Professor and Chairman Department of Child Health Pediatrician-in-Chief of Childrens Hospital University of Missouri Health Sciences Center Columbia, Missouri 2002 BC Decker Inc Hamilton London CURRENT MANAGEMENT IN CHILD NEUROLOGY Exit Sales and Distribution United States U.K., Europe, Scandinavia, Japan BC Decker Inc Middle East Igaku-Shoin Ltd. P.O. Box 785 Harcourt Publishers Limited Foreign Publications Department Lewiston, NY 14092-0785 Customer Service Department 3-24-17 Hongo Tel: 905-522-7017 / 1-800-568-7281 Foots Cray High Street Bunkyo-ku,Tokyo, Fax: 905-522-7839 / 1-888-377-4987 Sidcup, Kent Japan 113-8719 E-mail: info @ bcdecker.com DA14 5HP, UK Tel: 3 3817 5680 Website: www.bcdecker.com Tel: 44 (0) 208 308 5760 Fax: 3 3815 6776 Fax: 44 (0) 181 308 5702 E-mail: fd@igaku.shoin.co.jp E-mail: cservice@harcourt_brace.com Canada Australia, New Zealand Singapore, Malaysia, Thailand, BC Decker Inc Harcourt Australia Pty. 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No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. 01 02 03 04 / FP / 6 5 4 3 2 1 ISBN 1-55009-162-X Printed in Canada Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication. However, since research and regulation constantly change clinical standards, the reader is urged to check recent publications and the product information sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications. This is particu- larly important with new or infrequently used drugs. PASQUALE J. ACCARDO, MD Professor of Pediatrics New York Medical College Director of Pediatrics Westchester Institute for Human Development Valhalla, New York COLEEN ADAMS, MB, FRCPC Associate Professor University of Calgary Pediatric Neurologist Alberta Childrens Hospital Calgary, Alberta, Canada JEAN AICARDI, MD Consultant Hpital Robert Debr Paris, France Honorary Professor of Child Neurology Institute of Child Health University College London, United Kingdom JOHN ALVIN, PhD Associate Professor of Physiology and Pharmacology University of Pittsburgh School of Dental Medicine and Pharmacy Pittsburgh, Pennsylvania JOHN C. ANDREFSKY, MD Department of Neurosurgery and Neurology Director, Neuro-Intensive Care Unit Cleveland Clinic Foundation Cleveland, Ohio STEPHEN ASHWAL, MD Chief, Division of Pediatric Neurology Department of Pediatrics Loma Linda University Loma Linda, California ANTHONY M. AVELLINO, MD Assistant Professor of Neurological Surgery The Johns Hopkins Medical Institutions Baltimore, Maryland ELIA M. AYOUB, MD Distinguished Service Professor Emeritus Department of Pediatrics University of Florida Gainesville, Florida IDA SUE BARON, PhD Clinical Associate Professor Pediatrics Georgetown University School of Medicine Washington, DC Private Practice Potomac, Maryland ANITA L. BELMAN, MD, MS Professor of Pediatric Neurology School of Medicine State University of New York at Stony Brook Stony Brook, New York THOMAS B. BENTON, MD Adjunct Visiting Professor, Pediatrics University of Florida Gainesville, Florida M. TARIQ BHATTI, MD Assistant Professor of Ophthalmology and Neurology Co-Director, Neuro-Ophthalmology University of Florida College of Medicine Gainesville, Florida GENILA M. BIBAT, MD Research Associate Neurogenetics Unit Kennedy Krieger Institute The Johns Hopkins Medical Institutions Baltimore, Maryland THOMAS A. BLONDIS, MD Associate Professor of Clinical Pediatrics University of Chicago Childrens Hospital Chicago, Illinois iii CONTRIBUTORS JUDITH S. BLUVSTEIN, MD Pediatric Neurology Fellow Albert Einstein College of Medicine Bronx, New York BLAISE F.D. BOURGEOIS, MD Professor of Neurology Harvard Medical School Director, Division of Epilepsy and Clinical Neurophysiology Childrens Hospital Boston, Massachusetts JOHN B. BODENSTEINER, MD Chief, Pediatric Neurology Barrow Neurological Institute St. Josephs Childrens Health Center Phoenix, Arizona EUGEN J. BOLTSHAUSER, MD Professor of Pediatric Neurology University Childrens Hospital Zurich, Switzerland LAWRENCE W. BROWN, MD Co-Director, Pediatric Neuropsychiatry Program Co-Director, Pediatric Regional Epilepsy Program Childrens Hospital of Philadelphia Philadelphia, Pennsylvania JANICE E. BRUNSTROM, MD Assistant Professor of Neurology and Cell Biology Washington University School of Medicine Director, Pediatric Neurology Cerebral Palsy Center at St. Louis Childrens Hospital St. Louis, Missouri IAN J. BUTLER, MB, BS, FRACP Professor and Chairman Department of Pediatric Neurology University of Texas Medical School Houston, Texas LEONARD H. CALABRESE, DO Vice-Chairman Department of Rheumatic and Immunologic Diseases The Cleveland Clinic Foundation Cleveland, Ohio CAROL CAMFIELD, MD, FRCPC Professor, Department of Pediatrics Dalhousie University and the IWK Grace Healthcare Center Halifax, Nova Scotia, Canada PETER CAMFIELD, MD, FRCPC Professor and Chair, Department of Pediatrics Dalhousie University and the IWK Grace Healthcare Center Halifax, Nova Scotia, Canada LIONEL CARMANT, MD, FRCPC Assistant Professor of Pediatrics, Division of Neurology Hpital Sainte-Justine Montreal, Qubec, Canada BENJAMIN S. CARSON SR, MD Director of Pediatric Neurological Surgery The Johns Hopkins Medical Institutions Baltimore, Maryland BRUCE H. COHEN, MD Chief, Pediatric Neurology Cleveland Clinic Foundation Cleveland, Ohio WILLIAM I. COHEN, MD Developmental-Behavioral Pediatrician Director, Down Center of Western PA Associate Professor of Pediatrics University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania MATTHEW D. DABBS, BA Graduate Student Department of Clinical and Health Psychology University of Florida Gainesville, Florida CANDACE H. DAVID, MEd Head, Northstar Academy Richmond, Virginia RONALD B. DAVID, MD Associate Clinical Professor of Pediatrics (Pediatric Neurology) Medical College of Virginia Richmond, Virginia CAROL DELAHUNTY, MD Assistant Professor Developmental and Behavioral Pediatrics Childrens Hospital, Pittsburgh Pittsburgh, Pennsylvania LINDA DE MEIRLEIR, MD, PhD Professor of Pediatric Neurology Free University of Brussels Brussels, Belgium WILLIAM DEMYER, MD Professor Emeritus of Child Neurology Indiana University School of Medicine Indianapolis, Indiana PAOLA DIADORI, MD Assistant Clinical Professor Department of Neurology Hpital Sainte-Justine Montreal, Qubec, Canada THOMAS N. DIKEL, PhD Department of Clinical and Health Psychology University of Florida Gainesville, Florida iv / Contributors MICHAEL DUCHOWNY, MD Director, Epilepsy Program Miami Childrens Hospital Clinical Professor in Neurology and Pediatrics University of Miami School of Medicine Miami, Florida DAVID W. DUNN, MD Associate Professor of Psychiatry and Neurology Divisions of Child and Adolescent Psychiatry and Child Neurology Indiana University School of Medicine Indianapolis, Indiana LEON S. DURE IV, MD Associate Professor of Pediatrics and Neurology The University of Alabama at Birmingham Birmingham, Alabama TERENCE S. EDGAR, MD, FAAP, FAACPDM, FAAEM Assistant Professor of Neurology and Pediatrics Director of Neuromuscular and Movement Disorder Center Medical Director of the Neurophysiology Laboratory Arkansas Childrens Hospital Little Rock, Arkansas RICHARD C. ELLENBOGEN, MD Associate Professor, Department of Neurological Surgery University of Washington School of Medicine Childrens Hospital and Regional Medical Center Seattle, Washington CYNTHIA R. ELLIS, MD Associate Professor of Pediatrics Director, Division of Developmental Pediatrics University of Nebraska Medical Center Munroe-Meyer Institute for Genetics and Rehabilitation Omaha, Nebraska LYDIA EVIATAR, MD Professor of Neurology and Pediatrics Albert Einstein College of Medicine Attending Pediatric Neurologist Schneider Childrens Hospital New Hyde Park, New York SHEILA M. EYBERG, PhD Professor of Clinical and Health Psychology University of Florida Gainesville, Florida EILEEN B. FENNELL, PhD Professor of Clinical and Health Psychology and Neurology University of Florida Gainesville, Florida RICHARD S. FINKEL, MD Director, Neuromuscular Program The Childrens Hospital of Philadelphia Associate Clinical Professor of Neurology and Pediatrics, The University of Pennsylvania Philadelphia, Pennsylania NANCY M. GIUNTA, MHA, FACMPE Reimbursement Manager University of Florida Faculty Group Practice Gainesville, Florida JACK GLADSTEIN, MD Associate Dean for Student Affairs Associate Professor of Pediatrics Director, Pediatric Headache Clinic University of Maryland School of Medicine Baltimore, Maryland NANCY E. HALL, PhD Assistant Professor Department of Communication Sciences and Disorders Albert D. Conley Speech and Hearing Center University of Maine Orono, Maine ANDREW D. HERSHEY, MD, PhD Director, Headache Center Childrens Hospital Medical Center Assistant Professor of Neurology and Pediatrics The University of Cincinnati College of Medicine Cincinnati, Ohio RALPH E. HORKY, MS Senior Vice-President, Strategy Shands Healthcare Gainesville, Florida JAMES H. JOHNSON, PhD Professor of Clinical and Health Psychology University of Florida College of Health Professions Gainesville, Florida COLIN KENNEDY, MD, FRCP, FRCPCH Consultant and Senior Lecturer, Pediatric Neurology Southampton General Hospital Southampton, United Kingdom KIMBERLY N. KIMMEL, BS University of Miami School of Medicine Miami, Florida FENELLA J. KIRKHAM, MB BCHIR. FRCPCH Senior Lecturer in Pediatric Neurology, Neurosciences Unit Institute of Child Health (University College London) The Wolfson Centre, Mecklenburgh Square London, United Kingdom EDWIN KOLODNY, MD Bernard A. and Charlotte Marden Professor and Chairman New York University School of Medicine Department of Neurology New York, New York BRUCE R. KORF, MD, PhD Medical Director, Center for Human Genetics, Partners HealthCare System Associate Professor of Neurology Harvard Medical School Boston, Massachusetts Contributors / v SURESH KOTAGAL, MD Senior Associate Consultant Department of Neurology Chair, Division of Child and Adolescent Neurology Mayo Clinic Rochester, Minnesota WILLIAM G. KRONENBERGER, PhD Associate Professor Department of Psychiatry Indiana University School of Medicine Indianapolis, Indiana JOHN KURATINI, MD Assistant Professor of Neurology and Pediatrics University of Washington School of Medicine Seattle, Washington ALVIN E. LAKE III, PhD Division Director, Psychology Michigan Head Pain and Neurological Institute Ann Arbor, Michigan STEVEN M. LEBER, MD, PhD Clinical Associate Professor Division of Pediatric Neurology Departments of Pediatrics and Neurology University of Michigan Medical Center Ann Arbor, Michigan MACIEJ S. LESNIAK, MD Surgical Neuro-Oncology Fellow The Johns Hopkins Hospital Baltimore, Maryland DONALD W. LEWIS, MD Associate Professor of Pediatrics and Neurology Childrens Hospital of the Kings Daughters Eastern Virginia Medical School Norfolk, Virginia LAWRENCE M. LEVINE, MD Assistant Professor of Ophthalmology and Pediatrics Director, Pediatric Ophthalmology University of Florida College of Medicine Gainesville, Florida STEVEN L. LINDER, MD Assistant Clinical Professor University of Texas Health Science Center Dallas, Texas CHRIS N. LOFTIS, MS Doctoral Student University of Florida Department of Clinical and Health Psychology Gainesville, Florida MERYL D. LUALLIN, BA Partner Sullivan/LuAllin Inc. San Diego, California KENNETH J. MACK, MD, PhD Senior Associate Consultant Mayo Clinic Rochester, Minnesota DUANE L. MACGREGOR, MD, FRCPC Professor of Pediatric Neurology University of Toronto Hospital for Sick Children Toronto, Ontario, Canada BERNARD L. MARIA, MD, MBA Professor and Chairman, Department of Child Health Pediatrician-in-Chief, University Childrens Hospital University of Missouri School of Medicine Columbia, Missouri JOHN H. MENKES, MD Professor Emeritus of Neurology and Pediatrics University of California Los Angeles Director Emeritus of Pediatric Neurology Cedars-Sinai Medical Center Los Angeles, California LAURA R. MENT, MD Professor, Departments of Pediatrics and Neurology Yale University School of Medicine New Haven, Connecticut JONATHAN W. MINK, MD, PhD Associate Professor of Neurology, Neurobiology, and Anatomy Pediatrics and Chief, Child Neurology University of Rochester School of Medicine Rochester, New York JOHN L. MORIARITY Jr., MD Assistant Chief of Service Department of Neurosurgery The Johns Hopkins Hospital Baltimore, Maryland SOLOMON L. MOSH, MD Professor of Neurology Neuroscience and Pediatrics Vice-Chairman, Department of Neurology Director of Pediatric Neurology Director of Clinical Neurophysiology Martin A. & Emily L. Fisher Fellow Albert Einstein College of Medicine Bronx, New York DENISE K. MOSS, CPC Psychiatry Practice Manager University of Florida Physicians University of Florida School of Medicine Gainesville, Florida TANYA K. MURPHY, MD University of Florida Assistant Professor Director of Child Anxiety and Tic Disorder Clinic Medical Director of Autism Treatment and Evaluation Unit Gainesville, Florida vi / Contributors SAKKUBAI NAIDU, MD The Kennedy Krieger Institute The Johns Hopkins Medical Institutions Baltimore, Maryland ERIN M. NEARY, BS Graduate Student Department of Clinical and Health Psychology University of Florida Gainesville, Florida MATHEW NGUYEN, MD Assistant Clinical Professor Medical Director Outpatient Services Shands at Vista Gainesville, Florida MICHAEL J. PAINTER, MD Professor of Neurology in Pediatrics Chief, Division of Child Neurology University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania JOHN M. PELLOCK, MD Chairman, Division of Child Neurology Professor of Neurology, Pediatrics, Pharmacy, and Pharmaceutics Director, Comprehensive Epilepsy Institute Medical College of Virginia Hospitals Virginia Commonwealth University Healthcare Systems Richmond, Virginia LINDA PFIFFNER, PhD Assistant Professor in Residence Department of Psychiatry University of California San Francisco, California PAUL H. PHILLIPS, MD Assistant Professor, Neuro-Ophthalmology, Pediatric Ophthalmology, and Strabismus Department Ophthalmology Arkansas Childrens Hospital University of Arkansas for Medical Sciences Little Rock, Arkansas SCOTT W. POWERS, PhD Associate Professor of Pediatrics, Department of Psychology Cincinnati Childrens Hospital Medical Center Cincinnati, Ohio RONALD G. QUISLING, MD Professor of Radiology Director of Inventional Neurology University of Florida School of Medicine Gainsville, Florida MOBEEN H. RATHORE, MD, FAAP Professor and Assistant Chairman Department of Pediatrics Chief Pediatric Infectious Diseases and Immunology University of Florida Health Science Center Jacksonville, Florida KATHLEEN M. REILLY, PHARM. D. Education Coordinator, Pharmacy Services Shands at the University of Florida Associate Professor of Pharmacy Practice University of Florida College of Pharmacy Gainesville, Florida MOBEEN H. RATHORE, MD, FAAP Professor and Assistant Chairman Department of Pediatrics Chief Pediatric Infectious Diseases and Immunology University of Florida Health Science Center Jacksonville, Florida JONG M. RHO, MD Assistant Professor of Pediatrics University of California at Irvine College of Medicine Irvine, California E. STEVE ROACH, MD Helen & Robert S. Strauss Professor of Neurology University of Texas Southwestern Medical School Dallas, Texas ROBERT S. RUST, MD Thomas E. Worrall, Jr. Professor in Epileptology and Neurology Professor, Pediatric Neurology Childrens Medical Center University of Virginia School of Medicine Charlottesville, Virginia G. BRADLEY SCHAEFER, MD Professor of Pediatrics University of Nebraska Medical Center Munroe-Meyer Institute for Genetics and Rehabilitation Omaha, Nebraska MICHAEL SHEVELL, MD, CM, FRCPC Associate Professor of Neurology, Neurosurgery, and Pediatrics Associate Member, Human Genetics McGill University Division of Pediatric Neurology Montreal Childrens Hospital Montreal, Qubec, Canada SHOLOMO SHINNAR, MD, PhD Professor of Neurology and Pediatrics Director, Comprehensive Epilepsy Management Center Monteore Medical Center Albert Einstein College of Medicine Bronx, New York SUZANNE SKODA-SMITH, MD Assistant Professor of Pediatrics Division of Immunology and Infectious Diseases University of Florida College of Medicine Gainesville, Florida Contributors / vii JOHN T. SLADKY, MD Professor of Pediatrics and Neurology Emory University School of Medicine Chief of Neurology Emory Childrens Center Atlanta, Georgia JOHN B.P. STEPHENSON, MA, DM, FRCP, Hon. FRCPCH Visiting Professor and Consultant in Pediatric Neurology Fraser of Allander Neurosciences Unit Royal Hospital for Sick Children Glasgow, United Kingdom PHILLIP B. STORM, MD Surgical Neuro-Oncology Fellow The Johns Hopkins Hospital Baltimore, Maryland RAFAEL J. TAMARGO, MD, FACS Director, Division of Neurosurgery Associate Professor, Neurosurgery The Johns Hopkins Hospital Baltimore, Maryland ANN HENDERSON TILTON, MD Associate Professor of Neurology and Pediatrics Chief Section of Child Neurology Louisiana State University Health Science Center New Orleans, Louisiana R. WILLIAM TRELOAR, RRA, MBA Director of Clinical Resource Management Shands Healthcare Gainesville, Florida MARGARET TREMWEL, MD, PhD Chief Resident of Neurology University of Florida School of Medicine Gainesville, Florida JIRI VAJSAR, MD, MSc, FRCPC Director, Electrodiagnostic Medicine and Neuromuscular Program Staff Neurologist and Assistant Professor The University of Toronto Associate Scientist, The Research Institute The Hospital for Sick Children Toronto, Ontario, Canada ROBERT C. VANNUCCI, MD Professor of Pediatrics Division of Neurology Pennsylvania State University College of Medicine and Milton S. Hershey Medical Center Hershey, Pennsylvania WARREN W. WASIEWSKI, MD Director of Mayday Pediatric Headache Center Lancaster, Pennsylvania JAMES W. WHELESS, MD Professor of Pediatrics and Neurology Director, Epilepsy Monitoring Unit Memorial Hermann Childrens Hospital Director, Texas Comprehensive Epilepsy Program University of Texas at Houston Houston, Texas PAUL S. WOLF, MD Assistant Professor Pediatric Neurology Childrens Hospital of Philadelphia Philadelphia, Pennsylvania viii / Contributors PREFACE Current Management in Child Neurology aims to provide busy practitioners with succinct standard-of-care reviews on the evaluation and treatment of the most common neuro- logic conditions. In many cases, this textbook will enable pediatricians to independently manage febrile or rst unpro- voked seizures, common migraine, attention decit hyperac- tivity disorder (ADHD), and mild cerebral palsy. However, if a child must be referred to the neurologist, then the infor- mation contained in each chapter and in the Suggested Readings can better prepare caregivers for the consultation. Electronic copies of the chapters can be easily printed out from the CD-ROM for trainees in clinics and on ward rota- tions. Importantly, the chapters contain relevant website addresses and other information on patient resources that enable caregivers to do their homework about their childs condition. I strongly encourage the distribution of the elec- tronic copies of the chapters to caregivers because their edu- cation and satisfaction are key success factors in the practice of child neurology. In the the years since the first edition was published, the remarkable pace of medical discoveries and their applica- tion to clinical practice has continued unabated. In fact, I often wonder how it will be possible to keep up, given the strong driving forces of subspecialization within the field of child neurology. The second edition of Current Management in Child Neurology builds on the success of the first by offering succinct reviews from a whole new set of experts, Suggested Readings, and a listing of Patient Resources. The book is designed to supplement standard textbooks that provide detailed information on etiology, pathogenesis, and therapeutic controversies in Child Neurology. The CD-ROM will now enable immediate link capability to websites and access to the National Library of Medicine for the very latest information. Thus, for the first time, we can ensure that the information will stay current until the next edition. In the rst section of the book, Clinical Practice Trends, new chapters on the art of medicine and patient satisfaction, practice management, and the Internet have been added. The two chapters on common neurologic complaints and the neurologic examination are excellent introductory chapters for medical students, residents, and fellows. The second sec- tion, The Ofce Visit, has been expanded to include a broader array of conditions and a more comprehensive review of available therapies. The tables on pharmacothera- py for epilepsy, migraine, ADHD, and spasticity provided by Dr. Kathleen Reilly are an extremely valuable addition to the book. The third section, The Hospitalized Child, reviews management of traumatic brain injury, infection, neurologic injury to the preterm or term neonate, and other conditions that account for most pediatric neurologic admissions. When I rst envisioned the publication of a Current Therapy book in Child Neurology, it was not clear that there would be sufcient new information every three years to make the effort worthwhile. I wish to express my sincere appreciation to the authors for demonstrating how dynamic the eld of child neurology has become. I would also like to thank my superb editorial assistant Melanie Fridl Ross, MSJ, ELS, and my dedicated research assistants Kimberly Kimmell and Meadow Maze. Finally, I would like to recognize the publisher, Brian Decker, for his support of Child Neurology and for staying one step ahead of the competition in the world of medical publishing. Bernard L. Maria, MD, MBA October, 2001 ix To my wife Barbara and my son Alexander, who continue to ll my life with wonder. To my mother Margaret and my father Maurice for helping me see that anything is possible. CONTENTS Preface ...............................................................................ix SECTION 1. CLINICAL PRACTICE TRENDS 1. The Business of Health Services................................3 R. Horky 2. Excelling at the Art of Medicine .............................12 M.D. LuAllin 3. Secrets of Successful Practice Management ...........16 N.M. Giunta and D.K. Moss 4. Common Neurologic Complaints and Conditions ...............................................................23 B.L. Maria and R.W. Treloar 5. The Neurologic Examination..................................28 P. Diadori and L. Carmant 6. Neurologic Complaints and Conditions in Primary Care Pediatrics ..........................................35 T.B. Benton 7. Education of Medical Students, Pediatricians, and Neurologists in Child Neurology ....................39 I.J. Butler 8. The Internet in Child Neurology............................44 K.J. Mack and S.M. Leber SECTION 2. THE OFFICE VISIT HEADACHE 9. Migraine in Children and Adolescents ...................53 W.W. Wasiewski 10. Migraine Variants and Mimics................................57 S.L. Linder 11. Chronic Daily Headache..........................................62 W.W. Wasiewski and J. Gladstein 12. Abortive Therapy for Migraine...............................65 A.D. Hershey and S.W. Powers 13. Preventive Therapy for Migraine ............................70 D.W. Lewis 14. Psychosocial Issues in Pediatric Headache .............78 D.W. Lewis and A.E. Lake III 15. Biofeedback for Childhood Migraine.....................83 S.W. Powers and A.D. Hershey SEIZURES AND EPILEPSY 16. What is Epilepsy? .....................................................86 J. Aicardi 17. Febrile Seizures.........................................................90 P.S. Wolf and S. Shinnar 18. First Unprovoked Seizure ........................................96 J.S. Bluvstein and S.L. Mosh 19. Staring Spells ..........................................................100 J.M. Rho and J. Kuratani 20. Partial Seizures .......................................................108 J.M. Pellock and M. Duchowny 21. Generalized Seizures ..............................................113 B.F.D. Bourgeois 22. First-Choice Antiepileptic Drugs ..........................122 J. M. Pellock 23. Infantile Spasms (Wests Syndrome) ....................134 L. Carmant 24. Recurrent Seizures .................................................138 J.W. Wheless 25. Discontinuing Antiepileptic Drugs.......................154 J.M. Rho 26. Nonepileptic Events Simulating Seizures in Childhood..........................................................158 P. Cameld and C. Cameld 27. Ketogenic Diet........................................................164 L.W. Brown xi 28. Epilepsy Surgery and Electrical Stimulation........168 M. Duchowny NEUROBEHAVIORAL DISORDERS 29. Diagnostic Approaches and Assessment of ADHD.............................................................173 P. Accardo 30. ADHD Comorbidity and Mimicry.......................179 J.H. Johnson and C. Loftis 31. Pharmacologic Treatment of ADHD....................184 L.W. Brown 32. Behavioral Management and Treatment of ADHD ................................................................192 T.A. Blondis and L. Pffner 33. Individual Child and Family-Based Therapies for ADHD...............................................................197 S.M. Eyberg, M.D. Dabbs, and E.M. Neary 34. Medical Management of Pervasive Developmental Disorder .......................................200 C. Delahunty SCHOOL READINESS 35. Is My Child Ready for School? ..............................206 D.L. MacGregor 36. Psychological Assessment: Interpreting Test Results and Reports ...............................................210 E.B. Fennell and T.N. Dikel 37. Developmental Language Disorders .....................215 N.E. Hall 38. Learning Disability.................................................220 I.S. Baron DEVELOPMENTAL DELAY 39. Diagnostic Approach to Developmental Delay .......................................................................227 M. Shevell 40. Cerebral Palsy.........................................................232 J.E. Brunstrom and A.H. Tilton 41. Spasticity.................................................................237 T.S. Edgar 42. Degenerative Disorders..........................................245 E.H. Kolodny 43. Mitochondrial Cytopathies ...................................254 B.H. Cohen 44. Mental Retardation................................................261 J.B. Bodensteiner, C.R. Ellis, and G.B. Schaefer 45. Down Syndrome ....................................................273 W.I. Cohen 46. Rett Syndrome........................................................280 G.M. Bibat and S. Naidu 47. Inborn Errors of Metabolism................................285 L. de Meirleir 48. Autism....................................................................291 R.B. David and C.H. David OTHER NEUROLOGIC COMPLAINTS AND CONDITIONS 49. Small, Large, or Abnormally Shaped Head ..........299 W. DeMyer 50. Tic Disorders ..........................................................305 J.W. Mink 51. Sleep Disturbances.................................................313 S. Kotagal 52. Breath-Holding Spells............................................321 W. DeMyer 53. Human Immunodeciency Virus 1 and Acquired Immune Deciency Syndrome in Infants and Children..............................................324 A.L. Belman 54. Bells Palsy...............................................................334 M. Tremwel and B.L. Maria 55. Management of Dizziness in Children.................338 L. Eviatar 56. Fainting and Syncope ............................................345 J.B.P. Stephenson 57. Hereditary Neuropathy..........................................352 T.S. Edgar 58. Muscular Dystrophy and Myopathy .....................360 R.S. Finkel 59. Neuromuscular Junction Disorders......................368 J. Vajsar 60. Ataxia, Clumsiness, and Tremor ...........................374 E.J. Boltshauser 61. Paroxysmal Movement Disorders in Childhood...............................................................379 L.S. Dure IV 62. Visual System Problems.........................................383 L.M. Levine and M.T. Bhatti 63. Childhood Depression...........................................388 T.K. Murphy and M. Nguyen 64. Conversion Reaction..............................................395 W.G. Kronenberger and D.W. Dunn 65. Neurobromatosis .................................................400 B.R. Korf 66. Tuberous Sclerosis Complex .................................405 E.S. Roach 67. Sturge-Weber Syndrome .......................................411 B.L. Maria 68. Brainstem and Cerebellar Malformations ............416 B.L. Maria, K.N. Kimmel, and R.G. Quisling xii / Contents SECTION 3. THE HOSPITALIZED CHILD 69. Neonatal Seizures...................................................425 M.J. Painter and J. Alvin 70. Status Epilepticus ...................................................430 J.W. Wheless 71. Meningitis and Encephalitis ..................................435 M.H. Rathore and E.M. Ayoub 72. Traumatic Brain and Spinal Cord Injuries in Children .............................................................442 J.H. Menkes and R.C. Ellenbogen 73. Neonatal Hypotonia ..............................................455 C. Adams 74. Injury to the Preterm Brain...................................460 L.R. Ment 75. Injury to the Term Brain .......................................466 R.C. Vannucci 76. Altered States of Consciousness............................470 B.H. Cohen and J.C. Andrefsky 77. Increased Intracranial Pressure.............................481 A.M. Avellino and B.S. Carson Sr. 78. Evaluation and Management of Acute Headache ...............................................................487 R.S. Rust 79. Brain Tumors .........................................................495 C. Kennedy 80. Pseudotumor Cerebri: Idiopathic Intracranial Hypertension..........................................................503 P.H. Phillips 81. Central Nervous System Vascular Malformations in Pediatric Patients ...................................................................509 J.L. Moriarity Jr., P.B. Storm, and R.J. Tamargo 82. Pediatric Intracranial Aneurysms .........................519 M.S. Lesniak and R.J. Tamargo 83. Cerebrovascular Disease ........................................525 F.J. Kirkham 84. Vasculitis.................................................................533 S. Skoda-Smith and L.H. Calabrese 85. Inammatory Demyelinating Neuropathy.............................................................538 J.T. Sladky 86. Brain Death in Children........................................544 S. Ashwal Index...............................................................................551 Contents / xiii NATIONAL LIBRARY OF MEDICINE LINKS ADHD Language/Learning Disorders Ataxia Autism Bell's Palsy Brain Death Brain Injury Brain Tumors Cerebral Palsy Cerebrovascular Disease Conversion Reaction Depression Down Syndrome Epilepsy HIV-1 Mental Retardation Migraine Muscular Dystrophy Myopathy Neurobromatosis Rett Syndrome Seizure Sleep Disturbances Spasticity Tic Disorders Tuberous Sclerosis Visual System Problems