Paediatric Neurology and Developmental Disorders
Neurology questions test febrile seizures and their boundaries, status epilepticus management, meningitis, and the recognition of cerebral palsy and developmental delay. Examiners reward restraint: many wrong answers involve over-investigating a benign event.
Seizures
- Simple febrile seizure: generalised, under 15 minutes, once in 24 hours, in a child 6 months to 5 years with fever and no central nervous system infection. No routine EEG, no neuroimaging, no long-term antiepileptic drugs. Antipyretics do not prevent recurrence.
- Complex features: focal, over 15 minutes, or repeated within 24 hours; these warrant closer evaluation.
- Status epilepticus: benzodiazepine first (buccal midazolam or rectal diazepam), then a second benzodiazepine, then phenytoin, levetiracetam or valproate. Check glucose immediately.
- Meningitis: neck stiffness is often absent in infants; do a lumbar puncture when safe, and give antibiotics before imaging if there is any delay.
Development and motor disorders
Cerebral palsy is a disorder of movement and posture due to a non-progressive lesion; the lesion is static but the presentation evolves. Persistent primitive reflexes, hand preference before 18 months, and asymmetry of movement are red flags. Global delay needs audiology, vision assessment, thyroid function, metabolic screening and genetic testing; fragile X and array comparative genomic hybridisation are common first-line tests.
Other core topics
Duchenne muscular dystrophy: boys, proximal weakness, Gowers sign, raised creatine kinase, calf pseudohypertrophy. Headache red flags: waking at night, vomiting, worse on coughing, focal signs, age under 6 years, change in personality. Tics are common and usually need only reassurance. Autism presents with poor eye contact, absent joint attention and language delay before 3 years.
Worked example
A 2-year-old, fully immunised, has a 3-minute generalised seizure with fever and is now alert with a clear source. This is a simple febrile seizure. No lumbar puncture, no EEG, no imaging. Explain the recurrence risk of about one third, teach rescue benzodiazepine use for prolonged seizures, and advise on fever management without claiming it prevents seizures.
Traps
Diagnosing epilepsy after one febrile seizure; routine EEG afterwards; missing neck stiffness in an infant with meningitis; attributing delay to prematurity beyond 2 years; investigating a single tic with imaging.