SECOND EDITION

BERNARD L. MARIA, MD, MBAProfessor and Chairman

Department of Child HealthPediatrician-in-Chief of Children’s Hospital

University of Missouri Health Sciences CenterColumbia, Missouri

2002BC Decker Inc

Hamilton • London

CURRENTMANAGEMENT IN

CHILD NEUROLOGY

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ISBN 1-55009-162-XPrinted in Canada

Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice ofdrugs and drug dosages, is in accord with the accepted standard and practice at the time of publication. However, since researchand regulation constantly change clinical standards, the reader is urged to check recent publications and the product informationsheet included in the package of each drug, which includes recommended doses, warnings, and contraindications. This is particu-larly important with new or infrequently used drugs.

PASQUALE J. ACCARDO, MDProfessor of PediatricsNew York Medical CollegeDirector of PediatricsWestchester Institute for Human DevelopmentValhalla, New York

COLEEN ADAMS, MB, FRCPCAssociate Professor University of CalgaryPediatric NeurologistAlberta Children’s HospitalCalgary, Alberta, Canada

JEAN AICARDI, MDConsultantHôpital Robert DebréParis, FranceHonorary Professor of Child NeurologyInstitute of Child Health University CollegeLondon, United Kingdom

JOHN ALVIN, PhDAssociate Professor of Physiology and PharmacologyUniversity of Pittsburgh School of Dental Medicineand PharmacyPittsburgh, Pennsylvania

JOHN C. ANDREFSKY, MDDepartment of Neurosurgery and NeurologyDirector, Neuro-Intensive Care UnitCleveland Clinic FoundationCleveland, Ohio

STEPHEN ASHWAL, MDChief, Division of Pediatric NeurologyDepartment of PediatricsLoma Linda UniversityLoma Linda, California

ANTHONY M. AVELLINO, MDAssistant Professor of Neurological SurgeryThe Johns Hopkins Medical InstitutionsBaltimore, Maryland

ELIA M. AYOUB, MDDistinguished Service Professor EmeritusDepartment of PediatricsUniversity of FloridaGainesville, Florida

IDA SUE BARON, PhDClinical Associate Professor PediatricsGeorgetown University School of MedicineWashington, DCPrivate PracticePotomac, Maryland

ANITA L. BELMAN, MD, MSProfessor of Pediatric NeurologySchool of MedicineState University of New York at Stony BrookStony Brook, New York

THOMAS B. BENTON, MDAdjunct Visiting Professor, PediatricsUniversity of FloridaGainesville, Florida

M. TARIQ BHATTI, MDAssistant Professor of Ophthalmology and NeurologyCo-Director, Neuro-OphthalmologyUniversity of Florida College of MedicineGainesville, Florida

GENILA M. BIBAT, MDResearch AssociateNeurogenetics UnitKennedy Krieger InstituteThe Johns Hopkins Medical InstitutionsBaltimore, Maryland

THOMAS A. BLONDIS, MD Associate Professor of Clinical PediatricsUniversity of Chicago Children’s HospitalChicago, Illinois

iii

CONTRIBUTORS

JUDITH S. BLUVSTEIN, MDPediatric Neurology Fellow Albert Einstein College of MedicineBronx, New York

BLAISE F.D. BOURGEOIS, MDProfessor of Neurology Harvard Medical SchoolDirector, Division of Epilepsy and Clinical NeurophysiologyChildren’s HospitalBoston, Massachusetts

JOHN B. BODENSTEINER, MDChief, Pediatric NeurologyBarrow Neurological InstituteSt. Joseph’s Children’s Health Center Phoenix, Arizona

EUGEN J. BOLTSHAUSER, MDProfessor of Pediatric NeurologyUniversity Children’s HospitalZurich, Switzerland

LAWRENCE W. BROWN, MDCo-Director, Pediatric Neuropsychiatry ProgramCo-Director, Pediatric Regional Epilepsy ProgramChildren’s Hospital of PhiladelphiaPhiladelphia, Pennsylvania

JANICE E. BRUNSTROM, MDAssistant Professor of Neurology and Cell BiologyWashington University School of MedicineDirector, Pediatric NeurologyCerebral Palsy Center at St. Louis Children’s HospitalSt. Louis, Missouri

IAN J. BUTLER, MB, BS, FRACPProfessor and ChairmanDepartment of Pediatric NeurologyUniversity of Texas Medical SchoolHouston, Texas

LEONARD H. CALABRESE, DOVice-ChairmanDepartment of Rheumatic and Immunologic DiseasesThe Cleveland Clinic FoundationCleveland, Ohio

CAROL CAMFIELD, MD, FRCPCProfessor, Department of PediatricsDalhousie University and the IWK Grace Healthcare CenterHalifax, Nova Scotia, Canada

PETER CAMFIELD, MD, FRCPCProfessor and Chair, Department of PediatricsDalhousie University and the IWK Grace Healthcare CenterHalifax, Nova Scotia, Canada

LIONEL CARMANT, MD, FRCPCAssistant Professor of Pediatrics, Division of NeurologyHôpital Sainte-JustineMontreal, Québec, Canada

BENJAMIN S. CARSON SR, MDDirector of Pediatric Neurological Surgery The Johns Hopkins Medical InstitutionsBaltimore, Maryland

BRUCE H. COHEN, MDChief, Pediatric NeurologyCleveland Clinic FoundationCleveland, Ohio

WILLIAM I. COHEN, MDDevelopmental-Behavioral PediatricianDirector, Down Center of Western PAAssociate Professor of PediatricsUniversity of Pittsburgh School of MedicinePittsburgh, Pennsylvania

MATTHEW D. DABBS, BAGraduate StudentDepartment of Clinical and Health PsychologyUniversity of FloridaGainesville, Florida

CANDACE H. DAVID, MEdHead, Northstar AcademyRichmond, Virginia

RONALD B. DAVID, MDAssociate Clinical Professor of Pediatrics (Pediatric Neurology)Medical College of VirginiaRichmond, Virginia

CAROL DELAHUNTY, MDAssistant ProfessorDevelopmental and Behavioral PediatricsChildren’s Hospital, PittsburghPittsburgh, Pennsylvania

LINDA DE MEIRLEIR, MD, PhDProfessor of Pediatric NeurologyFree University of BrusselsBrussels, Belgium

WILLIAM DEMYER, MDProfessor Emeritus of Child NeurologyIndiana University School of MedicineIndianapolis, Indiana

PAOLA DIADORI, MDAssistant Clinical ProfessorDepartment of NeurologyHôpital Sainte-Justine Montreal, Québec, Canada

THOMAS N. DIKEL, PhD Department of Clinical and Health PsychologyUniversity of Florida Gainesville, Florida

iv / Contributors

MICHAEL DUCHOWNY, MDDirector, Epilepsy Program Miami Children’s Hospital Clinical Professor in Neurology and Pediatrics University of Miami School of Medicine Miami, Florida

DAVID W. DUNN, MDAssociate Professor of Psychiatry and NeurologyDivisions of Child and Adolescent Psychiatry and Child NeurologyIndiana University School of MedicineIndianapolis, Indiana

LEON S. DURE IV, MDAssociate Professor of Pediatrics and NeurologyThe University of Alabama at BirminghamBirmingham, Alabama

TERENCE S. EDGAR, MD, FAAP, FAACPDM, FAAEMAssistant Professor of Neurology and PediatricsDirector of Neuromuscular and Movement Disorder CenterMedical Director of the Neurophysiology LaboratoryArkansas Children’s HospitalLittle Rock, Arkansas

RICHARD C. ELLENBOGEN, MDAssociate Professor, Department of Neurological SurgeryUniversity of Washington School of MedicineChildren’s Hospital and Regional Medical CenterSeattle, Washington

CYNTHIA R. ELLIS, MDAssociate Professor of PediatricsDirector, Division of Developmental PediatricsUniversity of Nebraska Medical CenterMunroe-Meyer Institute for Genetics and RehabilitationOmaha, Nebraska

LYDIA EVIATAR, MDProfessor of Neurology and PediatricsAlbert Einstein College of MedicineAttending Pediatric NeurologistSchneider Children’s HospitalNew Hyde Park, New York

SHEILA M. EYBERG, PhDProfessor of Clinical and Health PsychologyUniversity of FloridaGainesville, Florida

EILEEN B. FENNELL, PhDProfessor of Clinical and Health Psychology and NeurologyUniversity of FloridaGainesville, Florida

RICHARD S. FINKEL, MDDirector, Neuromuscular ProgramThe Children’s Hospital of PhiladelphiaAssociate Clinical Professor of Neurology and Pediatrics,The University of PennsylvaniaPhiladelphia, Pennsylania

NANCY M. GIUNTA, MHA, FACMPEReimbursement ManagerUniversity of Florida Faculty Group PracticeGainesville, Florida

JACK GLADSTEIN, MDAssociate Dean for Student AffairsAssociate Professor of PediatricsDirector, Pediatric Headache ClinicUniversity of Maryland School of MedicineBaltimore, Maryland

NANCY E. HALL, PhDAssistant ProfessorDepartment of Communication Sciences and DisordersAlbert D. Conley Speech and Hearing CenterUniversity of MaineOrono, Maine

ANDREW D. HERSHEY, MD, PhDDirector, Headache CenterChildren’s Hospital Medical CenterAssistant Professor of Neurology and PediatricsThe University of Cincinnati College of MedicineCincinnati, Ohio

RALPH E. HORKY, MSSenior Vice-President, StrategyShands HealthcareGainesville, Florida

JAMES H. JOHNSON, PhDProfessor of Clinical and Health PsychologyUniversity of Florida College of Health ProfessionsGainesville, Florida

COLIN KENNEDY, MD, FRCP, FRCPCHConsultant and Senior Lecturer, Pediatric NeurologySouthampton General HospitalSouthampton, United Kingdom

KIMBERLY N. KIMMEL, BSUniversity of Miami School of MedicineMiami, Florida

FENELLA J. KIRKHAM, MB BCHIR. FRCPCHSenior Lecturer in Pediatric Neurology, Neurosciences Unit Institute of Child Health (University College London)The Wolfson Centre, Mecklenburgh SquareLondon, United Kingdom

EDWIN KOLODNY, MDBernard A. and Charlotte Marden Professor and ChairmanNew York University School of MedicineDepartment of NeurologyNew York, New York

BRUCE R. KORF, MD, PhDMedical Director, Center for Human Genetics,Partners HealthCare SystemAssociate Professor of NeurologyHarvard Medical SchoolBoston, Massachusetts

Contributors / v

SURESH KOTAGAL, MD Senior Associate ConsultantDepartment of NeurologyChair, Division of Child and Adolescent NeurologyMayo ClinicRochester, Minnesota

WILLIAM G. KRONENBERGER, PhDAssociate ProfessorDepartment of PsychiatryIndiana University School of MedicineIndianapolis, Indiana

JOHN KURATINI, MD Assistant Professor of Neurology and PediatricsUniversity of Washington School of MedicineSeattle, Washington

ALVIN E. LAKE III, PhDDivision Director, PsychologyMichigan Head Pain and Neurological InstituteAnn Arbor, Michigan

STEVEN M. LEBER, MD, PhDClinical Associate Professor Division of Pediatric NeurologyDepartments of Pediatrics and NeurologyUniversity of Michigan Medical CenterAnn Arbor, Michigan

MACIEJ S. LESNIAK, MDSurgical Neuro-Oncology FellowThe Johns Hopkins HospitalBaltimore, Maryland

DONALD W. LEWIS, MDAssociate Professor of Pediatrics and NeurologyChildren’s Hospital of the King’s DaughtersEastern Virginia Medical SchoolNorfolk, Virginia

LAWRENCE M. LEVINE, MDAssistant Professor of Ophthalmology and PediatricsDirector, Pediatric OphthalmologyUniversity of Florida College of MedicineGainesville, Florida

STEVEN L. LINDER, MDAssistant Clinical ProfessorUniversity of Texas Health Science CenterDallas, Texas

CHRIS N. LOFTIS, MSDoctoral StudentUniversity of FloridaDepartment of Clinical and Health Psychology Gainesville, Florida

MERYL D. LUALLIN, BAPartnerSullivan/LuAllin Inc.San Diego, California

KENNETH J. MACK, MD, PhDSenior Associate ConsultantMayo ClinicRochester, Minnesota

DUANE L. MACGREGOR, MD, FRCPCProfessor of Pediatric NeurologyUniversity of TorontoHospital for Sick ChildrenToronto, Ontario, Canada

BERNARD L. MARIA, MD, MBAProfessor and Chairman, Department of Child HealthPediatrician-in-Chief, University Children’s HospitalUniversity of Missouri School of MedicineColumbia, Missouri

JOHN H. MENKES, MDProfessor Emeritus of Neurology and PediatricsUniversity of California Los AngelesDirector Emeritus of Pediatric NeurologyCedars-Sinai Medical CenterLos Angeles, California

LAURA R. MENT, MDProfessor, Departments of Pediatrics and NeurologyYale University School of MedicineNew Haven, Connecticut

JONATHAN W. MINK, MD, PhDAssociate Professor of Neurology, Neurobiology, and AnatomyPediatrics and Chief, Child NeurologyUniversity of Rochester School of MedicineRochester, New York

JOHN L. MORIARITY Jr., MDAssistant Chief of ServiceDepartment of NeurosurgeryThe Johns Hopkins HospitalBaltimore, Maryland

SOLOMON L. MOSHÉ, MDProfessor of NeurologyNeuroscience and PediatricsVice-Chairman, Department of NeurologyDirector of Pediatric NeurologyDirector of Clinical NeurophysiologyMartin A. & Emily L. Fisher FellowAlbert Einstein College of MedicineBronx, New York

DENISE K. MOSS, CPCPsychiatry Practice ManagerUniversity of Florida PhysiciansUniversity of Florida School of MedicineGainesville, Florida

TANYA K. MURPHY, MDUniversity of Florida Assistant ProfessorDirector of Child Anxiety and Tic Disorder ClinicMedical Director of Autism Treatment and Evaluation UnitGainesville, Florida

vi / Contributors

SAKKUBAI NAIDU, MDThe Kennedy Krieger InstituteThe Johns Hopkins Medical InstitutionsBaltimore, Maryland

ERIN M. NEARY, BSGraduate StudentDepartment of Clinical and Health PsychologyUniversity of FloridaGainesville, Florida

MATHEW NGUYEN, MDAssistant Clinical ProfessorMedical Director Outpatient ServicesShands at VistaGainesville, Florida

MICHAEL J. PAINTER, MDProfessor of Neurology in PediatricsChief, Division of Child NeurologyUniversity of Pittsburgh School of MedicinePittsburgh, Pennsylvania

JOHN M. PELLOCK, MDChairman, Division of Child NeurologyProfessor of Neurology, Pediatrics, Pharmacy, and PharmaceuticsDirector, Comprehensive Epilepsy InstituteMedical College of Virginia HospitalsVirginia Commonwealth University Healthcare SystemsRichmond, Virginia

LINDA PFIFFNER, PhDAssistant Professor in ResidenceDepartment of PsychiatryUniversity of CaliforniaSan Francisco, California

PAUL H. PHILLIPS, MDAssistant Professor, Neuro-Ophthalmology, PediatricOphthalmology, and StrabismusDepartment OphthalmologyArkansas Children’s HospitalUniversity of Arkansas for Medical SciencesLittle Rock, Arkansas

SCOTT W. POWERS, PhDAssociate Professor of Pediatrics, Department of PsychologyCincinnati Children’s Hospital Medical CenterCincinnati, Ohio

RONALD G. QUISLING, MDProfessor of RadiologyDirector of Inventional NeurologyUniversity of Florida School of MedicineGainsville, Florida

MOBEEN H. RATHORE, MD, FAAPProfessor and Assistant ChairmanDepartment of Pediatrics ChiefPediatric Infectious Diseases and ImmunologyUniversity of Florida Health Science CenterJacksonville, Florida

KATHLEEN M. REILLY, PHARM. D.Education Coordinator, Pharmacy ServicesShands at the University of FloridaAssociate Professor of Pharmacy PracticeUniversity of Florida College of PharmacyGainesville, Florida

MOBEEN H. RATHORE, MD, FAAPProfessor and Assistant ChairmanDepartment of Pediatrics ChiefPediatric Infectious Diseases and ImmunologyUniversity of Florida Health Science CenterJacksonville, Florida

JONG M. RHO, MDAssistant Professor of PediatricsUniversity of California at IrvineCollege of MedicineIrvine, California

E. STEVE ROACH, MDHelen & Robert S. Strauss Professor of NeurologyUniversity of Texas Southwestern Medical School Dallas, Texas

ROBERT S. RUST, MDThomas E. Worrall, Jr. Professor in Epileptology and NeurologyProfessor, Pediatric Neurology Children’s Medical CenterUniversity of Virginia School of MedicineCharlottesville, Virginia

G. BRADLEY SCHAEFER, MDProfessor of PediatricsUniversity of Nebraska Medical CenterMunroe-Meyer Institute for Genetics and RehabilitationOmaha, Nebraska

MICHAEL SHEVELL, MD, CM, FRCPCAssociate Professor of Neurology, Neurosurgery,and PediatricsAssociate Member, Human GeneticsMcGill UniversityDivision of Pediatric NeurologyMontreal Children’s HospitalMontreal, Québec, Canada

SHOLOMO SHINNAR, MD, PhDProfessor of Neurology and Pediatrics Director, Comprehensive Epilepsy Management Center Montefiore Medical Center Albert Einstein College of Medicine Bronx, New York

SUZANNE SKODA-SMITH, MDAssistant Professor of PediatricsDivision of Immunology and Infectious Diseases University of Florida College of MedicineGainesville, Florida

Contributors / vii

JOHN T. SLADKY, MDProfessor of Pediatrics and NeurologyEmory University School of MedicineChief of NeurologyEmory Children’s CenterAtlanta, Georgia

JOHN B.P. STEPHENSON, MA, DM, FRCP, Hon. FRCPCHVisiting Professor and Consultant in Pediatric NeurologyFraser of Allander Neurosciences UnitRoyal Hospital for Sick ChildrenGlasgow, United Kingdom

PHILLIP B. STORM, MDSurgical Neuro-Oncology FellowThe Johns Hopkins HospitalBaltimore, Maryland

RAFAEL J. TAMARGO, MD, FACSDirector, Division of NeurosurgeryAssociate Professor, NeurosurgeryThe Johns Hopkins HospitalBaltimore, Maryland

ANN HENDERSON TILTON, MD Associate Professor of Neurology and Pediatrics Chief Section of Child Neurology Louisiana State University Health Science Center New Orleans, Louisiana

R. WILLIAM TRELOAR, RRA, MBADirector of Clinical Resource ManagementShands Healthcare Gainesville, Florida

MARGARET TREMWEL, MD, PhDChief Resident of NeurologyUniversity of Florida School of MedicineGainesville, Florida

JIRI VAJSAR, MD, MSc, FRCPCDirector, Electrodiagnostic Medicine and Neuromuscular ProgramStaff Neurologist and Assistant ProfessorThe University of TorontoAssociate Scientist, The Research InstituteThe Hospital for Sick ChildrenToronto, Ontario, Canada

ROBERT C. VANNUCCI, MDProfessor of PediatricsDivision of NeurologyPennsylvania State UniversityCollege of Medicine and Milton S. Hershey Medical CenterHershey, Pennsylvania

WARREN W. WASIEWSKI, MDDirector of Mayday Pediatric Headache CenterLancaster, Pennsylvania

JAMES W. WHELESS, MDProfessor of Pediatrics and NeurologyDirector, Epilepsy Monitoring UnitMemorial Hermann Children’s HospitalDirector, Texas Comprehensive Epilepsy ProgramUniversity of Texas at HoustonHouston, Texas

PAUL S. WOLF, MDAssistant Professor Pediatric NeurologyChildren’s Hospital of PhiladelphiaPhiladelphia, Pennsylvania

viii / Contributors

PREFACE

Current Management in Child Neurology aims to providebusy practitioners with succinct standard-of-care reviews onthe evaluation and treatment of the most common neuro-logic conditions. In many cases, this textbook will enablepediatricians to independently manage febrile or first unpro-voked seizures, common migraine, attention deficit hyperac-tivity disorder (ADHD), and mild cerebral palsy. However, ifa child must be referred to the neurologist, then the infor-mation contained in each chapter and in the SuggestedReadings can better prepare caregivers for the consultation.Electronic copies of the chapters can be easily printed outfrom the CD-ROM for trainees in clinics and on ward rota-tions. Importantly, the chapters contain relevant websiteaddresses and other information on patient resources thatenable caregivers to “do their homework” about their child’scondition. I strongly encourage the distribution of the elec-tronic copies of the chapters to caregivers because their edu-cation and satisfaction are key success factors in the practiceof child neurology.

In the the years since the first edition was published, theremarkable pace of medical discoveries and their applica-tion to clinical practice has continued unabated. In fact, Ioften wonder how it will be possible to keep up, given thestrong driving forces of subspecialization within the fieldof child neurology. The second edition of CurrentManagement in Child Neurology builds on the success ofthe first by offering succinct reviews from a whole new setof experts, Suggested Readings, and a listing of PatientResources. The book is designed to supplement standardtextbooks that provide detailed information on etiology,pathogenesis, and therapeutic controversies in ChildNeurology. The CD-ROM will now enable immediate linkcapability to websites and access to the National Library of

Medicine for the very latest information. Thus, for the firsttime, we can ensure that the information will stay currentuntil the next edition.

In the first section of the book, “Clinical Practice Trends,”new chapters on the art of medicine and patient satisfaction,practice management, and the Internet have been added. Thetwo chapters on common neurologic complaints and theneurologic examination are excellent introductory chaptersfor medical students, residents, and fellows. The second sec-tion, “The Office Visit,” has been expanded to include abroader array of conditions and a more comprehensivereview of available therapies. The tables on pharmacothera-py for epilepsy, migraine, ADHD, and spasticity provided byDr. Kathleen Reilly are an extremely valuable addition to thebook. The third section, “The Hospitalized Child,” reviewsmanagement of traumatic brain injury, infection, neurologicinjury to the preterm or term neonate, and other conditionsthat account for most pediatric neurologic admissions.

When I first envisioned the publication of a “CurrentTherapy” book in Child Neurology, it was not clear that therewould be sufficient new information every three years tomake the effort worthwhile. I wish to express my sincereappreciation to the authors for demonstrating how dynamicthe field of child neurology has become. I would also like tothank my superb editorial assistant Melanie Fridl Ross, MSJ,ELS, and my dedicated research assistants Kimberly Kimmelland Meadow Maze. Finally, I would like to recognize thepublisher, Brian Decker, for his support of Child Neurologyand for staying one step ahead of the competition in theworld of medical publishing.

Bernard L. Maria, MD, MBAOctober, 2001

ix

To my wife Barbara and my son Alexander,

who continue to fill my life with wonder.

To my mother Margaret and my father Maurice

for helping me see that anything is possible.

CONTENTS

Preface ...............................................................................ix

SECTION 1. CLINICAL PRACTICE TRENDS

1. The Business of Health Services................................3R. Horky

2. Excelling at the Art of Medicine .............................12M.D. LuAllin

3. Secrets of Successful Practice Management ...........16N.M. Giunta and D.K. Moss

4. Common Neurologic Complaints and Conditions ...............................................................23

B.L. Maria and R.W. Treloar

5. The Neurologic Examination..................................28P. Diadori and L. Carmant

6. Neurologic Complaints and Conditions in Primary Care Pediatrics ..........................................35

T.B. Benton

7. Education of Medical Students, Pediatricians,and Neurologists in Child Neurology ....................39

I.J. Butler

8. The Internet in Child Neurology ............................44K.J. Mack and S.M. Leber

SECTION 2. THE OFFICE VISIT

HEADACHE

9. Migraine in Children and Adolescents ...................53W.W. Wasiewski

10. Migraine Variants and Mimics................................57S.L. Linder

11. Chronic Daily Headache..........................................62W.W. Wasiewski and J. Gladstein

12. Abortive Therapy for Migraine...............................65A.D. Hershey and S.W. Powers

13. Preventive Therapy for Migraine ............................70D.W. Lewis

14. Psychosocial Issues in Pediatric Headache .............78D.W. Lewis and A.E. Lake III

15. Biofeedback for Childhood Migraine.....................83S.W. Powers and A.D. Hershey

SEIZURES AND EPILEPSY

16. What is Epilepsy? .....................................................86J. Aicardi

17. Febrile Seizures.........................................................90P.S. Wolf and S. Shinnar

18. First Unprovoked Seizure ........................................96J.S. Bluvstein and S.L. Moshé

19. Staring Spells ..........................................................100J.M. Rho and J. Kuratani

20. Partial Seizures .......................................................108J.M. Pellock and M. Duchowny

21. Generalized Seizures ..............................................113B.F.D. Bourgeois

22. First-Choice Antiepileptic Drugs ..........................122J. M. Pellock

23. Infantile Spasms (West’s Syndrome) ....................134L. Carmant

24. Recurrent Seizures .................................................138J.W. Wheless

25. Discontinuing Antiepileptic Drugs.......................154J.M. Rho

26. Nonepileptic Events Simulating Seizuresin Childhood ..........................................................158

P. Camfield and C. Camfield

27. Ketogenic Diet........................................................164L.W. Brown

xi

28. Epilepsy Surgery and Electrical Stimulation ........168M. Duchowny

NEUROBEHAVIORAL DISORDERS

29. Diagnostic Approaches and Assessment of ADHD .............................................................173

P. Accardo

30. ADHD Comorbidity and Mimicry.......................179 J.H. Johnson and C. Loftis

31. Pharmacologic Treatment of ADHD....................184L.W. Brown

32. Behavioral Management and Treatment of ADHD ................................................................192

T.A. Blondis and L. Pfiffner

33. Individual Child– and Family-Based Therapiesfor ADHD...............................................................197

S.M. Eyberg, M.D. Dabbs, and E.M. Neary

34. Medical Management of PervasiveDevelopmental Disorder .......................................200

C. Delahunty

SCHOOL READINESS

35. Is My Child Ready for School? ..............................206D.L. MacGregor

36. Psychological Assessment: Interpreting Test Results and Reports ...............................................210

E.B. Fennell and T.N. Dikel

37. Developmental Language Disorders .....................215N.E. Hall

38. Learning Disability.................................................220I.S. Baron

DEVELOPMENTAL DELAY

39. Diagnostic Approach to Developmental Delay .......................................................................227

M. Shevell

40. Cerebral Palsy.........................................................232J.E. Brunstrom and A.H. Tilton

41. Spasticity.................................................................237T.S. Edgar

42. Degenerative Disorders..........................................245E.H. Kolodny

43. Mitochondrial Cytopathies ...................................254B.H. Cohen

44. Mental Retardation ................................................261J.B. Bodensteiner, C.R. Ellis, and G.B. Schaefer

45. Down Syndrome ....................................................273W.I. Cohen

46. Rett Syndrome........................................................280G.M. Bibat and S. Naidu

47. Inborn Errors of Metabolism................................285L. de Meirleir

48. Autism ....................................................................291R.B. David and C.H. David

OTHER NEUROLOGIC COMPLAINTS AND CONDITIONS

49. Small, Large, or Abnormally Shaped Head ..........299W. DeMyer

50. Tic Disorders ..........................................................305J.W. Mink

51. Sleep Disturbances.................................................313S. Kotagal

52. Breath-Holding Spells............................................321W. DeMyer

53. Human Immunodeficiency Virus 1 and Acquired Immune Deficiency Syndrome in Infants and Children..............................................324

A.L. Belman

54. Bell’s Palsy...............................................................334M. Tremwel and B.L. Maria

55. Management of Dizziness in Children .................338L. Eviatar

56. Fainting and Syncope ............................................345J.B.P. Stephenson

57. Hereditary Neuropathy..........................................352T.S. Edgar

58. Muscular Dystrophy and Myopathy .....................360R.S. Finkel

59. Neuromuscular Junction Disorders......................368J. Vajsar

60. Ataxia, Clumsiness, and Tremor ...........................374E.J. Boltshauser

61. Paroxysmal Movement Disorders in Childhood...............................................................379

L.S. Dure IV

62. Visual System Problems.........................................383L.M. Levine and M.T. Bhatti

63. Childhood Depression...........................................388T.K. Murphy and M. Nguyen

64. Conversion Reaction..............................................395W.G. Kronenberger and D.W. Dunn

65. Neurofibromatosis .................................................400B.R. Korf

66. Tuberous Sclerosis Complex .................................405E.S. Roach

67. Sturge-Weber Syndrome .......................................411B.L. Maria

68. Brainstem and Cerebellar Malformations ............416B.L. Maria, K.N. Kimmel, and R.G. Quisling

xii / Contents

SECTION 3. THE HOSPITALIZED CHILD

69. Neonatal Seizures...................................................425M.J. Painter and J. Alvin

70. Status Epilepticus ...................................................430J.W. Wheless

71. Meningitis and Encephalitis ..................................435M.H. Rathore and E.M. Ayoub

72. Traumatic Brain and Spinal Cord Injuriesin Children .............................................................442

J.H. Menkes and R.C. Ellenbogen

73. Neonatal Hypotonia ..............................................455C. Adams

74. Injury to the Preterm Brain...................................460L.R. Ment

75. Injury to the Term Brain .......................................466R.C. Vannucci

76. Altered States of Consciousness............................470B.H. Cohen and J.C. Andrefsky

77. Increased Intracranial Pressure .............................481A.M. Avellino and B.S. Carson Sr.

78. Evaluation and Management of Acute Headache ...............................................................487

R.S. Rust

79. Brain Tumors .........................................................495C. Kennedy

80. Pseudotumor Cerebri: Idiopathic IntracranialHypertension..........................................................503

P.H. Phillips

81. Central Nervous System Vascular Malformations in Pediatric Patients ...................................................................509

J.L. Moriarity Jr., P.B. Storm, and R.J. Tamargo

82. Pediatric Intracranial Aneurysms .........................519M.S. Lesniak and R.J. Tamargo

83. Cerebrovascular Disease ........................................525F.J. Kirkham

84. Vasculitis .................................................................533S. Skoda-Smith and L.H. Calabrese

85. Inflammatory Demyelinating Neuropathy.............................................................538

J.T. Sladky

86. Brain Death in Children........................................544S. Ashwal

Index...............................................................................551

Contents / xiii

NATIONAL LIBRARY OF

MEDICINE LINKS

ADHD Language/Learning Disorders

Ataxia

Autism

Bell's Palsy

Brain Death

Brain Injury

Brain Tumors

Cerebral Palsy

Cerebrovascular Disease

Conversion Reaction

Depression

Down Syndrome

Epilepsy

HIV-1

Mental Retardation

Migraine

Muscular Dystrophy

Myopathy

Neurofibromatosis

Rett Syndrome

Seizure

Sleep Disturbances

Spasticity

Tic Disorders

Tuberous Sclerosis

Visual System Problems