Curbside Consultation in Pediatric Neurology

Daniel J. Licht, MD is a child neurologist with expertise in critical care neurology, stroke, and noninvasive imaging. Dr. Licht started his career as a synthetic organic chemist after completing his bachelor’s degree in biochemistry at NYU in 1984. He graduated from New Jersey Medical School (UMDNJ) in 1997 and began his second (and final) career as a pediatric resident at The Children’s Hospital of Philadelphia, following into a neurology residency at the University of Pennsylvania.Nicole R. Ryan, MD is a child neurologist and epileptologist at The Children’s Hospital of Philadelphia. After completing a bachelor’s degree in psychology at Cornell University, she entered the Albert Einstein School of Medicine where she discovered her passion for neurology. She completed her residency training at the Perelman School of Medicine and has stayed on at The Children’s Hospital of Philadelphia as the Section Head of Community Neurology and member of the Pediatric Regional Epilepsy Program.

• Dedication About the Editors Contributing Authors Introduction Section I SEIZURES Question 1 How Are Seizures Classified?Nicole R. Ryan, MD Question 2 How Do I Distinguish Syncope From Seizure?Daphne M. Hasbani, MD, PhD Question 3 Are Children With Febrile Seizures at Greater Risk for Epilepsy? Which of These Patients Should Be Referred to a Neurologist?Ryan P. Williams, MD, EdM Question 4 Are the Benign Childhood Epilepsies Really Benign?Katherine S. Taub, MD Question 5 Do Seizures Cause Developmental Delay? Can Treating the Seizures Help?John R. Mytinger, MD Question 6 Does Epilepsy Run in Families?Jason Coryell, MD, MS Question 7 Are There Any Diet Changes or Vitamins That May Help a Child With Epilepsy?Adam L. Hartman, MD and Brian Masselink, MD Question 8 Do Children Outgrow Epilepsy?Emily A. Gertsch, MD, MPH and Kelly Knupp, MD Question 9 What Are Common Side Effects of Antiseizure Medications?Laufey Yr Sigurdardottir, MD Question 10 When Is Epilepsy Considered Refractory? What Happens Next?Karen L. Skjei, MD Question 11 Can a Child With Seizures Receive All Vaccinations?Kashif Ali Mir, MD and Karen L. Skjei, MD Question 12 What Do I Do When a Child Seizes in My Office? Can a Child Die From Seizures?Mai T. Dang, MD, PhD and Ernest Barbosa, MD Section II ALTERED MENTAL STATUS: METABOLIC, INFECTIOUS, TOXINS/DRUGS/CONCUSSION Question 13 What Is a Breath-Holding Spell? Can It Be Treated?Donna J. Stephenson, MD Question 14 A Mother Calls Because Her Child Has Had Episodes of Confusion Over the Last Week but Is Otherwise Acting Normally. How Should the Child Be Evaluated?Caitlin Rollins, MD Question 15 A Child Has Had a Progressive Decline in School Performance Over the Last Few Months. How Should This Be Evaluated?Xilma R. Ortiz-Gonzalez, MD, PhD Section III HEADACHE Question 16 What Are the Most Common Types of Headaches in Children?Christina Szperka, MD and Douglas Smith, MD Question 17 When Should I Consider Head Imaging in a Child With Headache? Computed Tomography or Magnetic Resonance Imaging?Laura A. Adang, MD, PhD Question 18 What Medications Are Best to Abort a Migraine?Steven Kugler, MD Question 19 Are There Ways to Prevent Migraines? What Lifestyle Factors Contribute to Headaches?Christina Szperka, MD and Emily Robbins, MD Question 20 Are Tension-Type Headaches Treated Differently From Migraines?Joyce Sapin, MD Question 21 What Is a Migraine Variant? Is It Treated Differently?Daniel J. Licht, MD Question 22 What Can Be Done for a Post-Concussive Headache?Nicole R. Ryan, MD Section IV FLOPPY BABY Question 23 What Are the Most Important Components of the Exam in Evaluating a Hypotonic Baby?Sabrina W. Yum, MD Question 24 How Do I Distinguish Central From Peripheral Causes of Hypotonia?Michele L. Yang, MD Question 25 What Are the Most Common Genetic Causes of Hypotonia?Michele L. Yang, MD Question 26 What Are the Clinical Features of Infant Botulism? How Is It Treated?Jennifer L. McGuire, MD, MSCE Section V CONCUSSION Question 27 How Do I Know if a Child Has Had a Concussion?Christina L. Master, MD, FAAP, CAQSM Question 28 What Is the Role for Head Imaging in Suspected Concussion?Matthew P. Kirschen, MD, PhD and Ronald F. Marchese, MD Question 29 What Is the Acute Management After a Concussion? When Can a Child Return to School and Sports?Matthew Grady, MD, FAAP, CAQSM and Christian Turner, MD, FAAP, CAQSM Question 30 What Is Post-Concussive Syndrome?Matthew P. Kirschen, MD, PhD and Maximillian H. Shmidheiser, PsyD, ABPP-CN Section VI WEAKNESS Question 31 How Do You Evaluate Acute Weakness in a Child?Diana X. Bharucha-Goebel, MD Question 32 What Are the Causes of Guillain-Barré Syndrome, How Often Does It Occur, and How Do You Treat It?Jennifer L. McGuire, MD, MSCE Section VII FOCAL NEUROLOGICAL DISEASE Question 33 What Are the Signs of a Stroke in a Child? Are There Other Conditions That Can Present Like a Stroke?Renée A. Shellhaas, MD, MS and Louis T. Dang, MD, PhD Question 34 What Can I Tell a Parent to Expect About the Recovery From a Perinatal-Onset Arterial Ischemic Stroke? How About a Childhood-Onset Arterial Ischemic Stroke?Lauren A. Beslow, MD, MSCE and Lori L. Billinghurst, MD, MSc, FRCPC Question 35 What Is the Chance of Developing Epilepsy After Stroke?Courtney J. Wusthoff, MD, MS Question 36 What Causes a Child to Have a Stroke?John M. Binder, MD; Amanda L. Hollatz, MA; and Timothy J. Bernard, MD, MSCS Section VIII VISION PROBLEMS Question 37 What Are the Important Things to Consider When You See a Child With the Complaint of Vision Changes?Robert A. Avery, DO, MSCE Question 38 What Is the Evaluation of a Child With Optic Nerve Head Elevation (Papilledema)?J. Michael Taylor, MD and Robert A. Avery, DO, MSCE Section IX VERTIGO Question 39 What Is the Difference Between Vertigo and Dizziness? What Are Common Causes of Both?Alyssa Pensirikul, MD Question 40 How Should Vertigo Be Evaluated and Treated?Alyssa R. Rosen, MD Section X ATAXIA Question 41 What Are Common Causes of Acute Ataxia in Children?David Bearden, MD Question 42 How Do You Distinguish Weakness From Ataxia?Amy T. Waldman, MD, MSCE Question 43 How Do You Tell a Pathologic Gait From a Functional Gait?Laura A. Adang, MD, PhD Section XI GENETIC DEVELOPMENTAL DELAY Question 44 How Should I Begin a Workup for a Child With Significant Developmental Delay?Ethan M. Goldberg, MD, PhD Question 45 What Is a Good Approach to Thinking About a Child With Multiple Dysmorphisms?Mai T. Dang, MD, PhD Question 46 When Should I Think About a Mitochondrial Disorder, and What Is a Good Approach to an Initial Evaluation?Xilma R. Ortiz-Gonzalez, MD, PhD Question 47 What Are the Neurodevelopmental Disorders Leading to Language Delay and What Workup Is Needed?Laufey Yr Sigurdardottir, MD Section XII UNUSUAL EPISODIC MOMENTS Question 48 How Are Movement Disorders Classified and Why Is That Important?Jessica A. Panzer, MD, PhD Question 49 How Do I Diagnose Tics and How Do I Treat Them? When Is It Considered Tourette Syndrome? 2Donna J. Stephenson, MD Financial Disclosures Index