58  Spectrum of Neurological Disorders

Published

June 9, 2025

58.1 Introduction

Neurological disorders in children represent a diverse group of conditions that affect the brain, spinal cord, peripheral nerves, or neuromuscular junctions. These disorders can lead to developmental delays, motor dysfunction, seizures, and cognitive impairments. In Ghana, the burden of childhood neurological disorders is significant due to factors such as limited resources, perinatal complications, infections, malnutrition, and lack of early diagnosis and intervention.

Understanding the spectrum of pediatric neurological conditions is vital for early identification, diagnosis, treatment, and referral.

58.2 Classification of Pediatric Neurological Disorders

Neurological disorders in children can be classified into the following major categories:

  1. Neurodevelopmental Disorders
  2. Epileptic Disorders
  3. Cerebrovascular Disorders
  4. Neuromuscular Disorders
  5. Infectious and Post-infectious Disorders
  6. Metabolic and Genetic Disorders
  7. Neurocutaneous Syndromes
  8. Brain Tumors and Space-occupying Lesions
  9. Head Trauma and Acquired Brain Injuries

58.3 Neurodevelopmental Disorders

These disorders typically manifest early in development and are characterized by impairments in personal, social, academic, or occupational functioning.

  1. Cerebral Palsy (CP)

    1. Definition: A group of permanent movement disorders due to non-progressive disturbances in the developing brain.
    2. Types: Spastic (most common), dyskinetic, ataxic, and mixed.
    3. Causes:
      • Perinatal asphyxia (common in Ghana)
      • Premature birth
      • Neonatal jaundice (kernicterus)
      • Infections (TORCH)

  2. Clinical Features:

    • Delayed milestones
    • Abnormal tone (increased or decreased)
    • Reflex abnormalities

  3. Management:

    • Multidisciplinary approach: physiotherapy, occupational therapy, antispastic medications (e.g., baclofen), orthopedic interventions.
    • Early intervention programs are critical.

B. Autism Spectrum Disorder (ASD)

  • Definition: Neurodevelopmental disorder characterized by deficits in social interaction and communication, with restricted, repetitive behaviors.
  • Diagnosis: Based on DSM-5 criteria.
  • Onset: Before age 3.
  • Red Flags:
    • Lack of eye contact
    • No single words by 16 months
    • No two-word phrases by 2 years
  • Management:

    • Behavioral therapy

    • Speech therapy

    • Structured educational support

C. Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Symptoms: Inattention, hyperactivity, impulsiveness.
  • Diagnosis: Based on clinical history and observation.
  • Management:
    • Behavioral therapy
    • Medications (e.g., methylphenidate—rarely used in Ghana due to availability)

58.4 Epileptic Disorders

Epilepsy is a common neurological disorder in Ghanaian children due to high rates of perinatal insults, CNS infections, and trauma.

A. Seizure Classification

  • Focal (Partial) Seizures
  • Generalized Seizures
  • Absence Seizures
  • Febrile Seizures
  • Infantile Spasms (West Syndrome)

B. Etiology

  • Idiopathic (genetic)
  • Structural (trauma, tumor)
  • Metabolic (hypoglycemia, electrolyte imbalance)
  • Infectious (meningitis, cerebral malaria)

C. Diagnosis

  • Clinical history

  • EEG

  • Neuroimaging (CT or MRI if accessible)

  • Blood tests for metabolic derangements

D. Management

  • Acute seizure: Diazepam or lorazepam

  • Long-term: Carbamazepine, sodium valproate, phenobarbital (commonly used in Ghana)

  • Treat the underlying cause

  • Educate caregivers

58.5 Cerebrovascular Disorders

Relatively rare but essential to consider.

A. Stroke in Children

  • Causes:

    • Sickle Cell Disease (SCD) is common in Ghana

    • Congenital heart disease

    • Infections (e.g., meningitis, endocarditis)

  • Signs:

    • Hemiplegia

    • Altered consciousness

  • Diagnosis:

    • Neuroimaging

    • Blood tests (e.g., sickling test)

  • Management:

    • Supportive care

    • Antiplatelets (aspirin)

    • Transfusion in SCD

58.6 Neuromuscular Disorders

These affect motor nerves, neuromuscular junctions, or muscles.

A. Duchenne Muscular Dystrophy (DMD)

  • Genetic disorder: X-linked recessive

  • Onset: 2–5 years

  • Signs:

    • Gower’s sign

    • Proximal muscle weakness

    • Calf pseudohypertrophy

  • Diagnosis:

    • Elevated CK

    • Genetic testing (if available)

  • Management:

    • Steroids

    • Physiotherapy

    • Monitor respiratory and cardiac function

B. Guillain-Barré Syndrome (GBS)

  • Acute autoimmune polyneuropathy

  • Trigger: Often post-infectious (e.g., Campylobacter, CMV)

  • Symptoms:

    • Ascending paralysis

    • Areflexia

  • Management:

    • Supportive care

    • IVIG (limited availability)

    • Monitor respiratory function

58.7 Infectious and Post-Infectious Disorders

A significant cause of neurological disease in children in Ghana.

A. Bacterial Meningitis

  • Causes: S. pneumoniae, N. meningitidis, H. influenzae

  • Symptoms:

    • Fever, neck stiffness, bulging fontanelle (infants)

    • Altered consciousness, seizures

  • Diagnosis:

    • CSF analysis

  • Complications:

    • Hydrocephalus

    • Hearing loss

    • Epilepsy

  • Treatment:

    • IV antibiotics (ceftriaxone)

    • Supportive care

B. Cerebral Malaria

  • Caused by: Plasmodium falciparum

  • Symptoms:

    • Seizures

    • Coma

  • Diagnosis:

    • Blood smear

  • Treatment:

    • IV artesunate

    • Anticonvulsants

  • Prevention:

    • Insecticide-treated nets

    • IPT in pregnancy

C. Tuberculous Meningitis

  • Symptoms:

    • Gradual onset of fever, headache, vomiting, neck stiffness

  • Diagnosis:

    • CSF (high protein, low glucose)

    • GeneXpert (if available)

  • Treatment:

    • Anti-TB drugs for 12 months

    • Steroids (dexamethasone)

58.8 Metabolic and Genetic Disorders

Rare, but often underdiagnosed in Ghana due to a lack of advanced diagnostics.

A. Phenylketonuria (PKU), Tay-Sachs, and Others

  • Symptoms:

    • Developmental delay

    • Seizures

    • Hypotonia

  • Diagnosis:

    • Requires metabolic screening (Guthrie test—limited availability)

  • Management:

    • Dietary modifications

    • Genetic counseling

B. Mitochondrial Disorders

  • Often present with multisystem involvement.

  • Poor feeding, lactic acidosis, seizures.

58.9 Neurocutaneous Syndromes

A. Tuberous Sclerosis Complex (TSC)

  • Signs:

    • Seizures (infantile spasms)

    • Skin lesions (ash leaf spots, shagreen patches)

    • Intellectual disability

  • Diagnosis:

    • Clinical + imaging (MRI may show cortical tubers)

  • Management:

    • Seizure control

    • Multidisciplinary follow-up

B. Neurofibromatosis Type 1

  • Signs:

    • Café-au-lait spots

    • Neurofibromas

    • Learning disabilities

  • Complications:

    • Optic gliomas

  • Management:

    • Surveillance for tumors

    • Genetic counseling

58.10 Brain Tumors and Space-Occupying Lesions

Though rare, brain tumors must be considered, especially in children with persistent headaches, vomiting, or seizures.

Common Types in Children:

  • Medulloblastoma

  • Astrocytoma

Symptoms:

  • Headache

  • Morning vomiting

  • Papilledema

  • Focal deficits

Diagnosis:

  • CT/MRI

  • Biopsy (if accessible)

Management:

  • Surgical resection

  • Radiotherapy

  • Chemotherapy

58.11 Head Trauma and Acquired Brain Injury

Frequent in Ghana due to road traffic accidents and falls.

A. Types:

  • Concussion

  • Contusion

  • Hematomas (epidural, subdural)

B. Signs:

  • Loss of consciousness

  • Vomiting

  • Seizures

  • Pupillary changes

C. Management:

  • ABCs (Airway, Breathing, Circulation)

  • Neuroimaging

  • Neurosurgical referral

D. Prevention:

  • Use of helmets, child restraints

  • Public health education

58.12 Diagnostic Approach to a Child with Neurological Symptoms

  2. History Taking

    • Antenatal, birth, and developmental history

    • Family history

    • Onset and progression of symptoms

  4. Physical Examination

    • Neurological exam: tone, reflexes, cranial nerves

    • General exam: dysmorphic features, skin lesions

  6. Investigations

    • Imaging (CT/MRI)

    • EEG

    • CSF analysis

    • Laboratory (CBC, glucose, electrolytes, infection screening)

    • Genetic/metabolic workup (if available)

58.13 Challenges in Ghana

  • Limited access to pediatric neurologists

  • Inadequate neuroimaging facilities in rural areas

  • Delayed diagnosis and referral

  • Financial constraints

  • Stigmatization and lack of awareness

58.14 Recommendations for Medical Students and Health Workers

  • Recognize early signs of neurological disorders

  • Take a thorough developmental and birth history

  • Use clinical judgment when diagnostic tools are limited

  • Educate parents and caregivers

  • Refer early to tertiary centers (e.g., Korle-Bu, Komfo Anokye Teaching Hospital)

  • Advocate for public health interventions and awareness

58.15 Conclusion

Neurological disorders in children in Ghana are diverse, with significant morbidity. Early recognition, timely referral, and multidisciplinary care are crucial. Despite resource limitations, medical students and practitioners can make a significant impact through clinical acumen, advocacy, and community education.