Paediatric neurology: ‘Little brains’ matter
There are many children suffering from various neurological disorders worldwide, and they require special attention as well as care. To provide the same, paediatric neurology as a speciality is fast catching up in developed nations, but is India working towards
A sub-speciality of neurology, paediatric neurology has received emphasis in the recent years. Dealing with the disorders among children, paediatric neurology is a branch of medical science that combines the special expertise in diagnosing and treating disorders of the nervous system (brain, spinal cord, muscles, nerves) in the paediatric age group. “Paediatric neurology and neurosurgery is a fast growing sub speciality in neurosciences. This deals with all the disorders of the central nervous system in children under the age of 18 years ranging from congenital, infections, trauma, malignancies and developmental disorders,” says Dr N K Venkataramana, Vice-Chairman and Chief Neurosurgeon, BGS Global Hospitals. Paediatric neurologists treat children for neurological problems from birth into young adulthood (up to 18 years). It is also very essential to have an understanding of medical disorders in childhood and the special needs of the children, their family and their environment. In short, it comprehensively deals with the whole gamut of neurological diseases in childhood and looking at the growing cases of such neurological diseases among children more emphasis needs to be given to this sub-speciality in India.
Diagnosis and causes
Any neurological condition that originates from birth for various reasons can disable the child for life and affects the family too. Almost 40 per cent of the population comprises children with metabolic diseases, neuro oncological problems and vascular diseases. Survival rates among these children have improved because of better medical facilities. The most common conditions are cerebral palsy, autism, learning difficulty (mental retardation), encephalitis (brain fever), muscular dystrophy and epilepsy. Epilepsy is a seizure-causing disorder that is most common in children and generally, most of the symptoms of epilepsy can be controlled but not cured. Many other neurological disorders are common in children. Neuromuscular diseases, such as cerebral palsy, can cause severe physical disability in human development.
In some cases, delays in the development of a child can be linked to neural causes. Children often get unexplained headaches that are related to problems in the central nervous system. Learning and behavioral disorders, such as Attention-Deficit Disorder (ADD) and Attention-Deficit Hyperactivity Disorder (ADHD) are very common in children. Paediatric neurologists are specially trained to recognise and, in any way possible, treat these unique neural problems of children. Each of these diseases has their own symptoms that a trained paeditaric neurologist can identify. There are various factors that bring about these disorders among the young population. “First, birth-related brain injury is very common, they can be prevented if better healthcare facilities are available in every part of India. Increasing awareness about these conditions among the public and health professionals is vital to manage these conditions better and to provide better quality of life for the children with these neurological conditions. Second, big group comprises learning difficulty (mental retardation), autism; again awareness and facility to rehabilitate them is limited,” says Dr V Murugan, Consultant Paediatric Neurologist.
Development of the sub-speciality in India
This sub-speciality under neurology has received enough attention from developed countries and there is increasing awareness regarding the need of such speciality. But in a developing country like India the situation is still in a nascent stage, though efforts have started. “In India, congenital disorders, infections, neuromuscular disorders and tumours are the commonest and most of these problems are being addressed adequately. Diagnostic facilities have improved a lot in the recent past.
Prenatal diagnosis & screening for anomalies has become the norm. At present, paediatric neurosurgery has evolved a lot but unfortunately the number of clinicians is dismally
low in the country.
There are few centres with state-of-the-art facility functioning as referral centres, yet lack of awareness and early diagnosis, poor referral pattern, lack of adequate centers and specialists are the indigenous problems of this country,” avers Dr Venkataramana. The awareness is better in developed countries as compared to developing countries such as ours. Large resources (both human and financial) are required but what is available is comparatively very less.
As no facilities exist in rural areas and semi urban towns, families have to look after these children without professional guidance. There are a few regional centres in state capitals that cater to those who have access to these centres. “I have seen resistance among healthcare professionals in terms of training more doctors in the speciality and also referring patients appropriately to paediatric neurologists for specialist care. The treatment gap is huge in specialist services like paediatric neurology. The urban population has better access to rehabilitation therapy as compared to the rural population,” believes Dr Murugan. Thus, in a developing nation like India this speciality is facing increasing number of hurdles and loopholes that need to be addressed.
Loopholes to be addressed
One of the glaring loopholes in this speciality is the lack of trained professionals. This speciality requires highly trained doctors and India has very few to offer. “At the very least we should aim to match the number of adult neurologists; currently adult neurologists are available in almost every district,” says Dr Murugan. Paediatric neurology services work better if the whole rehabilitation (physiotherapy, occupational therapy, speech therapy and clinical psychologist) team work together as a unit. “They demand dedicated paediatric anaesthetist, intensivist and whole lot of specialists with paediatric experience apart from psychologists and counselors,” informs Dr.Venkataramana. And most of these rehabilitation centres are located in the urban areas while the children from the remote corners of the country are deprived of these facilities. The appalling lack of awareness among the population is also leading to neglect of this specialty. Public awareness about neurological conditions in children is lacking, and this can be addressed through media with the help of paediatric neurologists. After discharge, the family has to get geared up for home care and schools must know how to handle such children, hence awareness plays a major role in it. “Our ambulance services should improve with facilities and paramedics trained to handle paediatric emergencies, and we must encourage research to address our indigenous problems. Also, affordability is a factor in a country like India, so more support groups are urged to come forward and help these children,” says Dr Venkataramana.
India has started recognising the need of such a speciality and making progress in acknowledging the same. But more emphasis on awareness is required, while the diagnostic facilities should improve along with the support services. Despite the limitations, the speciality is growing but we have a long road ahead to cover.