Pediatric Neurology for Psychiatrists

Pediatric Neurology for Psychiatrists
Magdi M. Sobeih
▪ INTRODUCTION
As the child’s brain develops, new developmental abilities arise. Skills in multiple domains are acquired concurrently. These domains include motor, sensory, language, cognitive, attention, social, and self-care skills. Development of any one or multiple domains may go awry in childhood, resulting in patterns of developmental impairments with clinical diagnostic features.
▪ BRAIN DEVELOPMENT
The fetal brain develops from the neural tube and prosencephalon. Neuronal precursors proliferate between 12 and 16 weeks of gestation. Neurons migrate to form the six-layered insideout cortex between 12 and 20 weeks gestational age. Subsequently (in fetal as well as years into postnatal brain development), organization of the multilayered cortex takes place, with dendritic arborization, synaptogenesis, pruning of synapses, and apoptosis. Glial cells proliferate, and the myelin-forming cells, oligodendrocytes, differentiate. Finally, myelination prenatally proceeds first in the brainstem and cerebellum. Myelination continues into young adulthood, with central sensory system pathways becoming myelinated before motor systems. Myelination of central cortical sites occurs, followed by the occipital and then frontotemporal poles. From early development into late adolescence, functional connectivity of neural networks is continuously modified.
▪ EXPECTED DEVELOPMENTAL MILESTONES
Evaluation of children relies heavily on comparison of their developmental abilities relative to those of their peers. For this reason, adjustments for conceptual age and knowledge of typical developmental milestones are essential. Children’s early development proceeds in an orderly fashion in several areas, first with primitive reflexes and then more complex developmental processes (Tables 18.1 and 18.2). Much like in neurological examination of adults, children’s developmental milestones can be organized based on various domains. These include motor skills (both fine motor and gross motor), language abilities (both receptive and expressive), socialization skills, cognitive abilities, and executive function. Significant delays in acquisition of these milestones can occur in any of the domains or a combination of domains. For example, a child may have language delay only, delays in fine or gross motor skills, or a combination of language and motor delay. These delays assume an otherwise normal neurological examination, without evidence of focal or lateralizing neurological signs indicating a possible underlying structural etiology. Regression warrants neurological consultation for metabolic disorder or neurodegenerative disorder, such as leukodystrophy or gray matter disorder.
TABLE 18.1 PRIMITIVE REFLEXES IN FULL-TERM INFANT

REFLEX

DISAPPEARS BY

Moro

3-4 months

Tonic neck

6 months

Babinski

Usually 12 months

Up to 3 years old is normal if symmetrical

Grasp reflex

4-6 months in hand, 10 months in foot

Suck

4 months

Stepping reflex

6 weeks

TABLE 18.2 TYPICAL DEVELOPMENTAL MILESTONES

AGE

GROSS MOTOR

FINE MOTOR

LANGUAGE

SOCIAL

1 month

 

 

 

Smiles responsively

2 months

 

 

Coos

Recognizes mother, tracks 180 degrees

3 months

Head control, rolls over

Reaches for objects

Babbling and cooing

 

4 months

 

Reaches whole hand

 

Laughs

5 months

Head up on horizontal suspension

 

 

 

6 months

Sits with support

Transfers objects

Turns to name

 

8 months

Sits unsupported

Pincer grasp

 

 

9 months

Stands with support, crawls

 

“Dadda,” “Mamma” specifically

 

10 months

Cruises

 

 

 

11 months

 

 

 

Plays peek-a-boo

12 months

Walks independently

Handedness develops, tower of 2 cubes

One or two words more to identify objects specifically

 

15 months

 

 

Points for communication to desired objects

18 months

Walks forward and backward, stoops and recovers, ascends steps

Tower of 3 cubes

10-20-word expressive vocabulary, larger receptive

Imaginative play

2 years

Runs well

Tower of 8 cubes

200-word expressive vocabulary, two-word phrases

Helps around house

3 years

Throw, catch, kick, pedals

Copies circle

Speaks in sentences, follows two-step directions

Toilet trained, Pretend play

4 years

Hops

Copies cross

Begins to write

 

5 years

Skips

Copies square

Beginning to read

 

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Sep 7, 2016 | Posted by in PSYCHIATRY | Comments Off on Pediatric Neurology for Psychiatrists

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