IAP Textbook of PEDIATRIC NEUROLOGY
Get Video Contents Online at emedicine360.com
Video Atlas
Anoop Verma, Arun Agrawal
Videos online at emedicine360.com consists of videos of various disorders discussed in the text of Chapters 19, 22, 29, 32. The videos can be simultaneously run while reading the text (refer to video).
The collection of videos are contributions from eminent clinicians and neurologists across the country. These videos are for teaching and education purpose and not for individual download for presentation.
Chapter 19: Approach to a Child with Epilepsy by Dr KN Shah, Mumbai
Chapter 22: Approach to Seizures Imitator and Seizure Mimics by Dr Neeta Naik, Mumbai
Chapter 29: Approach to Early Intervention Therapy in Cerebral Palsy by Col DY Shrikhande, Dr Shiela Shrikhande, Ahmednagar
Chapter 32: Approach to Movement Disorders in Children by Dr Anoop Verma, Raipur
IAP Textbook of PEDIATRIC NEUROLOGY
SECOND EDITION
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IAP Textbook of Pediatric Neurology
First Edition: 2014
Second Edition: 2019
9789352709793
Printed at:
- AK Rawat MD FPAI
- Formerly, Dean and Professor
- Department of Pediatrics
- Government of Medical College
- Sagar, Madhya Pradesh, India
- Amarjeet Wagh MD DNB Fellow in Pediatric Neurology (AIMS)
- Director, Little Brain Center
- Editor, Indian Journal of Pediatric Neurology
- Nagpur, Maharashtra, India
- Anaita Udwadia Hegde DCH MD (Ped) MRCPCH (London) Fellowship Pediatric Neurology(London)
- Consultant
- Department of Pediatric Neurologist
- Jaslok Hospital and Research Centre
- Breach Candy Hospital Trust
- Wadia Children's Hospital
- Mumbai, Maharashtra, India
- Anju Agarwal MD FIAP MNAMS
- Professor
- Department of Pediatrics
- University College of Medical Sciences
- Guru Teg Bahadur Hospital
- New Delhi, India
- Anoop Verma MD FIAP FIAMS FCGP FPNC FPAI
- Former National Chairperson, Neurology Chapter, IAP
- Director, Swapnil Institute of Child Health
- Raipur, Chhattisgarh, India
- Arijit Chattopadhyay DCH MD MRCP FRCPCH CCST
- Consultant Pediatric Neurologist
- Apollo Gleneagles Hospitals
- Kolkata, West Bengal, India
- Arpita Thakker Adhikari MD PGDDN Fellowship in Pediatric Neurology (USA)
- Associate Professor
- Department of Neurology, Epilepsy and Developmental Pediatrics
- Lokmanya Tilak Municipal Medical College
- Mumbai, Maharashtra, India
- Arun Agrawal MD MNAMS FIAP FPAI FPNC FIAMS MIUAT FICMCH
- Honorary Professor
- Department of Pediatrics
- Indian College of Maternal and Child Health
- Past Chairperson, Neurology Chapter
- Chandra Laxmi Hospital
- Ghaziabad, Uttar Pradesh, India
- Arundhati Patil MD Fellow in Pediatric Neurology PG Diploma in Developmental Neurology
- Associate Professor
- Department of Pediatrics
- Mahadevappa Rampure Medical College
- Kalaburagi, Karnataka, India
- Bindu Thankappan MD DCH DM (Neurology)
- Assistant Professor
- Department of Pediatric Neurology
- Medical College
- Thiruvananthapuram, Kerala, India
- D Kalpana MD DM
- Pediatric Neurologist
- Kerala Institute of Medical Science Hospital
- Thiruvananthapuram, Kerala, India
- DY Shrikhande MD FPAI
- Professor and Head
- Department of Pediatrics
- Pravara Institute of Medical Sciences, Loni
- Ahmednagar, Maharashtra, India
- G Malini MD
- Senior Consultant and In-Charge
- Neonatal Unit
- Department of Pediatrics
- Jawaharlal Nehru Hospital and
- Research Center
- Bhilai, Chhattisgarh, India
- Girish Subramanium MD DNB
- Consultant, Department of Pediatric
- Children Hospital, Midas Heights
- Nagpur, Maharashtra, India
- Himani Bhasin MD
- Senior Resident
- Lady Hardinge Medical College
- New Delhi, India
- Jayashri L MD
- Professor
- Department of Radiodiagnosis
- Government Medical College
- Kollam, Kerala, India
- Jeeson Unni MD FIAP
- Editor-in-Chief
- National Pediatric Drug Formulary
- Consultant
- Department of Pediatrics
- Dr Kunhalu's Nursing Home
- Kochi, Kerala, India
- Jitendra Sahu MD DM (Ped Neuro)
- Additional Professor
- Department of Pediatric Neurology
- Advanced Pediatric Center
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Kalpana Dutta MD
- Professor
- Department of Pediatrics
- Kolkata Medical College
- Institute of Post Graduate Medical Education and Research
- Kolkata, West Bengal, India
- Kavita Srivastava MD Fellowship in Pediatric Neurology
- Professor, Department of Pediatrics
- In-Charge, Pediatric Epilepsy and Neurology Unit
- Bharti Vidyapeeth Deemed University Medical College
- Pune, Maharashtra, India
- Kiran Makhija MD
- Consultant
- Department of Pediatrics
- Makhija Hospital
- Raipur, Chhattisgarh, India
- KN Shah FRCP (Edinburgh) MRCP (London) DCH (London) DPed
- Pediatric Neurologist and Epileptologist
- Bai Jerbai Wadia Hospital for Children
- Lilavati Hospital and Research Centre
- Bhatia General Hospital
- Conwest Jain Clinic Group of Hospitals
- Ruxmani Hospital
- Mumbai, Maharashtra, India
- KP Sarbhai MD FCGP FPNC
- Consulting Pediatrician
- National Chairperson (2019) IAP, Neurology Chapter
- Raipur, Chhattisgarh, India
- Lokesh Lingappa MD (Ped) MD MRCPCH (Neuro)
- Consultant
- Department of Pediatric Neurology
- Rainbow Children's Hospital
- Hyderabad, Telangana, India
- Madhu Singh MD
- Lecturer
- Department of Pediatrics
- SN Medical College
- Agra, Uttar Pradesh, India
- Mahak Bansal MD
- Clinical Fellow
- Department of Pediatric Intensive Care
- King's College Hospital
- London, England, UK
- Meenakshi Girish MD DNB FRCPCH
- Associate Professor
- Department of Pediatrics
- NKP Salve Institute of Medical Sciences
- Nagpur, Maharashtra, India
- Neelu Desai MD DNB Fellowship Pediatric Neurology (London)
- Consultant
- Department of Pediatric Neurology
- Jupiter Hospital, Sion Hospital
- Mumbai, Maharashtra, India
- Neeta Naik MD DCH DNB
- Child Neurologist and Developmental Pediatrician
- Director and Chief
- EN1 Neuro Services Pvt Ltd
- Mumbai, Maharashtra, India
- Visisting Consultant, Child Neurology and Neurosciences
- BYL Nair Hospital, Hindu Sabha Hospital, Mumbai
- Masina Hospital
- Goa, India
- Neha Garg MD
- Pediatric Consultant
- Dr NehaGarg's Clinic
- Agra, Uttar Pradesh, India
- Nitin Maheshwari MD MRCPCH (London) CCT (Oxford) FRCPCH (Lonon)
- Pediatric Neurologist
- John Radcliffe Hospital
- Oxford, England, UK
- Nitish Vora MBBS MD DPed MRCPCH (UK) FRCPCH (UK)
- Pediatric Neurologist and Epileptologist
- Lilawati Child Neuro Care
- Ahmedabad, Gugarat, India
- Consultant Pediatric Neurologist
- CCT, Paediatric Neurology (UK)
- PAM Kunju MD DM WHO Fellow (USA)
- Dean, Faculty of Medicine, University of Kerala
- Professor and Head, Department of Pediatric Neurology
- Medical College, Thiruvananthapuram
- Member, American Academy of Neurology
- President, Kerala Association of Neurologists
- President, Indian Academy of Pediatrics (IAP)
- Kerala, India
- Payal Shah DCH MD
- Senior Clinical Associate
- PD Hinduja National Hospital and Medical Research Center
- Mumbai, Maharashtra, India
- Pranati Sharma Agrawal MS FAGE MCh (Neurosurgery)
- Senior Resident
- Department of Neurosurgery
- Sri Aurobindo Institute of Medical Sciences
- Indore, Madhya Pradesh, India
- Prateek Kumar Panda MD
- Senior Resident
- Child Neurology Division, Department of Pediatrics
- All India Institute of Medical Sciences
- New Delhi, India
- Priyanka Madaan MD DM
- Senior Research Officer
- Child Neurology Division
- Department of Pediatrics
- Advanced Pediatric Center
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Rachana Dubey MD DNB MNAMS (Ped)
- DM (Ped Neuro)
- Consultant
- Department of Child Neurology
- Medanta Superspeciality Hospital
- Indore, Madhya Pradesh, India
- Rajeshwar Dayal MD FAMS FIAP DNB DCH (London)
- Professor and Head
- Department of Pediatrics
- SN Medical College
- Agra, Uttar Pradesh, India
- Ramesh Konanki MD (Ped) DM (Ped Neuro)
- Consultant
- Department of Pediatric Neurology
- Rainbow Children's Hospital
- Hyderabad, Telangana, India
- Razia A Kadwa MD DNB DM (Ped Neuro)
- Consultant Pediatric Neurologist
- Ankura Hospital for Women and Children
- Hyderabad, Telangana, India
- Shekhar G Patil MD DM
- Consultant
- Department of Pediatric Neurology
- Apollo Hospital
- Navi Mumbai, Maharashtra, India
- SM Dewangan MD
- Joint Director and Head
- Department of Pediatrics
- Jawaharlal Nehru Hospital and Research Center
- Bhilai, Chhattisgarh, India
- Sanjeev Joshi MD
- Director, Chirayu Criticare Center
- National Secretary
- Neurology Chapter (2017–2018)
- Yavatmal, Maharashtra, India
- Sanwer Agrawal MD
- Director, Head and DNB Coordinator
- Ekta Institute of Child Health
- Raipur, Chhattisgarh, India
- Sharad Sharma MD MRCPCH (UK)
- Fellowship in Pediatric Neurology
- Additional Director
- Fortis Hospital
- Jaipur, Rajasthan, India
- Sheffali Gulati MD FAMS FIAP FIMSA
- Professor and Chief, Child Neurology Division
- Department of Pediatrics
- All India Institute of Medical Sciences
- New Delhi, India
- Sheila Shrikhande BDS MS Psychotherapy & Counseling PgD Psychological Counseling (Rehabilitation)
- Ahmednagar, Maharashtra, India
- Shilpa Kulkarni MD DNB MNAMS
- In-Charge, Pediatric Neuroscience
- Bai Jerbai Wadia Hospital for Children
- Mumbai, Maharashtra, India
- Siddhartha Shah MD DCH MRCPCH (UK) FRCPCH (UK)
- Pediatric Neurology Clinic
- Ahmedabad, Gujarat, India
- Sujata Kanhere MBBS DCH DNB (Ped) MNAMS FRCPCH PhD
- Professor and Head
- Chief, Pediatric Neurology and Neurodevelopment
- Department of Pediatrics and Neonatology
- KJ Somaiya Medical College, Hospital and Research Centre
- Mumbai, Maharashtra, India
- Supratim Dutta MD DCH
- Professor and Head
- Department of Pediatrics
- Kolkata Medical College
- Institute of Post Graduate Medical Education and Research
- Kolkata, West Bengal, India
- Suvasini Sharma MD DM (Ped Neuro)
- Assistant Professor
- Department of Pediatrics
- Lady Hardinge Medical College
- New Delhi, India
- TM Anandakeshavan MD FIAP MNAMS FIAMS
- Department of Pediatrics
- Government Medical College
- Thrissur, Kerala, India
- Trupti Jadhav MBBS DNB FRACP
- Pediatric Neurologist
- The Royal Children's Hospital
- Parkville, VIC, Australia
- Vasant Khalatkar MD (Ped) FIAP
- Khlalatkar Hospital
- Nagpur, Maharashtra, India
- Vineet Bhushan Gupta MD MRCP (UK) MRPCH DCH (London)
- Senior Consultant
- Department of Pediatric Neurology
- Indraprastha Apollo Hospitals
- New Delhi, India
- Vineet Wankhede DCH DNB Fellowship in Pediatric Neurology
- Consultant Pediatric Neurologist and Epileptologist
- Director, Kids Neuro Clinic and Child Rehabilitation Center
- Nagpur, Maharashtra, India
- Vishal Sondhi MD (Ped) DM (Ped Neuro)
- Associate Professor
- Department of Pediatrics
- Armed Forces Medical College
- Pune, Maharashtra, India
- Vrajesh Udani MD Diplomate of the American Board of Child Neurology; Diplomate of the American Board of Clinical Neurophysiology
- Consultant
- Department of Child Neurology and Comprehensive Epilepsy Center
- PD Hinduja National Hospital and Medical Research Center
- Mumbai, Maharashtra, India
I am delighted to know that IAP Textbook of Pediatric Neurology has been revised under the editorial stewardship of Dr Anoop Verma and Dr PAM Kunju. This, the second edition, continues the tradition of excellence with thorough revisions that bring you fully up-to-date with all that's new in the field of neurology. Few new sections and many new chapters and a reconfigured format make this a comprehensive and clearly written resource for the experienced clinician as well as the physician-in-training as IAP neurology fellowships are getting popular. I am sure this is going to be an excellent reference book for the would-be pediatric neurologist. This is a remarkable and commendable achievement. I am astonished that they have brought out this edition in record time. I wish to congratulate all colleagues involved in this monumental effort.
What this comprehensive and reader-friendly book strives to do is to demystify the subject and make it comprehensible even to the average reader. The book encompasses, within the covers of a single volume, all aspects of pediatric neurology with great skill and dexterity. It gives an in-depth account of the diagnosis and management of all common pediatric neurological problems as well as rare neurological diseases. Dr Anoop and Dr Kunju with their expertise and long years of experience, give us a masterly analysis of different topics from neonates to adolescents. I am impressed that epilepsy, a disease dreaded by many, with lots of superstitions has been dealt extensively. As this book is intended primarily as a textbook for students of MD, fellows of pediatrics neurology as well as pediatricians who wish to have deeper knowledge of the subject, I am sure all these target categories will find the book quite useful.
I wish the reader an enlightening academic experience. I am sure this book is going to be a darling of IAPians and I hope to see next edition as soon as possible.
Santosh T Soans
President
Indian Academy of Pediatrics
FOREWORD
It gives me sense of honor and pleasure to write foreword for the Textbook of Pediatric Neurology.
In earlier time in India, there was a handful of institutions where children with neurological problems were managed and probably for getting trained in this subspecialty, one had to go out of country. But, in the last few years, pediatric neurology has emerged as an important subspecialty with many institutions not only offering treatment to children with neurological problems but also extend training to students in this subspecialty. In view of country-specific medical problems and difficulties associated with its management within the available resources, it will be imperative to have a textbook written by local experts who not only know the problems but also have developed alternative indigenous management system.
Keeping this in mind, the Indian Academy of Pediatrics (IAP) decided to come out with the second edition of IAP Textbook of Pediatric Neurology, which will be useful to pediatric neurology fellowship trainees as well as to practicing pediatricians. The text will surely be proved useful to DM neurology students who have special interest in pediatric neurology.
The book covers almost all aspects of pediatric neurology, neuroimaging and neurosurgical problems in children. This book is enriched with flowcharts, diagrams, photographs and guidelines.
My sincere compliments and congratulations to all the authors, who as a part of their sincere efforts to disseminate the knowledge, have contributed chapters for this prestigious publication. I congratulate the entire editorial board led by Dr Anoop Verma, Dr PAM Kunju, Dr TM Anandakeshavan and Dr Sujata Kanhere, for their untiring efforts to bring out this book.
I am sure that this book will be popular amongst the postgraduate students, teaching faculties as well as practicing pediatricians. I wish this landmark publication great success and wish it will contribute in rational management of neurological conditions.
Digant D Shastri
President
Indian Academy of Pediatrics, 2019
FOREWORD
It is both a pleasure and privilege to be involved with the second edition of IAP Textbook of Pediatric Neurology. The pediatric neurology textbook in its first visit had a phenomenal acceptance from the pediatric fraternity of the country. And, to satiate the academic appetite of our academician friends, the Indian Academy of Pediatrics (IAP) has decided to bring out the second edition of this book with updates from all aspects in child neurology.
The neurology textbook of IAP had been a boon to the students of this discipline. The entire gamut of pediatric neurology has been analyzed and dissected in a standardized format for better and easy understanding.
I am sure this book will be an asset to the students, teachers as well as practising pediatricians. The authors and the editors especially Dr Anoop Verma and Dr PAM Kunju are to be congratulated for providing the updated edition of such a high standard book, which is highly relevant to the pediatric scenario of our country.
With best wishes
Remesh Kumar R
Honorary Secretary General
Indian Academy of Pediatric, 2018 and 2019
PREFACE TO THE SECOND EDITION
The history of neurology in India stems from its rich culture and tradition. The first neurosurgical operation in India was trans-sphenoidal hypophysectomy done in 1935 at Chennai, Tamil Nadu, India. At that time, neurosurgeon and neurophysician were not trained in India; in fact, they went abroad to acquire the specialized knowledge. In around 1948, the first neurosurgical training was established at Christian Medical College (CMC), Vellore, Tamil Nadu. Later, the notion of establishment of neurosciences department was conceptualized. Over the years, similar developments were seen in other parts of the country. In the West, pediatric neurology is now a distinct and separate department. In India, the history of pediatric neurology emerges from Chennai; subsequently, this subspecialty dominated the medical field in other parts of the country.
The pediatric neurology department serves as a vital link between pediatrician and traditional adult neurologist. The pediatric neurology brings home the expertise in anatomical localization leading to correct diagnosis and management of chronic neurological disorders learned from traditional neurology and combines with it the knowledge of normal maturation and development, learned from pediatric training. Even till date, many pediatricians rate their training in pediatric neurology as inadequate.
Clinical neurology has become increasingly dependent on laboratory tests and to an even greater degree on imaging procedures, at the expense of the history and the physical examination. Although this kind of technological support has become available in much of the developing world, still to an inadequate extent in India. Clearly, the practice of tropical neurology will remain a ‘hands-on’ clinical discipline for many years to come. Young neurologists coming home from abroad, who have been accustomed to the easy availability of an avalanche of ancillary diagnostic aids, may find it difficult to go back to relying on not much more than a thorough history and a detailed neurological examination.
Medicine involves playing the odds, assessing the relative chance that a patient is/is not suffering from a particular illness. There is always an element of uncertainty. The clinical approach, i.e. history and clinical examination discussed here will help pediatricians to reach the tentative neurological diagnosis. The stepwise approach of neurophysiological diagnosis, how to read computed tomography (CT) scan and magnetic resonance imaging (MRI) will help in day-to-day practice effectively. This book is having an excellent collection of common neonatal, pediatric neurological problems by eminent scientists in the field for years; not only they have precisely selected the topic but also given their best experience in it.
The actual practice of medicine is as much about style as it is about science. It is a known fact that “a picture is worth a thousand words and video is worth a thousand pictures”. Videos of common neurological disorders in children are given online at emedicine360.com. Just enjoy viewing the videos and get an experience of classroom teaching in real time. This wonderful, clinically rich material will help pediatricians in long way.
PREFACE TO THE FIRST EDITION
The history of neurology in India stems from its rich culture and tradition. The first neurosurgical operation in India was trans-sphenoidal hypophysectomy done in 1935 at Chennai, Tamil Nadu, India. At that time, neurosurgeons and neurophysicians were not trained in India; in fact, they went abroad to acquire the specialized knowledge. In around 1948, the first neurosurgical training was established at Christian Medical College and Hospital, Vellore, Tamil Nadu; later on, the notion of establishment of neurosciences department was conceptualized. Over the years, similar developments were seen in other parts of the country. In the West, pediatric neurology is now a distinct and separate department. In India, the history of pediatric neurology emerges from Chennai; subsequently, this subspecialty dominated the medical field in other parts of the country.
The pediatric neurology department serves as a vital link between pediatricians and traditional adult neurologists. The pediatric neurology brings home the expertise in anatomical localization leading to correct diagnosis and management of chronic neurological disorders learned from traditional neurology and combines with it the knowledge of normal maturation and development, learned from pediatric training. Even till date, many pediatricians rate their training in pediatric neurology as inadequate.
Clinical neurology has become increasingly dependent on laboratory tests and to an even greater degree on imaging procedures, at the expense of the history and the physical examination. Although this kind of technological support has become available in much of the developing world, still to an inadequate extent in India. Clearly, the practice of tropical neurology will remain a “hands-on” clinical discipline for many years to come. Young neurologists coming home from abroad, who have been accustomed to the easy availability of an avalanche of ancillary diagnostic aids, may find it difficult to go back to relying on not much more than a thorough history and a detailed neurological examination.
Medicine involves playing the odds, assessing the relative chance that a patient is/is not suffering from a particular illness. There is always an element of uncertainty. The clinical approach, i.e. history and clinical examination discussed here will help pediatricians to reach the tentative neurological diagnosis. The stepwise approach of neurophysiological diagnosis, how to read computed tomography (CT) scan and magnetic resonance imaging (MRI) will help in day-to-day practice effectively. This book is having an excellent collection of common neonatal and pediatric neurological problems by eminent scientists in the field for years; not only they have precisely selected the topic but also given their best experience in it.
The actual practice of medicine is as much about style as it is about science. It is a known fact that“a picture is worth a thousand words and video is worth a thousand pictures”. The accompanying interactive DVD in this book is a collection of common movement disorders in children. The videos are having voice-over to explain you the basic phenomenology of each of movement disorder. Just enjoy viewing the videos and get an experience of classroom teaching in real time. This wonderful and clinically rich material will help pediatricians in long way.
Anoop Verma
ACKNOWLEDGMENTS
We are extremely thankful to Dr Santosh T Soans, National IAP President – 2018, who has taken the challenge of bringing IAP Textbook of Pediatric Neurology for IAP members. We are thankful for his valuable support, encouragement, supervision and useful suggestions throughout this work. His moral support and continuous guidance and his blessings in the form of foreword enabled us to complete this work successfully.
We are in debt to our National President – 2019, Dr Digant D Shastri; Secretary General, Dr Bakul Parekh, for their blessings and support during this publication.
The editorial board in the form of Dr Anandakeshavan as Academic Editor, Dr Sujata Kanhere, as Editor has worked really hard to give excellent shape to this book. Words are insufficient to express the deep gratitude to them.
If editorial board is the brain, contributors are the nerves, this piece of work was only possible due to excellent communication between us. We are proud to have great contributors of national and international fame. We feel short of words to decorate our feeling of gratitude for them.
Our due regards to Shri Jitendra P Vij (Group Chairman), Mr Ankit Vij (Managing Director) and Mr MS Mani (Group President), M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for rendering help to come out with this publication in time. Ms Madhuri Aggarwal, Development Editor from Jaypee Brothers Medical Publishers, being instrumental and helpful for this publication and extended profound support and interest in the release.
Our thanks to Mr Manoj Verma, Director, Swapnil Digital Studio, Raipur, Chhattisgarh, for helping in consolidating the videos for the book.