Neurological disorders in children: Autism is a developmental disorder (neurobehavioral condition) of variable severity in children – often associated with impairment of communication, language and interaction skills – along with restrictive patterns of activities, behaviours and interests. Children affected by this condition demonstrate versatile symptoms – hence the disorder is also known as Autism Spectrum Disorder (ASD). There are many subtypes of autism – and each child with autism demonstrate unique strengths and challenges.
Characteristic Features of the Disorder
- Onsets before 36 months
- Restrictive patterns of activities, behaviours and interests
- Stereotypical -repetitive behaviour
- Impairment of social interaction
- Impairment of social interaction
- The symptoms associated with autism are found early in childhood
- Speaking difficulties, lack of communication and other developmental skills
- 1 in 88 children are diagnosed with autism spectrum disorder.
How to know whether a child has autism?
One can suspect autism in a child if the child lacks synchronous eye gestures – eye pointing or eye gaze; shows lack of interest in play and social gathering or social interaction; lacks eye contact; communicate rarely or uses language rarely for social communication and lacks imitation.
Can a child develop autism at an early age? If yes, then how to identify?
• You can suspect autism in a child if there is absence of typical sounds by age 12 months (Gibberish meaningless utterances made by a baby) • If a child does not gesture by 12 months (typical hand waving) • If a child does not utter single words by age 16 months. • If a child does not utter two words spontaneously by 24 months • Loss of language or social skills at any age
What is the cause for autism?
The exact cause is unknown, but proposed mechanisms suggests abnormal connectivity among neurons; molecular levels defects in the brain during its development in a foetus; imbalances in neurotransmitters and abnormal neurons.
Diagnosis of autism based on the symptoms?
Autism can be diagnosed in a child if the child shows restricted interests, activities and behaviours and the child is deficient in social communication and interaction. Lack of gestures, body postures, eye contact, facial expressions, smile and interests. Other symptoms may include finger twirling, hand flapping, body rocking and tiptoeing. The child may also be adhered to non-functional routine or rituals and shows intense interest in some objects, numbers or letters. The other abnormal behaviour shown by the child include increased sensitivity to touch, clapping hands over their ears, refusing to eat food with certain taste or texture, diminished response to pain, uncontrollable laughing or crying. Sometimes children may develop excessive fear of harmless objects. Symptoms are present early in childhood and they impair or hinder day-to-day activities of the child. There is no specific biological diagnostic test to detect autism in children. But there are some improved diagnostic procedures that help clinicians diagnose autism in children at a younger age. Diagnosis is based on systematic screening involving the inputs from parents and the other parameters, such as: M-CHAT: modified Checklist for Autism in toddlers and ABC (Autism Behavioural checklist for older children); ADI-R: Autism Diagnostic Inventory-Revised and CARS: Childhood Autism Rating Scale. Thus, structured and systematic screening helps in measuring the prevalence of symptoms. Diagnosis: MRI is usually not recommended for the diagnosis of autism. However, when a child neurologist suspects neurological causes including abnormal head size or neurocutaneous stigmata, MRI is useful. When the patient’s history is indicative of cognitive decline, encephalopathy or seizures, then EEG may be recommended. In cases of children with a positive family history, abnormal head size or dysmorphic features, genetic evaluation should be recommended.
What are the co- morbidities?
Sleep disturbances, behavioural disorders, mood disturbances, abnormal moods, hyperactivity, sensory deviance, hearing and vision problems, obsessive compulsive behaviour, intellectual disability and epilepsy. Nearly 50% of children with autism spectrum disorder find sleeping difficulty, wake up frequently during nights and sleep less.
Whom should you consult?
You should consult a paediatrician or preferably a pediatric neurologist or a child neurologist in Hyderabad
Who are involved in the management of Autism?
Child’s family, pediatric neurologist, clinical psychologist, special educator, geneticist, occupational and speech therapist are involved in the management of autism.
What is the role of drug therapy and diet in autism?
There is no specific drug or single drug which can cure or treat autism. There is no definite conclusive evidence to support dietary therapy in children with Autism.
What are febrile seizures?
A febrile seizure is one of the most common neurological disorders in children. It is an uncontrolled, involuntary body movement – especially the uncontrolled shaking of hands and legs. Majority of the febrile seizures are convulsions which are triggered by fever. During a febrile seizure a child may lose consciousness for a few seconds to minutes. Stiff limbs, rapid eye movements and twitching of a leg or arm or a part of the body are the less common symptoms. Young children between 6 months to 5 years age are most likely to experience febrile seizures. The fever may be associated with flu, cold or an ear infection. In some cases, fever is not present when the seizure begins, but develops later.
Febrile seizures are often frightening for parents though they occur for a brief period of around 5 to 15 minutes. Such seizures do not cause any long-term health issues. They do not increase the risk of epilepsy either. As many people worry that febrile seizures may lead to epilepsy. However, prolonged seizures (lasting for more than 15 minutes) can carry an increased risk of developing epilepsy in children. They usually have a good outcome though.
Are febrile seizures common?
These are common type of convulsions in infants and young children and nearly about 2 to 5 percent of children before age 5 experience them. Among children who experienced one febrile seizure, nearly 40 percent will experience another one or recurrent seizures. However, the risk increases if a child experiences the first febrile seizure at a young age (less than 18 months age) and has a family history of seizures or when the child experiences febrile seizure as the first sign of an illness. A prolonged first seizure doesn’t necessarily mean that the risk of recurring seizures increases, but when it occurs, then it is more likely to be prolonged.
Are febrile seizures harmful?
In majority of the cases of febrile seizures, there seems no apparent harm or long-term damage to the child as majority of the febrile seizures are short. The hazards such as choking and injury by falling can be avoided if proper first aid measures are followed by the parents. Children with febrile seizures and with prolonged febrile seizures have normal recovery, proper schooling, school achievements and performance as majority of the studies have shown that children with febrile seizures performed well in aptitude and intellectual tests and performed as good as their counterparts. Even the children with prolonged seizures have shown complete recovery and better performance in studies. Recurring seizures, multiple seizures and prolonged seizures increases the risk for epilepsy, but majority of the children who experience seizures do not go on to develop repeated seizures. Multiple seizures increase the risk of epilepsy. However, some children with neurological abnormalities, delayed development, cerebral palsy and a family history of seizures are at increased risk of developing epilepsy irrespective of whether they have febrile seizures. Even febrile seizures are also common in such children. Even then the seizures do not contribute much to the overall risk of developing epilepsy.
What are the factors that increases the risk of epilepsy after a seizure?
The factors that increases the risk of epilepsy after a seizure include the following: A brief full-body febrile seizure A febrile seizure lasting more than 10 to 15 minutes A seizure that begins on one side of the brain – focal seizure Seizures that reoccur within 24 hours In the above type of cases, there is a moderately increased risk of developing epilepsy. There are some cases of febrile seizures occurring in a small group of children, which last longer than 30 minutes (very prolonged febrile seizures), the risk of developing epilepsy is as high as 30 to 40 percent.
How are febrile seizures evaluated?
A paediatric neurologist makes a note of child’s medical history, present health condition, accompanying illnesses, symptoms – and then physically examines the child. Prior to making a clinical diagnosis, the doctor may order certain tests to ensure that the seizures are not due to any underlying – more serious health condition, such as meningitis. If a child experiencing seizures is presented with prolonged seizures or seizures accompanied by other illnesses such as serious infections or if the child is younger than 6 months of age, then the paediatric neurologist may recommend hospitalization. However, majority of the cases of febrile seizures do not require hospitalization. If the physician suspects that the underlying cause of the seizure could be meningitis, then cerebrospinal fluid testing is done after removing the spinal fluid by spinal tap. In some cases – excessive water loss (dehydration) from the infant’s body due to vomiting and loose motions (diarrhea) can also trigger seizures. In such cases, blood and urine tests may be recommended by the physician. However, in majority of the cases, a child who has a febrile seizure does not require hospitalization.
Can subsequent febrile seizures be prevented?
Most of the febrile seizures are harmless and brief. However, this does not mean that there will be no subsequent seizures. The risk of having another seizure is there. There are some medicines which are well tolerated by children and are effective in treating seizures and also effective in reducing the risk of having another febrile seizure. However, majority of the children with febrile seizures do not require medication. Therefore, medicines should be prescribed to children with caution as there are some medicines for seizures whose side effects outweighs their benefits. A prolonged first febrile seizure in a child doesn’t mean that the child will have recurring prolonged seizures. However, if they encounter another one, it would be a prolonged one. As prolonged repeated seizures are associated with the risk of developing epilepsy, doctors prescribed medicines to prevent prolonged seizures. Doctors counsel the parents about the treatment options. Prolonged febrile seizures are often associated with the risk of injury and developing epilepsy.
Research on febrile seizures
Research studies are being performed to explore the potential risk factors involving environmental, genetic and biological – which could play a role in making some children susceptible to febrile seizures. In addition, scientists are also working on certain other aspects to know the factors that will help predict which children are at increased risk of prolonged and recurring febrile seizures. Scientists are also studying and continuing their research on febrile seizures to understand the long-term impact that a febrile seizure may have on the cognitive abilities, memory, behaviour, intelligence, school achievement and progress in studies of children – and the future consequence of developing epilepsy. Researchers are particularly assessing and studying the effects of long-duration and recurring febrile seizures on the brain part – the hippocampus. This area of the brain plays a crucial role in learning and memory. Furthermore, researchers are also focussing their attention on the impact of febrile seizures in the development of epilepsy. Temporal lobe epilepsy (TLE) is a type of epilepsy. This type of epilepsy is more likely to develop in children who have experienced prolonged febrile seizures. TLE is generally seen in young adults or adolescents with a history of seizures as young children. This type of epilepsy is difficult to treat as it involves scarring of hippocampus. The children who are potentially at risk of developing this type of condition are being studied by scientist in order to develop better treatment options for this condition. They are also investigating the condition to come out with drugs that can help prevent the potential risks – such as injury, febrile seizures, memory problems and epilepsy.
First-aid for febrile seizures / Do’s
- Remain calm
- Support the child and protect him from injury. Keep the child away from potentially harmful objects - sharp corners, sharp objects and furniture, fire or water sources.
- Loosen tight clothing.
- Be with your child and note the time when seizure starts and ends.
- Support your child's head with a pillow or soft object.
- Clean the secretions from nose and mouth.
- Remove any objects if present in the child’s mouth.
- If you notice any vomiting, then turn the child to his or her side, to prevent choking.
- Be patient and make a note of the types of movements, the duration of seizure and the parts of the body being affected.
- Inform your pediatric neurologist about all the symptoms you noted.
- After the seizure subsides, your child will be disoriented for a few minutes while the brain rests and recharges. This is normal.
- Don’t panic – remain calm.
- Do not put any objects or something in the child’s mouth.
- Do not try to hold or force the child to lie down.
- Do not put your child into cool or lukewarm water to cool off.
Seek medical help:
- If the seizure lasts longer than 5 to 10 minutes.
- If the seizure doesn’t seem to last longer, but the child is not recovering quickly.
- If the child is experiencing the seizure for the first time. Take the child to the doctor once the seizure stops – to know the cause of the fever.
- If the child becomes weak, lethargic and has stiff neck, rigid hands and legs and vomits – these are the signs of meningitis – a brain infection.
- If the child seems to have breathing difficulty.
- If the child’s skin appears or turns blue.
- If the seizures occur repeatedly.
The child should be taken immediately to the nearest medical facility or to the best child neurologist in Hyderabad for diagnosis and treatment.