[Posted on 25 February, 2021 by Ola Skjeldal]
During the years I have been a neurologist, most of my clinical activity and my “doctor’s heart” have been devoted to children and adolescents with neurological diseases. In particular, I have focused on children and adolescents with chronic disorders such as neuronal degenerative diseases, metabolic conditions and so-called developmental disorders. This has been a rewarding and valuable patient group to work with, and my education in the field of adult neurology was useful, and in my opinion a necessary experience to bring into the field of children.
The panorama of neurological conditions in childhood is extensive, and requires the same clinical neurological experiences as in adulthood. In addition to topographic diagnostics, it is also most often required that a neurological developmental assessment is also performed on children. Neurological diseases in childhood include many of the same conditions found in the adult population. In addition, children may have neurological diseases that start in childhood and are therefore diagnosed, investigated and eventually treated by a paediatric neurologist. This applies, for example, to neurometabolic and neuromuscular diseases, epilepsy, developmental disorders, genetic conditions and malformation syndromes. The field of paediatric neurology therefore includes all congenital and acquired malformations in the central nervous system, diseases and functional disorders in the nervous system and in muscles.
In children with neurological disorders, the problems are often complex and complicated. Epilepsy, learning disabilities, intellectual disability, major motor difficulties are among the things that can be found in one and the same patient. In the paediatric neurological habilitation, where many patients are cared for, the patients are followed, not infrequently throughout adolescence and into young adulthood. In Norway, children with neurological conditions constitute the largest group in interdisciplinary habilitation. I guess this is the case in most western countries. Almost 30 years ago, Waaler and colleagues (1991) found that up to 30% of inpatients and outpatients in a paediatric ward had primary or secondary neurological problems. I do not have a full overview, but after consulting with colleagues, there is nothing to suggest that this number is lower now.
In most western countries, a specialist education in paediatric neurology and habilitation has been introduced. In Sweden, paediatric neurology / habilitation has been a formal speciality since 1992. The speciality is a so-called “supplementary education” where general paediatrics forms the basis. In other countries, general neurology will also form a basis. The education, like the specialist education in adult neurology, provides clinical, neurobiological and neurophysiological formal education in the subject. With this as a background, I have, in all these years, wondered why my home country Norway is one of the few countries in the western world that does not yet have a formal education in the field of paediatric neurology and habilitation. To my knowledge, there are still no plans to initiate such an education. This education is thus not offered to Norwegian paediatric neurologists, neither now, nor at the time when, many years ago, I entered the paediatric environment.
With a few exceptions, it is mostly specialists in paediatrics who go into paediatric neurology. The vast majority have no neurobiological background. This means that most people have no experience in clinical neurology. Rather, they have special expertise in neurophysiology. Still, they do a brilliant job, and they know a lot about children’s psychomotorical development. The neurological knowledge and the clinical neurological examination they have never received any training in. This they must acquire in a kind of autodidactic process and it is in strong contrast to what is offered to Norwegian adult neurologists and what is the scheme for paediatric neurologists in other western countries.
In the years I have worked with neurological diseases in children, I have wanted a stronger and closer professional collaboration between adult neurology and paediatric neurology. Occasional discussion about some patients is not so difficult to achieve. A formal collaboration – on the basis of a formal education, however, has been more problematic. Let us hope that our younger colleagues see this in a completely different and more fruitful perspective.