Essays on the Development of General and Pediatric Neurology
Neurology today is a dynamically developing branch of medicine at the intersection of genetics, molecular biology and neurophysiology. Pediatric neurology is developing especially rapidly, studying not just a reduced copy of an adult organism, but a unique developing system with its own laws and characteristics. Every year on December 1st, neurologists around the world celebrate their professional holiday, and this is a great opportunity to trace how the understanding of nervous diseases in children has changed throughout history and what revolutionary treatment methods modern science offers 1 .
Understanding hereditary factors in neurological disorders
Studying the functioning of the developing nervous system
Deciphering molecular mechanisms of pathological processes
Initial stage limited to symptom description and anatomical correlations
The establishment of pediatric neurology as an independent discipline became possible thanks to the contribution of great neurologists whose lives and work were dedicated to medical science 2 .
Transition to fundamental biochemical and genetic research
Today, neurology relies on fundamental biochemical and genetic studies that decipher the molecular mechanisms of pathological processes 2 .
Integration with neonatology, genetics, pediatrics and psychiatry
A feature of the development of pediatric neurology in recent decades has been close interaction with related specialties - neonatology, genetics, pediatrics and psychiatry. This has made it possible to develop a comprehensive approach to the treatment of young patients, taking into account all aspects of the formation of their nervous system 3 .
Practicing neurologists regularly encounter established misconceptions that worry parents and interfere with adequate assessment of the child's condition.
Detection of enlarged brain ventricles on ultrasound in a child under one year of age often causes panic among parents. However, according to Eleonora Serebrennikova, chief pediatric neurologist of the Perm Territory, slight enlargement of the ventricular system is normal in the vast majority of cases and does not require medication. True intracranial hypertension has serious causes: brain mass lesions, hemorrhages, infectious processes or impaired cerebrospinal fluid outflow. Symptoms such as eye symptoms (limited eye movement, strabismus), repeated vomiting, fever, motor impairments and coordination disorders should alert 1 .
Slight regurgitation, trembling of the chin, arms and legs in infants are features of the newborn nervous system and in most cases resolve without any treatment. Increased muscle tone in the first weeks of life is also considered a physiological norm and is associated with the fact that the formation of the nervous system continues after birth 1 .
Epilepsy can occur at any age, but is more common in children due to physiological characteristics of the developing brain. Although it is a serious chronic disease, it can be successfully treated in 70% of cases. Modern antiepileptic drugs allow controlling the course of the disease, and it is important for children to lead as normal an active lifestyle as possible. Excessive care and unjustified restrictions can cause more harm than the disease itself 1 .
Professor Valery Zykov calls one of the leading problems of modern pediatric neurology the lack of evidence base for the treatment being carried out. The introduction of unified assessment scales for different diseases, where each symptom corresponds to a certain score, would allow standardizing diagnosis and assessing the effectiveness of therapy 3 .
| Common Misconception | Scientific Explanation | When to Really Worry |
|---|---|---|
| Ventricular enlargement on ultrasound is a sign of intracranial pressure | Slight enlargement is usually normal | With repeated vomiting, coordination disorders, eye symptoms |
| Infant regurgitation is a neurological pathology | Non-abundant regurgitation is normal for children up to 6-9 months | With abundant, frequent regurgitation leading to weight loss |
| Epilepsy inevitably leads to disability | Successfully controlled with medications in 70% of cases | With incorrectly selected therapy, resistant forms |
| Trembling of chin and limbs in newborns is a disease | Physiological norm for immature nervous system | If tremor does not go away after 3 months, intensifies |
The Department of Pediatric Neurology of the RMAPO became the only one in Russia that purposefully began studying tics and Tourette syndrome - an urgent problem whose prevalence in children in the Russian Federation is 6% 3 .
Scientists detailed the classification of tics, comparing it with the WHO classification, which made it possible to unify diagnosis in practical healthcare. An infantile form of Tourette syndrome was identified, characterized by a benign course. The study used:
The study revealed that in one third of patients with Tourette syndrome without obsessive-compulsive disorders, a benign course is observed, which can be considered as an age-dependent infantile form of the disease. For local tics, the prognosis is favorable in 90% of cases 3 .
A recently completed study of the use of the domestic drug Pantocalcin in the treatment of chronic tics in children showed its reliable effectiveness and good tolerability, which opens up new possibilities for the treatment of this common neurological disorder 3 .
| Form of Tics | Prevalence | Prognosis | Treatment Effectiveness |
|---|---|---|---|
| Local Tics | Most common form | Favorable in 90% of cases | High with adequate drug selection |
| Tourette Syndrome with obsessive-compulsive disorders | About 2-3% | Requires long-term treatment | Moderate, relapses possible |
| Infantile form of Tourette Syndrome | About 1/3 of Tourette syndrome cases | Benign course | Often does not require drug treatment |
Neurological disorders in children under one year of age are observed in 80% of cases, which is associated with various factors: heredity, lack of oxygen during the intrauterine period, severe toxicosis in women during pregnancy and complicated childbirth .
The dynamics of early child development is a sensitive indicator of the state of his nervous system. Parents should know the main stages of development:
Child learns to hold head, focuses gaze, smiles, turns on side
Gets on all fours, learns to sit, confidently grabs toys, pronounces individual syllables
Sits confidently, stands up holding onto support, understands some words, pronounces first words
Starts walking, has about 10 words in active vocabulary
Modern neurology offers a comprehensive approach to the treatment of nervous system diseases, including:
The method is based on injecting botulinum toxin into the spastic muscle, which blocks the signal from the nerve, leading to its relaxation for 3-6 months. Used to treat many neurological diseases, as well as in the rehabilitation of patients after stroke or traumatic brain injury 4 .
A highly effective method for diagnosing and correcting balance function disorders in various neurological diseases. The method is based on working with a stabilometric platform equipped with sensors for changing the center of gravity. The duration of the training course is 7-10 sessions over 14-20 days 4 .
Using international treatment protocols with monitoring of neurological status effectiveness using a complex of specialized scales. This approach is effective for all diseases of the nervous system and allows objectifying the assessment of treatment results 4 .
| Treatment Method | Principle of Action | Indications | Effectiveness |
|---|---|---|---|
| Botulinum Therapy | Blocking neuromuscular transmission | Spasticity, chronic migraine, blepharospasm | Effect lasts 3-6 months |
| Stabilization Training | Training vestibular apparatus and coordination | Balance disorders, stroke consequences | Coordination improvement in 80-90% of patients |
| Therapeutic Blockades | Injecting drugs into pain focus | Pain syndromes, neuralgias | Rapid pain relief for long term |
| Pharmacopuncture | Subcutaneous drug injection into biologically active points | Neuroses, autonomic dystonia, migraine | High when combining reflexology and pharmacology |
Botulinum therapy involves the use of purified botulinum toxin type A to temporarily relax overactive muscles. The treatment is particularly effective for:
The effects typically begin within 3-10 days after injection and last for 3-6 months, after which treatment can be repeated.
The evidence-based approach in pediatric neurology involves:
This approach has been shown to improve treatment outcomes and patient satisfaction.
The future of pediatric neurology is associated with the introduction of antenatal neurology principles and early diagnosis of nervous system diseases even during the intrauterine period. The transition to world standards for registering newborns from 22 weeks of pregnancy will require creating a powerful diagnostic base, including even intrauterine fetal MRI 3 .
The development of evidence-based medicine, the introduction of standardized scales for assessing neurological status and the creation of comprehensive rehabilitation programs will significantly improve the treatment results of young patients. As Professor Zykov emphasizes, treatment effectiveness depends not only on the type and form of the disease, but much is in the hands of the patients themselves and their family 3 .
Pediatric neurology has come a long way from describing symptoms to understanding the molecular mechanisms of diseases, and today continues to develop dynamically, offering new opportunities to help children with neurological pathology.