Children can develop neurological conditions that affect their brain development, movement, speech, muscle strength, and everyday activities. Some conditions are present from birth, while others develop due to genetic factors, infections, or injuries.
In an interview with The Sunday Morning, Consultant Paediatric Neurologist Dr. Anuruddha Padeniya explained the different conditions that could affect children, their causes and symptoms, and the importance of early assessment and appropriate care.
Following are excerpts:
What are the common neurological disorders among children in Sri Lanka?
I think headaches are the most common problem. When discussing neurology, I consider it under several headings, including the brain, the spinal cord, and the peripheral nerves.
The brain and spinal cord form the central nervous system, while the nerves extending from the spinal cord form the peripheral nervous system. These nerves connect to muscles and other organs, transmitting messages that enable the body to function.
The transmission of these messages involves electrical signals along the nerves and chemical communication at the neuromuscular junction, where a nerve connects with a muscle. The movement of electrolytes, including sodium and chloride, helps transmit electrical signals along the nerves.
Headaches are extremely common among children. According to the World Health Organization (WHO), global figures show that around 40% of children experience headaches by the age of seven, and this proportion rises to around 70–80% among older children. Sri Lankan-specific figures are limited, but similar patterns may apply here. According to 2024 publications by the American Academy of Neurology, around 60% of children experience significant headaches.
What is epilepsy, how does it affect children, and why is it now described as ‘epilepsies’ rather than a single condition?
Epilepsy is another brain-related condition. The brain acts as the body’s control centre, and when its electrical activity becomes abnormal, it can affect different parts of the body, causing jerking movements or other symptoms. This is known as a seizure.
Epilepsy is characterised by a tendency to experience recurrent epileptic seizures. However, not all seizures indicate epilepsy. Some are provoked by factors such as low blood sugar or a lack of oxygen to the brain, while unprovoked seizures occur without an immediate trigger. The diagnosis of epilepsy depends on the clinical circumstances and the likelihood of further seizures.
The International League Against Epilepsy (ILAE) uses the term ‘epilepsies’ because the condition encompasses several different types, each with its own characteristics.
The symptoms depend on the area of the brain where the seizure originates. For example, seizures arising in the frontal, occipital, or temporal lobes may produce different symptoms. By assessing a child’s symptoms and clinical presentation, doctors can often identify the likely type of seizure and determine whether further investigations are needed.
There are around 40–50 recognised epilepsy syndromes, including self-limited epilepsy with centrotemporal spikes (formerly known as Rolandic epilepsy), childhood absence epilepsy, and juvenile absence epilepsy.
What is cerebral palsy, what causes it, and how does it affect a child’s posture and movements?
Cerebral palsy occurs when damage to, or abnormal development of, the brain affects a child’s posture and movements. The brain may be affected during pregnancy, at birth, or in early life. For example, damage to the left side of the brain may affect the right side of the body and vice versa.
There are different types of cerebral palsy. When one side of the body is affected, it is called hemiplegia. When all four limbs are affected, it is known as quadriplegia. A child’s posture, the way they hold their limbs and body, and their movements can help doctors assess the effects of the condition.
How are children’s intellectual abilities assessed, and how can those with intellectual disabilities be supported?
Cognitive abilities include intelligence, speech, reasoning, logical thinking, and learning. A child’s abilities are assessed according to their age, as the level of reasoning expected of a two-year-old differs from that of a five-, eight-, or 14-year-old.
Intelligence Quotient (IQ) tests, including verbal and non-verbal assessments, are used to assess cognitive abilities. An IQ score of around 100 is generally considered average. A child’s cognitive development can be influenced by genetic factors, brain development, and other circumstances.
Children with lower IQ scores may experience learning difficulties and struggle to keep up with their classmates. For example, a child in Grade 7 may find lessons difficult and demonstrate academic abilities closer to those expected of a much younger child. An assessment can help identify the child’s strengths and difficulties and determine the support they need.
A person with an IQ of around 60 may have difficulty understanding everyday situations and reasoning. In the past, such people were referred to as ‘mentally retarded,’ but the appropriate term today is ‘people with intellectual disabilities’.
However, having an intellectual disability does not mean that a person cannot develop skills or become more independent. I recently treated a child with an IQ of 62. When I learnt that the father was a commercial dancer, I advised the parents to train the child in dancing. The child learnt the skills well and now has the potential to pursue dancing as a career.
In another case, an 18-year-old girl with an IQ of around 70 learnt to prepare and package spices from her grandmother. She now collects goraka (Garcinia), processes and packs it, and sells the products.
We must identify each person’s abilities and help them become productive members of society. Inclusive education, which promotes the participation of children with disabilities in education and society, is also important.
Above all, we must protect their self-esteem. These are the principles we follow.
What conditions can affect brain development, and what happens when the cerebellum does not work properly?
There are also genetic neurological conditions that affect brain development. One example is trisomy 21, commonly known as Down syndrome. These children may have intellectual and developmental difficulties, and their muscle strength may be lower than expected for their age. These difficulties can affect their daily activities and other functions.
Moving on to the cerebellum, commonly known as the ‘little brain,’ it actually contains more nerve cells than the rest of the brain. It plays an important role in movement, balance, and coordination.
When the cerebellum does not function properly, a person may develop a condition called ataxia, which affects balance and coordination. Eye movements may also be affected. When the person speaks, they may have difficulty articulating words clearly because of problems coordinating the muscles involved in speech.
These symptoms may lead parents to seek a neurologist’s assessment for their child.
What other spinal cord, nerve, and muscle conditions can affect children, and what problems can they cause?
The spinal cord is another part of the nervous system that can be affected. Some children are born with conditions such as neural tube defects, which can affect the spinal cord. Depending on the damage, their legs may not function properly. They may also have difficulty controlling their urine and bowel movements. These problems need to be assessed and managed.
There are also other spinal cord conditions, such as syringomyelia, in which a fluid-filled cavity develops within the spinal cord.
Next are the motor nerve cells. If these do not function properly, conditions such as spinal muscular atrophy (SMA) can develop. In SMA, a genetic problem affects the motor nerve cells, preventing them from sending the necessary signals to the muscles. As a result, the muscles become weak and waste away. If the nerves supplying the breathing muscles are affected, the child may develop severe breathing difficulties, which can be life-threatening.
Polio is another condition that damages motor nerve cells. Depending on which nerves are affected, the child may develop weakness or paralysis in the limbs.
Peripheral nerves can also be affected by conditions such as hereditary motor and sensory neuropathy (HMSN). These conditions may be inherited and can affect muscle strength and sensation.
Another area is the neuromuscular junction, where nerves communicate with muscles. Myasthenia gravis is a condition that affects this communication. Some children may develop drooping eyelids, which can become more noticeable if they do not take their prescribed medication.
Muscles themselves can also be affected. Some conditions cause muscles to function poorly, while others cause them to deteriorate progressively. The latter include muscular dystrophies, a group of genetic conditions in which muscles gradually weaken and waste away. In severe cases, children may develop breathing difficulties or have trouble coughing effectively to clear their airways. These complications can be life-threatening.
Apart from conditions present from birth or caused by genetic factors, children can also develop neurological problems later in life. Infections affecting the brain or spinal cord can cause damage. The impact of infections varies between countries depending on social conditions, immunisation programmes, and other factors. Covid-19 can also affect the nervous system in some children.
Injuries are another cause. These may result from road accidents, falls, sports injuries, non-accidental injuries, or complications arising during surgery.