PEDIATRIC NEUROLOGY CONSULT AND REFERRAL GUIDELINES

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PEDIATRIC NEUROLOGY CONSULT AND REFERRAL GUIDELINES Powered By Docstoc
					               University
of
South
Carolina
School
of
Medicine.
Department
of
Pediatrics




                        PEDIATRIC
NEUROLOGY
CONSULT
AND
REFERRAL
GUIDELINES

    DIAGNOSIS
              EVALUATION
PRIOR
TO
                          WHEN
TO
REFER
                              WHAT
TO
SEND

                            REFERRAL

    FIRST
TIME
AFEBRILE
    •
An
awake
and
asleep/video
EEG
at
least
 •After
first
unprovoked
afebrile
seizure
at
    •Send
all
relevant
medical

    SEIZURE
                one
week

after
a
first
unprovoked
        discretion
of
referring
provider
              records,
ER
reports
and
copies
of

                            afebrile
seizure.

                                                                       the
official
reports
of
ancillary

                            
                                                                                         studies
and
the
films
of
all
brain

                            Prefer
                                                                                   imaging
studies.

                            EEG
obtained
at
USC
Pediatric
                                                            •
A
home
videotape
of
seizure

                            Neurology
office
lab
MedPark
9
                                                           or
spell
is
helpful.

                            Call

803
434‐7961
                                                                       •
Brief
history
of
event
prepared

                            
                                                                                         by
parents

                            •
An
MRI
scan
if
EEG
shows
a
focal
                                                       •
Any
reports
of
prior
EEG
studies

                            abnormality.
(CT
scans
are
not

the
study

                            of
choice
for
evaluating
seizure
foci)





    FEBRILE
SEIZURES
       •Infants
and
toddlers
less
than
2
years
of
   •Children
greater
than
2
years
             •Brain
imaging
and
EEG
should
be

                            age
with
a
first
simple
                      of
age
with
a
first
simple
                 deferred
unless
recommended
by

                            (benign)
febrile
seizure
do
not
              (benign)
febrile
seizure
may
               the
neurologist.
CT
scans
are

                            require
brain
imaging,
EEG,
or
               benefit
from
consultation
on
a
             rarely
if
ever
helpful
for
febrile

                            neurological
consultation.
                   case
by
case
basis.
                        seizure
evaluations.

                            •
Diastat
can
be
discussed
and
offered
       •
Children
with
multiple
recurrences
of
    •
Copies
of
the
official
reports

                            especially
if
seizure
resulted
in
ER
or
      simple
febrile
seizures
may
benefit
from
   of
the
studies,
if
obtained,
sent

                            hospital
admission.
                          consultation
on
a
case‐by‐case
basis.
      with
all
relevant
medical
records.

                                                                          •
Consultation
may
be
considered
for
       If
brain‐imaging
studies

                                                                          children
with
atypical
(complex)
febrile
   were
interpreted
as
abnormal,

                                                                          seizures
(defined
as
a
febrile
seizure
     please
send
films

                                                                          lasting
greater
than
15
minutes,

                                                                          or
a
febrile
seizure
with
partial

                                                                          onset
or
focal
features
during

                                                                          or
after
the
seizure,
or
recurrent)

                University
of
South
Carolina
School
of
Medicine.
Department
of
Pediatrics






    DIAGNOSIS
           EVALUATION
PRIOR
TO
                         WHEN
TO
REFER
                              WHAT
TO
SEND

                         REFERRAL

    HEADACHE
            •prescribe
prn
medication
(ibuprofen
        •headaches
associated
with
focal
           •Send
all
relevant
medical

                         with
or
without
metoclopramide)
to
be
       weakness,
cranial
nerve
signs,
or
mental
   records,
ER
reports
and
copies
of

                         used
sparingly
for
migraine
episodes
with
   status
changes
(consider
admission
and
     the
official
reports
of
ancillary

                         nausea
or
vomiting
                          inpatient
neurology
consultation)
          studies
and
the
films
of
all
brain

                         
                                            
                                           imaging
studies.

                         •
prescribe
preventive
medication(
          •
headaches
unresponsive
to
abortive
or
    •
Brief
history
of
event
prepared

                         cyproheptadine,
propranolol,
or
             preventive
therapy
                         by
parents

                         gabapentin
)for
frequent
episodes
of
                                                    

                         headache
                                                                                

                         
                                                                                        

                         •encourage
lifestyle
changes
(e.g.
limit
                                                

                         caffeine,
ensure
adequate
sleep,
do
not
                                                 

                         overuse
NSAIDS,

                                                                        

                         
                                                                                        

                         •
refer
to
psychiatry
or
psychology
for
                                                 

                         substantial
psychosocial
stressors,
                                                     

                         depression
                                                                              

                         
                                                                                        

                         •
order
CT
of
the
brain
emergently
for
                                                  

                         headaches
associated
with
focal
                                                         

                         weakness,
cranial
nerve
signs,
or
mental
                                                

                         status
changes
(prefer
MRI
if
able
to
be
                                                

                         done
promptly,
otherwise
to
follow
CT)

                                                 

                                                                                                                  

                                                                                                                  

                                                                                                                  

                                                                                                                  

                                                                                                                  

                                                                                                                  

                                                                                                                  

                                                                                                                  

                                                                                                                  

             University
of
South
Carolina
School
of
Medicine.
Department
of
Pediatrics



    DIAGNOSIS
                EVALUATION
PRIOR
TO
                        WHEN
TO
REFER
                               WHAT
TO
SEND

                              REFERRAL

    HYPOTONIA
                •examine
for
muscular
atrophy,
             •when
regression,
abnormal
MRI
brain,

      •Send
all
relevant
medical

                              dysmorphic
features
                        substantially
elevated
CPK
or
abnormal
      records,
copies
of
the
official

                              •
order
blood
CPK
if
atrophy
or
            karyotype
present
                           reports
of
blood
and
brain
imaging

                              fasciculations
are
present.
                                                             studies.

                              •
order
blood
karyotype
(especially
if

                              dysmorphic)

                              •
refer
to
genetics
if
dysmorphic


                              •
order
MRI
brain
with
+

without

                              contrast
if
globally
delayed

                              •
refer
for
physical
+occupational
therapy

















Tips
for
an
effective
visit:
   
      
       
       
        
       
       
        
      
        
       For
more
information
call
(803)
434‐7950

             • Talk
with
your
patient
and
family
about
the
reason
for
the
referral
and
the
questions
to
be
answered.

             • Please
send
all
pertinent
information
ahead
of
time
to
allow
us
to
better
serve
our
patients
and
their
families.







                                                                                                                                                             


				
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posted:11/14/2011
language:English
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