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Neurological Conditions

Epilepsy

What is it?

Epilepsy is a common disease of the brain where there is a tendency to have recurrent seizures. It is a neurological disorder, and seizures are caused by a temporary disruption of the electrical activity in the brain. Depending on where the seizure is within the brain, it can cause changes in sensation and feeling, awareness and consciousness, emotions, behaviour and movement. Seizures vary greatly and can be very brief or last up to two or three minutes. Most seizures are over in less than two minutes. Some seizures are severe and some very subtle.

There are many different types of epilepsies and people’s experiences differ greatly. Some types of epilepsy are age-limited and the person eventually stops having seizures. For others, epilepsy is a life-long condition.

How Epilepsy Affects Children?

Having epilepsy can affect a child in different ways and the impact can vary. Depending on their age and the type of seizures the child has. For some children having a diagnosis of epilepsy will not affect their day-to-day lives. For others it may be frightening or difficult to understand. They may feel embarrassed, isolated or different in front of their peers. Encouraging your child to talk about their concerns may help them to feel more positive.

Seizures are often focal and include twitching, numbness or tingling of the child’s face or tongue, and may interfere with speech and cause drooling. Sometimes they can progress into a tonic-clonic seizure. Seizures usually happen in early stages of sleep. Medication is not always needed.

Some children’s seizures happen in response to triggers such as stress, excitement, missed medication or lack of sleep. Keeping a diary of their seizures can help to see if there are any patterns to when seizures happen. If you recognise triggers, avoiding them as far as possible may help to reduce the number of seizures your child has.

Getting enough sleep, and well-balanced meals, will help keep your child healthy and may help to reduce their seizures.

For some children, having epilepsy and taking AEDs will not affect their behaviour. However, some people may notice a change in their child’s mood or behaviour such as becoming irritable or withdrawn. Some children may be responding to how they feel about having epilepsy and how it affects them.

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Neurological Conditions

Cerebral Palsy

What is it?

Cerebral palsy is the most common physical disability in childhood. It is a general term for a group of conditions caused by non-progressive disturbances to the developing brain during pregnancy or infancy. There is no cure for cerebral palsy (CP) and for most people living with CP the cause is unknown.

Cerebral palsy is caused by abnormal development of part of the brain or by damage to parts of the brain that control movement. This damage can occur before, during, or shortly after birth. The majority of children have congenital cerebral palsy CP (that is, they were born with it), although it may not be detected until months or years later. A small number of children have acquired cerebral palsy, which means the disorder begins after birth. Some causes of acquired cerebral palsy include brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, problems with blood flow to the brain, or head injury from a motor vehicle accident, a fall, or child abuse.

Cerebral palsy presents as a life-long disorder of posture and movement and may be accompanied by other impairments such as disturbances of sensation, communication issues, epilepsy, visual, hearing and behavioural issues.

How Cerebral Palsy affects children?

Whilst cerebral palsy is not a progressive condition, changes may occur over time. As the child grows and uses their muscles more, their muscles may become tighter. Cerebral palsy varies greatly in how it affects the individual due to varying types of CP, severity of movement disorder, and related functional abilities and limitations. Some effects of CP include:

  • Inactivity due to impairment of motor centers in the brain
  • Intellectual disability
  • Growth and developmental delay
  • Deformities of the spine
  • Strabismus (cross eyes)
  • Impaired hearing
  • Speech and language disorders
  • Incontinence
  • Contractures
  • Poor dental health
  • Early intervention is important in supporting children with CP and their families.

Childhood inactivity is magnified in children with CP due to impairment of the motor centers of the brain that produce and control voluntary movement. While children with CP may exhibit increased energy expenditure during activities of daily living, movement impairments make it difficult for them to participate in sports and other activities at a level of intensity sufficient to develop and maintain strength and fitness.

Prenatal screening and diagnosis?

Most children with cerebral palsy are diagnosed during the first 2 years of life.  But if a child’s symptoms are mild, it can be difficult for a doctor to make a reliable diagnosis before the age of 4 or 5.

Doctors will order a series of tests to evaluate the child’s motor skills. During regular visits, the doctor will monitor the child’s development, growth, muscle tone, age-appropriate motor control, hearing and vision, posture, and coordination, in order to rule out other disorders that could cause similar symptoms. Although symptoms may change over time, CP is not progressive. If a child is continuously losing motor skills, the problem more likely is a condition other than CP such as a genetic or muscle disease, metabolism disorder, or tumours in the nervous system.

Lab tests can identify other conditions that may cause symptoms similar to those associated with CP.

Getting help?

It is recommended that early occupational therapy is implemented for babies and young children with any type or severity of cerebral palsy.  The first two years of life is a critical period for neuroplasticity and so the brain is most likely to be more responsive to intensive practice of activities during this time.

Cerebral palsy can’t be cured, but treatment will often improve a child’s capabilities.  Many children go on to enjoy near-normal adult lives if their disabilities are properly managed. In general, the earlier treatment begins, the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them.

There is no standard therapy that works for every individual with cerebral palsy. Once the diagnosis is made, and the type of CP is determined, a team of health care professionals will work with a child and his or her parents to identify specific impairments and needs, and then develop an appropriate plan to tackle the core disabilities that affect the child’s quality of life.

Physical therapy, usually begun in the first few years of life or soon after the diagnosis is made, is a cornerstone of CP treatment. Specific sets of exercises (such as resistive, or strength training programs) and activities can maintain or improve muscle strength, balance, and motor skills, and prevent contractures. Special braces (called orthotic devices) may be used to improve mobility and stretch spastic muscles.

Occupational therapy focuses on optimizing upper body function, improving posture, and making the most of a child’s mobility. Occupational therapists help individuals address new ways to meet everyday activities such as dressing, going to school, and participating in day-to-day activities.

Recreation therapy encourages participation in art and cultural programs, sports, and other events that help an individual expand physical and cognitive skills and abilities. Parents of children who participate in recreational therapies usually notice an improvement in their child’s speech, self-esteem, and emotional well-being.

Neurological Conditions

Dystonia

What is it?

Dystonia is involuntary muscle contractions that cause repetitive or twisting movements in the body. Dystonia may affect one or more parts of the body and sometimes the entire body with the condition ranging from mild to severe. The main symptom involved with Dystonia is involuntary muscle contractions that result in slow repetitive movements, cramps or abnormal posture.

What causes Dystonia?

Most cases of dystonia do not have a specific cause. Dystonia seems to be related to a problem in the basal ganglia. That’s the area of the brain that is responsible for initiating muscle contractions. The problem involves the way the nerve cells communicate.

Acquired dystonia is caused by damage to the basal ganglia. The damage could be the result of:

  • Brain trauma
  • Stroke
  • Tumor
  • Oxygen deprivation
  • Infection
  • Drug reactions
  • Poisoning caused by lead or carbon monoxide
  • Idiopathic or primary dystonia is often inherited from a parent.
  • Some carriers of the disorder may never develop a dystonia themselves. And the symptoms may vary widely among members of the same family.

How Dystonia Affects Children?

Dystonia can occur at any age, but is often described as either early, or childhood, onset versus adult onset.

Early-onset dystonia often begins with symptoms in the limbs and may progress to involve other regions. Some symptoms tend to occur after periods of exertion and/or fluctuate over the course of the day.

Dystonias often progress through various stages. Initially, dystonic movements may be intermittent and appear only during voluntary movements or stress. Later, individuals may show dystonic postures and movements while walking and ultimately even while they are relaxed. Dystonia can be associated with fixed postures and shortening of tendons.

Getting help?

There are several options for treating dystonia. The doctor will determine the course of treatment based on the type of dystonia and its severity. Treatments may include drugs, injections and physiotherapy.

A recently introduced treatment is botulinum toxin, also called Botox or Xeomin. The toxin is injected into the affected muscle. There it blocks the effect of the chemical acetylcholine that produces muscle contractions. The injection needs to be repeated about every three months.

Medications can help reduce the “overdrive” messages that cause muscles to contract excessively in dystonia.

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Neurological Conditions

Attention Deficit Hyperactivity Disorder (ADHD or AD/HD or ADD)

What is it?

ADHD is the most commonly studied and diagnosed psychiatric disorder in children, affecting about 3 to 5 percent of children globally and diagnosed in about 2 to 16 percent of school aged children. It is a chronic disorder[5] with 30 to 50 percent of those individuals diagnosed in childhood continuing to have symptoms into adulthood. Adolescents and adults with ADHD tend to develop coping mechanisms to compensate for some or all of their impairments.

 

ADHD is diagnosed two to four times more frequently in boys than in girls, though studies suggest this discrepancy may be partially due to subjective bias of referring teachers. ADHD management usually involves some combination of medications, behaviour modifications, lifestyle changes, and counselling. Its symptoms can be difficult to differentiate from other disorders, increasing the likelihood that the diagnosis of ADHD will be missed.

ADHD and its diagnosis and treatment have been considered controversial since the 1970s. The controversies have involved clinicians, teachers, policymakers, parents and the media. Topics include the actuality of the disorder, its causes, and the use of stimulant medications in its treatment. Most healthcare providers accept that ADHD is a genuine disorder with debate in the scientific community centering mainly around how it is diagnosed and treated.

What causes it?

Hyperactivity is commonly seen in ADHD. Inattention, hyperactivity, and impulsivity are the key behaviours of ADHD. The symptoms of ADHD are especially difficult to define because it is hard to draw the line at where normal levels of inattention, hyperactivity, and impulsivity end and clinically significant levels requiring intervention begin. To be diagnosed with ADHD, symptoms must be observed in two different settings for six months or more and to a degree that is greater than other children of the same age.

How ADHD affects children?

The symptom categories of ADHD in children yield three potential classifications of ADHD—predominantly inattentive type, predominantly hyperactive-impulsive type, or combined type if criteria for both subtypes are met.

Predominantly inattentive type symptoms may include:

  • Be easily distracted, miss details, forget things, and frequently switch from one activity to another
  • Have difficulty maintaining focus on one task
  • Become bored with a task after only a few minutes, unless doing something enjoyable
  • Have difficulty focusing attention on organizing and completing a task or learning something new or trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
  • Not seem to listen when spoken to
  • Daydream, become easily confused, and move slowly
  • Have difficulty processing information as quickly and accurately as others
  • Struggle to follow instructions.

Predominantly hyperactive-impulsive type symptoms may include:

  • Fidget and squirm in their seats
  • Talk nonstop
  • Dash around, touching or playing with anything and everything in sight
  • Have trouble sitting still during dinner, school, and story time
  • Be constantly in motion
  • Have difficulty doing quiet tasks or activities.

and also, these manifestations primarily of impulsivity:

  • Be very impatient
  • Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
  • Have difficulty waiting for things they want or waiting their turns in games

Most people exhibit some of these behaviours, but not to the degree where such behaviours significantly interfere with a person’s work, relationships, or studies—and in the absence of significant interference or impairment, a diagnosis of ADHD is normally not appropriate. The core impairments are consistent even in different cultural contexts.

Symptoms may persist into adulthood for up to half of children diagnosed with ADHD. This rate is difficult to estimate, as there are no official diagnostic criteria for ADHD in adults. ADHD in adults remains a clinical diagnosis. The signs and symptoms may differ from those during childhood and adolescence due to the adaptive processes and avoidance mechanisms learned during the process of socialisation.

A 2009 study found that children with ADHD move around a lot because it helps them stay alert enough to complete challenging tasks.

Comorbid disorders

Inattention and “hyperactive” behaviour are not the only problems in children with ADHD. ADHD exists alone in only about 1/3 of the children diagnosed with it. Such combinations can greatly complicate diagnosis and treatment. Many co-existing conditions require other courses of treatment and should be diagnosed separately instead of being grouped in the ADHD diagnosis.

Anxiety and depression are some of the disorders which can accompany ADHD. Academic studies and research in private practice suggest that depression in ADHD appears to be increasingly prevalent in children as they get older, with a higher rate of increase in girls than in boys, and to vary in prevalence with the subtype of ADHD. Where a mood disorder complicates ADHD, it would be prudent to treat the mood disorder first, but parents of children who have ADHD often wish to have the ADHD treated first, because the response to treatment is quicker.

Medical problems associated?

Medical conditions that must be excluded include hypothyroidism, anaemia, lead poisoning, chronic illness, hearing or vision impairment, substance abuse, medication side effects, sleep impairment and child abuse, and cluttering (tachyphemia) among others.

The relationship between ADHD and sleep is complex. As with other psychological and neurological issues. In addition to clinical observations, there is substantial empirical evidence from a neuroanatomic standpoint to suggest that there is considerable overlap in the central nervous system centres that regulate sleep and those that regulate attention/arousal. Primary sleep disorders play a role in the clinical presentation of symptoms of inattention and behavioural dysregulation. There are multilevel and bidirectional relationships among sleep, neurobehavioral functioning and the clinical syndrome of ADHD.

Behavioural manifestations of sleepiness in children range from the classic ones (yawning, rubbing eyes), to externalizing behaviours (impulsivity, hyperactivity, aggressiveness), to mood lability and inattentiveness. Many sleep disorders are important causes of symptoms which may overlap with the cardinal symptoms of ADHD; children with ADHD should be regularly and systematically assessed for sleep problems.

Prenatal screening and diagnosis?

As part of the diagnostic process for ADHD, the health care professional must determine whether there are any other conditions affecting the individual. Often, the symptoms of ADHD may overlap with other disorders. The challenge for the professional is to figure out whether a symptom belongs to ADHD, to a different disorder or to both disorders at the same time.

Getting help: Management

Methods of treatment often involve some combination of behaviour modification, life-style changes, counselling, and medication. A 2005 study found that medical management and behavioural treatment is the most effective ADHD management strategy, followed by medication alone, and then behavioural treatment. While medication has been shown to improve behaviour when taken over the short term, they have not been shown to alter long term outcomes. Medications have at least some effect in about 80% of people.

Getting help: Psychosocial

The evidence is strong for the effectiveness of behavioural treatments in ADHD. It is recommended first line in those who have mild symptoms and in preschool aged children. Psychological therapies used include psych educational input, behaviour therapy, cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT), family therapy, school-based interventions, social skills training and parent management training.

Getting help: Medication

Stimulant medication is the medical treatment of choice. There are a number of non-stimulant medications, such as atomoxetine, that may be used as alternatives. There are no good studies of comparative effectiveness between various medications, and there is a lack of evidence on their effects on academic performance and social behaviours. While stimulants and atomoxetine are generally safe, there are side effects and contraindications to their use.

Neurological Conditions

Tourette’s Syndrome

What is it?

Tourette syndrome is a neurological disorder characterized by repeated involuntary behaviours known as ‘tics’. Motor tics can include everything from eye blinking or grimacing to head jerking or foot stomping, while vocal tics may display as throat clearing, making clicking sounds, repeated sniffing, yelping, or shouting. In rare cases, people with Tourette syndrome might have a tic that makes them harm themselves, such as head banging. Prior to diagnosis of Tourette syndrome, both motor and phonic tics must be consistently present for a period of 12 months.

What causes tourette's syndrome

The exact cause of Tourette syndrome isn’t known. It’s a complex disorder likely caused by a combination of inherited (genetic) and environmental factors. Chemicals in the brain that transmit nerve impulses (neurotransmitters), including but not limited to dopamine and serotonin.

Risk factors for Tourette syndrome include having a family history of Tourette syndrome or other tic disorders might increase the risk of developing Tourette syndrome. Males are about three to four times more likely than females to develop Tourette syndrome.

How tourette's syndrome Affects Children?

Children with Tourette’s syndrome often outgrow their tics by their late teens or early adult years — they happen less often and sometimes disappear altogether. ADHD symptoms often last into adulthood.

Medical problems associated?

Children with Tourette syndrome often lead healthy, active lives. However, Tourette syndrome frequently involves behavioural and social challenges that can harm your self-image.

Conditions often associated with Tourette syndrome include:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Obsessive-compulsive disorder (OCD)
  • Autism spectrum disorder
  • Learning disabilities
  • Sleep disorders
  • Depression
  • Anxiety disorders
  • Pain related to tics, especially headaches
  • Anger-management problems

Symptoms include rapid, repetitive and involuntary muscle movements and vocalisations called ‘tics’, which are classified as simple or complex. Simple tics involve sudden, brief movement within a limited number of muscle groups. These occur in a single and isolated fashion and are often repetitive. 

Complex tics involve distinct, co-ordinated patterns of movements which involve several muscle groups. These may include jumping, smelling objects or touching the nose.

Typically, tics increase as a result of tension or stress, and decrease with relaxation or concentration.

Prenatal screening and diagnosis?

As part of the diagnostic process for ADHD, the health care professional must determine whether there are any other conditions affecting the individual. Often, the symptoms of ADHD may overlap with other disorders. The challenge for the professional is to figure out whether a symptom belongs to ADHD, to a different disorder or to both disorders at the same time.

In the case of tics, the intermittent nature of the condition may make it difficult to identify in its early stages. However, over time, a pattern of motor tics and other behaviours will emerge. During the assessment process, it is important to determine the frequency of the symptoms and the degree to which the tics and other behaviours impair functioning. Patterns associated with the tics (for example, are they brought on or made worse by stress or tiredness) may also be key in recommending appropriate modifications or strategies to deal with them.

Getting help?

In many cases when a child has both ADHD and tics, the health care professional may elect to treat the ADHD first because primary treatment of ADHD may reduce stress, improve attention and sometimes reduce tics by enhancing the individual’s ability to suppress tics. Treatment options for ADHD include medication, skills training, counselling, behaviour therapy and school support. These interventions can help the patient control symptoms, cope with the disorder, improve overall psychological well-being and manage social relationships.

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Neurological Conditions

Tic Disorder

What is it?

Tics are sudden twitches, movements, or sounds that people do repeatedly. People who have tics cannot stop their body from doing these things. For example, a person with a motor tic might keep blinking over and over again. Or a person with a vocal tic might make a grunting sound unwillingly.

What causes Tic Disorder?

Tics are thought to be due to changes in the parts of the brain that control movement. They can run in families, and there’s likely to be a genetic cause in many cases. They also often happen alongside other conditions such as attention deficit hyperactivity disorder (ADHD).

Tics are irregular, uncontrollable, unwanted, and repetitive movements of muscles that can occur in any part of the body. Movements of the limbs and other body parts are known as motor tics. Involuntary repetitive sounds, such as grunting, sniffing, or throat clearing, are called vocal tics.

Tic disorders usually start in childhood, first presenting at approximately 5 years of age. In general, they are more common among males compared with females. Many cases of tics are temporary and resolve within a year. However, some people who experience tics develop a chronic disorder.

How Tic Disorder affects children?

Transient tic disorder

According to the American Academy of Child and Adolescent Psychiatry, transient tic disorder or provisional tic disorder affects up to 10 percent of children during their early school years.

Children with transient tic disorder will present with one or more tics for at least 1 month, but for less than 12 consecutive months. The onset of the tics must have been before the individual turned 18 years of age. Motor tics are more commonly seen in cases of transient tic disorder than vocal tics. Tics may vary in type and severity over time.

Some research suggests that tics are more common among children with learning disabilities and are seen more in special education classrooms. Children within the autism spectrum are also more likely to have tics.

Tics that appear before the age of 18 and last for 1 year or more may be classified as a chronic tic disorder. These tics can be either motor or vocal, but not both. Chronic tic disorder is less common than transient tic disorder, with less than 1 percent of children affected. If the child is younger at the onset of a chronic motor or vocal tic disorder, they have a greater chance of recovery, with tics usually disappearing within 6 years. People who continue to experience symptoms beyond age 18 are less likely to see their symptoms resolved.

Medical problems associated?

The defining symptom of tic disorders is the presence of one or more tics. These tics can be classified either motor tics such as head and shoulder movements, blinking, jerking, banging, clicking fingers, or touching things or other people. Motor tics tend to appear before vocal tics, although this is not always the case. Or vocal tics such as coughing, throat clearing or grunting, or repeating words or phrases.

Tics can also be divided into two categories:

  1. Simple tics which are sudden and fleeting tics using few muscle groups. Examples include nose twitching, eye darting, or throat clearing.
  2. Complex tics involving coordinated movements using several muscle groups. Examples include hopping or stepping in a certain way, gesturing, or repeating words or phrases.

Tics are usually preceded by an uncomfortable urge, such as an itch or tingle. While it is possible to hold back from carrying out the tic, this requires a great deal of effort and often causes tension and stress. Relief from these sensations is experienced upon carrying out the tic.

Prenatal screening and diagnosis?

When the child has one or more motor tics (for example, blinking or shrugging the shoulders) or vocal tics (for example, humming, clearing the throat, or yelling out a word or phrase).

Motor or vocal tics have been present for no longer than 12 months in a row and have tics that start before age 18 years.

When the child has symptoms that are not due to taking medicine or other drugs, or due to having a medical condition that can cause tics (for example, Huntington disease or postviral encephalitis) and lastly not have been diagnosed with TS or persistent motor or vocal tic disorder.

Getting help?

Treatment depends on the type of tic disorder and its severity. In many cases, tics resolve on their own without treatment. Severe tics that interfere with daily life may be treated with therapies, medications, or deep brain stimulation. OTFC Group are available to help children control tics and reduce their occurrence by different cognitive behavioural therapies.

Coping and self-help tips for children with tics can be simple changes in lifestyle like avoiding stress and anxiety and getting enough sleep.

Neurological Conditions

CVI - Cortical Vision Impairment

What is it?

Presently, Cortical Visual Impairment (CVI) is the most common cause of permanent visual impairment in children aged 1-3. The diagnosis of CVI is indicated for children showing abnormal visual responses that cannot be attributed to the eyes themselves. Brain dysfunction must explain the abnormal visual responses, as abnormal ocular structures, abnormal eye movements, and refractive error do not. Fixation and following, even to intense stimulation, may be poor and the child does not respond normally to people’s faces. Visual regard and reaching (in the child with motor capabilities) toward objects is absent.

What causes CVI?

It is now widely accepted that “cortical blindness” is not an appropriate diagnostic term for children with early, acquired visual impairment due to non-ocular causes. The term “cortical” is misleading because the visual impairment is due to abnormality of bilateral.

Common causes CVI in infants and young children include:

  • Hypoxic ischemic encephalopathy (HIE) (in the term born infant)
  • Periventricular leukomalacia (PVL) (in the preterm infant)
  • Traumatic brain injury due to shaken baby syndrome and accidental head injuries
  • Neonatal hypoglycaemia, infections (e.g., viral meningitis)
  • Metabolic disorders.

Other causes include:

  • Antenatal drug use by the mother
  • Cardiac arrest
  • Twin pregnancy
  • Central nervous system developmental defects
  • Accompanying features of CVI include cerebral palsy and developmental delays.
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How CVI Affects Children?

Behaviours reported by parents, teachers and low vision specialists include:

  • Variable or inconsistent visual responses to the same stimuli
  • Better responses to familiar than to novel stimuli
  • Fatiguing from visual tasks
  • Peripheral vision dominates when reaching
  • Coloured stimuli elicit better responses than black and white stimuli
  • Visual attention for moving stimuli is better than for static stimuli
  • Vision for navigation is unexpectedly good
  • Difficulty seeing an object or image in a “crowded” array or a busy background
  • Reduced responses to visual stimuli when music, voices, and other sounds are present, and often, when the child is touched.

Parents are most disturbed by the child’s lack of social gaze and direct eye contact. Active avoidance of or withdrawal from unfamiliar visual stimulation, including people’s faces, is frequently reported. Tactile stimulation may be avoided by the child, while in others, touch may be utilized in preference to vision. Commonly, the child positively responds to voices and music

Partial recovery of vision in many children with CVI and severe visual impairment occurs. Improvements are seen in visual acuity, orienting to peripheral stimuli, attention to and reaching for objects and for social gaze. Effective management of intractable seizures often results in improved visual behaviour’s (personal experience).

Medical problems associated?

The most common CVI symptoms are:

  • Abnormal light response — light gazing or photophobia
  • Blunted or avoidant social gaze
  • Brief fixations, intermittent following
  • Poor visual acuity
  • Visual field loss — generalized constriction, inferior altitudinal, hemianopia defect

Prenatal screening and diagnosis?

The diagnosis of Cortical Visual Impairment is a difficult diagnosis to make. It is diagnosed when a child has poor or no visual response and yet has normal pupillary reactions and a normal eye examination. The child’s eye movements are most often normal. The visual functioning will be variable.

Getting help?

In addition to the complete eye examination, objective measures of visual abilities should be done where feasible. Visual acuity is measurable in most children with CVI using large, black and white gratings (stripes) presented using preferential looking tests or using cortical visually evoked potentials.

Acuity may be very poor in infancy and remain so. In others there is gradual improvement in acuity. In most children with CVI, acuity does not reach normal levels. And, when measurable, recognition acuity for pictures, symbols or letters may be much poorer than the acuities previously measured for gratings. Glasses should be given if warranted which may help to improve your child’s vision.

Visual field abnormalities are much more common in children with CVI than realized probably because of the difficulties in assessing peripheral vision in children with poor fixation, poor orienting, and visually avoidant behaviours.

In all children with cerebral visual impairment, services of trained and experienced teachers are very important for the child’s development, rehabilitation and education.

Your child’s GP is normally responsible for their general medical care. The GP may refer your child to a paediatrician or paediatric neurologist (a children’s doctor who specialises in the brain and nervous system). An epilepsy specialist nurse may also be involved in their care.

Young people usually start to see a specialist in adult services (a neurologist) from around 16 years old. Most people with epilepsy take anti-epileptic drugs (AEDs) to control their seizures. The paediatrician can discuss with you whether AEDs are the best option for your child. Although AEDs aim to stop seizures from happening, they don’t stop seizures while they are happening, and they do not cure epilepsy.

Most children stop having seizures once they are on an AED that suits them. Like all drugs, AEDs can cause side effects for some children. Some side effects go away as the body gets used to the medication, or if the dose is adjusted. If you are concerned about your child taking AEDs you can talk to their paediatrician, epilepsy nurse, GP or pharmacist. Changing or stopping your child’s medication without first talking to the doctor can cause seizures to start again or make seizures worse.

Although AEDs work well for many children, this doesn’t happen for every child. If AEDs don’t help your child, their doctor may consider other ways to treat their epilepsy.

For some children who still have seizures even though they have tried AEDs, the ketogenic diet may help to reduce the number or severity of their seizures. The diet is a medical treatment, often started alongside AEDs and is supervised by trained medical specialists and dietitians.

It may be possible for some children to have epilepsy surgery depending on the type of epilepsy they have and where in the brain their seizures start. Epilepsy surgery involves removing a part of the brain to stop or reduce the number of seizures a child has.

Neurological Conditions

Sensorineural Hearing Loss

What is it?

Sensorineural hearing loss means there is damage either to the tiny hair cells in your inner ear (known as stereocilia), or to the nerve pathways that lead from your inner ear to the brain. It normally affects both ears. Once you develop sensorineural hearing loss, you have it for the rest of your life. It can be mild, moderate, severe or profound.

What Causes Sensorineural Hearing Loss?

The causes of this type of hearing loss are generally sorted into two categories: acquired or congenital. Most people have acquired hearing loss.

Acquired sensorineural hearing loss means the hearing loss develops after a person is born, usually later in life. Causes can include:

  • Aging: One of the most common conditions of growing older is presbycusis, or age-related hearing loss, affecting one in three Americans between the ages of 65-74. Because this type of loss occurs over time, typically in both ears, it’s sometimes difficult to notice.
  • Noise: Noise-induced hearing loss (NIHL) can be caused by exposure to a one-time loud noise, such as an explosion or gunfire, or from sounds louder than 85 decibels (dB) over an extended period of time. If you have to shout to be heard or your ears ring after attending a live concert or ballgame, your hearing health is at risk.
  • Disease and infections: Viral infections—including measles, meningitis and mumps—can cause sensorineural hearing loss.
  • Head or acoustic trauma: Damage to your inner ear also can be caused by a blow to the head or exposure to extremely loud noise, such as an explosion.
  • Medications: More than 200 medications and chemicals are ototoxic, or damaging to your hearing health. Some of those known to cause permanent damage include certain types of antibiotics, anti-inflammatory medications and cancer chemotherapy drugs.

How Sensorineural Hearing Loss affects children?

Sensorineural hearing loss affects both the loudness and the clarity of the sounds heard and can affect all ranges of hearing.

Many with sensorineural hearing loss report that they can hear but struggle to understand speech. This is especially true in the presence of background noise, and it can be frustrating and exhausting to deal with.

Prenatal screening and diagnosis?

Congenital sensorineural hearing loss happens during pregnancy. It’s far more rare. Some causes include prematurity, maternal diabetes, lack of oxygen during birth, genetics, and infectious diseases passed from the mother to child in the womb, such as rubella.

Thanks to newborn screening, some children born with hearing loss are diagnosed right away and treated with hearing aids or cochlear implants as soon as possible to help with language development. 

Getting help?

Most often, the recommended treatment is hearing aids programmed to your unique hearing loss. Simply amplifying all sounds won’t help you hear better because some sounds would still be distorted. Proper testing and fitting is vital.  In some cases a cochlear implant may be the better option.

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