Child and Adolescent Neurology for Psychiatrists

447 Pages·2008·4.04 MB·English

by  Audrey M. Walker MD

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Child and Adolescent Neurology
for Psychiatrists
Editors
Audrey M.Walker,M.D.
Departments of Psychiatry and Pediatrics
Montefiore Medical Center
Bronx Children's Psychiatric Center
Associate Clinical Professor of Psychiatry
Assistant Clinical Professor of Pediatrics
Albert Einstein College of Medicine
Bronx, New York
David Myland Kaufman,M.D.
Departments of Neurology and Psychiatry
Montefiore Medical Center
Professor of Neurology and Psychiatry
Albert Einstein College of Medicine
Bronx, New York
Cynthia R.Pfeffer,M.D.
Department of Psychiatry
New York Presbyterian Hospital
Professor of Psychiatry
Weill Cornell Medical College
New York, New York
Gail Ellen Solomon,M.D.
Attending Pediatric Neurologist
Director of Electroencephalography Laboratory
New York Presbyterian Hospital/Weill Cornell Medical Center
Professor of Clinical Neurology and Professor of Clinical Neurology in Pediatrics and Psychiatry
Weill Cornell Medical College
New York, New York
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Acquisitions Editor:Charles W. Mitchell
Managing Editor:Sirkka E. Howes
Project Manager:Cindy Oberle
Manufacturing Manager:Benjamin Rivera
Marketing Manager:Kimberly Schonberger
Design Coordinator:Steve Druding
Production Services:Nesbitt Graphics, Inc.
© 2008 by LIPPINCOTT WILLIAMS & WILKINS, a Wolters Kluwer business
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Printed in the USA
Library of Congress Cataloging-in-Publication Data
Child and adolescent neurology for psychiatrists / [edited by] Audrey M. Walker ... [et al.].
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7817-7191-7
ISBN-10: 0-7817-7191-9
1. Child psychiatry. 2. Pediatric neurology. 3. Developmental neurobiology. 4. Nervous system--Diseases.
I. Walker, Audrey M.
[DNLM: 1. Nervous System Diseases--diagnosis. 2. Adolescent. 3. Child. 4. Diagnosis, Differential. 5. Diagnos-
tic Techniques, Neurological. 6. Nervous System Diseases--psychology. 7. Neurologic Examination--methods.
8. Psychiatry--methods. WS 340 C5355 2008]
RJ499.C48225 2008
618.92'89--dc22
2008020769
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This project would not have been possible without the inspiration, support,
patience, and understanding of our families and mentors.
Thank you to Robert Catenaccio, Caroline, Charlie, and Peter Walker Kaplan;
Rita Kaufman and our children: Rachel, Bob, and Lila;
Jennifer and William; and Sarah and Josh;
Harvey Hecht, MD-husband; Samuel Solomon, MD-father; Sidney Carter, MD-mentor; and
Ann C. Pfeffer, a loving mother whose nine-plus decades of wisdom, empathy,
and intellect have enhanced her family.
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Acknowledgments
We thank our LWW editors, Charles Mitchell and Sirkka Bertling, and Bonnie Boehme of
Nesbitt Graphics, Inc., for their expertise and devotion to this project. We also thank the
chapter authors for their tireless efforts to produce this ambitious and unique text.
We thank our chairmen, Drs. T. Byram Karasu and Mark Mahler, of Montefiore Med-
ical Center/Albert Einstein College of Medicine; and Dr. Jack Barchas, of Weill Cornell
Medical College/New York Presbyterian Hospital, for their visionary leadership and devo-
tion to the interdisciplinary pursuit of knowledge in the fields of neurology and psychia-
try. We also thank the Presidents and CEOs of Montefiore Medical Center and New York
Presbyterian Hospital/Weil Cornell Medical Center—Drs. Spike Foreman, Steven Safyer,
and Herb Pardes. They provided our professional homes, where we began, grew, and re-
main happy and successful.
iv
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Preface
The relationship between psychiatry and neurology remains complex, with twists and
turns, approach and avoidance, interconnection, and divergence. At a time when neurol-
ogy and psychiatry were not yet recognized as distinct medical specialties, Sigmund
Freud’s early work focused on neurological subjects, including aphasia and neuropathol-
ogy. A psychiatrist, Hans Berger, was the principal inventor of the electroencephalogram
(EEG) and coined the term “elektenkephalogram.” Despite the fields’ common ground,
neurology and psychiatry split during the twentieth century: Neurologists claimed neu-
roanatomy as their province, and psychiatrists focused on pathological behavior and
thinking. With the development of sophisticated diagnostic techniques and systematic
empirical research to understand etiology, pathophysiology, and symptoms of brain func-
tioning, greater overlap between neurology and psychiatry has diminished their distinc-
tions. Psychiatrists realize the blurring of mind-brain dichotomies and neurologists ap-
preciate the impact of emotional and environmental factors on disease manifestations.
This edition of Child and Adolescent Neurology for Psychiatrists, coming 16 years after
the original, attempts to reconcile these sister disciplines. At the same time, this book elu-
cidates the differences between diseases that affect adults and those that affect children.
For neurologists and psychiatrists, children and adolescents are not diminutive adults.
The afflictions of children and adolescents are often unique, with different manifestations
than those encountered in adults, and requiring special treatment. The neurological dis-
orders of childhood and adolescence deserve the combined, collaborative perspectives of
these two distinct disciplines.
Child and Adolescent Neurology for Psychiatrists speaks to psychiatrists who treat chil-
dren and adolescents. It reviews developments in the diagnosis and treatment of neuro-
logical illnesses that psychiatrists are likely to encounter in their clinical practice. Most
chapters have been written collaboratively by teams of neurologists and psychiatrists who
discuss the psychiatric comorbidity of neurological illnesses and the psychiatric ramifica-
tions of medications often prescribed by neurologists. As an extension of the customary
topics in a neurology textbook, Child and Adolescent Neurology for Psychiatrists has in-
cluded discussions of psychiatric aspects of congenital and acquired childhood visual and
hearing impairments. Currently available imaging techniques and their appropriate appli-
cations are discussed and, acknowledging Berger’s seminal invention, the role of EEG in
the diagnosis of epilepsy is reviewed.
The book’s chapters, written by multiple authors who are experts in their fields, are pre-
sented in an accessible format for the practicing psychiatrist. Most chapter text is sup-
plemented with case discussions that illustrate the complexities of diagnosis and treat-
ment. Chapters conclude with multiple-choice questions that allow for interactive
learning.
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In Remembrance of Paulina F. Kernberg, MD
Prior to her death, we discussed our concepts for this book with Dr. Paulina Kernberg,
child and adolescent psychiatrist and psychoanalyst and Professor of Psychiatry and Di-
rector of Training of Child and Adolescent Psychiatry at the Westchester Division of New
York Presbyterian Hospital-Weill Cornell Medical College. She enthusiastically remarked
that “the collaboration and interspecialty communication between psychiatrists and neu-
rologists is a must!” She emphasized that awareness of neurological problems is important
in assessing what might appear to be psychiatric symptomatology. She remarked, “I re-
member my first paper, the problem of organicity; in those times, many years ago, lan-
guage processing disturbances were erroneously diagnosed as schizophrenic disorder. As
a child psychiatry resident, I felt like a magician when I noticed that a school-age child
had responded correctly after a significant delay to the question of how long it took her
parents and her to get from her home to the hospital. Approximately ten minutes later, she
answered. So, I decided to slow down the speed of my language. Her speech and mood
improved significantly in the two remaining diagnostic sessions—to the extent that all
ideas of a formal thought disorder were ruled out.”
Paulina noted, “The child psychiatrist can contribute uniquely to the child’s awareness
of his body and cognitive functions so that the child can accommodate, adapt, accept, and
hopefully compensate for these deficits in an effective manner. The meaning of the illness
for the patient and its impact on the siblings and parents are an additional input on the
psychological dimension.”
“My personal wish for the commendable work of the authors and editors is a success-
ful, effective new book!”
We lament that Dr. Kernberg will not see the completed product of our work, a clearly
written, informative, and concise reference on neurological problems often impacting
children’s psychosocial development.
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Foreword
A textbook of clinical neurology for psychiatrists? The twenty-first century is indeed a
brave new world for American psychiatry! Neuroscience at the dawn of the twenty-first
century has revolutionized the field. Freud, who started his career as a clinician studying
the neuropathology of infantile hemiplegia, would be pleased with this transformation, as
he clearly believed that behavior belongs in the brain. Though a great divide still exists be-
tween our nascent understanding of the complexities of human behaviors and their neu-
roanatomic foundations, the coming decades hold great promise for breakthroughs in this
important area of medicine.
The publication of Child and Adolescent Neurology for Psychiatrists signals the narrowing
of the breach between psychiatry and neurology, which developed nearly a century ago.
The book focuses on common neurological conditions that affect the immature brain and
explores the psychiatric comorbidities that accompany them. It is enriched by cases that
illustrate the fruitful collaboration that results from a joint neuropsychiatric approach to
children whose presentations are at the border between psychiatry and neurology. It is
hoped that this book will find a niche on the shelves of both psychiatrists and child neu-
rologists, and bring greater sophistication to practitioners in both disciplines, ultimately
for the benefit of the many children who enter our consulting rooms with vexing prob-
lems requiring mutual understanding and collaboration.
Isabelle Rapin, M.D.
Saul R. Korey Department of Neurology
Department of Pediatrics
Rose F. Kennedy Center for Research in Mental Retardation and Human Development
Albert Einstein College of Medicine
Bronx, New York
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Contributors
Kenneth S. Allison, M.D. Martha Bridge Denckla, M.D.
Resident, Department of Radiology, Albert Professor of Neurology, Pediatrics and Psychiatry,
Einstein College of Medicine of Yeshiva Johns Hopkins University School of Medicine;
University; Montefiore Medical Center, Director, Developmental Cognitive Neurology,
Bronx, New York Kennedy Krieger Institute, Baltimore,
Maryland
Karen R. Ballaban-Gil, M.D.
Professor of Clinical Neurology and Clinical Aleksandra Djukic, M.D., Ph.D.
Pediatrics, Albert Einstein College of Assistant Professor of Neurology and Pediatrics,
Medicine; Director, Child Neurology Albert Einstein College of Medicine;
Residency Program, Montefiore Medical Attending Physician, Neurology, Montefiore
Center, Bronx, New York Medical Center, Bronx, New York
Jacqueline A. Bello, M.D., FACR Patricia K. Duffner, M.D.
Professor of Clinical Radiology, Albert Einstein Professor of Neurology and Pediatrics, University
College of Medicine of Yeshiva University; at Buffalo School of Medicine; Attending in
Director, Division of Neuroradiology, Child Neurology, Women and Children’s
Montefiore Medical Center, Bronx, New York Hospital of Buffalo, Buffalo, New York
Lucy Ann Civitello, M.D. David W. Dunn, M.D.
Assistant Professor of Neurology, George Professor of Psychiatry and Neurology, Indiana
Washington University; Attending University School of Medicine; Director, Child
Neurologist, Children’s National Medical and Adolescent Psychiatry Clinics, Riley
Center, Washington, District of Columbia Hospital for Children, Indianapolis, Indiana
Lee Cohen, M.D. Josephine Elia, M.D.
Assistant Clinical Professor of Psychiatry, Assistant Professor of Psychiatry, University of
Columbia University College of Physicians Pennsylvania; Medical Co-director, ADHD
and Surgeons; Attending Psychiatrist, New Center, Child and Adolescent Psychiatry,
York Presbyterian Hospital/Columbia, St. The Children’s Hospital of Philadelphia,
Lukes–Roosevelt Hospital Center, Roosevelt Philadelphia, Pennsylvania
Division, New York, New York
Howard L. Geyer, M.D., Ph.D.
Michael E. Cohen, M.D. Assistant Professor of Neurology, Albert Einstein
Professor of Neurology and Pediatrics, State College of Medicine; Attending Neurologist,
University of NY at Buffalo; Neurologist, Montefiore Medical Center, Bronx, New York
Women and Children’s Hospital of Buffalo,
Buffalo, New York Rick O. Gilmore, Ph.D.
Associate Professor of Psychology, Pennsylvania
Kelly A. Condefer, M.D. State University, University Park,
Fellow, Department of Neurology, Beth Israel Pennsylvania
Medical Center, New York, New York
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x CHILD AND ADOLESCENT NEUROLOGY FOR PSYCHIATRISTS
Elisabeth Guthrie, M.D. Stewart H. Mostofsky, M.D.
Associate Clinical Professor of Psychiatry and Associate Professor of Neurology and Psychiatry,
Pediatrics, Columbia University; Director, Johns Hopkins University School of Medicine;
Residency Training, Child and Adolescent Medical Director, Center for Autism and
Psychiatry, New York Presbyterian Hospital, Related Disorders, Kennedy Krieger Institute,
New York, New York Baltimore, Maryland
Rana S. Jehle, PA-C. Ngoc Nguyen, M.D.
Pediatric Physician Assistant, Department of Fellow, Child and Adolescent Psychiatry, Albert
Neurology, Montefiore Medical Center, Einstein College of Medicine; Pediatric
Bronx, New York Psychosomatic Fellow, Child and Adolescent
Psychiatry, Montefiore Medical Center, Bronx,
David L. Kaye, M.D. New York
Professor of Clinical Psychiatry, University at
Buffalo School of Medicine and Biomedical Wendy Osterling, M.D.
Sciences; Chief, Clinical Services, Division of Pediatric Neurology Fellow, Department of
Child/Adolescent Psychiatry, Women and Pediatrics, University of Utah, Salt Lake City,
Children’s Hospital of Buffalo, Buffalo, Utah
New York
Maryland Pao, M.D.
Robert A. King, M.D. Deputy Clinical Director, Office of the Clinical
Professor of Child Psychiatry, Medical Director, Director NIMH, National Institutes of Health,
Tourette’s Syndrome/OCD Clinic, Yale Child Bethesda, Maryland
Study Center, Yale University School of
Medicine; Attending Physician, Yale–New John M. Pellock, M.D.
Haven Hospital, New Haven, Connecticut Professor and Chair, Division of Child Neurology,
Vice Chair, Department of Neurology, Virginia
Lauren B. Krupp, M.D. Commonwealth University; Chief, Child
Professor of Neurology, SUNY Stony Brook; Neurology, Medical College of Virginia
Director, National Pediatric MS Center; Hospital, VCU Health System, Richmond,
Co-Director, MS Comprehensive Care Center, Virginia
Stony Brook University Hospital and Medical
Center, Stony Brook, New York Maris D. Rosenberg, M.D.
Associate Professor of Clinical Pediatrics, Albert
Thornton B.A. Mason II, M.D., Ph.D. Einstein College of Medicine; Developmental-
Assistant Professor of Neurology and Pediatrics, Behavioral Pediatrician, Children’s Evaluation
University of Pennsylvania; Attending and Rehabilitation Center, Rose F. Kennedy
Neurologist, The Children’s Hospital of UCEDD, Bronx, New York
Philadelphia, Philadelphia, Pennsylvania
A. David Rothner, M.D.
Patricia Engel McGoldrick, N.P. Director Emeritus, Section of Child Neurology;
Adjunct Faculty in Nursing, New York University Director, Children’s Headache, Child
and Columbia University; Associate Director, Neurology Program; Staff, Section of Child
DDC; Nurse Practitioner in Neurology, Neurology, The Cleveland Clinic Foundation,
Beth Israel Pediatrics and St. Luke’s Roosevelt, Cleveland, Ohio
New York, New York
Rachel Saunders-Pullman, M.D., M.P.H.
Todd S. Miller, M.D. Assistant Professor of Neurology, Albert Einstein
Assistant Professor of Clinical Radiology, Albert College of Medicine, Bronx, New York;
Einstein College of Medicine of Yeshiva Attending Neurologist, Beth Israel Medical
University; Department of Radiology, Center, New York, New York
Montefiore Medical Center, Bronx, New York