One of the newest societies of child neurology in the world, the Child Neurology Society of Nigeria has been inaugurated in West Africa. The population of Nigeria was estimated to be 124 million in 2003, which placed it as tenth most populous nation in the world.
It is the most populated country in Africa, with 44% of the population under 15 years of age. Nigeria has 12 medical schools. It has an active Paediatric Association, with its own journal, Nigerian Journal of Paediatrics. In January 2007, the Child Neurology Society of Nigeria (http://cnsnonline.org/index.php) was formed and now has over 20 members, paediatricians trained and interested in child neurology and development.
In January 2009 ICNA was invited by Dr Gabriel Ofovwe, a consultant Child Neurologist at the University of Benin Nigeria, to participate at a symposium at the Annual meeting of the Paediatric Association of Nigeria held at Ilorin, Nigeria from in January 20-23rd 2010. Dr Barbara Laughton and Prof Charles Newton accept the invitation on behalf of ICNA to present at the symposium and attend the Paediatric Association of Nigeria.
The symposium consisted of 4 lectures and much discussion: Dr Ofovwe reported the prevalence of Attention Deficit Hyperactivity Disorder was 8% in Nigeria, but this was probably an underestimate, and this disorder needs to be recognised more in Africa. Prof Newton gave an overview of infections of the central nervous system as a cause or neurological morbidity in Africa, followed by a more detailed talk on cerebral malaria by Dr Lesi. Dr Laughton gave an excellent talk on the neurological complications of HIV which precipitated much discussion and questions.
After the meeting there were two further sessions on child neurology which included presentations on stroke in sickle cell disease, cerebral palsy, epilepsy and even a case report of Krabbe’s disease, a challenging diagnosis to make in most parts of Africa. In other sections of the conference, there were presentations on tetanus (both neonatal and older children), meningitis, case reports of encephalopathy and other conditions associated with neurological conditions.
The Child Neurology Society of Nigeria is currently guided by Dr Ofovwe (President), Dr. Edward Alikor (Secretary) and Dr. Ngozi Ojinaka (treasurer). The members are keen to explore opportunities for training, particularly in electroencephalography, and the management of cerebral palsy and epilepsy. They would like to interact with other clinicians interested in child neurology, particularly in Africa, but also other countries of the world.
Charles R Newton
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In May 2010 the International Child NeurologyAssociation will meet on African soil in Cairo. It is a fittingevent to launch the African Paediatric Neurology Association (APNA).
This decision was taken at a joint meeting of representatives of an African steering committee and the executive of ICNA on Friday 12th of March 2009 in Cairo, chaired by Andre Venter, National Chairman of The Paediatric Neurology and Developmental Association of Southern Africa (PANDA SA).
It has become clear that an Association catering for all professionals in Africa who manage children and adolescents with neurological conditions, is an imperative, not only to improve services, but also to build skills in this continent.
The vision for such an Association has provisionally been highlighted as:
1.Communication and the development of a professional network.
2.Promotion of training in the fields of neurology and child developmentby identifying training centers and programs and making them availableto professionals working in the field.
3. Identification of services and resources (or lack of) and lobbying regionally, nationally and internationally for improvements.
4.Promoting research collaboration and offer assistance.
5.Identify key areas of burden of disease specific to Africa and develop treatment and management strategies
It is envisaged that at the first meeting of delegates from Africa in Cairo on the 1st of May 2010 this Association would be officially constituted, an executive committee elected and the principles of a the constitution agreed upon. Interested parties from African countries are invited to be part of this initiation of APNA. There is no cost for attendance at the meeting (it is included in the registration for the ICNC conference). Non-African attendees are also most welcome.
This will indeed be an historic occasion for child neurology in Africa as well as our mother organization ICNA. Just like adult neurology a few years ago, the time has come to put Africa on the map with regards to child neurology as well.
Opening of the 1st African Paediatric Neurology Association
Introductory Workshop
May 1st 2010, Saturday
Venue: Grand Hyatt Congress Hotel
14.00-17.00
| |
Topic |
Speaker |
Chairs |
| 14.00-14.30 |
Opening of the 1st African Paediatric Neurology Association |
Prof Andre Venter Prof Ahmed Roauf Ibrahim |
Prof Andre Venter / Prof Ahmed Raouf Ibrahim |
| 14.30-14.40 |
Report of child neurology services across Africa |
Assoc Prof Jo Wilmshurst |
|
| |
Regional summaries |
|
|
| 14.40-15.00 |
Child neurology needs in Malawi and beyond |
Dr Mac MallewaLecturer (Clinical) in Paediatric Neurology This email address is being protected from spambots. You need JavaScript enabled to view it. |
|
| 15.00-15.15 |
Child neurology needs in Uganda and beyond |
Dr Angelina Kaooza This email address is being protected from spambots. You need JavaScript enabled to view it. |
|
| 15.15-15.30 |
Child neurology needs in Ghana and beyond |
Dr Ben Badoe This email address is being protected from spambots. You need JavaScript enabled to view it. |
|
| 15.30-15.45 |
Child Neurology needs in Nigeria |
Dr Robinson Wammanda, Department of paediatrics, Ahmadu Bello University teaching hospital,Zaria, This email address is being protected from spambots. You need JavaScript enabled to view it. |
|
| 15.45-17.00 |
Discussion, Inauguration and election of office bearers |
all |
Prof Andre Venter / Prof Ahmed Raouf Ibrahim |
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A new guideline from the American Academy of Neurology and the Child Neurology Society finds botulinum toxin type A to be an effective treatment for spasticity, muscle tightness that interferes with movement, in children and adolescents with cerebral palsy, but poses some risk. The guideline is published in the January 26, 2010, issue of Neurology
"Spasticity in children with cerebral palsy is best treated by a multidisciplinary medical and surgical team," said lead guideline author Mauricio R. Delgado, MD, FRCPC, with the University of Texas Southwestern Medical Center in Dallas and Fellow of the American Academy of Neurology. "It is important that doctors, patients and caregivers together set a goal for measuring the success of medication use or any other spasticity treatment."
Spasticity is a form of abnormally increased muscle tone and is usually associated with muscle weakness and abnormal reflexes. Cerebral palsy is the most common cause of spasticity, and spasticity affects the majority of children with cerebral palsy. More than 10,000 babies born in the United States each year will be affected by cerebral palsy, which is a complex neurologic disorder that affects body movement and posture. While cerebral palsy cannot be cured, treatment often improves a child's capabilities.
After reviewing all available research on medication treatments for spasticity in cerebral palsy, the guideline found botulinum toxin type A is effective and generally safe, but there is some risk. "In reviewing this drug for treatment of spasticity in children, the Food and Drug Administration is investigating isolated cases of generalized weakness following use of botulinum toxin type A for spasticity," said Delgado.
The guideline also recommends the drug diazepam be considered for short-term treatment of spasticity, although generalized side effects may occur. The drug tizanidine may also be considered, but there is risk of liver toxicity. For several other treatments, the authors determined that there was insufficient evidence to make a recommendation and encouraged additional research in this area.
"There is an urgent need for more research to establish the effectiveness of the current treatments for generalized spasticity and to find additional, safer and more effective medications," said Delgado.
Source: American Academy of Neurology (AAN)
Practice Parameter: Pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review)
Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society Formula [ Full Text ]
M. R. Delgado, MD, FRCPC, FAAN, D. Hirtz, MD, FAAN, M. Aisen, MD, FAAN, S. Ashwal, MD, FAAN, D. L. Fehlings, MD, MSc, FRCPC, J. McLaughlin, MD, L. A. Morrison, MD, M. W. Shrader, MD, A. Tilton, MD, FAAN and J. Vargus-Adams, MD, MS
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A new guideline from the American Academy of Neurology and the Child Neurology Society finds botulinum toxin type A to be an effective treatment for spasticity, muscle tightness that interferes with movement, in children and adolescents with cerebral palsy, but poses some risk. The guideline is published in the January 26, 2010, issue of Neurology
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Niels L. Low, a long-term colleague and friend and one of the pioneers in child neurology, was born in Copenhagen, Denmark, on December 16, 1916, the third generation of a family of physicians. He attended the medical school of Charles University in Prague, transferring for his last year to the Medical College of South Carolina, Charleston, from which he graduated in 1940. A rotating internship in Racine, Wisc, from 1940 to 1941 was followed by 2 years of pediatric residency at Milwaukee Children’s Hospital. It was while he was performing a spinal tap on an infant that he met a charming rotating student nurse, Mary Margaret, who was holding down the child and would become his wife of 64 years.
Niels L. Low at his 90th birthday celebration in December 2006.During World War II, Niels served in the United States Army in England, Belgium, and France and was discharged with the rank of Captain in 1946. He entered pediatric practice in Racine until 1953, during which time he was in charge of the epilepsy clinic and electroencephalography (EEG) at the Milwaukee Children’s Hospital. He then moved as research fellow to Chicago, Ill, to receive formal training in EEG under Dr Frederick Gibbs, the father of clinical EEG, with whom he wrote 2 papers on childhood EEGs.
His next move, in 1955, was to The Neurological Institute of New York at Columbia– Presbyterian Medical Center for a 1-year United Cerebral Palsy Fellowship under the mentorship of Dr Sidney Carter. Armed with these new skills, he was recruited by Dr James F. Bosma to the University of Utah Medical School as Associate Research Professor of Pediatrics. This is where he was exposed to the severe consequences of untreated phenylketonuria and to a variety of other neurologic illnesses of childhood.
Determined to become a card-carrying child neurologist, Niels returned in 1958 to The Neurological Institute as an NIH-supported trainee to complete 2 more years of fellowship, including the year of adult neurology, that would make him eligible to sit for the American Board of Psychiatry and Neurology exami- nation, which he easily passed in December 1960, after walking several miles in a blizzard from his house in New Jersey to The Neurological Institute.
Dr Carter, impressed by the unique talents displayed by Niels both as a clinician and as a teacher, invited him to join the Columbia University faculty where he climbed through the ranks, being appointed Professor of Clinical Neurology and Pediatrics in 1989. He was in charge of the very active child neurology clinic, made teaching rounds, and took care of patients. Deeply interested in the care of handicapped children, Niels, Dr Carter, and other child neurologists from The Neurological Institute regularly went to Blythedale Children’s Hospital to consult on those with cerebral palsy and other chronic illnesses.
Often they invited trainees, stu- dents, and any others with an afternoon to spare to come with them. His services were so much appreciated that Blythedale Children’s Hospital appointed him to the staff and embraced him as Medical Director and Chief of Pediatrics for the 8 years that followed his mandatory retire- ment at age 65 years from Columbia–Presbyterian Medical Center. Indefatigable, he then joined part time a group of colleagues for a few more years to continue caring for chil-dren with neurological illnesses.
His many trainees universally remember him as an out- standing clinician, a no-nonsense teacher, and kind to and caring of children and their parents. He was an early and dogged champion of the use of corticosteroids to treat infants with infantile spasms, one of his enduring interests. At a time when child neurology was a new specialty focused on exotic diseases, Niels concern was chronic disorders and their consequences for children’s lives. He wrote, in collabo- ration with the physiatrist Dr James Downey, The Child With Disabling Illness, which went through 2 editions. He was also the author of some 2 dozen papers and chapters, and he lectured widely in the United States and abroad.
He was very active in national and international pediatric, neurologic, and child neurology societies, and was elected early, in 1965, to active membership of the American Neurological Association, the senior academic neurologic society. He served on the boards of both the American EEG Society and the International Child Neurology Association, of which he was a founding member and its second presi- dent (1975-1979).
Niels had many outside interests: he liked gardening, history, stamp collecting, and travel. Above all, his 2 enduring loves were his family,his wife, 2 highly accomplished children, 5 grandchildren, and 1 great grandson and child neurology. Instantly recognizable (Figure 1) by his bow tie, spare and erect silhouette, and the patch to cover the eye he lost to cancer more than 30 years ago, his many friends and colleagues and his innumerable trainees and students all miss his forthrightness and no-nonsense approach to prob- lems, dry wit, remarkable clinical acumen, and unfailing kindness. He died quietly at home in Tenafly, New Jersey, on August 29, 2007.
Bibliography of Niels L. Low
- Gibbs FA, Low NL. Electroencephalography in children. Pediatr Clin North Am. 1955;Feb, Vol. 2:291-303.
- Low NL, Gibbs EL, Gibbs FA. Electroencephalographic findings in breath holding spells. Pediatrics. 1955;15:595-599.
- Low NL. Electroencephalographic studies following pertussis immunizations. J Pediatr. 1955;47:35-39.
- Low NL, Carter S. Multiple sclerosis in children. Pediatrics. 1956;18:24-30.
- Low NL, Scheinberg L, Andersen DH. Brain tissue in the nose and throat. Pediatrics. 1956;18:254-259.
- Armstrong MD, Carlisle JW, Low NL. Phenylketonuria; two unusual cases. Lancet. 1956;271(6949):917-918.
- Low NL, Bosma JF, Armstrong MD. Studies on phenylketonuria. VI. EEG studies in phenylketonuria. AMA Arch Neurol Psychiatry. 1957;77:359-365.
- Armstrong MD, Low NL. Phenylketonuria VIII. Relation between age, serum phenylalanine level, and phenylpyruvic acid excre- tion. Proc Soc Exp Biol Med. 1957;94:142-146.
- Armstrong MD, Low NL, Bosma JF. Studies on phenylketonuria. IX. Further observations on the effect of phenylalanine- restricted diet on patients with phenylketonuria. Am J Clin Nutr. 1957;5:543-554.
- Low NL, Myers GG. Suvren in brain-injured children. J Pediatr. 1958;52:259-263.
- Low NL, Schneider J, Carter S. Polyneuritis in children. Pediatrics. 1958;22:972-990.
- Low NL, Bosma JF, Armstrong MD, Madsen JA. Infantile spasms with mental retardation. I. Clinical observations and dietary experiments. Pediatrics. 1958;22:1153-1164.
- Low NL. Infantile spasms with mental retardation. II. Treatment with cortisone and adrenocorticotropin. Pediatrics. 1958;22: 1165-1169.
- Low NL. Infantile spasms. Pediatr Clin North Am. 1960 May;7:373-380.
- Low NL, Yahr MD. The lack of pulmonary fibrosis in patients receiving diphenylhydantoin. JAMA. 1960;174:1201-1202.
- Poser CM, Low NL. Autopsy findings in three cases of hypsarhythmia (infantile spasms with mental retardation). Acta Paediatr.1960;49:695-706.
- Low NL, Dawson SP. Electroencephalographic findings in juvenile delinquency. Pediatrics. 1961;28:452-457.
- Fois A. The Electroencephalogram of the Normal Child. Translated and edited by Niels L. Low. Springfield, IL: C. C. Thomas; 1961.
- Low NL, Carter S. Paediatric neurology. Dev Med Child Neurol.1963;18:412-415.
- Low NL, Correll JW, Hammill JF. Tumors of the cerebral hemispheres in children. Arch Neurol. 1965;13:547-554. Low NL, Correll JW. Head pain due to leptomeningeal cysts. Br J Surg. 1966;53:791-793.
- Chutorian AM, Gold AP, Low NL. Steroid therapy of non-infantile (childhood) myoclonic epilepsy. Neurology. 1968;18:304-305. Low NL. Cerebral palsy. Med Clin North Am. 1972;56:1273-1279.
- Downey JA, Low NL, eds. The Child With Disabling Illness;Principles of Rehabilitation. Philadelphia: W. B. Saunders;1974; 2nd ed. New York: Raven Press; 1982.
- Low NL. Spinal muscular atrophy syndromes. Pediatr Ann.1977;6:162-168.
- Low NL. A hypothesis why “early intervention” in cerebral palsy might be useful. Brain Dev. 1980;2:133-135.
- Jankovic J, Armstrong D, Low NL, Goetz CG. Case 2, 1988.Congenital mental retardation and juvenile parkinsonism. MovDisord. 1988;3:352-361.
- Jankovic J, Armstrong D, Low NL, Rapin I. Case 3, 1988. Progressive myoclonic epilepsy, dementia, and blindness in a young girl. Mov Disord. 1988;3:362-369.
Original article:
In Memoriam: Niels L. Low, MD (1916-2007)
Arnold P. Gold and Isabelle Rapin J Child Neurol 2008 23: 468
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