Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: New Recommendations in the Decade of the Brain

Category: Child Care


The 1990's are designated as the decade of the brain. At the recent American Academy of Pediatrics annual convention, several prominent neurologists discussed research coming out regarding headaches, head trauma and seizures. The pertinent recommendations that impressed me included the need to detoxify many headache patients who come to a neurologist. The patients have usually been on several pain medicines, and they have any number of a variety of headache types including simple tension headaches which are just not well controlled. After ruling out serious vascular headaches, Dr. Fenichel, professor of neurology and pediatrics at Vanderbilt, recommends getting them off many of their pain medicines and trying physical therapies, which usually means some type of meditation. For serious migraine headaches, he recommends sleep, even if it takes an injection to break the cycle of the vascular headache and induce sleep. He does not recommend calcium channel blockers and has had good success with amitriptyline. He also praised the real benefit of placebo medicines and reassurance.

Dr. Kissoon, neurology professor at the University of Florida, covered head injuries and reminded us of the ABC's of managing a head injury: airway, breathing, and circulation. He broke down the head injuries into three groups, mild, moderate, and severe. The mild ones with loss of consciousness less than five minutes, the moderate ones with loss of consciousness exceeding five minutes, and the severe ones with loss of consciousness over five minutes and other worrisome signs and symptoms such as vomiting pupillary changes, and severe headache. The mild group simply requires reassurance and being aware of those signs which may come on over the next several hours. The moderate group may not require hospitalization but does require close observation, nevertheless. The severe group obviously needs to be in the hospital and a CT scan needs to be done immediately.

Finally, Dr. Clancy, a professor of neurology at the University of Pennsylvania discussed seizures and made it clear to all present that all seizures are not the same. There are many, many new medications, each with certain advantages. For any child with poorly controlled seizures it is wise to consult a neurologist, preferably a pediatric neurologist. It is important that anyone with seizures understand their prognosis and be offered all the possible treatment alternatives available so that they can live as full a life as possible. In almost all cases they can.