What is a Pediatric Neurologist ?

Knowing who to turn to when your child needs a helping hand, is important and critical for their well-being and for yours. Find out more about what a Pediatric Neurologist does in my interview with Dr. Aman Sohal, the Founding Partner and Clinical Director of Neuropedia, Dubai. This is the first part of the two-part interview and it focuses on the role of a pediatric neurologist, what a neurological examination entails, the kinds of patients seen, as well as some specifics on the condition of epilepsy.

Dr. Aman PS Sohal is a U.K Board certified Consultant Pediatric Neurologist with vast experience in managing various pediatric neurological conditions which include Simple and Complex epilepsy, Headaches and Migraine, Cerebral palsy and Spasticity management, Movement disorders, Developmental impairments, Autism, ADHD, Neuromuscular disorders and Sleep disorders. His special interest includes Complex epilepsy, Pediatric Neuropathies and Neuro-rehabilitation.

What is a Pediatric Neurologist?

A Pediatric Neurologist, also known as Child Neurologist, is a doctor that looks after children with problems affecting their Nervous System. In simple terms, any child who suffers from problems relating to their Brain, Spinal Cord, Nerves and Muscles is dealt by a Pediatric Neurologist. A Pediatric Neurologist deals with children from birth up to the age of 16 years, and in some circumstances to the age of 18 years.

Pediatric Neurology is a highly sub-specialized branch of Pediatrics and the doctor has to first train as General Pediatrician after completing basic medical degree, followed by 3-4 years of training in Pediatric Neurology in a highly specialized tertiary Pediatric Hospital.

My common daily practice of a Pediatric Neurologist deals with childhood neurological problems like Headache, Migraine, Seizures, Epilepsy, Poor muscle tone or Increased muscle tone, ADHD, Autistic Spectrum Disorder, Speech disorder, Tic disorder etc just to name a few.

What inspires you to do the work that you do?

Pediatric Neurology is a very challenging, yet hugely exciting branch of Pediatrics. I have always been intrigued by the varied presentations of Neurological problem in Children right from early years of my career. I have done various research projects whilst I was training as a Pediatric Neurologist in the UK in this field.

I suppose the most rewarding aspect of this branch is the smile which we can put on the child and parents’ face, who have gone through an extremely difficult time with their child. And this, I believe inspires me to get up every morning to go to my job, and try and help families burdened with some of the most complex childhood disorders which one can come across.

What kinds of cases do you see?

I come across wide variety of cases in my daily practice. Some children are quite sick and unwell who need urgent hospital admission due to brain infection (Meningitis, Encephalitis), sudden onset weakness due to stroke, prolonged seizures etc, and these children are carefully monitored in a hospital setting under the direct supervision of a Pediatric Neurologist, Pediatrician and/or Intensive care doctor.

On the other hand, my outpatient clinic practice includes problems like Headache, Migraine, Epilepsy and Seizures, Autistic Spectrum Disorder, ADHD, Muscle diseases, Cerebral Palsy and Spasticity management, Neurodevelopment disorder, Movement Disorders eg Tics, Sleep disorder just to name a few.

I also come across Neurobehavioral disorders like Autism, challenging behaviors, attention and concentration problems, poor focus, low self esteem, anxiety and depression in my clinic as well. These disorders are dealt in a multi-disciplinary way with various professional working together for the benefit of the child.

What does a neurological examination entail?

A neurological assessment of the child relies heavily on a detailed history carried out by the Pediatric Neurologist followed by a comprehensive Neurological examination. I typically also ask for any videos which the parents may have taken, which could aid and help me to come at an appropriate diagnosis.

In older children, typically 5 years and above the neurological examination is a standard assessment wherein a Pediatric Neurologist ensures that complete head-to-toe examination to look for Central and Peripheral Nervous System is carried out which includes, Cranial Nerves (nerves coming out of one’s brain), Power and Tone of muscles, Muscle/Tendon Stretch reflexes, touch sensations, eye examination and much more is carried out in a detailed fashion. The Pediatric Neurologist may use simple tools like a torch, Ophthalmoscope, Reflex hammer, tuning fork, cotton wool, blunt pin etc to help elucidate “neurological signs”.

Neurological examination of infants and small ones can be very tricky and difficult to carry out on the other hand. However, with years of training and experience a Pediatric Neurologist can undertake “opportunistic approach” in small babies in a playful fashion which helps to get all the information needed to diagnose neurological problems on a day-to-day basis. The focus on small children is also their Neurodevelopment, for which the doctor relies heavily on parents’ account. In infants and small children, in addition to the standard neurological exam, we also carry out Head Circumference to monitor the head size regularly, anthropometric (weight and height/length) measurements, primitive reflexes e.g. Moro’s reflex etc is carried out.

After the detailed neurological assessment the Doctor may ask for some tests, which may include Blood or Urine test, EEG (Brain waves tests), and in some cases MRI scan of the Brain including the others depending on the assessment.

What other professionals work as part of your Multidisciplinary team and why?

Pediatric Neurologists work in a Multi-team environment on a daily basis with various health professionals with an aim to improve the child’s quality of life. The health professionals include Physiotherapists, Speech therapists, Occupational therapists, Child Psychologists, Behavior therapists, Clinical Dietician just to name a few. We also engage with Special Education Needs Coordinator, Educational Psychologists in schools as the “aim of the game” is to help children to transition stay in the education system

What is Epilepsy? How common are they? And how must they be treated? Why should they be taken seriously?

Electrical activity is happening in our brain all the time, as the cells in the brain send messages to each other. A seizure happens when there is a sudden burst of intense electrical activity in the brain. This causes a temporary disruption to the way the brain normally works. The result is an epileptic seizure. When a child has epilepsy, it means they have a tendency to have seizures. Anyone can have a one-off seizure, but this doesn’t always mean they have epilepsy.

Epilepsy in children is usually only diagnosed if someone has had more than one seizure. Epilepsy can start at any age and there are many different types. Some types of epilepsy last for a limited time and the person eventually stops having seizures. But for many people epilepsy is a lifelong condition.

How is epilepsy diagnosed?

The main way doctors diagnose epilepsy is by taking a detailed description of the seizures. They may also arrange for some tests to help give them more information about the possible type and cause of the epilepsy. This can also help rule out any other conditions that could be causing seizures. These tests can include blood tests, an EEG (recording of the brainwaves) and brain scans. But there isn’t a single test that can prove if someone does or does not have epilepsy.

How is epilepsy treated?

The main treatment for epilepsy is epilepsy medicines. These are sometimes called anti-epileptic drugs or AEDs. The medicine doesn’t cure epilepsy, but helps to stop or reduce the number of seizures.

If epilepsy medicine doesn’t work well for someone, their doctor might suggest other types of treatment. Other types of treatment include brain surgery, another type of surgery called vagus nerve stimulation, and a special diet called the ketogenic diet which is sometimes used for children.

Stay tuned for more with Dr. Aman on the 2nd part of this interview.