with it the knowledge of normal maturation and development, learned from pediatric training. Even till date, many pediatricians rate their training in pediatric neurology as inadequate.
Clinical neurology has become increasingly dependent on laboratory tests and to an even greater degree on imaging procedures, at the expense of the history and the physical examination. Although this kind of technological support has become available in much of the developing world, still to an inadequate extent in India. Clearly, the practice of tropical neurology will remain a “hands-on” clinical discipline for many years to come. Young neurologists coming home from abroad, who have been accustomed to the easy availability of an avalanche of ancillary diagnostic aids, may find it difficult to go back to relying on not much more than a thorough history and a detailed neurological examination.
Medicine involves playing the odds, assessing the relative chance that a patient is/is not suffering from a particular illness. There is always an element of uncertainty. The clinical approach, i.e. history and clinical examination discussed here will help pediatricians to reach the tentative neurological diagnosis. The stepwise approach of neurophysiological diagnosis, how to read computed tomography (CT) scan and magnetic resonance imaging (MRI) will help in day-to-day practice effectively. This book is having an excellent collection of common neonatal and pediatric neurological problems by eminent scientists in the field for years; not only they have precisely selected the topic but also given their best experience in it.
Anoop Verma
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15Acknowledgments
We are extremely thankful to Dr CP Bansal (National President of IAP 2013), who has taken the challenge of bringing IAP Textbook of Pediatric Neurology for IAP members. We are thankful for his valuable support, encouragement, supervision and useful suggestions throughout this work. His moral support and continuous guidance and his blessings in the form of Foreword enabled us to complete this work successfully.
I am indebt to Dr Vijay Yewale (National President of IAP 2014), Dr Shailesh Gupta (Secretary General), for their blessings and support during this publication.
Several people have been instrumental in allowing this project to be completed. We would like to thank especially to all the editorial board and contributors, for their encouragement and patience throughout this project.
The editorial board in the form of Dr PAM Kunju (Academic Editor), Dr Sujata Kanhere (Editor), and Dr Nitin Maheshwari (Editor) has worked really hard to give an excellent shape to this book. Words are insufficient to express the deep gratitude to them.
I am extremely thankful to contributors of Guidelines for the Diagnosis and Management of Childhood Epilepsy 2006 and equally obliged to Dr Sheffali Gulati and her team, for reviewing and updating the article as per advised by National President Dr CP Bansal.
I am thankful to Dr Arun Agrawal and Dr Vijay Jain, for constant watch and guidance throughout the period of work.
My due regards to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director) and Mr Tarun Duneja (Director-Publishing) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for rendering help to come out with this publication in time. Mrs Samina Khan, being so instrumental and helpful for this publication, extended profound support and interest in this release.
My whole regards to my wonderful colleagues Dr Shyam Sharma and Dr Manoj Vaishnav, who really shared my routine workload and kept me free for this wonderful cause.
My heartfelt gratitude to my whole family (wife Rashmi Verma, daughter Dr Swapnil Verma and son Dr Shantanu Verma), for encouragement during this project.