by Dr. Asim Shrestha
It has been proven that persistently and severe low blood glucose during the neonatal period leads to poor neurodevelopmental outcome. Although the ‘neurologically safe’ blood glucose level has not been determined, but low blood glucose can lead to seizures, vision problem, learning disability and behavioural issues like hyperactivity, autism. So please be aware of low blood glucose during the neonatal period especially in premature and low birth weight babies.
by Dr. Asim Shrestha
They help develop an individualized treatment plan specialized to each child’s specific needs that can improve their verbal and nonverbal communication. They help individuals express themselves, improve their personal and social relationships, and better function in day-to-day activities. Your child is destined for great things – he/she may just need a little more help getting there.
The communication skills that can be improved are: verbal communication, body language, social pragmatics, prosody (volume and intonation of our voices in conversation), grammar, social skills, questions, alternative/augmentative communication technologies (sign language, picture, apps).
by Dr. Asim Shrestha
A child that is speech or language delayed typically follows the same developmental patterns as their peers, but is slower to reach these milestones. However, they are still strongly motivated by social responses, like hugs and smiles. They desire to build strong social bonds with their parents and peers, respond positively to attention, and are inclined to mimic the actions of people around them.
However in children with autism, apart from speech delay there are other additional issues like impairment in communication, socialization and behaviour.
Communication related issues of autistic child are: Being non-responsive to his/her own name, trouble getting your child’s attention, slower development of gestures to communicate his/her needs, repetitive usage of a single word or phrase, using a robotic-sounding speaking voice.
Social challenges of autistic kids are: Being unresponsive to social cues, like waving “hi”, Inability to focus on the same object with someone else (called joint attention), Difficulty with social skills such as sharing, taking turns, and maintaining friendships, avoiding eye contact, limited or restricted interests in particular toys or activities, decreased interest in engaging in play routines with others.
Behaviour issues of autistic kids are: Repetitive behaviors or hand and body movements, like rocking his/her head back and forth or lining up his/her toys, aversion to being touched or held, getting easily upset for unknown reasons, strong attachment to certain objects, like toys or a television show, having trouble staying still, being easily upset or distressed when there is a sudden change to his/her daily routine.
by Dr. Asim Shrestha
Q. What is muscular dystrophy?
Ans. Muscular dystrophy (MD) refers to a group of more than 30 genetic diseases that cause progressive weakness and degeneration of skeletal muscles. Muscular dystrophies are progressive, and affected individuals eventually lose the ability to walk.
Q. What are the symptoms of muscular dystrophy?
Ans. The clinical feature varies according to the type of MD. Delayed attainment of walking, recurrent falls, difficulty in climbing stairs and getting up from sitting posture are common complaints. Often these children are clumsy while walking and not able to run as peers and easily fatigued. Children with muscular dystrophy can have enlarged calf or pain in calf muscles. Toe walking and foot deformities are common.
Q. What causes muscular dystrophy?
Ans. All muscular dystrophies are inherited disorders and involve a mutation in the genes that program proteins critical to muscle integrity. Many muscular dystrophies are familial, meaning there is other family members affected with the disease.
Q. How common is muscular dystrophy?
Ans. MD occurs worldwide, affecting all races. Its incidence varies, as some forms are more common than others. It’s most common form in children, Duchenne muscular dystrophy affects approximately 1 in every 3,500 to 6,000 boys.
Q. How does muscular dystrophy cause muscle weakness?
Ans. Our muscles are made up of thousands of muscle fibers. Each muscle fiber is an individual muscle cell that contains several proteins involved muscle fiber contraction, relaxation and membrane stabilization. Lack of a particular protein or dysfunctional protein leads to muscle fiber damage. Because of ongoing muscle fibers damage, our muscles tend to get weak, thin and short.
Q. What are the types of muscular dystrophies?
Ans. There are >40 types of muscular dystrophies. Most common muscular dystrophies with childhood-onset are Duchenne muscular dystrophy, Becker muscular dystrophy, and congenital muscular dystrophy. Other less common conditions are Limb-girdle muscular dystrophy, Emery dreifuss muscular dystrophy and Facioscapulo-humeral muscular dystrophy. Muscular dystrophies vary by the age of onset, pattern of involvement and rate of progression.
Q. What is Duchenne muscular dystrophy?
Ans: Duchenne muscular dystrophy is the most common childhood form of MD, as well as the most common of muscular dystrophies accounting for approximately 50% of all cases. Duchenne muscular dystrophy primarily affects boys; they present with frequent falls, difficulty in climbing stairs noted from 4-5 years of age and loss of ambulation by ten years of age.
Q. What are the other complications of muscular dystrophy?
Ans. Muscular dystrophy also affects our other organs, like heart, bones, respiration, and brain. The heart muscles involvement may present with rhythm abnormalities or heart failure. Respiratory muscle weakness in muscular dystrophy may require ventilator support.
Q. How are the muscular dystrophies diagnosed?
Ans. Diagnosis of muscular dystrophy is based on the history and examination findings. Several investigations can help in diagnoses such as creatine kinase, nerve conduction study and electromyography. The diagnosis of muscular dystrophy is confirmed by muscle biopsy, and genetic testing.
Q. How are the muscular dystrophies treated?
Ans. There is no specific treatment for muscular dystrophies. However, available treatments are aimed at keeping the person independent for as long as possible and prevent complications that result from weakness, reduced mobility, and cardiac and respiratory difficulties. Treatment may involve a combination of approaches-
· Physical therapy and regular muscle stretches
· Orthotic devices
· Drug therapy
· Surgical correction of contractures.
Regular muscle stretching and exercise is necessary to maintain the muscle strength and prevention of contractures. Drug therapy may help in reducing muscle degeneration. Corticosteroids may reduce the rate of progression of weakness in Duchenne muscular dystrophy. Orthotic devices such as ankle-foot orthosis, night splints help in improving mobility.
Q. What are the home modifications to help the patient with muscular dystrophy?
Ans. The environmental modification can help the patient in daily activity. Supporting bars in the bathroom, removal of obstacles in the home, ramp in place of stairs may help the patients with muscular dystrophy.
Q. What is the prognosis?
Ans. The prognosis varies according to the type of muscular dystrophy, and the speed of progression. Some types are mild and progress very slowly, allowing normal life expectancy, while others are more severe and result in functional disability and loss of ambulation.
Q. What research is being done?
Ans. Although muscular dystrophies are not curable at present, however research related their natural history, immunomodulation therapy, and gene therapy is ongoing. Exon skipping therapy has been approved in some countries for the treatment of Duchenne muscular dystrophy.
by Dr. Asim Shrestha
1.What is Neurocysticercosis (NCC)?
Cysticercosis is an infection caused by the larvae of the parasite tapeworm (Taenia solium). The larvae get into tissues such as muscle and brain, and form cysts there (these are called cysticerci). When cysts are found in the brain, the condition is called neurocysticercosis.
2.What is tapeworm?
Tapeworm is a parasite that lives in intestines of animals and humans. It is a flat worm, resembling a tape in appearance and hence the name. And as the term “parasite” suggests if there is a tapeworm in your child’s intestine, it absorbs the nutrients present in the food your child eats.
3.Is it a common infection in Nepal?
Yes, it is a common infection in Nepal and other developing countries due to poor sanitation of food and water.
4.How did my child get cysticercosis?
Children get cysticercosis when they swallow tapeworm eggs that are passed in the faeces of a human with a tapeworm. It spreads through food, water, or surfaces contaminated with faeces. Children swallow the eggs when they eat contaminated food or put contaminated fingers in their mouth.
5.What are the common foods implicated in causing cysticercosis?
Eating roadside food and raw fruits and vegetables washed with contaminated water can cause it. Eating pork does not always cause cysticercosis. Chinese food especially those with undercooked/raw vegetables like cabbage have risk of causing this disease.
6.Can my other children also get the same disease?
Yes, due to passage of eggs in stool, others can get infected in the family.
7.How long does it take to manifest symptoms once my child is infected?
Symptoms can occur months to years after infection. They usually manifest when the cysts start dying and the brain or other tissue around the cyst swell. The pressure of the swelling is what usually causes the symptoms of the infection What are the signs and symptoms of neurocysticercosis? Seizures and headaches are the most common symptoms. Other common symptoms include confusion, lack of attention, difficulty with balance, excess fluid around the brain (called hydrocephalus) may also occur. It can also rarely cause blurring of vision if cysts are present in eyes.
8.How will the doctor confirm the diagnosis?
The doctor will recommend a CT scan (also called CAT scan) or magnetic resonance imaging (MRI) of the brain to check for cysts.
9.How is this disease treated?
Tapeworm infection can easily be treated with anti-parasitic drugs, anti-inflammatory and anti-epilepsy medications.
10.Does it need surgery for treatment?
If a child gets hydrocephalus (fluid in brain) because of cysticercosis, doctors might put in a shunt (tube like structure) to drain excess fluid. But it is uncommonly needed.
11.How long is the treatment?
It depends on case to case basis. All children will need anti-parasite treatment for a month. Antiepileptic treatment depends on the findings of repeat CT/MRI scan done after 6 months.
12.What is my child’s prognosis?
Most children on regular treatment have a good outcome.
13.Are there any complications of this disease?
There can be complications like cognitive problems, accumulation of fluid in the brain, seizure and loss of vision.
14.How can I prevent the infection in future?
By improving the hygiene and sanitation the infection can be avoided in future. It is important to develop certain habits in children like:
· Wash and cook all fruits and vegetables with safe water.
· Avoid raw or undercooked meat and fish, raw fruits and vegetables that you aren’t able to peel yourself, and any food from street vendors.
· Drink only water boiled or bottled water for drinking.
· Avoid undercooked Chinese food with unwashed/ raw vegetables especially cabbage.
· Avoid roadside ice cubes.
· Washing hands after toilet and washing hands before eating food.
