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On the occasion of “CHILDREN’S DAY” Brains Super Speciality Hospital is opening a centre of excellence for Pediatric Neuroscience to deal every problem related to brain and spine under one roof. The services include prenatal screening and counselling, genetic counselling, birth defects of brain and spine, developmental disorders, clinical evaluation, diagnosis, laboratory diagnostics, molecular testing, genetic testing and counselling, cognitive deployment, deformity correction, paediatric brain and spine tumours, epilepsy, paediatric brain attack or stroke, cranio-spinal deformities, imaging, paediatric anaesthesia and critical care, paediatric neurosurgery and neurology, paediatric spine and rehabilitation under one roof.
India being the country with large paediatric population amounting to more than 444 million needs special care to raise them into healthy and responsible citizens. They represent the future of India. Hence, we must create a platform for their future growth and health.
One of the most fascinating things is the development of human brain and the human body. A single cell undergoes specialised divisions in such a way that there will be reduction and equal distribution of the genetic material and later a series of multiplications to form various organs of the body. In about 55 multiplications the entire human body gets formed. It is important to note that the nervous system is the first one to develop.
The three initial layers called ectoderm, mesoderm and endoderm eventually completes the human formation. Beauty and the brain occurs together as the brain and skin comes from the ectoderm. The development is so intricate that so many steps takes place at a specific time and specific speed with specific certainty leading to the perfection and precision that the human organs have. It is like the satellite to land on the moon, needs to have perfectly timed actions and anything can go wrong at any time.
Similarly, many errors can happen during development leading to various defects, malformations, and metabolic abnormalities. Some are genetically mediated and the majority are process related. Yet it demands amazing perfection to be normal. At the same time unbelievable ability of the body to correct and repair if not compensate makes life more interesting. The mechanisms are too complex to comprehend. However, extrapolation of research is gradually unravelling the intricate mechanisms overtime and the role of various factors that can influence many factors including genes.
By the time the mother realises she is pregnant the neural tube is already formed. But folic acid, the simple vitamin has the ability to prevent such gross anomalies. Hence, it is necessary that the expectant mothers should take Folic acid in order to prevent any mal-development in general and the nervous system in particular. However it should be taken at least 3 months before the planning of pregnancy. All the developed countries have implemented Folic acid supplementation programme and reduced the incidence of such anomalies. Therefore, birth of children with such deformities is avoided. In India, we still have significant number of new born babies with such anomalies particularly in rural areas. It is high time we too give Folic acid either in diet or in other forms to all newly married women compulsorily. Prevention is better than cure. Managing a disabled child is associated with many medical, social and economic problems.
Adoption of ultrasound into obstetrics has become the norm to track the development of the baby as well as to diagnose the abnormalities. The detection of such abnormalities early to take suitable decisions have led to the new branch of Foetal medicine. If the abnormality is not compatible with life termination can be an option. Hence anomaly scan done around 15 to 17th week of pregnancy is crucial. Proper detection is another way of avoiding long term problems. When in doubt foetal MRI can help to make an accurate diagnosis. Later with advancements in technology and better understanding some of the abnormalities of the brain and spine are now being corrected or repaired while the baby is still in the mother’s womb.
The Foetal Neurosurgery is making a progress and might be the order of the day very soon. MRI scan be performed very safely on mothers imaging the mother as well as baby. This is highly sensitive to study the brain and spine abnormalities. The anomalies can be multiple at times. Generally the pregnancy is continued when the abnormality is treatable, controllable or correctable based on individual merits. This involves a combined, conscious decision by the parents and the treating team. Such babies need very close follow up till they are born and beyond.
The abnormalities can include right from the scalp, skull, membranes, brain, spine and the spinal cord. In addition, the nervous system and other organs can also get affected. It depends upon the type and time of the occurrence. In general, exposure to toxins, certain medicines, radiation and infections can induce such defects apart from the inherent genetic factors. At birth every baby must be examined thoroughly for such anomalies despite all the screening. Presence of some markers on the skin can give sufficient clue to the underlying neural tube defects. Similarly head size, circumference and rate of growth indicates the status of brain growth. Either large head or small should be investigated further for the brain abnormalities. Babies at this stage are highly prone for brain damage. Bliss discolouration of baby, any breathing difficulty, jaundice and infection can result in significant brain damage. Low blood sugar especially with diabetic mothers is another common cause of brain damage. All these risks increase multi fold if the baby is premature. Maximum brain growth and maturation occurs in the first 2 years. Hence they need close monitoring.
Childhood too can have variety of problems related to the brain. Epilepsy, developmental disorders such as cerebral palsy, autism, metabolic disorders and learning disabilities are common. Later on childhood headaches, strokes and infections dominate. One thing that can affect regardless of age is brain tumors. Genetic testing is now available so that many syndromes and genetically mediated diseases can be diagnosed effectively. All genetic abnormalities won’t manifest in the next generation. Hence, identifying the patterns and appropriate counselling is very important to guide the parents and also to put them at ease.
Brain tumors in children - constitute second largest malignancies after blood related tumours. Each age has a predilection for a distinct location and type of tumors in the brain and spine. Tumors in general and particularly in very young age have many genetic abnormalities. Study can help us to predict the prognosis, recurrence and overall outcomes. The advances in anaesthesia and surgical techniques have made it possible to remove such tumours in total, significantly improving the outcomes compared to yesterday years. Many children can recover, grow normally and lead a quality life with proper treatment.
Tethered cord syndrome - is a developmental anomaly of the spinal cord often manifests with a variety of neuro-cutaneous markers. These markers help in early diagnosis and majority of them are correctable. Proper and timely correction will ensure proper development of the spine.
Epilepsy - epilepsy in children need quick diagnosis and treatment. The delay will ensure progressive damage that can affect the intellectual development of the young brain.
Regardless of the problem early diagnosis and treatment is crucial to assure quality development of the growing brain. Imaging of the brain such as Ultrasound, MRI, Metabolic screening, Genetic screening, Molecular markers, Autoimmune screening will help us to a great extent to clinch the diagnosis even in complex neurological conditions. Paediatric neurologists are adept in diagnosing and managing them from childhood to adulthood.
Pediatric Neurology deals with all the brain, spine and muscle disorders that can occur in childhood. Pediatric neurosurgery is specialised to deal with congenital anomalies, tumors, injuries, epilepsy and functional surgery, vascular surgery and pediatric spine surgery.
The Centre also offers correction of a variety of CRANIOFACIAL deformities, head and neck surgeries and ear, nose and throat surgeries.
The Paediatric Neuroscience team includes: